Formative Research on HPV Vaccine Acceptance among Health Workers, Teachers, Parents, and Social Influencers in Uzbekistan
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Research Participants
2.3. Data Collection
- Knowledge of cervical cancer, HPV, or the vaccine (including information sources and ability to communicate information);
- Access to vaccination services or resources (time, money, etc.) affecting access;
- Systemic or societal factors influencing the decision to vaccinate young girls, including the language used to evaluate or discuss vaccination.
2.4. Ethical Considerations
2.5. Data Analysis
3. Results
3.1. Capability Factor Findings
“Why should we speak to [people refusing vaccination]? For example, in educated families, medical culture is accepted, access to information isn’t a problem … It is very difficult to work with religious or uneducated families. We … explain everything, but they do what they want in the end. Working with them is a little challenging”.—Doctor, District B, Tashkent
Moderator: What are your concerns [on recommending the HPV vaccine to family]?
Participant 1: Infertility … they might come to us later saying ‘you made [my child] take it’.
Participant 2: There were some reactions after the [Diphtheria-Tetanus-Pertussis] vaccine, such as a fever … polio leads to paralysis … since [HPV vaccine is] against cancer, would it cause cancer?—Patronage Nurses, District B, Tashkent
“…[urban mothers share] negative information on Telegram … They have their own groups for mothers and they throw in the information to exchange with each other: somewhere, someone got sick, somewhere, someone has died from vaccination, etc… I believe that incorrect information is the main reason for refusing from vaccination”.—Official, Mother and Child Care, MoH
“There are many people from provinces [here] … They never refuse immunization … they would stay at the hospital with their two-month old babies and get all possible vaccinations if allowed … Urbanites are completely different …”—Doctor, District A, Tashkent
“We talk about [vaccination] at teacher-parent meetings, because many parents … are against vaccination … [and] write waiver notes”.—Teacher, District B, Tashkent
“… previously they didn’t explain anything to us. When the [HPV] vaccine was [piloted], they said: ‘this this the vaccine, it is against this, do it—quickly find girls. We barely knew anything ourselves and could not explain it well”.—Doctor, District D, Tashkent Region
3.2. Opportunity Factor Findings
“Through groups of our little girls in nursery schools we try to cover not only issues related to education … but also health with their parents and grandmothers. We invite medical nurses and doctors to explain hygiene and medical issues”.—Women’s Committee Representative, District D, Tashkent
“Every Friday there is pedagogic hour [in schools], where vaccination might be discussed … there are separate parent groups and channels in Telegram, where we can organize explanatory works [for parents on vaccination]”.—Ministry of Education Representative, Tashkent
“I surf the Internet to find information on vaccines …I’ve learned for myself [to check what health workers have told], and then gotten the vaccine … With the exception of hepatitis A, I got other vaccines [for my kids] on time”.—Mother, District B, Tashkent
“I might ask my older sister-in-law [about health questions] if I don’t understand … or doubt doctors … she explains it to me because she knows”.—Mother, District C, Tashkent Region
“[parents] might think: ‘they only started promoting [HPV vaccine], who knows what it might result in … After all, In Uzbek culture one has to protect girls”.—Nurses, District C, Tashkent Region
“… we have Uzbek cultural ways, there is some self-consciousness [in talking about the womb] in the presence of men… it may be a little inconvenient to talk about [the new vaccine]”.—Teacher, District B, Tashkent
“Doctors just have to [tell us], ‘We guarantee [the vaccine is safe], trust us’ … After this, if I were to be held accountable, I could explain [information on the vaccine].”—Teacher, District D, Tashkent Region
3.3. Motivation Factor Findings
“It would be difficult to recommend [the HPV vaccine] before you know … [if it] is studied thoroughly, has no side effects … and [you see] a person who has taken this vaccine … Girls are a delicate matter … One might fear harming their fertility”.—Grandmother, District B, Tashkent
“We [mothers] ask each other … ‘how was it with vaccinating your children?’ After [others] say it went well, we allow vaccination of our children”.—Mother, District A, Tashkent
