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Challenges to Human Papillomavirus Vaccine Acceptability among Women in South India: An Exploratory Study

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  • 1 Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina;
  • | 2 Department of Microbiology, KS Hegde Medical Academy, Nitte (Deemed to be University), Deralakatte, Mangalore, India;
  • | 3 Mangalore University, Mangalore, India

ABSTRACT.

Cervical cancer is the second leading cause of cancer and one of the leading causes of cancer-related death in women in India. Human papillomavirus (HPV) vaccine uptake in India is low due to cost, low awareness of HPV, social stigma, and other factors. We assessed the awareness, attitudes, and beliefs regarding HPV and HPV vaccination and explored the barriers and challenges to HPV vaccine intent among women in Mangalore, India. An exploratory study was conducted using two focus group discussions (FGDs) and six in-depth one-on-one interviews. FGD-1 comprised nine women aged 18 to 26 years, and FGD-2 comprised seven women aged 27 to 45 years. The FGDs were recorded, transcribed, and analyzed using thematic content analysis. Themes identified were limited knowledge of HPV and vaccine, stigma associated with receiving HPV vaccine, vaccine safety concerns, and cost as a barrier to receiving vaccine. Participants expressed desire for physician and government recommendation of the HPV vaccine to validate vaccine intent. Contrasting themes between the two FGDs include support for vaccination at a younger age and lower perception of stigma and judgment in the 18- to 26-year-old group; however, participants in the 27- to 45-year-old group support vaccination at an older age and endorse greater fear of stigma and judgment associated with obtaining vaccination. Education regarding HPV-associated diseases and the HPV vaccine for the general public, physicians, and government officials in conjunction with lowering vaccine cost, improving vaccine access, and encouraging strong physician recommendations are key strategies to scale up HPV vaccine implementation in India.

    • Supplemental Materials (DOCX 19 KB)

Author Notes

Address correspondence to Avinash K. Shetty, Wake Forest School of Medicine and Brenner Children’s Hospital, Medical Center Blvd, Meads Hall, 3rd Floor, Department of Pediatrics, Winston-Salem, NC 27103. E-mail: ashetty@wakehealth.edu

Financial support: This study was supported by the Laura Scales Student Research Fellowship Fund and the Arnold P. Gold Foundation.

Disclosures: Written informed consent from each participant was obtained using an interpreter. Information from participants was treated confidentially. Funding sources played no role in the design and conduct of the study. All data generated and material used during this study are included in this published article and its supplementary information. This study was approved by the Institutional Review Boards at Wake Forest School of Medicine and the Ethics Committee at Nitte University.

Authors’ addresses: Pooja Shah and Avinash K. Shetty, Wake Forest School of Medicine, Winston-Salem, NC, E-mails: pmshah@wakehealth.edu and ashetty@wakehealth.edu. Veena Shetty, KS Hegde Medical Academy, Nitte (Deemed to be University), Deralakatte, Mangalore, India, E-mail: veenashetty@nitte.edu.in. Maithri Ganesh, Mangalore University, Mangalore, India, E-mail: maithrig97@gmail.com.

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