Selected African American Women’s Perceptions about the HPV Vaccine
Published on: 2020-05-17
Background: This study examined African American Women’s knowledge, attitudes, and perceptions about the Human Papillomavirus (HPV) Vaccine, through two focus groups.
Methods: Seventeen African-American freshmen women were purposively recruited through two Center for Academic Success (CAS-100) classes at a public, four-year degree granting institution in the Southeastern region of the United States. The women were between the ages of 18 and 19. Focus group discussions ranged from 60 -90 minutes. All focus groups were audio-taped, transcribed, coded and themed. Following a brief presentation about cervical cancer and HPV, participants were questioned about their attitudes and perceptions about the HPV vaccine.
Conclusions: These findings suggest that unique educational strategies need to be developed, based on the needs and perceptions of the targeted audience, in order to achieve widespread acceptability of this vaccine. Considerable continued health promotion efforts are also needed to improve the knowledge about cancer and HPV in general, and particularly about cervical cancer, to reduce fear and to highlight the effectiveness of prevention and screening.
KeywordsHuman Papillomavirus (HPV); Cervical cancer
Black women have higher rates of cervical cancer and lower rates of HPV vaccination than White women in the United States. To reduce these disparities, understanding differences among subgroups of Black women is crucial . Knowledge, attitudes, and behaviors are central to issues affecting the transmission and treatment of HPV and cervical cancer. Adolescent girls are especially vulnerable to HPV and cervical cancer risk . Research demonstrates that adolescent girls and young women as well as boys have limited understanding of HPV and cervical cancer with respect to etiology, modes of transmission, risk, prevention, and treatment . More commonly known may be the test for cervical cancer, the Pap smear, which has achieved considerable success in the prevention of invasive cervical cancer through the early identification of cervical dysplasia. Adolescent girls still lack knowledge however, about the benefit, aim, or purpose of a Pap smear or pelvic exam. In a study of adolescent female patients, researchers found that only 2.7% of participants could correctly define the term Pap smear . In a survey of freshmen at a private New England university, it was found that while 95.4% of female students had heard of genital warts, significantly fewer were familiar with HPV of the cervix (35.3%) or the penis (22%) . Moreover, it appears that young people often are unaware or misinformed about HPV prevalence and severity.
Cervical cancer is one of the top five cancer incidence sites among African American women
(5th) in the United States . The cervical cancer incidence rate ratio between African Americans and whites is 1.6/100,000. Studies have found multiple factors that are associated with such disparities in cervical cancer incidence between African Americans and their white counterparts, including income, education, delay in seeking care for symptoms, lower rates of Pap smear, and higher rates of human papillomavirus (HPV) infection . Since greater knowledge of HPV and cervical cancer has been associated with higher levels of socioeconomic status, higher levels of education we now see that there is a clear disparity between those who are ‘‘information rich’’ and those who are ‘‘information poor,’’ which corresponds with material well-being . Minority women, especially those with low socioeconomic status or low levels of education, may therefore be at a disadvantage in terms of cancer prevention knowledge, such as knowledge about the Pap test. Higher educational attainment appears to be associated with higher levels of knowledge about HPV.
Materials and Methods
Purpose of Study
The purpose of this study was to examine African American Women’s knowledge, attitudes, and perceptions about the Human Papillomavirus Vaccine. The information was used to inform health educators of some of the issues they need to address when creating programs for African American women regarding cervical cancer, Human Papillomavirus, and the Human Papillomavirus Vaccine.
The research questions for this study consisted of the following:
- What do African American Women know about HPV, HPV Vaccine, and Cervical Cancer?
- What is the attitude and perceptions of African American Women towards HPV, HPV Vaccine, and Cervical Cancer?
Significance of the study
The study was significant as it encouraged African-American women between the ages of 18 and 24 years old to become empowered to safeguard their health by learning about HPV, cervical cancer and the need for regular screening with the Pap test and HPV test. Its findings informed current and future campus and/or community health education interventions, and clinical health services. These changes could then lead to a reduction in the incidence of Human Papillomavirus and cervical cancer among African American women between the ages of 18-24.
This study was a qualitative study in which data collection was performed through focus groups with the target population being African American women.
Seventeen freshmen African-American women were purposively recruited through two Center for Academic Success (CAS-100) classes at a public, four-year degree granting institution in the Southeastern region of the United States, ranging in ages 18-19. Focus groups were held and data collection was completed in the conference rooms at the university. This study was approved by the public, four-year degree granting institution in the Southeastern region of the United States Human Subjects Approval Review Institutional Review Board. All participants gave written informed consent before participating.
Focus group interview questions or focus group guide derived from literature reviews, my own knowledge of HPV and cervical cancer and an expert panel.
