HPV vaccination and sexual health in France: Empowering girls to decide

• Published in: Vaccine 2019-03, Vol.37 (13), p.1792-1798
• Main Authors: Lefevre, Hervé, Samain, Stéphanie, Ibrahim, Nour, Fourmaux, Christine, Tonelli, Anne, Rouget, Sébastien, Mimoun, Emmanuelle, Tournemire, Renaud De, Devernay, Marie, Moro, Marie Rose, Lachal, Jonathan
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescents; Attitudes; Contraception; Decision Making; Female; France - epidemiology; Girls; Health care facilities; Health Knowledge, Attitudes, Practice; HPV; Human papillomavirus; Humans; Immunization; Life Sciences; Papillomavirus Infections - complications; Papillomavirus Infections - epidemiology; Papillomavirus Infections - prevention & control; Papillomavirus Vaccines - administration & dosage; Papillomavirus Vaccines - immunology; Patient Acceptance of Health Care; Physicians; Public Health Surveillance; Punitive damages; Qualitative Research; Representations; Risk; Sexual Health; Sexually transmitted diseases; STD; Teenagers; Uterine Cervical Neoplasms - etiology; Uterine Cervical Neoplasms - prevention & control; Vaccination; Vaccines
• ISSN: 0264-410X; 1873-2518; 1873-2518; 0264-410X
• DOI: 10.1016/j.vaccine.2019.02.020

•French low vaccination coverage against HPV cannot reduce cervical cancer incidence.•Adolescent girls ask for more information about to make an informed decision.•Parental authorisation is required before doctors can vaccinate minors against HPV.•We may authorise doctors to administer this vaccine without parental approval. Vaccination coverage against HPV in France is among the lowest in the industrialized world, although the public authorities have recently become aware of this issue. Few studies have looked at teenaged girls’ representations of this vaccination, even though they are the most concerned by it. This qualitative study explored the experiences and representations of HPV vaccination by adolescent girls seeing doctors at least occasionally. We used a written essay question to explore this issue among 101 adolescent girls at six urban medical centers and a semi-structured interview to discuss it in further depth with five of them. The analysis was lexicometric (ALCESTE®) and phenomenological (Interpretative Phenomenological Analysis). These results are organized around four superordinate themes: the teenage girls' factual knowledge about this vaccine, their motives for and obstacles to vaccination, their involvement in this decision, and finally the need for information about and solutions to this issue. Teenage girls know little about this vaccine and are more sensitive to the emotional discourse that surrounds it than to rational knowledge about it. The requirement for parental authorization for this vaccine reinforces the girls' lack of investment. Vaccination programs should integrate the HPV vaccine more thoroughly into general prevention concerning sexual health and should send a strong signal by offering minors anonymous vaccination free of charge, as is already the case in France for requests for contraception, the morning-after pill, elective abortion, and screening and treatment of sexually transmitted infections.