BACKGROUND: The Human papillomavirus vaccine (HPV) is an essential tool for the prevention of HPV-related cancers. In Puerto Rico, the Secretary of Health established a school entry requirement of at least one dose of HPV vaccination in girls and boys aged 11 and 12 years, taking effect in August 2018. Our study aimed to examine parents' and guardians' views of unvaccinated children about the process of implementation of the new HPV vaccination school entry policy in Puerto Rico and identify potential barriers and facilitators related to the implementation of this requirement.
METHODS: During April through November 2019, we conducted three focus groups (n = 12) and eight in-depth semi-structured interviews with parents of children aged 11 and 12 who had not yet initiated the HPV vaccine series. The interview topics addressed were: perception of vaccination, HPV vaccine and it is inclusion as new school entry requirement practice, procedure of the sources of information, influencers, and willingness to change. The interviews were recorded and transcribed by our staff members. We identified emergent themes through thematic analysis.
RESULTS: The participants' perspective on the HPV vaccine school requirement was mixed. Lack of information of the HPV vaccines and lack of communication about the school-entry requirement were the themes most mentioned in the interviews. Moreover, previous negative experiences from friends or family members and adverse effects deterred some participants from vaccinating their kids. We discussed barriers in the process of soliciting an exemption.
CONCLUSION: Most barriers mentioned by study participants are modifiable. Information about the HPV vaccine mandate's implementation and educational materials regarding HPV vaccine safety need to be provided to address parents' concerns related to the vaccine's side effects. Schools (teachers, principal directors, and administrative staff), the government, and parent organizations need to be part of these efforts. This multilevel approach will help to improve disseminating information about HPV vaccination to clarify doubts and misinformation among parents.
Digital Object Identifier (DOI)
This work was supported by National Cancer Institute (NCI), grant R01CA232743-01A1 (“Implementation of School-Entry Policies for Human Papillomavirus Vaccination”) within University of Puerto Rico Comprehensive Cancer Center.
The data sets generated and analyzed during the current study are not publicly available due to our confidentiality commitment to our participants to keep such data in our offices, but they are available from the corresponding author on reasonable request and after being discussed with the IRB.
Colón-López, Vivian; Medina-Laabes, Diana T.; Abreu, Roxana Soto; Díaz Miranda, Olga L.; Ortiz, Ana P.; Fernández, María E.; and Hull, Pamela C., "Understanding Parents' Views toward the Newly Enacted HPV Vaccine School Entry Policy in Puerto Rico: A Qualitative Study" (2021). Behavioral Science Faculty Publications. 72.
Additional file 1. GUÍA DEL MODERADOR: ENTREVISTA A PADRES O ENCARGADOS. Description of data: This document is the guideline questions used for the focus group and in-depth interview in our study.