Caregiver Barriers to HPV Vaccination in the African American and Afro-Caribbean Population

Purpose: The purpose of this systematic review was to explore caregiver barriers to Human Papillomavirus (HPV) vaccination in the African-American and Afro-Caribbean population. This knowledge can then guide the development of strategies to counteract existing obstacles to HPV vaccination. HPV is the most prevalent sexually transmitted infection (STI), causing around 79 million people in the United States (U.S.) to be currently infected with it, and an estimated new additional 14 million cases per year (Centers for Disease Control and Prevention, 2017). As such, not only can it cause physical manifestations at the site of sexual contact, like genital warts, but more importantly, it can lead to multiple types of cancers including cervical, vulvar, vaginal, penile, anal, and oropharyngeal cancers (Centers for Disease Control and Prevention, 2017). Despite recommendations by the Advisory Committee on Immunization Practices (ACIP) for vaccinating both girls and boys against HPV, there are still many challenges to reach appropriate immunization rates, particularly among minorities such as the African-American and Afro-Caribbean population. Furthermore, racial minorities such as African-Americans and Afro-Caribbeans have been found to have higher risks for HPV and HPV-associated cancers when compared to their white counterparts (Hull et al., 2014).

Methods: A search was conducted on CINAHL and Medline, and a total 38 records were identified, eight of which met the inclusion criteria. An assessment of the full-text manuscripts was performed, and one study was excluded after quality appraisal, leaving seven manuscripts to be included in this systematic review.

Results: The literature has revealed that the African-American and Afro-Caribbean population has a broad spectrum of caregiver concerns regarding HPV vaccination that need to be addressed, including: insufficient knowledge about HPV and HPV vaccines (Cates, Ortiz, Shafer, Romocki, & Coyne-Beasley, 2012; Hull et al., 2014; Joseph et al., 2012; Joseph et al., 2015), and desire for more guidance from healthcare providers (Katz et al., 2016; Thompson, Arnold, & Notaro, 2012); apprehension about promoting earlier and/or riskier sexual practices (Cates et al., 2012; Hull et al., 2014; Joseph et al., 2012; Joseph et al., 2015; Perkins et al., 2013); vaccine safety concerns and distrust (Cates et al., 2012; Hull et al., 2014; Joseph et al., 2012; Joseph et al., 2015; Katz et al., 2016; Perkins et al., 2013; Thompson et al., 2012); and financial difficulties (Cates et al., 2012; Thompson et al., 2012).

Conclusion: Important health disparities exist between African-Americans and Afro-Caribbeans’ and whites’ HPV immunization rates, HPV infection incidence, and HPV-associated cancer rates, which are inequities that all nurses around the globe dealing with these populations should address. These health disparities should be confronted partly through ensuring that nurses are providing appropriate recommendations for the HPV vaccine to patients and their caregivers as a means to address caregiver fears or doubts, and to promote earlier and complete HPV immunization; as well as through the development of educational interventions to advocate for HPV vaccine uptake increase, targeted to the African-American and Afro-Caribbean community. These health promotion interventions should be tailored to the immunization barriers this community faces in order to increase their effectiveness, and have a greater impact in HPV-related disease prevention for this population. Further research will then be needed to determine if such educational programs tailored to educating caregivers in the African-American and Afro-Caribbean population about all of the identified topics that prevent them from vaccinating their children with the HPV vaccines are effective in increasing HPV immunization rates.

Key words: Human Papillomavirus, immunization barriers, African-American and Afro-Caribbean.