Acceptability of HPV vaccination for cervical cancer prevention amongst emerging adult women in rural Mysore, India: a mixed-methods study

• Published in: BMC public health 2024-08, Vol.24 (1), p.2139-15, Article 2139
• Main Authors: Coursey, Kate, Muralidhar, Kiranmayee, Srinivas, Vijaya, Jaykrishna, Poornima, Begum, Fazila, Ningaiah, Nagalambika, Lee, Sung-Jae, Madhivanan, Purnima
• Format: Article
• Language: English
• Subjects: Acceptability; Adolescent; Adult; Adults; Age; Analysis; Cancer; Cancer vaccines; Care and treatment; Cervical cancer; Community health aides; Community health care; Complications and side effects; Conjoint analysis; Cost analysis; Education; Female; Focus Groups; Girls; Health Knowledge, Attitudes, Practice; HPV; Human papillomavirus; Humans; Immunization; Impact analysis; India; Infections; Informed consent; Medical personnel; Mixed methods research; Papillomavirus infections; Papillomavirus Infections - prevention & control; Papillomavirus Vaccines - administration & dosage; Patient Acceptance of Health Care - psychology; Patient Acceptance of Health Care - statistics & numerical data; Prevention; Public health; Qualitative analysis; Qualitative Research; Review boards; Risk analysis; Risk factors; Rural areas; Rural Population - statistics & numerical data; Sexually transmitted diseases; Side effects; STD; Uterine Cervical Neoplasms - prevention & control; Vaccination; Vaccine acceptability; Vaccines; Women; Womens health; Young Adult; Young adults
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-024-19485-8

India has the highest number of estimated deaths from cervical cancer globally, with most cases attributed to Human papillomavirus (HPV). The World Health Organization recommends primary HPV vaccination for girls ages 9-14, with catch-up vaccination for young women ≥ 15 if feasible. India authorized a new, inexpensive HPV vaccine in 2022; given anticipated vaccine expansion, we conducted a mixed-methods study exploring acceptability of HPV catch-up vaccination for young emerging adult women in rural Mysore, India. Between September 2022-April 2023, participants were recruited with assistance from community health workers. In the qualitative phase, gender-stratified, audio-recorded focus group discussions (FGDs) were conducted in Kannada with emerging adults ages 18-26. FGDs were transcribed, translated, and analyzed using rapid approach to identify key HPV vaccination attributes. In the quantitative phase, a conjoint analysis was conducted to assess the impact of seven vaccination attributes on likelihood to vaccinate (LTV). Women ages 18-26 ranked LTV in eight hypothetical vaccination scenarios, and the relative impact of each attribute on LTV was calculated. All participants received education about cervical cancer, HPV, and HPV vaccination. Fifty-two young adults (female = 31, male = 21) participated in seven FGDs, and 101 women participated in the conjoint analysis. Average age of the 153 participants was 22.5 years, 66.7% had married, and all had completed high school. Only 17.9% had heard of cervical cancer, and 2.7% knew of the HPV vaccine. FGDs identified seven HPV vaccination attributes: cost, vaccination location, family support, peer influence, dose number, side effects, and risk of acquiring HPV. In the conjoint analysis, all attributes except dose number significantly impacted LTV. Family support (impact score = 19.37, p