Background
Methods
Study setting
Participant recruitment
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Young Adults: Between the ages of 16 and 27 (the upper age limit for which many insurance plans will cover HPV vaccination in Ontario), any gender, did not have children, and were either newcomers or the children of newcomers.
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Caregiver: Over the age of 18, any gender, born outside of Canada, and had one or more children under the age of 18.
Survey instrument
Data collection
Data analysis
Results
Participant characteristics
Characteristic | Respondents (N = 50) | % |
---|---|---|
Survey Language | ||
English | 11 | 22.0 |
French | 12 | 24.0 |
Arabic | 27 | 54.0 |
Gender | ||
Female | 38 | 76.0 |
Male | 12 | 24.0 |
Age | ||
16–27a | 13 | 26.0 |
28–44 | 19 | 38.0 |
45+ | 15 | 30.0 |
Prefer not to say | 3 | 6.0 |
Religion | ||
Christian | 17 | 34.0 |
Muslim | 30 | 60.0 |
Agnostic | 1 | 2.0 |
None | 2 | 4.0 |
Immigrant Status | ||
Immigrant | 20 | 40.0 |
Refugee | 19 | 38.0 |
Other | 9 | 18.0 |
Prefer not to say | 2 | 4.0 |
Marital Status (n = 41)b | ||
Single | 3 | 6.0 |
Married | 34 | 68.0 |
Widowed | 3 | 6.0 |
Prefer not to say | 2 | 4.0 |
Number of children (n = 41) | ||
1 | 4 | 9.8 |
2 | 12 | 29.3 |
3 | 11 | 26.8 |
4 | 5 | 12.2 |
5+ | 9 | 22.0 |
Region of Origin | ||
Sub-Saharan Africa | 18 | 36.0 |
Middle East and North Africa | 29 | 58.0 |
Other | 3 | 6.0 |
Theme | |
---|---|
1. Lack of HPV Knowledge | |
Low Knowledge | |
Interviewer: Have you heard of HPV before? If yes, what do you know about it?“Nothing” (Participant #3) | |
“I think – where I come from, it’s not – we’re not – most people are not knowledgeable about it because I think it’s treated with – it’s not treated with as much attention as it should be given.” (Participant #1) “no, had never heard of it” - (Transcript 5) | |
Misconceptions about HPV and the HPV vaccine | |
“...they go to [the] swimming pool for example, they don’t have boyfriends or girlfriends, but because they go to public places, I’m concerned about that [HPV]... maybe with the public toilets they use. I want to make sure they’re protected. Public toilets, I’m very concerned about that.” (Participant #6) | |
2. Willingness to accept vaccination | |
Interviewer: “Do you believe that you would have your children vaccinated against HPV? “And my kids also, I would love them to get it when they get to the age. Yeah because you don’t play with your health, yeah. Health is wealth like they say.” (Participant #1) | |
“They are very important [vaccines]. As, there is something said at home, I do not know if here we say it, it is better to prevent than cure. We warn like that.” (Participant #4) | |
3. Access to vaccination | |
Cost | |
“They should cover it, that’s very sad. Most people those ages [i.e., young adults no longer covered by the school-based programs], they don’t have a permanent job, they’re working here and there, they can’t afford that, it’s very hard for them. They should make it easier for them to protect themselves and then they won’t have to pay for them to be treated and treated for cancer.” (Participant #6) | |
“Where I’ve come from, most vaccines are free [...] The government paid for them to pay for the – for the health workers at those administration boards, the recipients get it for free.” (Participant #2) | |
Lack of time and healthcare provider recommendation | |
Interviewer: “Did your doctor recommend the HPV vaccine for you (or your kids)”? “It’s very hard because when you go to the doctor, you have to limit your reason for going, you wait a lot of time and you have to have just one reason to be there, and it’s all a rush. There’s no time to mention that [HPV].” (Participant #6) | |
4. Cultural norms | |
