Abstract A10: Formative research with Hispanic migrants and health care providers related to the HPV vaccine
Authors: Luque John S. , Raychowdhury Swati , Weaver Mary 
Published: June 2012

Abstract
Background: This formative research study was a qualitative exploration of knowledge, attitudes and behavior toward the HPV vaccine among low-income Hispanic immigrants and vaccine providers in southeast Georgia. In Georgia, current estimated rates for completion of all 3 doses of HPV vaccine are 21.8%. Some key predictors for vaccine acceptability have been identified as a belief in the vaccine effectiveness, physician recommendation, and likelihood of HPV infection. On the other hand, common barriers to vaccination are the belief that the child does not need the vaccine, lack of knowledge, and the fact that the child is not sexually active. The study was accomplished by conducting focus groups with Hispanic parents and semi-structured interviews with vaccine providers to understand Hispanic parents’ acceptability of the HPV vaccine, as well as vaccine availability and access.
Methods: For the health care provider interviews, the study began with a list of 35 vaccine providers and six nurse managers from the six counties in Georgia Public Health District 9.2. Introduction letters followed by phone calls were used to recruit and schedule interviews either in person or on the phone. The study was assisted by a Hispanic-serving community agency to recruit focus group participants who were parents of girls within the vaccine-eligible age for the HPV vaccine under the Vaccines for Children program (ages 9–18). For both the individual interviews and the focus groups, an interview guide was utilized. All interviews were digitally recorded and transcribed. Content analysis was used to code transcripts using a social marketing framework: barriers, benefits, product, price, place, and promotion. Participants received a $10 stipend for participation. The study was approved by the university institutional review board.
Results: Interviews with medical professionals (n=8) identified numerous barriers to delivering the HPV vaccine to Hispanic adolescents including: low English proficiency of the parents, lack of health insurance coverage for the vaccine for women over 20 years old and Medicaid reimbursement shortfalls, difficulty in completing the 3-shot series with a mobile population, and lack of knowledge and misperceptions about the vaccine. Overall, the vaccine providers expressed that Hispanics were very positive toward vaccines in general, but there were cost issues on the provider side related to stocking the vaccine and reaching the target population. Two focus groups were also conducted with low-income, Hispanic immigrant parents, one with fathers (n=7) and another with mothers (n=5). The focus groups provided valuable insight into the concerns and barriers among this population to health care access. Many of the parents did not know that the vaccine was freely available at the health department through the Vaccines for Children program. However, there were also trust issues with the health department relating to patients’ confidentiality. One participant expressed that the schools needed to promote the vaccine in the same manner as with the flu shot to increase access. Benefits to vaccine uptake included preventing disease, saving on later treatment costs, and opportunities for mother/daughter communication.
Conclusions: Although the study sample size was relatively small because of recruitment challenges for both the focus groups and the semi-structured interviews, the participants provided data consistent with previous studies, which indicates that numerous barriers exist and ultimately impact the uptake of the HPV vaccine. The results of this formative research will be used to design a large survey of Hispanic parents to inform an overall social marketing plan to increase HPV vaccination rates for 9–18 year old Hispanic girls in rural, southeast Georgia.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A10.