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Research
Factors Motivating HPV Vaccine Uptake
Among Vaccinated and Nonvaccinated
Hispanic Young Adult Women
Dionne P. Stephens, PhD
1
, Hod Tamir, PhD
2
,
and Tami L. Thomas, PhD
1
Abstract
Introduction: To identify factors influencing human papillomavirus (HPV) vaccination up taking decision making among vacci-
nated and nonvaccinated Hispanic college women. Participants: Hispanic young women between the ages of 18 and 24 years
(N¼49). In total, 26 had not received the HPV vaccine, and 23 had started/completed the vaccine series. Method: Participants
registered for the study via a psychology research pool at a large public university in the southeast United States after institutional
review board approval. After completing a demographic information and HPV knowledge Web-based survey, participants were
individually interviewed. Results: Differences in HPV vaccine knowledge emerged between vaccinated and nonvaccinated
women. Fear of side effects, perceptions of risk, and sources of encouragement influenced willingness to be vaccinated against
HPV. Health care providers played a central role in addressing concerns and promoting vaccination. Conclusions: Health care
providers must address and integrate unique decision-making processes influencing Hispanic young adult women’s perceptions of
HPV vaccination.
Keywords
HPV vaccine, Hispanic, college women, decision making
Vaccination against human papillomavirus (HPV) vaccination
is of great importance given over 80%of women will be infec-
ted at some point in their lifetime (American Cancer Society,
2015). Health care providers are on the frontlines of national
uptake efforts, due to their role in the process and their capacity
to provide up-to-date information about this preventative tool.
Health care providers themselves recognize this role, as one
study found 73%agreed that they were integral to the success-
ful HPV vaccine series delivery (Wadi, Poliquin, Poliquin,
Lotocki, & Avery, 2014).
Health care providers’ encouragement is particularly impor-
tant for Hispanic women given they have the second highest
infection rate in the United States (Reiter et al., 2014). An
estimated 44%are infected with at least one type of HPV, and
31%are infected with high-risk HPV types linked to cervical,
vulvar, vaginal, and some oropharyngeal cancers (American
Cancer Society, 2015; Centers for Disease Control and Preven-
tion [CDC], 2013). Furthermore, Hispanic women’s cervical
cancer mortality rate is 48%higher than other groups (Ameri-
can Cancer Society, 2015; Reiter et al., 2014). Given this sub-
stantial burden of HPV infection, vaccination would be an
important preventative health tool for this group.
Although a number of studies have examined factors
influencing vaccination decision making (e.g., Morales-
Campos, Markham, Peskin, & Fernandez, 2013; Reiter et al.,
2014; Sanderson et al., 2009; Scarinci, Garce´s-Palacio, &
Partridge, 2007; Stephens & Thomas, 2014), none have com-
pared vaccinated and nonvaccinated women’s perceptions of
the process. This study’s objective is to contribute to health
care providers’ knowledge about where to target HPV vacci-
nation uptake efforts. By using a qualitative approach, this
study focused on Hispanic young women’s subjective reports
of their HPV vaccine knowledge and explored within-group
differences in factors influencing vaccine uptake.
Review of the Literature
HPV vaccination is a safe and effective way to protect against
the two HPV strains that cause 70%of cervical cancers (CDC,
2013). Although it is most effective when completed at 11 or 12
years of age, ‘‘catch-up’’ vaccination has been recommended
for women aged 13 to 26 years (CDC, 2013). As many Hispa-
nic women’s sexual onset occurs later than other groups’, many
1
Florida International University, Miami, FL, USA
2
Columbia University-Mailman School of Public Health, New York City, NY,
USA
Corresponding Author:
Dionne P. Stephens, Department of Psychology, Florida International
University, DM 256, 11200 SW 8th Street, Miami, Florida, FL 33199, USA.
Email: stephens@fiu.edu
Hispanic Health Care International
2016, Vol. 14(4) 184-191
ªThe Author(s) 2016
Reprints and permission:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/1540415316679808
journals.sagepub.com/home/hhci
would be eligible during this extended time period (Markowitz
et al., 2013). HPV vaccine uptake efforts are particularly
important as Hispanic young women have the additional infec-
tion vulnerability due to an increased likelihood of engaging in
unprotected intercourse and acceptance of traditional engende-
red sexuality norms that increase vulnerability to sexually trans-
mitted infections, including passivity and sexuality knowledge
(Lo´pez & Chesney-Lind, 2014; Stephens & Thomas, 2014).
