title: Parental acceptance of HPV vaccine in Peru: a decision framework.
abstract: OBJECTIVE
  Cervical cancer is the third most common cancer affecting women worldwide and it is an important cause of death, especially in developing countries. Cervical cancer is caused by human papillomavirus (HPV) and can be prevented by HPV vaccine. The challenge is to expand vaccine availability to countries where it is most needed. In 2008 Peru's Ministry of Health implemented a demonstration project involving 5(th) grade girls in primary schools in the Piura region. We designed and conducted a qualitative study of the decision-making process among parents of girls, and developed a conceptual model describing the process of HPV vaccine acceptance.
  
  
  RESULTS
  We found a nonlinear HPV decision-making process that evolved over time. Initially, the vaccine's newness, the requirement of written consent, and provision of information were important. If information was sufficient and provided by credible sources, many parents accepted the vaccine. Later, after obtaining additional information from teachers, health personnel, and other trusted sources, more parents accepted vaccination. An understanding of the issues surrounding the vaccine developed, parents overcome fears and rumors, and engaged in family negotiations-including hearing the girl's voice in the decision-making process. The concept of prevention (cancer as danger, future health, and trust in vaccines) combined with pragmatic factors (no cost, available at school) and the credibility of the offer (information in the media, recommendation of respected authority figure) were central to motivations that led parents to decide to vaccinate their daughters. A lack of confidence in the health system was the primary inhibitor of vaccine acceptance.
  
  
  CONCLUSIONS
  Health personnel and teachers are credible sources of information and can provide important support to HPV vaccination campaigns.
authors.affiliation: Instituto de Investigación Nutricional, La Molina, Lima, Peru.
authors.forename: Rosario M
authors.initials: RM
authors.lastname: Bartolini
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Winkler
authors.forename: Mary E
authors.initials: ME
authors.lastname: Penny
authors.forename: D Scott
authors.initials: DS
authors.lastname: LaMontagne
mesh_terms: D000328:Adult; D002648:Child; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008960:Models, Psychological; D027383:Papillomaviridae / Q000276:immunology; D030361:Papillomavirus Infections / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000276:immunology; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010568:Peru; D002583:Uterine Cervical Neoplasms / Q000276:immunology / Q000517:prevention & control* / Q000821:virology
chemical_list: D053918:Papillomavirus Vaccines