title: Barriers and facilitators to human papillomavirus vaccination among Chinese adolescent girls in Hong Kong: a qualitative-quantitative study.
abstract: OBJECTIVE
  To explore perceptions towards cervical cancer, human papillomavirus (HPV) infection and HPV vaccination and to identify factors affecting the acceptability of HPV vaccination among Chinese adolescent girls in Hong Kong.
  
  
  METHODS
  Six focus groups were conducted with Chinese adolescent girls (median age 16 years, age range 13-20, n = 64) in Hong Kong in April 2007. Thematic analysis was employed to identify major themes related to cervical cancer and HPV vaccination. A supplementary questionnaire was administered to all participants before and after group discussion to assess their knowledge, attitudes and intention to be vaccinated and to collect demographic information.
  
  
  RESULTS
  Participants' knowledge on cervical cancer was limited and HPV was largely unheard of. They had difficulty understanding the mechanism linking cervical cancer with HPV infection. Participants held a favourable attitude towards HPV vaccination but the perceived timing of vaccination varied. Barriers to vaccination include high monetary cost, uncertain length of vaccine effectiveness, low perceived risk of HPV infection, no immediate perceived need of vaccination, anticipated family disapproval and fear of the pain of injection. Factors conducive to vaccination include perceived family and peer support and medical reassurance on safety and efficacy of vaccine. The differences on knowledge, attitudes, intention to be vaccinated now and willingness to conform to significant others before and after the discussion were statistically significant, with an increased tendency towards favouring vaccination after the focus group.
  
  
  CONCLUSIONS
  Participants favoured HPV vaccination despite not feeling an immediate need to be vaccinated. Interventions could focus on providing professional information on HPV vaccination and raising adolescents' perceived need to take preventive measures against HPV infection.
authors.affiliation: Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, University of Hong Kong, Hong Kong, China.
authors.forename: T T C
authors.initials: TT
authors.lastname: Kwan
authors.forename: K K L
authors.initials: KK
authors.lastname: Chan
authors.forename: A M W
authors.initials: AM
authors.lastname: Yip
authors.forename: K F
authors.initials: KF
authors.lastname: Tam
authors.forename: A N Y
authors.initials: AN
authors.lastname: Cheung
authors.forename: P M C
authors.initials: PM
authors.lastname: Young
authors.forename: P W H
authors.initials: PW
authors.lastname: Lee
authors.forename: H Y S
authors.initials: HY
authors.lastname: Ngan
mesh_terms: D000293:Adolescent; D000328:Adult; D044466:Asian People / Q000208:ethnology*; D005260:Female; D017144:Focus Groups; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D030361:Papillomavirus Infections / Q000208:ethnology / Q000517:prevention & control*; D053918:Papillomavirus Vaccines; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D002583:Uterine Cervical Neoplasms / Q000523:psychology
chemical_list: D053918:Papillomavirus Vaccines