Human papillomavirus (HPV) vaccines: the attitudes and intentions of Australian health providers and parents from three diverse cultural groups toward HPV vaccination of pre-adolescent children

Abstract

Australia has one of the lowest incidences of cervical cancer globally, but its disproportionate rate among Aboriginal women, the underscreening cervical practices of some cultural groups, and the high incidence of other HPV-related morbidities in the general population makes a compelling need for HPV vaccination. High coverage of prophylactic HPV vaccines in sexually naïve adolescents will substantially reduce their risk of oncogenic HPV infection, and subsequent related disease; but as the hepatitis B vaccine experience demonstrated vaccinating this cohort presents challenges for public health providers. The delivery model of HPV immunisation into Australia, which commenced as an organised national program in 2007, mirrored that of other adolescent vaccination programs and its uptake has met forecast expectations.

Prior to the introduction of the HPV vaccines the lay public globally had little awareness of genital HPV infection and its sexual characteristics and concerns were held that once this factor was known it may impact on parental consent. Very little behavioural research had been undertaken to identify determinants of acceptance for HPV vaccination in pre-adolescents among Australian parents with diverse cultural norms for a new vaccine that has potentially controversial and some unique characteristics. This thesis argued that in order for there to be widespread uptake of the HPV vaccine among targeted female adolescents in a mixed-culture nation culturally appropriate implementation strategies are needed. The research examines the attitudes of General Practitioners (GPs) and parents from three distinct cultural groups towards HPV vaccination among preadolescent children, and in particular the influence of cultural norms on parental attitudes and intentions.

Applying qualitative methods through a systematic framework approach, this thesis aimed to (i) explore the determinants that influence parental and health provider attitudes; (ii) examine those elements through a multiple perspectives lens; and (iii) identify key factors and approaches for the successful uptake to the delivery of HPV vaccines into diverse cultural populations. To achieve these aims, a mixed-method purposive sampling strategy was applied with GPs practicing in Victoria, and Aboriginal, Anglo and Chinese-Australian parents residing in Victoria or Central Australia. The method and semi-structured interview guide explored knowledge and attitudes toward cervical cancer prevention from biomedical, structural, psychosocial and cultural perspectives.

A key finding is that socio-cultural and environmental factors do provide challenges for parents and health providers in accepting HPV vaccines in pre-adolescents. Participants demonstrated a positive attitude toward adolescent vaccination, but their attitudes reflected their normative values toward health prevention and sexuality. Their experiences were shown to influence their education resource and infrastructure needs indicating that implementation strategies for HPV vaccines cannot be generalised to cross-cultural populations. Findings from this study can begin to provide a socio-ecological basis for the development of culturally sensitive approaches to encourage HPV vaccination in the Australian adolescent cohort. The empirical findings also have significant implications for guiding its diverse population to a new cervical cancer prevention paradigm.