Despite Hispanic women having higher rates of HPV vaccine
initiation when compared with non-Hispanic Whites, they are
less likely to complete the full three-dose series (CDC, 2013).
Thus, researchers have called for studies that identify factors
influencing HPV vaccination willingness specifically among
Hispanic populations (Cohen & Legg, 2014; Marchand, Glenn,
& Bastani, 2012). To address gaps in this literature, this study
seeks to identify vaccinated and nonvaccinated Hispanic young
women’s subjective beliefs about the factors influencing their
HPV vaccine uptake decisions making. Using qualitative meth-
ods, participants’ subjective perceptions about HPV vaccination
are explored, allowing for the integration of personal truths,
cultural values, and cognitive frameworks unique to their indi-
vidual experiences not easily captured using other methods.
Method
Between September 3, 2012, and December 30, 2013, a purpo-
seful sample of 49 Hispanic undergraduate women aged 18 to
24 were recruited for this institutional review board–approved
study. Individuals interested in participating were screened for
ethnicity, age, and gender eligibility via an online psychology
research pool at a large Hispanic Serving Institution. Through
the system, participants scheduled their interview times, com-
pleted a consent forms detailing their rights as participants, and
were awarded course credit for participation.
Interview Procedure
Five self-identified Hispanic female research assistants conducted
the individual interview sessions. After reading a letter of consent,
participants completed a demographic questionnaire that asked
questions about age, racial/ethnic identity, familial nation of origin,
sexual onset history, and vaccination status. They also completed a
survey that required them to self-report their HPV and HPV vac-
cine knowledge (see Table 2). Interviews were then conducted in a
private conference room. Participants provided pseudonyms used
in the interview and to label their transcripts.
The interview questioning route provided a framework for the
series of semistructured, yet flexible questions to assess partici-
pants’ subjective perceptions of factors motivating their HPV
vaccine uptake decision making. To build rapport and frame the
broad interview topic, initial general questions focused on estab-
lishing basic HPV vaccination knowledge and beliefs. Then more
focused questions were asked to determine perceptions of influen-
tial sources of information relevant to the present study, which
included the following: ‘‘What do you know about the HPV
vaccine?’’ ‘‘How did you first hear about the HPV vaccine?’’
‘‘Why did you get/not get vaccinated against HPV?’’ ‘‘What were
you told about the HPV vaccine?’’ and ‘‘Where would you go to
find out information about HPV and the HPV vaccine?’’ Inter-
viewers wrote reflective notes after each interview; each session
was audiotaped, and lasted between 15 and 65 minutes.
Data Analysis
Corbin and Strauss’s (2008) method to identify patterns of
sexual advances, strategies, and decisions initiated by men was
employed, with slight modifications to make it applicable to
the sample population. Eight research assistants transcribed the
interviews; the principal investigator (PI) and two additional
research assistants verified transcripts’ quality and complete-
ness and discussion content accuracy. Collection and analysis
of data occurred concurrently.
A preliminary coding framework was constructed from the
first five transcribed interviews using cost/benefit findings
identified in prior HPV vaccine uptake research. The data col-
lection and analyses were conducted by two groups within the
research team to mitigate potential biases. The constant com-
parative method of analysis, which requires continuous evalua-
tion of the incoming data to establish or explain a phenomenon
(Strauss & Corbin, 1990), was employed to uncover underlying
vaccination perceptions themes. The PI and three research
assistants reviewed each transcript using open coding tech-
niques. Initial codes were assigned and then evaluated with
each subsequent review. These codes were then developed into
themes in the second stage of analysis. Research team members
met on three occasions to evaluate and confirm themes emer-
ging (see Tables 3 and 4).
