Adolescent girls’ recommendations for the design of a human papillomavirus vaccination program in Sindh, Pakistan: a qualitative study

Abstract

Purpose Vaccination of adolescent girls against human papillomavirus (HPV) significantly reduces the incidence of cervical cancer. HPV vaccines are available in Pakistan but plans to develop HPV vaccination program are at a nascent stage. We conducted a formative study to explore adolescent girls’ knowledge and perspectives on HPV and cervical cancer and collect their recommendations for implementing an HPV vaccination program in their community. Methods Using qualitative exploratory study design, we conducted four focus group discussions (FGDs) with 12 adolescent girls per group in District West, Karachi. We recruited unmarried girls aged 16–19 years from schools and community settings between May—December 2020. Data analysis was done using NVivo. Results Overall, participants displayed a positive attitude toward HPV vaccine. However, they were unfamiliar with basic concepts related to female reproductive health. Female relatives were indicated as girls’ preferred point of contact for discussions on HPV and cervical cancer, but fathers were portrayed as decision-making authority on vaccination. Participants indicated vaccine hesitancy among parents may affect HPV vaccination uptake. Girls suggested individual household visits and community-based camps as strategies for successful implementation of HPV vaccination program. A solid foundation of trust between girls’ families, program managers, and other stakeholders emerged as a key asset for the program’s success. Conclusion Adolescent girls’ suggestions of informing key decision-makers in the family (particularly fathers) of the benefits of HPV vaccination, establishing trust with vaccine providers, and increasing accessibility of vaccinations should be explored for successful implementation of an HPV vaccination program in Pakistan.

What do adolescents think about vaccines? Systematic review of qualitative studies

“…A US study showed some girls preferred seeing HPV vaccine information on the television rather than receiving information at their school, because they often watched TV together with their mothers which made it easier to bring up topic [73] highlighting the importance of providing vaccine information in a way that engages both parents and adolescents. In contrast, girls in a Pakistani study felt that television would not be an appropriate way to provide HPV information because it was mainly watched by men rather than women [74].…”

“…Many adolescents mentioned hearing about vaccines on the radio, television or on the internet. Social media was specifically mentioned in five studies (HPV, meningococcal vaccine) with four of these studies published in 2020 or later [33,63,[73][74][75].…”

Human papillomavirus vaccination in low- and middle-income countries: progression, barriers, and future prospective

“…Other frequently used information channels are instant messaging programs, Internet search engines, community health workers, and social media. In addition, there are less popular sources, including traditional healers and mass media such as news channels, television programs, and newspapers ( 86 ). Therefore, social mobilization is required to increase the acceptance of HPV vaccination among girls, parents, and respected influencers.…”

“…They can be another key challenge in executing the HPV vaccination schedule ( 54 ). Moreover, parents’ skepticism about the HPV vaccine is the most likely obstacle to the successful implementation of the vaccination program in the community ( 86 ). It is clear that infrastructure issues, including supply shortages and staffing, have reduced access to medical services ( 90 ).…”

“…Still, more money is needed to inform and encourage girls to get regular vaccinations ( 85 ). From the side, building a high level of trust among the girl’s family, program leaders, and other stakeholders is essential to the immunization program’s success ( 86 ).…”