Caregivers of Adolescents' Motivators and Barriers to Vaccinating Children against HPV in Georgia Öffentlichkeit

Abstract

Background: Acceptance of adolescent vaccines, as measured by vaccine uptake, is generally high amongst caregivers. However, this does not routinely extend to HPV vaccines. In the state of Georgia, HPV vaccine coverage rates remain subpar; vaccine initiation 64.3% versus coverage 45.7%; particularly to other adolescent vaccines administered (i.e. Tdap 93.3%) (Walker et al., 2018). The purpose of this study was to identify and examine caregivers’, motivators and barriers towards vaccinating their adolescent(s) against HPV in the state of Georgia.

Methods: Focus group discussions (n=9) with caregivers (n=75) were conducted throughout the state. Thematic analysis identified common motivators and barriers towards adolescent HPV vaccine uptake amongst caregivers.

Results: We identified motivators and barriers centralized around themes of healthcare provider relations and trust, presentation of HPV-related information, adolescent’s physical sex, and an essential need to protect adolescents. Barriers presented include caregivers being unable to develop a trusting relationship with their healthcare provider, fear of perceived side effects, management of an overload of HPV-related information, inability to prioritize the HPV vaccination, and perceiving the vaccination to be for females. Motivators presented include caregivers’ intrinsic need to protect their adolescent, shock-value HPV-vaccination marketing in commercials, and trusting their healthcare provider. Caregiver trust in their healthcare provider has been shown to ease perceived barriers in this study.

Conclusion: Trust in healthcare providers was found to be imperative to mitigating barriers and reinforced motivators to HPV vaccine acceptance and uptake. In improving patient-provider relationships throughout the state of Georgia, caregivers may become more receptive to vaccinating their adolescents against HPV, thus improving uptake and mitigating concerns causing hesitation to decide. Additionally, information and messaging must be streamlined across HPV vaccine educational sources and provided in layman’s terms to avoid confusion of otherwise complex and technical detail. While all barriers and motivators are interconnected and posed nuances, trust in provider and clarity of HPV and HPV vaccine related information influenced many caregivers.

Keywords: HPV Vaccine, Human Papillomavirus Vaccine, adolescents, barriers, motivators, caregivers, Georgia

Table of Contents

1.0 INTRODUCTION ........................................................         1

1.1 Overview ...................................................................         1

1.2 Background ...............................................................         3

Human Papillomavirus …………………………………..........…         3

HPV Vaccination ……………………………………………........           4

Caregivers’ of Adolescents Motivators and Barriers .........            4

1.3 Problem Statement ..................................................           6

1.4 Purpose Statement ..................................................            7

1.5 Research Questions .................................................            8

1.6 Significance Statement ............................................            8

Definition of Terms ……………………………………......…...           10

List of Acronyms ………………………………………......….....          10

2.0 BACKGROUND ........................................................           11

2.1 Literature Review ....................................................          11

Introduction ………………………………………………....……           11

Mistrust in the Health System …………………………….......          11

Source of Health Information …………………………...……            12

Sexual Activity ……………………………………………...…….           13

Perceived Risk ……………………………………...……………..           14

Perceived Cost …………………………………...………………..           14

Sex of Adolescent …………………………………...……………           15

Culture, Religion & Politics ……………………....…………….          16

Reaction to School Mandates …………………..………………           18

Georgia State Context ………………………………………....…..        19

Conclusion …………………..……………………………………..           19

3.0 MANUSCRIPT .........................................................            21

3.1 Contribution of the Student .....................................            21

Title Page .....................................................................           22

Abstract ........................................................................           23

3.2 Background ..............................................................          24

3.3 Methodology ............................................................          24

IRB Approval ………………………………………………...……..          24

Methods ……………………………………………………...……...          25

Participant Recruitment ………………………………...……....          25

Participant Eligibility Criteria ………………………..………..           25

Informed Consent Process …………………………..………....           26

Focus Group Facilitation ……………………………..…………           26

Analysis …………………………………….……………………....           27

3.4 Results ...................................................................           28

 Introduction ………………………………………………………            28

 Barriers to HPV Vaccination Uptake in Adolescents .......            28

 Motivators to HPV Vaccination Uptake in Adolescents ....          39

3.5 Discussion ..............................................................          43

Introduction ……………………………………………………….           43

Barriers to HPV Vaccination Uptake in Adolescents …......          44

Motivators to HPV Vaccination Uptake in Adolescents ....         54

3.6 Limitations .............................................................         57

3.7 Conclusions ............................................................          58

4.0 PUBLIC HEALTH IMPLICATIONS ..............................           61

REFERENCES ................................................................          62

APPENDIX ....................................................................          68

Appendix I: eIRB ............................................................         68

Appendix II: Consent Form .............................................          69

Appendix III: Focus Group Discussion Guide .....................         72

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Stichwort	Barriers HPV Vaccine Human Papillomavirus Caregivers Motivators Georgia Adolescents
Committee Chair / Thesis Advisor	Robert A. Bednarczyk, PhD, Emory University
Committee Members	Adrian King, MPH, Emory University

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