Using qualitative methodology often raises subjectivity con-
cerns; therefore steps were taken to ensure reliability. Prior to
analysis, two research assistants were tasked with identifying
discrepancies in the themes to increase rigor and credibility
(Lueng, 2015). Similarly, following Marshall and Rossman’s
(2006) suggestions, the research team met regularly to criti-
cally evaluate analyses and consider alternative views. The
PI and the research assistants summarized and reviewed the
transcribed interviews to identify key themes. Thus triangula-
tion of the data, survey data, and postinterview reflections were
used to address validity concerns (Leung, 2015). Incorporating
these steps improved trustworthiness and credibility of the data,
permitted detection of variation of the data, and the ability to
resolve interpretation variation.
Results
All participants’ self-identified as Hispanic; 15 familial nations
of origin were reported (see Table 1). Only 8 had resided 10
years or more outside the United States. The average number of
sexual partners in a lifetime was 2.6; of the 15 women who had
not begun having sex, 11 had not been vaccinated. From the
analysis of the HPV and HPV vaccination specific responses,
two broad themes emerged: (1) differences in current HPV
vaccination knowledge and (2) factors influencing their
Stephens et al. 185
vaccine uptake decision-making processes. Of the 49 partici-
pants, 26 had not been vaccinated, 20 had completed the vac-
cine series, and 3 had not yet completed the series. The latter
group’s responses were analyzed with those who had com-
pleted the series as the current study sought to identify factors
influencing vaccination decision making.
HPV and HPV Vaccine knowledge
Nonvaccinated women reported lower levels of perceived HPV
and HPV vaccine knowledge (see Table 2). In their survey
responses, 20 ‘‘somewhat’’ or ‘‘not’’ knowledgeable about
HPV (76%); the remaining 6 reported being ‘‘very’’ or ‘‘fairly’’
knowledgeable about the virus. Similarly, 24 of these women
stated they were ‘‘somewhat’’ or ‘‘not’’ knowledgeable when
specifically asked about the HPV vaccine in their interviews.
In contrast, the 23 vaccinated women’s survey result sho-
wed higher levels of HPV and the HPV vaccine knowledge (see
Table 2). Only 9 vaccinated women perceived themselves as
only ‘‘somewhat’’ or ‘‘not’’ knowledgeable about HPV (39%);
14 selected ‘‘very’’ or ‘‘fairly’’ knowledgeable. Similarly, the
majority of vaccinated women selected ‘‘very’’ or ‘‘fairly
knowledgeable’’ when rating their HPV vaccine knowledge
in the survey (n¼15).
However, vaccinated women’s responses in the interviews
indicated lower levels of HPV vaccine knowledge (n¼11).
These vaccinated women were primarily unsure about what the
vaccine was actually capable of doing, how the vaccine wor-
ked, and the degree of protection it gave them.
It prevents a virus that I think it can lead to like a cancer. It’s for
women? I don’t know [how it works] ...not a clue.
Nonvaccinated Women’s Decision Making
Nonvaccinated women’s reasons for not getting the vaccine fell
into three categories; the average number of motivators given
was 2.2 (see Table 3). A total of 92.3%were willing to
eventually get vaccinated (n¼24). Of the two unwilling, one
based her decision on previous bad reactions to other vaccines.
Similarly, the other woman unwilling to be vaccinated had read
about others’ adverse reactions to the HPV vaccine immedi-
ately following the shots and felt that these negative experien-
ces outweighed the benefits.
Concerns about possible side effects in the future was also
cited by nine nonvaccinated women as a reason they had not
yet been vaccinated. The most common cited concern was the
possible long-term negative consequences.
I’ve discussed it with my parents but we all agreed we wanted to
wait a couple more years to see what the side effects were.
The second most cited reason for not getting vaccinated was
the belief they had a low infection risk (n¼8). Among these
Table 2. Perceived and actual HPV and HPV Vaccine Knowledge.
