Passive decision-making
Our qualitative findings suggest that passive decision-making occurred frequently during the first year of HPV vaccine implementation, and may have occurred more often in mountainous areas. The quote below illustrates this passive decision-making process:
I told my daughter that this was a deadly disease, and that my family was still in difficulty. As what was stated in the loudspeaker, vaccination was to prevent the girl from this disease when she grew up and got married. If the disease did occur, we could not afford the treatment. So it would be better if she got vaccination to prepare for perfect health in the future when she got married.
Parent of fully vaccinated girl, FGD, Year 2, Mountainous, hard to reach commune
Passive decision-making may prevail when parents participate in the HPV vaccination as a routine response; in the example below, vaccination is just something that one does as a matter of course:
"“…Immunization is the best way of prevention. Whatever disease like tuberculosis or measles, immunization is the best. Prevention is better than treatment.”
Parent of fully vaccinated girl, FGD, Year 1, Rural, low uptake commune
Active decision-making
On the contrary, people in urban areas tended to engage in more active decision-making, seeking additional information, often from individuals or sources outside the vaccination program, as illustrated below:
"“I searched in newspapers and found that although this vaccine was new in Vietnam, its use had been growing in many countries. So when I received the information, I talked to my wife and came to a final decision. I have two daughters, the older has mental problem, so I consider health as the most important issue for my younger girl. In South East Asia, cervical cancer is quite common, so when there is scientific advance in treatment, we, the parents, should create good conditions for our child. We both decided that.”
Parent of fully vaccinated girl, SSI, Year 1, Urban, low uptake commune
"“After the doctor said the vaccine has been circulated in the market for everyone already and passed the trial period, I felt more secure. Plus, my relatives said the vaccine has been used in America so that’s why I agreed to vaccinate my daughter.”
Parent of fully vaccinated girl, SSI, Year 1, Urban, low uptake commune
Media, with both positive and negative messaging, may be particularly influential for Active Decision-makers, as illustrated below:
"“I heard from people and from the radio that this vaccination was dangerous, and this and that bad things and this and that bad things may happen so I was afraid. But then my mother, mother-in-law, and cousins urged that I should take my daughter to get vaccinated, that we were still poor and it was a great and rare chance to get this donation, and that I should take the girl to get vaccinated for good health.”
Parent of fully vaccinated girl, FGD, Year 2, Urban, low uptake commune
"“In my case, when my daughter brought the vaccination invitation from school, I was also afraid. I felt afraid as some people who got rabies vaccine became paralytic after that. Those cases were also shown on television. I also did not know much about this vaccine, what kind of cancer it would prevent, so I was afraid that it might cause side effects like rabies vaccine. After careful consideration, I thought that for such expensive vaccine, which was sponsored and was developed by professional doctors and scientists would be not harmful. So I changed my mind and allowed the girl to get vaccinated. But at first I felt quite confused.”
Parent of fully vaccinated girl, FGD, Year 2, Urban, low uptake commune
The process of active decision-making takes time, as parents seek out additional resources and mull over their decision, as shown below. Parents with residual concerns may also wait to observe any negative consequences among vaccine recipients, before committing to vaccination:
"“…at the beginning I did not allow my daughter to receive vaccination. [However], after about a month, her school and the local health workers patiently invited me over to inform me about the HPV program. The doctors and nurses were very enthusiastic. If I had any questions or concerns or anything was unclear, they clarified these issues very thoroughly. Besides, I have relatives abroad who told me that where she lives now, they provide vaccination for women at the age of 25 instead of 11 years old like in Vietnam. Then, I was much more at ease and agreed to vaccinate my daughter. So, in fact, my daughter received the vaccination one month later than her friends.”
Parent of fully vaccinated girl, SSI, Year 1, Urban, low uptake commune
"“I find that those girls who were vaccinated last year, now they are in 7th grade and their health is still good. Last year, a counseling group visited each household to persuade the parents to have the girls vaccinated. Then the parents found that their girls were still in good health after vaccination. Thus this year, they even took the younger sister to get vaccinated.”
Parent of fully vaccinated girl, FGD, Year 2, Rural, low uptake commune
We found that parents rarely made decisions based on a single factor. As many of the quotes from our qualitative findings demonstrate, parents weighed a host of often interconnected considerations. They employed various strategies to reinforce their decision, including actively seeking further information, getting advice from health professionals or family members (in-country or abroad), or waiting and following other parents’ actions. Though some parents had unresolved concerns about side effects and safety, even after receiving information on HPV vaccination, most decided to accept vaccination based on advice and information from external sources.