“I believe this is a bit difficult to speak about …. Africans don’t talk a lot about sex with their children. If it’s with girls, no it is difficult, with boys I can see us talking a little bit, but not in depth. With girls it is very difficult.” (Participant #7) Interviewer: “So, do you think you would leave the choice to be vaccinated or not get vaccinated up to your daughter”? Participant #4: “Yes”. |
HPV knowledge
Caregiver Survey response N (%) | Young Adult Survey Response N(%) | Overall Response N (%) | |
---|---|---|---|
Heard of HPV | N = 41 | N = 9 | N = 50 |
Yes | 13 (30%) | 2 (22%) | 15 (28%) |
No | 28 (65%) | 7 (78%) | 35 (70%) |
Prefer not to say | 0 | 0 | 2 (4%) |
Source of information | N = 13 | N = 2 | n = 14 |
Doctor | 2 | 0 | 2 (14%) |
Nurse | 0 | 0 | 0 (0%) |
Family member | 3 | 0 | 2 (14%) |
Friend | 1 | 1 | 1 (7%) |
School | 1 | 1 (7%) | |
Found their own information | 6 | 1 | 6 (42%) |
Other | 2 | 0 | 2 (14%) |
Belief around HPV transmission | N = 15 | N = 3 | N = 18 |
Kissing | 2 (13%) | 1 | 3 (17%) |
Sexual Contact | 11 (73%) | 2 | 12 (67%) |
Handshaking | 0 | 0 | 0 |
I don’t know/other | 3 (20%) | 0 | 3 (17%) |
Heard of HPV Vaccine | N = 40 | N = 9 | N = 49 |
Yes | 10 | 3 (33%) | 13 (26%) |
No | 30 | 6 (67%) | 37 (74%) |
Uncertain | 0 | 0 | 0 |
Believed the vaccine can be given to both males and females | N = 10 | N = 3 | N = 13 |
Yes | 7 (70%) | 1 | 8 (61%) |
No | 2 (20%) | 2 | 4 (31%) |
Uncertain | 1 (10%) | 0 | 1 (8%) |
Believed the vaccine to be safe | N = 10 | N = 3 | N = 13 |
Yes | 8 (80%) | 2 | 10 (77%) |
No | 1 (10%) | 1 (8%) | |
uncertain | 1 (10%) | 1 | 2 (15%) |
Believed the vaccine was only for those who are sexually active | N = 10 | N = 3 | N = 13 |
Yes | 4 (40%) | 1 | 5 (38%) |
No | 6 (60%) | 1 | 7 (54%) |
Uncertain | 1 | 1 (8%) | |
Believed the vaccine is effective in preventing certain types of cancers | N = 10 | N = 3 | N = 13 |
Yes | 5 (50%) | 1 | 6 (46%) |
No | 3 (30%) | 1 | 4 (31%) |
Uncertain | 2 (20%) | 1 | 3 (23%) |
Believed the vaccine is most effective if given before one become sexually active | N = 10 | N = 3 | N = 13 |
Yes | 8 (80%) | 2 | 10 (77%) |
No | 0 | 0 (0%) | |
Uncertain | 2 (20%) | 1 | 3 (23%) |
Believed the vaccine can cure the disease | N = 10 | N = 3 | N = 13 |
Yes | 4 (40%) | 1 | 5 (38%) |
No | 4(40%) | 2 | 6 (46%) |
Uncertain | 2 (20%) | 0 | 2 (15%) |
Believed the vaccine protects against all sexually transmitted infections | N = 10 | N = 3 | N = 13 |
Yes | 3 (30%) | 4 (31%) | |
No | 6 (50%) | 3 | 8 (61%) |
Uncertain | 1 (10%) | 1 (8%) | |
Worried that the vaccine can cause bad side effects | N = 10 | N = 3 | N = 13 |
Yes | 3 (30%) | 1 | 4 (31%) |
No | 6 (60%) | 2 | 8 (61%) |
uncertain | 1 (10%) | 1 (8%) | |
Believed that giving a child the vaccine will encourage them to have sex | N = 10 | N = 10 | |
Yes | 1 (10%) | 1 (10%) | |
No | 8 (80%) | 8 (80%) | |
uncertain | 1 (10%) | 1(10%) | |
Will you have your child vaccinated? | N = 41 | ||
Will be vaccinated | 15 (36%) | ||
No, will not receive the vaccine | 7 (17%) | ||
Undecided | 13 (32%) | ||
Prefer not to say | 6 (15%) | ||
Will you or have you been vaccinated | N = 6 | ||
vaccinated | 1 (17%) | ||
not vaccinated | 3 (50%) | ||
Undecided | 2 (33%) | ||
Vaccinate child even if had to pay | N = 36 | ||
Yes | 12 (33%) | ||
No | 7 (19%) | ||
Uncertain | 17 (47%) | ||
Will you vaccinate your child if it was free/publicly funded? | N = 36 | ||
Yes | 11 (31%) | ||
No | 13 (36%) | ||
Uncertain | 12 (33%) | ||
Opinions of friends and family influence my decision | N = 37 | N = 2 | N = 39 |
Yes | 10 (27%) | 10 (26%) | |
No | 19 (51%) | 2 | 21 (54%) |
Uncertain | 8 (22%) | 8 (20%) | |
Willing to get the vaccine if recommended by the doctor | N = 41 | ||
Yes | 19 (46%) | ||
No | 0 (0%) | ||
Uncertain | 8 (19%) | ||
No response | 14 (34%) |
HPV vaccine beliefs
Access and acceptance of vaccination
Interviewer: “If your doctor was to say, “I think that your child should be vaccinated.” Would that influence your decision”?“It’s okay. I am sure the doctor will never mislead”.