Questionnaire
responses
Nonvaccinated
women (% this
group)
Vaccinated women
(% within this group)
HPV knowledge
(questionnaire)
Very
knowledgeable
1 (3.8) 3 (13.0)
Fairly
knowledgeable
5 (19.2) 11 (47.8)
Somewhat
knowledgeable
11 (42.3) 8 (34.7)
No knowledge 9 (34.6) 1 (4.3)
HPV knowledge
(interview)
Very
knowledgeable
1 (3.8) 3 (13.0)
Fairly
knowledgeable
5 (19.2) 8 (34.7)
Somewhat
knowledgeable
8 (30.7) 12 (52.1)
No knowledge 12 (46.1) 0
HPV vaccine
knowledge
(questionnaire)
Very
knowledgeable
1 (3.8) 3 (13.0)
Fairly
knowledgeable
1 (3.8) 12 (52.1)
Somewhat
knowledgeable
12 (46.1) 8 (34.7)
No knowledge 12 (46.1) 0
HPV vaccine
knowledge
(interview)
Very
knowledgeable
0 1 (4.3)
Fairly
knowledgeable
2 (7.6) 10 (43.4)
Somewhat
knowledgeable
10 (38.4) 12 (52.1)
No knowledge 14 (53.8) 0
Table 1. Participants’ Familial Nations of Origin.
Country N%
Argentina 2 4.0
Bolivia 1 2.0
Brazil 2 4.0
Columbia 3 6.1
Cuba 15 30.6
Dominican Republic 2 4.0
Guatemala 4 8.1
Honduras 1 2.0
Mexico 1 2.0
Nicaragua 2 4.0
Peru 1 2.0
Puerto Rico 3 6.1
Spain 2 4.0
United States 7 14.2
Venezuela 3 6.1
186 Hispanic Health Care International 14(4)
women, not being sexually active (n¼6) and not being at high
risk for cancers (n¼2) were the two primary reasons given by
those who did not see vaccination as necessary at the time of
the interview. Finally, convenience was an important consid-
eration for seven nonvaccinated women. They did not view
vaccination as a priority given their busy work and/or school
schedules.
Well since I’m kinda, like, my schedule is full. Because, like, if
I actually had time I would go to the health center [to get
vaccinated].
Vaccinated Women’s Decision Making
Vaccinated women reasons for getting vaccinated fell into five
categories; the average number of motivators given by these
women was 2.4 (see Table 4). The reason cited most often in
support of vaccination included encouragement from individ-
uals the women viewed as being personally close to them. This
specifically included family members and friends who directly
encouraged them or who had already been vaccinated; a total of
19 vaccinated women reported encounters with sisters, moth-
ers, and friends that directly influenced their decision to be
vaccinated.
My sister got it before I did—my younger sister. So then I just went
to the clinic and I did it as well.
The second most cited reason for getting vaccinated was a
health care provider’s recommendation. A total of 14 women
reported encouragement from their health care providers
prompted their decision to be vaccinated.
I first went to [her gynecologist] and she told me about it. Then she
was like ‘‘Yeah, you should get it.’’
Nine vaccinated women based their decision on perceptions
of infection risk. These women viewed vaccination as an
Table 4. Factors that Influenced Vaccine Women’s Decision to Get Vaccinated.
Coding category Description Example quote
Total
responses
1. Close social network
member encourage
Encouragement to be vaccinated individuals the
women viewed as being personally close to
them
‘‘Um, yeah my sister actually got it. And some other
coworkers of mine also got it. So I did too!’’
19
2. Health care providers’
recommend
Health care provider introduced and/ or
encouraged vaccination as beneficial to
health
‘‘I didn’t really know that much about it, but I mean, I
do remember my doctor stressing the importance
of it, and obviously I trust her.’’
14
3. Perception of being
possibly risk for HPV
infection
Possibility that they could infected with HPV;
engage in behaviors that could put them
at risk
‘‘I know that there are benefits from getting it so I
decided to get it just to prevent something that
could possibly happen.
9
4. Personal connection to
HPV or related
outcomes
Family member or close friend infected with
HPV or has/had HPV related cancer
‘‘Actually my grandmother died of cervical cancer
caused by HPV. So my family has a history ...and
my mom just got diagnosed two days ago.’’
6
5. Influential Media
message
Media (e.g., commercial or news) message
directly influenced or prompted them to
seek more information or get vaccine
‘‘I had because they started this whole [television]
campaign with the HPV vaccines.’’
4
Table 3. Factors Influencing Nonvaccinated Women’s Decision to Not Get Vaccinated.
