title: Preparing for human papillomavirus vaccine introduction in Kenya: implications from focus-group and interview discussions with caregivers and opinion leaders in Western Kenya.
abstract: BACKGROUND
  Cervical cancer claims the lives of 275,000 women each year; most of these deaths occur in low-or middle-income countries. In Kenya, cervical cancer is the leading cause of cancer-related mortality among women of reproductive age. Kenya's Ministry of Public Health and Sanitation has developed a comprehensive strategy to prevent cervical cancer, which includes plans for vaccinating preteen girls against human papillomavirus (HPV) by 2015. To identify HPV vaccine communication and mobilization needs, this research sought to understand HPV vaccine-related perceptions and concerns of male and female caregivers and community leaders in four rural communities of western Kenya.
  
  
  METHODS
  We conducted five focus groups with caregivers (n = 56) and 12 key-informant interviews with opinion leaders to explore cervical cancer-related knowledge, attitudes and beliefs, as well as acceptability of HPV vaccination for 9-12 year-old girls. Four researchers independently reviewed the data and developed codes based on questions in interview guides and topics that emerged organically, before comparing and reconciling results through a group consensus process.
  
  
  RESULTS
  Cervical cancer was not commonly recognized, though it was understood generally in terms of its symptoms. By association with cancer and genital/reproductive organs, cervical cancer was feared and stigmatized. Overall acceptability of a vaccine that prevents cervical cancer was high, so long as it was endorsed by trusted agencies and communities were sensitized first. Some concerns emerged related to vaccine safety (e.g., impact on fertility), program intent, and health equity.
  
  
  CONCLUSIONS
  For successful vaccine introduction in Kenya, there is a need for communication and mobilization efforts to raise cervical cancer awareness; prompt demand for vaccination; address health equity concerns and stigma; and minimize potential resistance. Visible endorsement by government leaders and community influencers can provide reassurance of the vaccine's safety, efficacy and benefits for girls and communities. Involvement of community leadership, parents and champions may also be critical for combatting stigma and making cervical cancer relevant to Kenyan communities. These findings underscore the need for adequate planning and resources for information, education and communication prior to vaccine introduction. Specific recommendations for communication and social-marketing strategies are made.
authors.affiliation: U,S, Centers for Disease Control & Prevention (CDC), 1600 Clifton Road, NE, 30333 Atlanta, GA, USA. alf8@cdc.gov.
authors.forename: Allison L
authors.initials: AL
authors.lastname: Friedman
authors.forename: Kelvin O
authors.initials: KO
authors.lastname: Oruko
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Habel
authors.forename: Jessie
authors.initials: J
authors.lastname: Ford
authors.forename: Jennine
authors.initials: J
authors.lastname: Kinsey
authors.forename: Frank
authors.initials: F
authors.lastname: Odhiambo
authors.forename: Penelope A
authors.initials: PA
authors.lastname: Phillips-Howard
authors.forename: Susan A
authors.initials: SA
authors.lastname: Wang
authors.forename: Tabu
authors.initials: T
authors.lastname: Collins
authors.forename: Kayla F
authors.initials: KF
authors.lastname: Laserson
authors.forename: Eileen F
authors.initials: EF
authors.lastname: Dunne
mesh_terms: D000293:Adolescent; D000328:Adult; D017028:Caregivers; D002648:Child; D003142:Communication; D005260:Female; D017144:Focus Groups; D006293:Health Promotion; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010290:Parents; D010342:Patient Acceptance of Health Care; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014611:Vaccination
chemical_list: D053918:Papillomavirus Vaccines