Data Collection Procedures
Prior to the beginning of each focus group, the purpose of the study was explained, and participants completed a brief demographic questionnaire. Participants were informed again of the presents and reasoning of the observer, note taker, and transcriber. If they felt uncomfortable at any time they could leave. In the first segment of each focus group, a protocol script was used, the focus group cover letter was read again, and women were asked about their knowledge regarding sexually transmitted infections (STIs), sexual health, and HPV. Following a brief presentation about cervical cancer and HPV, participants were asked questions about attitudes, perceptions and acceptability of the HPV vaccine. Sessions lasted approximately 60-90 minutes and followed a topic guide. Every session was audiotaped and transcribed. Participants were fed and given pizza, snacks, and soda.
Data Analysis Procedures
Within 72 hours of conducting the focus groups, the observer, note taker, transcriber, and researcher completed debriefing reports. The debriefing process covered the logistics of the space where the focus groups were held, the group dynamics, the researcher’s performance, the perceived clarity of the focus group guide, the emerging themes, and any unanticipated findings. This provided an opportunity for everyone to discuss concerns while simultaneously providing contextual information that was useful in the analysis of the transcripts. Focus group transcriptions were analyzed in four stages. First, everyone independently read the focus groups’ transcripts to identify emerging themes. Second, we discussed the identified themes and agreed on categories. This phase was carried out by going through the identified themes within each question and coming to an agreement on the major themes that were identified by all. Based on this discussion, a grid of agreed-upon themes was generated. During the third phase of the analysis, we reread transcripts and attempted to include the previously identified themes and other new themes into the agreed-upon categories. The fourth stage consisted of a final grouping arrangement that was agreed upon by all. No software was used in the analysis of this data.
Results and Discussion
Finding from this study found that all study participants are sexually active, and started having sex at the ages of 14-16.
Participant’s knowledge level about HPV, HPV vaccine, and cervical cancer was as following:
- Did not know about pap smears and had never had one.
- Did not know of HPV or cervical cancer.
- Response:” I don’t know what HPV is”, “Never heard of cervical cancer”
- Few had seen the HPV vaccine commercials but did not understand what it was meant for.
Participant’s attitudes after learning about HPV, HPV vaccine and cervical cancer from researcher were as following:
- Fear: “My grandmother is scared of vaccines and won’t consider it”
- Uncertainty: “I am not sure I will take the vaccine”
- Anxiety: “Cervical cancer sounds really scary”
Participant’s perceptions after learning about HPV, HPV vaccine and cervical cancer from researcher were as following:
- Skeptical, citing concerns about the effectiveness and side effects.
- Concerned that being vaccinated would protect women their age from HPV, leading them to increased promiscuity or unprotected sex.
- Motivating factors for vaccine use:
- “Receiving education/information about the vaccine”
- “Affordable prices”
“Knowing others who had already gotten the vaccine”
Participants had no knowledge of HPV, HPV vaccine and cervical cancer. After learning about HPV, HPV vaccine and cervical cancer from the researcher, participants expressed fear, uncertainty and anxiety. Grandmothers seem to be a key influencer of their attitude towards vaccines. It is recommended that middle schools add sex education their Health Education curriculum. The education of parents and grandparents about HPV, HPV vaccine and cervical cancers would benefit the African American population a great deal, because these are the individuals that are respected. Findings suggest that considerable continued health promotion efforts are needed to improve knowledge about cancer in general, and particularly about cervical cancer, to reduce fear and to highlight the effectiveness of prevention and screening. Educational strategies need to be developed, based on the needs and perceptions of the targeted audience, in order to achieve widespread acceptability of the HPV vaccine. Further studies could also include a larger group of participants; with more diverse characteristics, such as age and class rank. Adding a quantitative component to assess knowledge, attitudes, and perceptions toward HPV, HPV vaccine and cervical cancer would also strengthen the study.
- Joseph NP, Clark JA, Bauchner H, Walsh MA, Glory M, Figaro J, et al. Knowledge, attitudes, and beliefs regarding HPV vaccination: ethnic and cultural differences between African-American and Haitian immigrant women. Women's Health Issues. 2012; 571-579.
- Cothran MM, Joyce PW. Adolescent behavior and sexually transmitted diseases: the dilemma of human papillomavirus. Health Care Women Int. 2002; 306-319.
- Baer H, Susan A, Lundy B. Knowledge of human papillomavirus infection among young adult men and women: implications for health education and research. J community health. 2000; 67-78.
- Atlanta GA. Cancer facts and figures for African Americans. American Cancer Society.
- Freeman HP, Wingrove BK. Excess cervical cancer mortality: A marker for low access to health care in poor communities. National Cancer Institute, Center to Reduce Cancer Health Disparities. 2005.
- Viswanath K. Cancer knowledge and disparities in the information age. J Health Communication. 2006; 1-17.