title: HPV vaccination among young adult women: a perspective from Appalachian Kentucky.
abstract: BACKGROUND
  Few studies have assessed barriers to human papillomavirus (HPV) vaccination uptake and adherence, particularly among women of Appalachian Kentucky, a population with higher rates of cervical cancer, lower rates of HPV vaccination, and lower socioeconomic status compared with the rest of the nation. The objective of this study was to address women's reasons for declining the HPV vaccine and, among women who initiated the vaccine series, barriers to completion of the 3-dose regimen.
  
  
  METHODS
  We recruited 17 women aged 18 to 26 from a Federally Qualified Health Center who participated in in-depth, semistructured telephone interviews. All interviews were audio-recorded and transcribed verbatim; analysis of the interview transcripts was an iterative process conducted by all 3 authors.
  
  
  RESULTS
  We identified 3 primary barriers: 1) a knowledge gap wherein women are both uninformed and misinformed about cervical cancer, HPV, and the HPV vaccine, all of which affect vaccination behaviors; 2) environmental and tangible barriers (transportation and prioritizing health over other responsibilities such as child care, work, and school); and 3) ambiguous information sources, which contribute to misinformation and subsequently affect vaccination decisions.
  
  
  CONCLUSIONS
  Health professionals should use clear and purposeful communication about how cervical cancer develops, the purpose and safety of the HPV vaccine, and the necessity of completing the 3-dose series. Health promotion campaigns and services tailored for young women in Appalachian Kentucky that focus on increasing knowledge and eliminating barriers are needed.
authors: Eastern Kentucky University, Department of Health Promotion and Administration, Richmond, KY 40475, USA. laurel.mills@eku.edu
authors: Laurel A
authors: LA
authors: Mills
authors: Katharine J
authors: KJ
authors: Head
authors: Robin C
authors: RC
authors: Vanderpool
mesh_terms: D000293:Adolescent; D000328:Adult; D001061:Appalachian Region; D055088:Early Detection of Cancer / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033181:Information Dissemination; D007407:Interviews as Topic; D007629:Kentucky; D027383:Papillomaviridae; D053918:Papillomavirus Vaccines; D011369:Professional-Patient Relations; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000517:prevention & control* / Q000523:psychology; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
references: Adv Nurse Pract. 2010 May;18(5):29-32
references: 20491190
references: Prev Med. 1997 Nov-Dec;26(6):817-24
references: 9388793
references: Qual Health Res. 2012 Apr;22(4):476-87
references: 22068039
references: J Womens Health (Larchmt). 2009 Oct;18(10):1679-86
references: 19785564
references: J Rural Health. 2011 Winter;27(4):380-4
references: 21967381
references: Vaccine. 2011 Jan 10;29(3):528-34
references: 21050904
references: Health Psychol. 2007 Mar;26(2):136-45
references: 17385964
references: Fam Community Health. 2012 Jan-Mar;35(1):31-43
references: 22143486
references: MMWR Morb Mortal Wkly Rep. 2012 Feb 3;61(4):66-72
references: 22298302
references: J Obstet Gynecol Neonatal Nurs. 2011 Nov-Dec;40(6):691-701
references: 22092373
references: J Adolesc Health. 2007 Feb;40(2):108-15
references: 17259050
references: MMWR Morb Mortal Wkly Rep. 2002 Jun 21;51(24):527-9
references: 12088143
references: MMWR Morb Mortal Wkly Rep. 2011 Aug 26;60(33):1117-23
references: 21866084
references: Prev Med. 2007 Aug-Sep;45(2-3):107-14
references: 17628649
references: Prev Med. 2009 May;48(5):426-31
references: 19100762
references: J Adolesc Health. 2009 May;44(5):437-45
references: 19380090
references: Qual Health Res. 2011 Feb;21(2):262-77
references: 20841433
references: Vaccine. 2009 Jun 19;27(30):3945-52
references: 19389447
references: Fam Community Health. 2011 Apr-Jun;34(2):119-25
references: 21378508
references: Prev Chronic Dis. 2006 Oct;3(4):A113
references: 16978488