Sex: F
Vaccine: HPV4
Symptoms: Unevaluable event
Clinical narrative: Information has been received from a published literature article title. Human papillomavirus (HPV) vaccines provide an opportunity to greatly reduce the burden of cervical cancer. Although there has been improvement in uptake, there are notable ethnic/racial disparities. This qualitative study was conducted to better understand factors related to vaccine uptake among female adolescents from 3 racial/ethnic groups. Findings can inform the development of optimal messages and strategies for clinical and population-based interventions. Materials and Methods: A mixed-methods study was conducted to compare knowledge, perceptions, and practices regarding HPV, HPV vaccination, and cervical cancer among female adolescents of a certain ancestry. Six focus groups were conducted, 2 each in groups. Study participation was completed during a single appointment that lasted approximately 2.5 hours. Participants first completed a self-administered survey and then participated in a focus group discussion. Participants received $ 25 cash for their time and effort. An institutional review board approved the study; all participants provided assent and written informed consent from a parent or guardian was obtained. Participants and Setting: Participants were recruited from high schools, public health clinics, and churches. Embracing the principles of community-based participatory research, trusted community members such as school nurses, a bilingual clinic staff, and a church leader helped to recruit participants. Focus group participants were recruited from a church (n =1 group), a public health clinic that serves underinsured youth (n=1 group), and racially diverse high schools (n=4 groups). Focus groups were conducted at high schools, a health clinic, a community meeting facility, and a home). Female adolescents were eligible if they were ages 13-19, able to provide parental or guardian consent, and identified themselves as a certain group. The focus group protocol, guided by our model focused on the inquiry domains of: (1) usual (non-HPV) vaccines; (2) HPV, HPV vaccination, and cervical cancer; and (3) barriers to HPV vaccination. Discussion around other themes was encouraged as necessary. Focus group moderators were women with previous training and experience in moderating focus groups and matched the race/ethnicity of the groups they moderated. They participated in a training session covering the study goals and the focus group discussion guide. When the focus group moderators shifted discussion from non-HPV vaccines to HPV infection and cervical cancer, a pictorial depiction of the uterine cervix was presented to each group to acquaint participants with the anatomical site for cervical cancer. The overall mean age of participants was 16.6 years (SD-1.37), with the average age across race/ethnicity groups being 17.1 (SD -1.00) for one, 16.4 (SD -1.68) for the second, and 16.3 (SD -1.22) for the third group. Each focus group had at least 1 girl who had experienced the HPV vaccination series. Representative comments on this topic were "I just got a shot that was to help us prevent cervical cancer. I got the first one and I can get the other two. There are three of them." and "You go; then you have to wait three months and then I had to wait a couple more months before I got my shot." Unique to the 3-shot series, a few girls stated each shot in the series grew progressively more painful. For example, a girl commented "The second one hurts more than the first one and the third one hurts more than the second one," and another girl commented, "The first time it didn't hurt, but the second time and the third time it hurt real bad." Girls across groups also reported redness, swelling, and fever as side effects and symptoms not mentioned in the discussion of vaccines in general. For example, one girl noted, "It got swollen. I also felt that it burned and then it got swollen and then I also had a fever." Other girls commented, "Yeah, you are really sore afterwards," and "It got red." This author refers to an unspecified adolescent female patients. The patient's relevant medical history, concurrent conditions and concomitant medications were not reported. On an unknown date the patients were vaccinated with quadrivalent human papillomavirus (types 6,11,16,18) recomb. Vaccine (manufacturer unknown) (dosing details were not reported) for prophylaxis. The author stated that few girls in two of the groups stated each shot in the series grew progressively more painful. For example, a girl commented "The second one hurts more than the first one and the third one hurts more than the second one," and another girl commented, "The first time it didn't hurt, but the second time and the third time it hurt real bad." Girls across groups also reported redness, swelling, and fever as side effects and symptoms not mentioned in the discussion of vaccines in general. For example, one girl noted, "It got swollen. I also felt that it burned and then it got swollen and then I also had a fever." Other girls commented, "Yeah, you are really sore afterwards," and "It got red (erythema, pain, thermal burn, pyrexia and swelling). The outcome of the events erythema, pyrexia, pain, thermal burn and swelling was unknown. The reporter considered the events erythema, pain, thermal burn, pyrexia and swelling to be related to Quadrivalent Human Papillomavirus (Types 6,11,16,18) Recomb. Vaccine (manufacturer unknown). Additional information has been requested.