Coding category Description Example quote
Total
responses
1. Fear of side effects 11
a. Short-term side effects Fear of adverse reactions immediately following
or soon after vaccine injection
‘‘I haven’t really gotten that vaccine because I
was researching online and I was reading like
some people’s reaction to the vaccine’’
2
b. Long-term side effects Fear of negative health side effects from
infection in the future
‘‘If I knew more about it and I knew maybe the
side effects and stuff in the future.’’
9
2. Perception of being at low risk
for HPV infection
Low level of probability that they would be
infected with HPV; not engaging in behaviors
that put them at risk including sexual onset
or no history of cancers
‘‘I don’t think I’m that much of a risk, you know.
Just, I’m not at risk for those kinds of things.
I am still a virgin, so that’s why I haven’t
taken it.’’
8
3. Inconvenience of vaccination
process
Barriers to going to provider to get more
information or vaccine; includes time
limitations or having to wait around
‘‘I never got around to it and to be honest I
don’t think it’s a big deal to change my
schedule for.’’
7
Stephens et al. 187
important prevention tool; a desire to protect themselves
against HPV acquisition motivated their vaccination uptake.
I’m not completely sure what it was. But I know it was to prevent
like cervical cancer, so yeah. I wanted to be protected. I could be
at risk.
Relatedly, having a personal connection to HPV or related
cancers was another factor that influenced women to get vac-
cinated. Having a family member or close friend who was
infected or experienced cervical cancer was a reason that six
women decided to get vaccinated against HPV.
Um,mymomwasactuallydiagnosedwithitnottoolong
ago ...It’s something that has to be monitored because it could
potentially cause cancer.
Although most vaccinated women recalled HPV vaccine
media messages (n¼18), only four women felt it influenced
their decision to be vaccinated. They believed media messages
increased their awareness about the vaccine’s existence and led
lead them to seek more information.
Discussion
HPV and HPV Vaccine Knowledge
Vaccinated women in this study accurately perceive them-
selves as knowledgeable about HPV and the HPV vaccine. In
contrast, nonvaccinated women perceived themselves as hav-
ing, and actually had, lower levels of HPV and HPV vaccine
knowledge. These findings support prior research showing that
vaccination increases young women’s knowledge of HPV and
the vaccine’s purpose (Marchand et al., 2012; Stephens &
Thomas, 2014).
However, these findings do not indicate a causal relation-
ship. Rather, while knowledge may increase vaccination will-
ingness, its influence on actual uptake outcomes is less clear.
While studies have found correlational links between knowl-
edge and HPV vaccine uptake, others have shown that
increased knowledge did not result in actual higher rates of
vaccination (Fishman, Taylor, Kooker, & Frank, 2014; Gerend
& Shepherd, 2011). This points to the possibility that vaccina-
ted women may have unique factors that motivated them to
actually get vaccinated. For example, Gerend and Shepherd
(2011) found Hispanic identifying as politically conservative,
being evangelical Christian, having no sexual experience, and
being opposed to premarital sex further decreased vaccination
likelihood (Gerend & Shepherd, 2011). Thus, clinicians must
also explore personal beliefs and experiences motivating indi-
vidual clients’ HPV vaccine decision-making processes.
HPV Vaccine Uptake Decision Making
Perception of risk. Safety concerns was the most common reason
nonvaccinated women had not been vaccinated against HPV.
These women were worried about potential short- and long-
term negative health outcomes. As noted by previous HPV
research focusing on Hispanic women, uptake efforts must
integrate accurate information about the vaccine’s risk to allay
fears of negative outcomes (Ferna´ndez et al., 2014; Morales-
Campos et al., 2013).
Perception of risk for HPV was cited by both vaccinated and
nonvaccinated women motivating their decision to be vaccina-
ted. Not having had sexual intercourse or perceived low risk for
cancer were reasons nonvaccinated women gave for not having
been vaccinated. In contrast, currently or potentially becoming
sexually active and cancer concerns were important motivators
for almost one third of the vaccinated women. These risk per-
ception concerns must be carefully considered given HPV is
the most common STI among women in this age- and ethnic
group (Ferna´ndez et al., 2014). Greater awareness about HPV
and the vaccine as a tool for prevention will increase Hispanic
young adult women’s ability to accurately assess their risk.
