Knowledge and Attitudes Toward Human Papillomavirus Vaccination Among Latina Mothers of South American and Caribbean Descent in the Eastern US

"Lack of information was cited as the most common barrier to HPV vaccination."

In the United States (US), there are pervasive disparities in national morbidity and mortality rates of human papillomavirus (HPV)-related cancers for Latino individuals. Mothers' knowledge about the HPV vaccine has been found to be a strong predictor and important facilitator for adolescent uptake of the HPV vaccine. In that light, the purpose of this qualitative study was to examine knowledge, attitudes, barriers, and facilitators for HPV vaccination among Latina mothers in low-income urban areas, as well as to identify communication strategies to improve HPV vaccination.

The study included 132 Latina mothers of HPV vaccine-eligible children, interviewed in 14 focus groups. Two Spanish-speaking facilitators, who were also fluent in English, received training on active interviewing, facilitating discussions, engaging participants, and research ethics. The focus group questions were developed based on the Health Belief Model (HBM).

The data analysis, which compared differences and similarities in knowledge and perceptions separately for South and Central American (SCA) mothers and for Caribbean Latina (CL) mothers, found, in brief:

Knowledge about HPV and the HPV vaccine:

• There was overall limited knowledge and confusion about HPV infection, methods of transmission, and its consequences.
• SCA mothers, in particular, lacked knowledge and had more misinformation about the HPV infection.
• The most common source of information about HPV was the child's doctor; other sources included: the internet, TV commercials, and knowing others who were infected with HPV.
• Fifty-five percent had ever heard of the HPV vaccine, 27% had adolescent child(ren) who had received at least one dose, and 14% had child(ren) who had completed the HPV vaccine 3-dose series.
• There was lack of information about the HPV vaccine guidelines (age, gender, number of doses, dosing intervals, etc.).
• Higher rates of ever hearing of the HPV vaccine were found among the insured, English speakers, and those with higher annual income.
• Higher rates of receiving the HPV vaccine were found among the insured and mothers who had ever heard of the HPV vaccine.
• The most common source of information about the HPV vaccine was the child's doctor; other sources included: posters, brochures, the internet, TV commercials, peers, and family members. The majority did not see HPV vaccine advertisements in Spanish magazines, and there was some concern that schools do not inform parents about the HPV vaccine.

Attitudes toward the HPV vaccine:

• Mothers are the primary and sole people making decisions about their children's vaccines.
• There was overall high acceptability for the vaccine for both female and male adolescent children.
• Concern was expressed that the HPV vaccination age of 11 is too young; mothers preferred it to be given around the time of puberty. However, there was agreement that the vaccine does not encourage sexual activity.

Barriers to and facilitators of HPV vaccination:

• Barriers: lack of recommendation from the HCP for the HPV vaccine, lack of available information on the HPV vaccine in Spanish, and concern about potential adverse and vaccine safety.
• Facilitators: HCP recommendation is the strongest facilitator. Mothers also want to protect their children from the HPV infection and HPV-related cancers.

Strategies to improve HPV vaccination:

• Provide information, address concerns about side effects, and present a strong recommendation and support for the HPV vaccine.
• Educate mothers by using print materials on the vaccine such as booklets and brochures, holding community outreach activities, developing school-based approaches, and using mobile technology (e.g., apps and text messaging).
• Set up follow-up visits immediately after receiving the first dose to improve HPV vaccine completion.

Because the focus group discussions revealed considerable lack of knowledge regarding HPV infection and vaccination, the focus group facilitators led a brief educational session at the end of the focus group to correct misconceptions and answer any questions. Written information materials about HPV infection and vaccination were also distributed in Spanish and English.

In conclusion, the findings of this study "support the need for multicomponent interventions to address low HPV vaccination in all populations, but particularly for low-income, racial/ethnic minority subgroups with compounding social and demographic barriers to health information and HPV vaccination." Specifically, mothers from these communities directly suggested improved provider communication with Latina mothers about HPV infection and HPV vaccination combined with strategies to motivate and remind Latina mothers to vaccinate their children. "Additional efforts are needed to adapt and accelerate the implementation of evidence-based HPV vaccine promotion strategies in varying settings and for vulnerable subgroups..."