'They're not going to tell you everything': A qualitative study with HPV vaccine hesitant parents and caregivers in the northeast and southeast U.S.

BACKGROUND

Human papillomavirus (HPV) is a prevalent sexually transmitted infection linked to various cancers, yet HPV vaccine uptake among U.S. adolescents remains suboptimal. This study aimed to explore sources caregivers use for HPV vaccine decisions, examine factors that impact decision-making, and identify opportunities for effective communication strategies.

METHODS

This qualitative study utilized thematic analysis. A quantitative survey (N = 1068) informed purposeful sampling of vaccine-hesitant parents and caregivers in the Northeast and Southeast U.S. Forty-one participants engaged in in-depth, semi-structured Zoom interviews regarding HPV vaccine attitudes and decision-making. Iterative data review and coding led to the development of key themes.

RESULTS

Four overarching themes emerged: (1) Complex pathways, including concerns about side effects, vaccine efficacy, and child's perceived immaturity, lead to HPV vaccine hesitancy; (2) Overarching mistrust in healthcare systems and government, amplified by the COVID-19 pandemic, characterizes hesitancy; (3) Parental decision-making is influenced by varying levels of health and media literacy, with many relying on social media; and (4) Caregivers struggle to navigate adolescent autonomy in HPV vaccination decisions, often complicated by the vaccine's sexual connotations.

DISCUSSION: Parental HPV vaccine hesitancy is multifaceted, driven by a confluence of mistrust, misinformation, low health literacy, and difficulties addressing adolescent sexuality and autonomy. The COVID-19 pandemic has further eroded trust. Findings underscore the need for tailored, transparent communication strategies from trusted healthcare providers to debunk myths, improve health literacy, and address specific caregiver concerns, thereby fostering informed decision-making and improving HPV vaccine uptake.