Perception of risk was also influenced by external sources,
as knowing someone who was infected motivates over 20%of
these women to get vaccinated. As noted in prior research,
having a genetic predisposition for cervical cancer and kno-
wing someone who has/had HPV increase the likelihood that
vaccination is encouraged among Hispanic familial members
(Gerend, Zapata, & Reyes, 2013; Morales-Campos et al.,
2013). Sanderson et al.’s (2009) study of HPV-positive Hispa-
nic mothers found that they were more likely to have their
daughters vaccinated as compared to noninfected mothers;
even if they had to pay for the vaccine, infected mothers vie-
wed vaccination uptake for their daughters as an important
health prevention task (Sanderson et al., 2009).
Health care provider. Prior research suggests clients’ perception
of health care providers’ specialized education, skills, and
training increases their acceptance of providers’ health directi-
ves (Ai, Appel, Huang, & Lee, 2012). One third of the vacci-
nated women’s health care providers played an important role
in their decision-making processes. As was found in other
studies, health care providers’ encouragement was viewed by
nonvaccinated women as influential and has been found to
increase their desire to seek out vaccine information in future
visits (Rahman, Laz, & Berenson, 2015; Reiter et al., 2014;
Vadaparampil et al., 2014). This highlights the importance of
health care providers’ role in the provision and promotion of
accurate information about HPV.
The importance of including discussions of HPV vaccina-
tion as part of health care providers’ routine prevention discus-
sions is highlighted by the fact that over 25%of the
nonvaccinated women noted convenience as a vaccination bar-
rier. As noted in prior research, the inconvenience of having to
visit a health care provider was a reason these women had not
been vaccinated (Ferna´ndez et al., 2014; Stephens & Thomas,
2014). If health care providers address vaccination during rou-
tine visits it would be more likely that nonvaccinated women
are provided with accessible information during an existing
appointment, ensuring the process is convenient and routine.
188 Hispanic Health Care International 14(4)
Influence of kinship networks. Kinship networks emerged as an
important factor influencing HPV vaccine uptake; only three
nonvaccinated women had family members discourage vacci-
nation due to vaccine safety concerns. This supports research
showing that kinship networks members’ shared history, cul-
ture, and connections influence Hispanic women’s willing-
ness engage in protective health behaviors (Ferna´ndez et al.,
2014; Fishman et al., 2014; Mcree, Reiter, Gottlieb, &
Brewer, 2011; Stephens & Thomas, 2014). Thus, incorpora-
ting discussions about HPV vaccination status of siblings,
peers, and other cohort members may be a useful strategy
for those seeking to increase HPV vaccine uptake among
Hispanic young adult women.
The fact that mothers were specifically mentioned by 16
vaccinated women when discussing people they spoke to about
vaccination and who they knew were affected by HPV supports
research showing Hispanic mothers’ beliefs and encourage-
ment can significantly influence daughters’ HPV vaccine
uptake decision-making processes (Ferna´ndez et al., 2014;
Gerend et al., 2013; Morales-Campos et al., 2013; Stephens
& Thomas, 2014). Thus increasing mothers’ knowledge could
potentially increase their endorsement of vaccination among
Hispanic young women (Morales-Campos et al., 2013; Scarinci
et al., 2007; Stephens & Thomas, 2014).
Media. It is particularly important to recognize the media’s role
in making women aware of the vaccine; nonvaccinated women
were more likely to report having first hearing about it from
this source, but it did not increase their actual vaccine uptake.
Thus media messages cannot simply raise awareness but must
also motivate women to seek more information about vaccina-
tion. Media genres, modes of dissemination, and focus of the
message content as it specifically relates to Hispanic women’s
needs are also important to address given the relevance of
culturally specific health messaging for successful health
behavioral changes (Jesus, 2013; Stephens & Thomas, 2014).
Furthermore, the ways in which media messages can serve as
complementary education tools for health providers should be
explored in future research.
Clinical Implications
Encouraging health care providers’ recommendations may be
the most effective path toward increasing HPV vaccination
among Hispanic young women. In their role of providing
health information, they have the ability to ask sensitive health
questions, introduce HPV vaccination, and create a space for
comfortable discussions with parents and daughters during rou-
tine checkups. Health care providers can also leverage their
experience and skill to address individual-level HPV vaccina-
tion needs (Ai et al., 2012; Jesus, 2013; Rahman et al., 2015).
