Introduction

The Human Papillomavirus (HPV) vaccination is an effective way at preventing the morbidity and mortality resulting from HPV-related cancers. The U.S. Advisory Committee on Immunization Practices recommends initiating the nine-valent HPV vaccine with a 2 dose schedule starting at age 11 or 12. However, HPV vaccination rates continue to be low among adolescents (13 to 17 years old) in the U.S. with only 54% completing the vaccination series in 2019. Offering vaccines at local schools has increased the overall vaccination rates a trend that can also be observed in neighboring countries. The purpose of this study is to understand parental beliefs regarding childhood HPV vaccination within schools. 

Methods

A qualitative analysis of transcribed phone interviews investigating parental beliefs surrounding childhood HPV vaccination in Southeast Texas during 2022-2023. The study utilized a semi-structured interview method between 10/3/22 and 7/13/23 to understand factors guiding parental decisions regarding HPV vaccination to improve vaccination rates among children 9-10 years. To be included in this study, caretakers were required to fill out the contact form and consent was received orally. All participants received a copy of the study via mail. The UTMB Institutional Review Board approved this qualitative study (approval number, 21-0031). Patient interviews (n= 21) comprised 29 questions during a single telephone call and averaged 40 minutes each. A $25 gift card was given to each caretaker as compensation for their time. Audio recordings were transcribed using InqScribe and verified by a second transcriber for accuracy. 

The interviews were transcribed and analyzed through creating an initial coding scheme based on interview responses that were agreed upon by two independent evaluators, by an objective third party. Inductive codes were synthesized from emerging themes and later refined based on the interview guides. All analysis was conducted in Microsoft Word. A thematic analysis related to vaccination beliefs and HPV vaccination locations was done based on the code summaries.

Results

Almost all participants believed that vaccines in general were safe for people. Multiple caretakers felt that they did not know enough about the HPV vaccine, and even more had not been exposed to either positive nor negative influences. The biggest vaccination concern was the possibility of side effects, however, many of these came from a lack of knowledge or understanding of medicine. More than half of the participants were reluctant to have their child vaccinated at school and would feel more comfortable if there was a supervising doctor on site. Most participants believed that HPV vaccination should not be required by the government to attend public school.

Conclusion

Our study provides insight into vaccination initiatives surrounding physician education where providers should be well educated in discussion techniques that directly address their patient's concerns about the HPV vaccine. Another approach to consider is an overall increase in vaccine education within public schools to increase public basic science and knowledge of immunity. Further research is needed to investigate whether this multidisciplinary approach could significantly increase HPV vaccination rates among 9-12-year-old children.