A Qualitative Exploration of HPV Vaccination Decisions Among Central American Immigrant Parents in the United States: A Socio-Ecological Perspective on Barriers and Facilitators.

IntroductionHPV vaccination is crucial for preventing HPV-related cancers, yet rates remain below target, particularly among ethnic and immigrant communities in the United States (U.S.), where systemic barriers contribute to disparities. While research on HPV vaccination in Latino populations is growing, immigrants from Northern Triangle-El Salvador, Guatemala, and Honduras-are underrepresented. This study explored multilevel barriers and facilitators to HPV vaccination among Central American immigrant parents, a largely understudied group in vaccine research.MethodsThis qualitative, descriptive, exploratory study used in-depth, semi-structured interviews, guided by the Social Ecological Model (SEM) and the Health Belief Model (HBM). These frameworks informed the interview guide and analysis, capturing multilevel influences (SEM) and individual perceptions of susceptibility, severity, benefits, and barriers (HBM). Thematic analysis, using inductive and deductive approaches in MAXQDA, was organized by SEM levels, with HBM constructs integrated to interpret intrapersonal beliefs shaping vaccination decisions.ResultsFifty-six parents (33 mothers, 23 fathers; mean age = 42.7 years) participated; nearly all (92.8%) were foreign-born (average U.S. residency = 17.3 years) from El Salvador, Guatemala, and Honduras. They had 77 children (ages 11-17). About 33% of children had received an HPV vaccine recommendation from a healthcare provider, and all who received a recommendation initiated vaccination (≥1 dose). Analysis revealed a complex interplay of intrapersonal, interpersonal, organizational, community, and policy-level factors. HBM constructs highlighted how perceived susceptibility, severity, benefits, and barriers influenced decisions. Key themes included knowledge gaps, cultural norms, institutional support, and systemic barriers impacting uptake.ConclusionsFindings underscore the need for multilevel approaches to vaccination decision-making among immigrant populations. Interventions should integrate SEM and HBM perspectives, combining culturally relevant education, family and provider support, community-driven initiatives, and supportive policies to enhance vaccine literacy, build trust, reduce barriers, and increase HPV vaccine acceptance and coverage among Central American immigrants in the U.S.