HPV vaccine acceptance among African-American mothers and their daughters: an inquiry grounded in culture

Abstract

Background: Much of the research on African-Americans’ HPV vaccine acceptance has largely focused on racial/ethnic differences related to cognitive, socio-economical, and structural factors that contribute to differences in HPV vaccine acceptance and completion. A growing body of literature suggest that cultural factors, such as mistrust of healthcare providers (HCPs) and the healthcare system, religion, and social norms related to appropriate sexual behaviors, also plays a prominent role in their HPV vaccine acceptance. However, these studies were limited in their use of theoretical approaches necessary to conceptualize and operationalize culture. Objective: To explore the influence of culture on African-American mothers’ and daughters’ HPV vaccine acceptance using the PEN-3, a culturally-centered conceptual framework. Methods: Grounded theory techniques were used to explore cultural factors that influenced the acceptance of the HPV vaccine among African-American mothers (n=28) and their daughters (n=34). Results: Positive attitudes towards vaccination stemmed from beliefs that the HPV vaccine has cancer prevention benefits and that vaccinations in general protected against infectious diseases. Negative attitudes stemmed from beliefs that the HPV vaccine was too new, not effective, daughters were too young, and that vaccines were not a one-size-fits-all intervention. Majority of mothers and daughters indicated that their religious doctrine did not impede their HPV vaccination decisions. For a few mothers, religious beliefs could not be separated from their HPV vaccination decisions and ultimately deterred HPV vaccine acceptance. HCP recommendations were valued however mothers were often dissatisfied with the detail of information communicated. Support networks provided both positive and negative types of social support to mothers and daughters. The media highlighted the cancer prevention benefits of the HPV vaccine and unintentionally communicated negative information of the HPV vaccine, which deterred HPV vaccine acceptance. Conclusion: Study findings can inform the development of culturally appropriate interventions that advances the evidence on cervical cancer prevention.

African‐American parents’ and daughters’ beliefs about HPV infection and the HPV vaccine

“…Research demonstrates that cultural norms and beliefs, often the product of religious doctrine, influence African‐Americans’ perception toward sexuality, medical decisions, and STIs, including HPV infection and HIV/AIDS. As HPV vaccination is stigmatized due to its link to sexual activity, our findings suggest the need for studies to address the role of cultural normative beliefs on African‐Americans’ decisions to adopt sexual health preventative behaviors, such as HPV vaccination (Galbraith‐Gyan et al, ). Understanding the role of contextual factors will assist in the development of culturally appropriate interventions that can take place in culturally appropriate settings.…”

Social Networks for Human Papillomavirus Vaccine Advice Among African American Parents

“…Items were designed to reflect common sentiments among African American parents about HPV vaccine as identified in prior studies. 11,19,29,30 Response options for the items were "none," "a few," "about half," "most," and "all." Perceived exposure to each of the five anti-HPV vaccine viewpoints was considered high if "about half" or more of a parent's network adhered to the negative viewpoint or provided the cue not to vaccinate.…”

Community members trusted by African American parents for vaccine advice

“…The included community figures were selected based on previous studies' findings of people potentially influential in parents' vaccination decisions. 5,6,31,40,42 Parents were shown labelled images of the figures in a stereotypical pose (e.g., school nurse in scrubs examining a child, pastor in church, school principal in a classroom, pediatrician in a white coat examining a child, mother/father hugging a child, disease survivor at a rally, and scientist with a microscope). We first pilot tested the survey with ten parents who met inclusion criteria, and interviewed them for feedback after the survey.…”

“…Parents trust the advice of social contacts to form their own opinions and beliefs about vaccination. [1][2][3][4][5] Social contacts may influence parents' behavior by providing cues as to whether vaccine acceptance or refusal is typical and acceptable among peers. 6,7 In fact, the proportion of a parent's social network recommending against vaccination may be more strongly associated with whether parents vaccinate their children than parents' own thoughts on childhood vaccination.…”

“…11 Credibility might be further influenced by the racial or cultural profile of the messenger. 5 For instance, racial concordance with health care providers has been associated with greater trust and satisfaction in care among African Americans patients. [14][15][16][17][18][19] Further, some communication literature has also shown that culturally relevant messages are more effective at changing health behavior of minorities including African Americans, [20][21][22] although the data are still inconclusive in terms of the cost-benefit of culturally tailored messaging.…”