Date of Award

12-2023

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Dr.Muslima Ejaz

Second Advisor

Dr.Saleema Gulzar

Third Advisor

Dr.Maryum Huda

Department

Community Health Sciences

Abstract

Background: Cervical cancer has become a major public health issue in Pakistan, being the third most common cancer among females of our country. HPV vaccine is a promising measure in preventing HPV-related cervical cancer and recommended by the ACIP to preadolescent and adolescent girls since 2007. Efforts are in progress to include HPV vaccine in the National Immunization program of Pakistan in coming years. Since the rollout of vaccine is imminent, there is a need to understand the knowledge and perceptions regarding HPV vaccine for adolescent girls, among parents and healthcare providers, key decision makers for making decision for vaccination of young girls.
Objectives: The primary objective of the study is exploring knowledge and perceptions of parents and healthcare providers towards HPV vaccination of young girls. The study aims to delve into the level of knowledge about cervical cancer and its prevention through HPV vaccine. The secondary objective is to explore the strategies to improve awareness regarding HPV vaccine of young girls.
Methods: This qualitative descriptive exploratory study was performed in Karachi. 32 mothers of young girls were interviewed in six FGDs at two different schools. 16 healthcare providers were interviewed through In-depth interviews at three health facilities. Distinct interview guides were made for each category. The guide for parents was prepared using Health belief model to explore willingness of parents to vaccinate their daughters through HBM constructs of perceived susceptibility and severity, perceived benefits and barriers, self-efficacy and cues to action. We used vignette in parents’ guide to facilitate understanding about the subject. Interview guide for healthcare providers was based on research questions. Face-to-face primary data collection was done. Interviews transcribed verbatim, and manual direct content analysis was done, using HBM constructs for coding and making categories. Five meaningful themes were generated by triangulating data from both sources.
Results: We interviewed 32 mothers and 16 healthcare providers to reach saturation. The participating mothers expressed variable knowledge and awareness about cervical cancer, its association with HPV and HPV vaccine. Mothers exhibited low perceived susceptibility and severity initially, but through vignette realized the risks of disease and expressed positive attitude towards the HPV vaccine and perceived it as beneficial. Multiple barriers identified by both type of participants i.e., mothers and healthcare providers, to get HPV vaccine included lack of doctor’s recommendation, low level of knowledge, high price, uncertainty about its availability, concerns about safety, socio[1]cultural restrictions and misconceptions about vaccine. Recommendation from doctors, norms of vaccinating among peer others and reminder for vaccine were identified as cues to vaccinate from both mothers and healthcare providers.
Conclusion: Parental consent is required to vaccinate adolescent girls, therefore factors that affect parental intention to have their daughters vaccinated must be considered. Based on qualitative analysis of factors affecting intention to vaccinate, it can be concluded that a variety of factors influence informed decision making of vaccinating. Healthcare providers should inform and emphasize taking HPV vaccine at the recommended age. Health education intervention relevant to HPV vaccine should be implemented across multiple sectors to inform adolescents and their parents about HPV vaccination. Providers knowledge and skills should be improved through trainings to enhance their communication to parents about HPV vaccine’s safety and benefits.

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