To address the low HPV information and vaccination rates
among Hispanic women, health care providers have an impor-
tant role in improving the development and delivery of infor-
mation and reducing HPV vaccine stigmas (Rahman et al.,
2015; Vadaparampil et al., 2014; Wadi et al., 2014). Safety
concerns were the key reasons women gave for opting out of
vaccination. Furthermore, as the present study and prior
research have shown, lack of knowledge about the vaccine also
decreases the likelihood of vaccination uptake (Ferna´ ndez
et al., 2014; Fishman et al., 2014; Gerend & Shepherd, 2011;
Morales-Campos et al., 2013; Stephens & Thomas, 2014).
Thus, health care providers are an important resource for fac-
tual information about the efficacy and safety of HPV vaccines.
Relatedly, this study points to the importance of clinicians’ role
as providers of accurate HPV and HPV vaccination informa-
tion to Hispanic young adult women’s familial members as
well. Although studies show that mothers positively influence
Hispanic daughters’ willingness to get vaccinated, they were
rarely perceived as providing education, including its purpose,
potential risks/outcomes, or health implications (Mcree et al.,
2011; Stephens & Thomas, 2014). Rather, health providers
play a central role in filling gaps in Hispanic young women
and their social networks HPV and HPV vaccine knowledge
(Mcree et al., 2011; Stephens & Thomas, 2014). This knowl-
edge will enhance health providers’ abilities to address percep-
tions that both deter and facilitate uptake within this
population.
It is also important to understand that a blanket approach to
addressing cultural norms cannot be used with Hispanic
women as there are distinctive sexuality messages that differ
across socioeconomic class, region, and familial nation of ori-
gin (Cohen & Legg, 2014; Scarinci et al., 2007; Stephens &
Thomas, 2014). Henry et al. (2016), found that Hispanic girls
living in predominantly Hispanic communities are more likely
to have received the vaccine (69%) as compared to those living
in majority White (50%) and Black neighborhoods (54%).
Furthermore, there are existing risk behavior within group dif-
ferences associated with HPV infection; low levels of accultu-
ration are associated with Hispanic women’s delayed initiation
of sexual intercourse and reduced numbers of sexual partners
(Deardorff, Tschann, Flores, & Ozer, 2010). Lee and Hahm
(2010) similarly found that Hispanic young women who spoke
English at home engaged in fewer sexual risk behaviors when
compared to those who were foreign-born and spoke Spanish at
home. The delaying of sexual onset into late adolescence or
early adulthood—like many of the present study participants—
extends a woman’s vaccination eligibility. Thus, clinicians
working with late adolescents and young adult Hispanic
women should promote ‘‘catch-up’’ vaccination among those
who have not engaged in behaviors that exposed them to the
virus (Markowitz et al., 2013). By recognizing within-group
diversities and the need to integrate differing cultural values,
they can successfully frame vaccination as routine and
important.
Conclusion
This study contributes to the general literature on HPV uptake
among female Hispanic young women and is especially rele-
vant considering the high rate of HPV infection and related
cancers occurring in this population. However, study
Stephens et al. 189
limitations must be acknowledged. For example, this was a
self-report study investigating issues related to personal beha-
viors and interactions including sexual partners, sexual expe-
riences, and STIs; participants possibly skewed responses to
maintain social desirability or to avoid discomfort and emba-
rrassment. As in all convenience-sample studies, it is important
to take into account the unique population and recognize that
results may differ in a more heterogeneous sample. Approxi-
mately 80%of the population within the city and at the insti-
tution where this study was conducted self-identified as
Hispanic, a concern given geographic composition can affect
rates of and access to vaccination providers. Follow-up studies
that draw from a more diverse sample can enhance our ability
to more comprehensively understand HPV uptake across His-
panic varied populations.
Despite these concerns, these comparative findings provide
new insights about Hispanic young adult women’s HPV vac-
cine uptake decision making within group differences. It also
contributes to our knowledge about the necessity of recogni-
zing unique factors and processes influencing Hispanic
women’s preventive health and decision-making behaviors.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
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