Examining multilevel influences on parental HPV vaccine hesitancy among multiethnic communities in Los Angeles: a qualitative analysis

Michelle B Shin; Kylie E Sloan; Bibiana Martinez; Claradina Soto; Lourdes Baezconde-Garbanati; Jennifer B Unger; W Martin Kast; Myles Cockburn; Jennifer Tsui

doi:10.1186/s12889-023-15318-2

Examining multilevel influences on parental HPV vaccine hesitancy among multiethnic communities in Los Angeles: a qualitative analysis

BMC Public Health. 2023 Mar 22;23(1):545. doi: 10.1186/s12889-023-15318-2.

Authors

Michelle B Shin¹, Kylie E Sloan², Bibiana Martinez², Claradina Soto², Lourdes Baezconde-Garbanati², Jennifer B Unger², W Martin Kast³, Myles Cockburn², Jennifer Tsui⁴

Affiliations

¹ Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, United States.
² Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
³ Department of Molecular Microbiology & Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
⁴ Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. tsuijenn@usc.edu.

Abstract

Background: Human papillomavirus (HPV) vaccine hesitancy is a growing concern in the United States, yet understudied among racial/ethnic minority parents. We conducted qualitative research to understand parental HPV vaccine hesitancy and inform community-specific, multilevel approaches to improve HPV vaccination among diverse populations in Los Angeles.

Methods: We recruited American Indian/Alaska Native (AI/AN), Hispanic/Latino/a (HL) and Chinese parents of unvaccinated children (9-17 years) from low-HPV vaccine uptake regions in Los Angeles for virtual focus groups (FGs). FGs were conducted in English (2), Mandarin (1), and Spanish (1) between June-August 2021. One English FG was with AI/AN-identifying parents. FGs prompted discussions about vaccine knowledge, sources of information/hesitancy, logistical barriers and interpersonal, healthcare and community interactions regarding HPV vaccination. Guided by the social-ecological model, we identified multilevel emergent themes related to HPV vaccination.

Results: Parents (n = 20) in all FGs reported exposure to HPV vaccine information from the internet and other sources, including in-language media (Mandarin) and health care providers (Spanish). All FGs expressed confusion around the vaccine and had encountered HPV vaccine misinformation. FGs experienced challenges navigating relationships with children, providers, and friends/family for HPV vaccine decision-making. At the community-level, historical events contributed to mistrust (e.g., forced community displacement [AI/AN]). At the societal-level, transportation, and work schedules (Spanish, AI/AN) were barriers to vaccination. Medical mistrust contributed to HPV vaccine hesitancy across the analysis levels.

Conclusion: Our findings highlight the importance of multilevel influences on parental HPV vaccine hesitancy and decision-making and the need for community-specific messaging to combat medical mistrust and other barriers to HPV vaccination among racial/ethnic minority communities.

Keywords: HPV vaccination; Medical mistrust; Multilevel influences; Racial/ethnic minority communities; Vaccine hesitancy.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Child
Ethnicity
Health Knowledge, Attitudes, Practice
Humans
Los Angeles
Minority Groups
Papillomavirus Infections* / prevention & control
Papillomavirus Vaccines*
Parents
Patient Acceptance of Health Care
Trust
United States
Vaccination
Vaccination Hesitancy

Substances

Papillomavirus Vaccines