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Article

Social Ecological Influences on HPV Vaccination Among Cape Verdean Immigrants in the U. S.: A Qualitative Study

by
Ana Cristina Lindsay
1,*,
Celestina V. Antunes
2,
Aysha G. Pires
2,
Monica Pereira
2 and
Denise L. Nogueira
3
1
Department of Urban Public Health, Donna M & Robert J Manning College of Nursing & Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA
2
Department of Exercise and Health Sciences, Donna M & Robert J Manning College of Nursing & Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA
3
Department of Nursing, Faculty Luciano Feijão, Sobral-CE 62050-215, Brazil
*
Author to whom correspondence should be addressed.
Vaccines 2025, 13(7), 713; https://doi.org/10.3390/vaccines13070713 (registering DOI)
Submission received: 18 May 2025 / Revised: 12 June 2025 / Accepted: 21 June 2025 / Published: 30 June 2025
(This article belongs to the Special Issue Vaccine Strategies for HPV-Related Cancers: 2nd Edition)

Abstract

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States (U.S.) and a major contributor to several cancers, including cervical, anal, penile, and oropharyngeal cancers. Although a safe and effective vaccine is available, HPV vaccination rates remain suboptimal, particularly among racial, ethnic, and immigrant minority groups. This study explored multiple factors, such as cultural, social, and structural influences, influencing HPV vaccine decision-making among Cape Verdean immigrant parents in the U.S., a population currently underrepresented in HPV research. Methods: Qualitative study using individual, in-depth interviews with Cape Verdean immigrant parents of children aged 11 to 17 years living in the U.S. Interviews were transcribed verbatim and analyzed thematically using the social ecological model (SEM) to identify barriers and facilitators at the intrapersonal, interpersonal, organizational, community, and policy levels. Results: Forty-five Cape Verdean parents (27 mothers, 18 fathers) participated. Fathers were significantly older than mothers (50.0 vs. 41.1 years, p = 0.05). Most were married or partnered (60%), had at least a high school education (84.4%), and reported annual household incomes of US$50,000 or more (66.7%), with no significant gender differences. Nearly all spoke Creole at home (95.6%). Fathers had lower acculturation than mothers (p = 0.05), reflecting less adaptation to U.S. norms and language use. Most parents had limited knowledge of HPV and the vaccine, with gendered beliefs and misconceptions about risk. Only seven mothers (25.9%) reported receiving a provider recommendation; all indicated that their children had initiated vaccination (1 dose or more). Mothers were the primary decision-makers, though joint decision-making was common. Trust in providers was high, but poor communication and the lack of culturally and linguistically appropriate materials limited informed decision-making. Stigma, misinformation, and cultural taboos restricted open dialogue. Trusted sources of information included schools, churches, and Cape Verdean organizations. While parents valued the U.S. healthcare system, they noted gaps in public health messaging and provider engagement. Conclusions: Findings revealed that HPV vaccine uptake and hesitancy among Cape Verdean immigrant parents in the U.S. were influenced by individual beliefs, family dynamics, healthcare provider interactions, cultural norms, and structural barriers. These findings highlight the need for multilevel strategies such as culturally tailored education, community engagement, and improved provider communication to support informed vaccination decisions in this population.
Keywords: human papillomavirus vaccination; HPV; qualitative research; Cape Verdean; African immigrants; social ecological model human papillomavirus vaccination; HPV; qualitative research; Cape Verdean; African immigrants; social ecological model

Share and Cite

MDPI and ACS Style

Lindsay, A.C.; Antunes, C.V.; Pires, A.G.; Pereira, M.; Nogueira, D.L. Social Ecological Influences on HPV Vaccination Among Cape Verdean Immigrants in the U. S.: A Qualitative Study. Vaccines 2025, 13, 713. https://doi.org/10.3390/vaccines13070713

AMA Style

Lindsay AC, Antunes CV, Pires AG, Pereira M, Nogueira DL. Social Ecological Influences on HPV Vaccination Among Cape Verdean Immigrants in the U. S.: A Qualitative Study. Vaccines. 2025; 13(7):713. https://doi.org/10.3390/vaccines13070713

Chicago/Turabian Style

Lindsay, Ana Cristina, Celestina V. Antunes, Aysha G. Pires, Monica Pereira, and Denise L. Nogueira. 2025. "Social Ecological Influences on HPV Vaccination Among Cape Verdean Immigrants in the U. S.: A Qualitative Study" Vaccines 13, no. 7: 713. https://doi.org/10.3390/vaccines13070713

APA Style

Lindsay, A. C., Antunes, C. V., Pires, A. G., Pereira, M., & Nogueira, D. L. (2025). Social Ecological Influences on HPV Vaccination Among Cape Verdean Immigrants in the U. S.: A Qualitative Study. Vaccines, 13(7), 713. https://doi.org/10.3390/vaccines13070713

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