“[The HPV vaccine] is necessary … We marry off our daughters but … We need to protect our girls from [HPV and cervical cancer] … Even if her husband catches the disease, our girl will not … be infected.—Grandmother, District C, Tashkent Region
“My child should not have to say in the future that she became infertile ‘because my mother got me vaccinated with this vaccine’. There must be 100% certainty [of HPV vaccine safety] to avoid any harmful consequences”.—Mother, District B, Tashkent
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Disclaimer
References
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COM-B Factors | Description | Examples |
---|---|---|
Capability | Focussed on Individuals’: Knowledge Skills or confidence in one’s skills Resilience, strength, or stamina to engage in the necessary mental processes or physically perform the behaviour | Individuals’ knowledge of vaccination Health workers’ ability to communicate importance of vaccination |
Motivation | Focussed on Individuals’: Attitudes, perceptions, risk assessment Intentions Values, beliefs Emotions, impulses, feelings | Parents considering potential outcomes or waiting to observe the response of other parents’ children to vaccination before deciding to vaccinate Fear or distrust of the health system and vaccination Not wanting one’s children to feel pain from vaccination |
Opportunity | Attending to Physical or Social Context: Access, affordability, availability of resources Convenience, appropriateness, or affordances for behaviour Social–cultural cues, norms, influences Structural frameworks (legislation, organisations, rights, etc.) | Cues to action for health workers to advise about vaccination Scheduling to help health workers adequately attend to patients Access to polyclinics Social norms or family/friends’ influence on vaccination decisions |
District A Urban, Lower-Middle Class | District B Urban, Affluent | District C Semi-Urban, Ethnically Diverse | District D Rural, Ethnically Homogenous | Total | ||
---|---|---|---|---|---|---|
Mothers (FGD) | n = 8 (8F) | n = 10 (10F) | n = 7 (7F) | n = 8 (8F) | 33 (33F) | |
Grandmothers (FGD) | 0 | n = 9 (9F) | n = 9 (9F) | 0 | 18 (18F) | |
General Practitioners (FGD) | n = 9 (9F) | n = 10 (9F, 1M) | n = 6 (5F, 1M) | n = 7 (7F) | 32 (30F, 2M) | |
Patronage Nurses (FGD) | 0 | n = 10 (10F) | n = 8 (8F) | 0 | 18 (18F) | |
Teachers (FGD) | n = 8 (8F) | n = 8 (8F) | n = 9 (9F) | n = 8 (8F) | 32 (32F) | |
Social Influencers | IDI | School Principal n = 1 (1F) | Gynaecologist n = 1 (1F) | Mahalla Representative, n = 1 (1F) | Women’s Committee, n = 1 (1F) Religious Leader, n = 1 (1F) School Principal n = 1 (1M) | 14 (12F, 2M) |
FGD | Social Media Influencers, n = 4 (4F) Mahalla Representatives, n = 2 (1F, 1M) | 0 | Mahalla Representatives, n = 2 (2F) | |||
National Level Key Informants | IDI | Health Ministry Officials, n = 4 (4F) Health Ministry Specialists, n = 1 (1F) Education Ministry Official, n = 1 (1M) Women’s Committee Official, n = 1 (1F) | 17 (10F, 7M) | |||
FGD | Ministry Specialists (Oncology), n = 3 (1F, 2M) Ministry Specialists (Gynaecology), n = 2 (1F, 1M) Muslim Board Officials, n = 5 (2F, 3M) |
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Warsi, S.K.; Nielsen, S.M.; Franklin, B.A.K.; Abdullaev, S.; Ruzmetova, D.; Raimjanov, R.; Nagiyeva, K.; Safaeva, K. Formative Research on HPV Vaccine Acceptance among Health Workers, Teachers, Parents, and Social Influencers in Uzbekistan. Vaccines 2023, 11, 754. https://doi.org/10.3390/vaccines11040754
Warsi SK, Nielsen SM, Franklin BAK, Abdullaev S, Ruzmetova D, Raimjanov R, Nagiyeva K, Safaeva K. Formative Research on HPV Vaccine Acceptance among Health Workers, Teachers, Parents, and Social Influencers in Uzbekistan. Vaccines. 2023; 11(4):754. https://doi.org/10.3390/vaccines11040754
Chicago/Turabian StyleWarsi, Sahil Khan, Siff Malue Nielsen, Barbara A. K. Franklin, Shukhrat Abdullaev, Dilfuza Ruzmetova, Ravshan Raimjanov, Khalida Nagiyeva, and Kamola Safaeva. 2023. "Formative Research on HPV Vaccine Acceptance among Health Workers, Teachers, Parents, and Social Influencers in Uzbekistan" Vaccines 11, no. 4: 754. https://doi.org/10.3390/vaccines11040754
APA StyleWarsi, S. K., Nielsen, S. M., Franklin, B. A. K., Abdullaev, S., Ruzmetova, D., Raimjanov, R., Nagiyeva, K., & Safaeva, K. (2023). Formative Research on HPV Vaccine Acceptance among Health Workers, Teachers, Parents, and Social Influencers in Uzbekistan. Vaccines, 11(4), 754. https://doi.org/10.3390/vaccines11040754