Discussion
Reference | Study setting | Sample Size | Country of Origin/Ethnicity | Objectives | Methods | Results | Conclusion |
---|---|---|---|---|---|---|---|
Grandahl et al., 2015 [29] | Sweden | n = 50, women aged 18–54 | Middle East, Africa, Asia, East Europe | To explore immigrant women’s experiences and views on the prevention of cervical cancer, screening, HPV vaccination and condom use. | 8 focus group interviews, 5–8 /group | Emergent themes: 1) deprioritization of women’s health in home countries 2) positive attitudes of availability of women’s health in Sweden 3) positive and negative attitudes towards HPV vaccination 4) communication barriers limit health care access. | Women wanted to participate in cervical cancer prevention and would accept HPV vaccination for their daughters but faced barriers to information from HCP (language, cultural norms) |
Aragones et al., 2017 [19] | USA | n = 36, parents of minors (i.e., 9–17 year old) who had not initiated the HPV vaccine series for their child | Latin America | To elucidate Latino immigrant parents’ barriers to obtaining the HPV vaccine for their children | 5 focus groups, 5–10/group | Three major findings were: (1) low levels of awareness and knowledge of HPV and the HPV vaccine, (2) increased confidence that parent can access the vaccine for their eligible child and (3) lack of provider recommendation as the main barrier to vaccination. | Increased provider recommendation for the HPV vaccine while providing tailored HPV information to parents. |
Stephens & Thomas, 2014 [30] | USA | n = 31, women, with a daughter between 11 and 18 years old | Haiti | To identify cultural beliefs influencing immigrant Haitian mothers’ willingness to vaccinate their daughters against HPV | Survey assessing HPV and HPV vaccine knowledge, followed by a semistructured interview. | Mothers had low levels of HPV and HPV vaccine knowledge, and asked for more information. Concerns centered on cultural values regarding adolescent sexuality and HIV/AIDS stigmas specific to Haitian communities. | Vaccination uptake could increase if recommended by a physician. Uptake efforts should emphasize physician involvement and incorporate culturally relevant health concerns. |
Kobetz et al., 2011 [21] | USA | n = 41 women aged 21–75 | Haiti | To examine Haitian women’s perceptions of, and barriers to, HPV vaccination | 5 focus groups, 8/group | Amongst those participants who had heard of HPV, many held misconceptions about virus transmission and did not understand the role of HPV in the development of cervical cancer. All participants showed support for vaccines as beneficial for health. | Addressing gaps such as lack of educational information available in Haiti language about HPV and cervical cancer. |
McComb et al., 2018 [10] | Canada | n = 11, women aged 18–26 | Africa, Asia, South America | Exploring underlying reasons for lower uptake of (HPV) vaccine among new immigrants and refugees | Semi-structured interviews | Participants had limited knowledge about HPV and the HPV vaccine. Most women perceived that their risk of HPV was low, however showed willingness to receive the vaccine if it were recommended by their physician. | Efforts are required to increase knowledge about HPV among immigrant and refugee women and support for physicians to discuss and offer vaccination to this population. |
Yi et al., 2013 [28] | USA | n = 113, women aged 18 or older | Vietnam | To determine receipt of HPV vaccine and assess if limited English proficiency and knowledge related to HPV vaccine were associated with HPV vaccine uptake | semi structured interviews | Women who were less proficient in English were less likely to receive the HPV vaccination. Participants lacked knowledge of HPV. | There is a need for public health evaluation and education programs on HPV and cervical cancer designed for Vietnamese-American women |
Lee & Lee, 2017 [24] | USA | n = 16, women, aged 21 and older | Korea | This study aimed to identify major barriers to Papanicolaou (Pap) test uptake and HPV vaccine acceptability. | 3 focus groups with 16 women | Three major themes emerged as barriers: 1) limited knowledge about cervical cancer and preventive behaviors, 2) culture-specific barriers, and 3) low accessibility to health care services. | Culturally tailored cervical cancer education is needed to promote Pap test uptake and HPV vaccination in this population. |
Luque et al., 2010 [23] | USA | n = 80, women, aged 18 to 55 n = 17, HCW’s, average age 42. | Mexico, Hondurus, Peurto Rico, USA | To explore knowledge, attitudes, and beliefs regarding HPV, the HPV vaccine, and cervical cancerscreening | Surveys | Mexicans and Hondurans had different perceptions of risk factors and lower levels of HPV knowledge than Puerto Ricans or Anglo-Americans. | Target areas for health education based on resulting cultural models of illness need to be identified |
Scarinci et al., 2007 [20] | USA | n = 55, women, aged 17 and 39 years old | Latinas and African Americans | To examine the acceptability of preventive HPV vaccination among Latina immigrants and African American women | 8 focus groups were conducted | The motivating factors for vaccine use included (1) receiving education/information about the vaccine through healthcare providers, (2) affordable prices, (3) good results in trials, and (4) knowing others who had already gotten vaccinated. | These findings suggest that unique educational strategies need to be developed, based on the needs and perceptions of the targeted audience, in order to achieve wide-spread acceptability of this vaccine. |