title: Barriers to HPV immunization among blacks and latinos: a qualitative analysis of caregivers, adolescents, and providers.
abstract: Despite recommendations that 11-12-year-olds receive the full three-shot Human papillomavirus (HPV) vaccine series, national HPV immunization coverage rates remain low. Disparities exist, with Blacks and Latinos being less likely than Whites to complete the series. We aimed to identify and compare barriers to HPV immunization perceived by healthcare providers, Black and Latino adolescents, and their caregivers to inform a clinic-based intervention to improve immunization rates.
  
  
  
  We conducted semi-structured interviews between March and July 2014 with Black and Latino adolescents (n = 24), their caregivers (n = 24), and nurses (n = 18), and 2 focus groups with 18 physicians recruited from two pediatric primary care clinics. Qualitative protocol topics included: general perceptions and attitudes towards vaccines; HPV knowledge; and perceived individual and systems-level barriers affecting vaccine initiation and completion.
  
  
  
  Themes were identified and organized by individual and systems-level barriers to HPV immunization. Adolescents and their caregivers, particularly Blacks, expressed concerns about HPV being an untested, "newer" vaccine. All families felt they needed more information on HPV and found it difficult to return for multiple visits to complete the vaccine series. Providers focused on challenges related to administering multiple vaccines simultaneously, and perceptions of parental reluctance to discuss sexually transmitted infections.
  
  
  
  Optimizing HPV immunization rates may benefit from a multi-pronged approach to holistically address provider, structural, and individual barriers to care. Further research should examine strategies for providing multiple modalities of support for providers, including a routinized system of vaccine promotion and delivery, and for addressing families' concerns about vaccine safety and efficacy.
authors: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. ikatz2@partners.org.|Massachusetts General Hospital, Center for Global Health, Boston, MassachusettsMA, USA. ikatz2@partners.org.|Harvard Medical School, Boston, Massachusetts, USA. ikatz2@partners.org.|Division of Women's Health, 1620 Tremont Street, 3rd Floor BWH, Boston, MA, 02120, USA. ikatz2@partners.org.
authors: Ingrid T
authors: IT
authors: Katz
authors: Harvard Medical School, Boston, Massachusetts, USA.|Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.|RAND Corporation, Santa Monica, California, USA.
authors: Laura M
authors: LM
authors: Bogart
authors: Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.
authors: Chong Min
authors: CM
authors: Fu
authors: Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.
authors: Yingna
authors: Y
authors: Liu
authors: Harvard Medical School, Boston, Massachusetts, USA.|Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.
authors: Joanne E
authors: JE
authors: Cox
authors: Harvard Medical School, Boston, Massachusetts, USA.|Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.
authors: Ronald C
authors: RC
authors: Samuels
authors: Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.
authors: Tami
authors: T
authors: Chase
authors: Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.
authors: Pamela
authors: P
authors: Schubert
authors: Harvard Medical School, Boston, Massachusetts, USA.|Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.
authors: Mark A
authors: MA
authors: Schuster
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000706:statistics & numerical data*; D002648:Child; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006630:Hispanic or Latino / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D030361:Papillomavirus Infections / Q000208:ethnology* / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010820:Physicians; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D053918:Papillomavirus Vaccines
keywords: Adolescents; HPV immunization; Parental preferences; Provider preferences; Qualitative methods