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Methods: The study included 132 Latina mothers of HPV vaccine-eligible children. Quantitative data was collected from the mothers related to demographic information, having ever heard of the HPV vaccine, and whether their children have received the HPV vaccine. Qualitative data was collected in 13 focus groups. Using semi-structured discussions, mothers were asked about their knowledge about HPV infection and vaccine, views towards HPV vaccination, barriers for HPV vaccine initiation as well as completion, and opinions on strategies to improve HPV vaccination. Quantitative data were analyzed to describe the characteristics of the study sample and conduct bivariate analysis (using chi-square) of demographic data associated with having ever heard of HPV vaccination and receipt of the HPV vaccine. Using thematic content analysis, qualitative data (including study transcripts and observations) were analyzed for patterns, themes, and categories of responses.
Results: The mother’s mean age is 40 years, of whom 41.7% are of Caribbean origin and the remaining are from South and Central America. The overwhelming majority of mothers spoke only Spanish (85%), had high school or less education (64%) and less than $14,000 annual income (82%), and were uninsured (52%) and unemployed (71%). The mean number of HPV vaccine-eligible children was 2.6 (range 1-6), 1.7 daughters (range 0-4), and 1.6 sons (range 0-5). Based on analysis of the quantitative data, only 55% of mothers reported having ever heard of the HPV vaccine, which was significantly associated with language (90% among English speakers vs. 49% among Spanish speakers), annual income (49% among those with ≤ $14,000 vs. 83% among those with > $14,000), and insurance status (64% among insured vs. 47% among uninsured). Further, only 27.3% of mothers indicated initiating the HPV vaccine and 14.4% indicated completing the 3-dose series. Receiving the HPV vaccine was significantly associated with language (45% among English speakers vs. 24% among Spanish speakers), insurance status (39% among insured vs. 16% among uninsured), and having ever heard of the HPV vaccine (47% among mothers who ever heard of the HPV vaccine vs. 3% among mothers who never heard of the HPV vaccine). Based on analysis of qualitative data, mothers lacked knowledge about HPV infection and vaccination across groups, with varying degrees of knowledge by Latino background. Caribbean Latina mothers had higher knowledge about and intake of the HPV vaccine (both initiation and completion). Mothers were generally receptive and believed that the vaccine should be given to both males and females. Barriers to HPV vaccine initiation included concern about possible side effects (among all mothers) and avoidance of talking about sex with children (mostly among South American mothers). Healthcare provider recommendation was the strongest facilitator for HPV vaccination. Mothers identified several useful strategies to improve HPV vaccine initiation and completion. Healthcare provider recommendation and communication about the vaccine was the predominantly identified strategy to improve HPV vaccination, particularly in providing strong recommendation for the vaccine and addressing side effects and safety concerns. Other useful strategies for improving HPV vaccination included using a school-based approach to educate mothers about the vaccine and the use of text messaging and smart phone technology to educate mothers and send reminders for completion of the 3-dose series of the vaccine. Also, mothers indicated the importance of making appointments for the second and third doses immediately after receiving the first dose to improve HPV vaccine completion.
Conclusion: Future research and community health efforts should involve the development of linguistically and culturally appropriate educational interventions focused on educating mothers about the vaccine, integrating communication strategies for healthcare providers on HPV vaccination, and developing effective strategies to improve HPV vaccine initiation and completion among Latino adolescents around the world. This study was funded by the American Nurses Foundation.