title: Acceptance patterns and decision-making for human papillomavirus vaccination among parents in Vietnam: an in-depth qualitative study post-vaccination.
abstract: BACKGROUND
  The GAVI Alliance's decision in late 2011 to invite developing countries to apply for funding for human papillomavirus (HPV) vaccine introduction underscores the importance of understanding levels of HPV vaccine acceptance in developing country settings. In this paper, we present findings from qualitative research on parents' rationales for vaccinating or not vaccinating their daughters (vaccine acceptance) and their decision-making process in the context of an HPV vaccination demonstration project in Vietnam (2008-2009).
  
  
  METHODS
  We designed a descriptive qualitative study of HPV vaccine acceptability among parents of girls eligible for vaccination in four districts of two provinces in Vietnama. The study was implemented after each of two years of vaccinations was completed. In total, 133 parents participated in 16 focus group discussions and 27 semi-structured interviews.
  
  
  RESULTS
  Focus group discussions and in-depth interviews with parents of girls vaccinated revealed that they were generally very supportive of immunization for disease prevention and of vaccinating girls against HPV. The involvement of the National Expanded Program of Immunization in the demonstration project lent credibility to the HPV vaccine, contributing to high levels of acceptance. For parents who declined participation, concerns about side effects, the possibility that the vaccine was experimental, and the possible impact of the vaccine on future fertility rose to the surface. In terms of the decision-making process, many parents exhibited 'active decision-making,' reaching out to friends, family, and opinion leaders for guidance prior to making their decision.
  
  
  CONCLUSIONS
  Vietnam's HPV vaccination experience speaks to the importance of close collaboration with the government to make the most of high levels of trust, and to reduce suspicions about new vaccines that may arise in the context of vaccine introduction in developing country settings.
authors.affiliation: PATH, 2201 Westlake Avenue, Seattle, WA, USA.
authors.forename: Jane K
authors.initials: JK
authors.lastname: Cover
authors.forename: Nguyen Quy
authors.initials: NQ
authors.lastname: Nghi
authors.forename: D Scott
authors.initials: DS
authors.lastname: LaMontagne
authors.forename: Dang Thi Thanh
authors.initials: DT
authors.lastname: Huyen
authors.forename: Nguyen Tran
authors.initials: NT
authors.lastname: Hien
authors.forename: Le Thi
authors.initials: le T
authors.lastname: Nga
mesh_terms: D002648:Child; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006801:Humans; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D036301:Qualitative Research; D014611:Vaccination / Q000706:statistics & numerical data*; D014744:Vietnam
chemical_list: D053918:Papillomavirus Vaccines