Table 4 Summary of barriers to HPV vaccination in newcomers

Grandahl et al., 2015 [29]

Sweden

n = 50, women aged 18–54

Middle East, Africa, Asia, East Europe

To explore immigrant women’s experiences and views on the prevention of cervical cancer, screening, HPV vaccination and condom use.

8 focus group interviews, 5–8 /group

Emergent themes:

1) deprioritization of women’s health in home countries

2) positive attitudes of availability of women’s health in Sweden

3) positive and negative attitudes towards HPV vaccination

4) communication barriers limit health care access.

Women wanted to participate in cervical cancer prevention and would accept HPV vaccination for their daughters but faced barriers to information from HCP (language, cultural norms)

Aragones et al., 2017 [19]

USA

n = 36, parents of minors (i.e., 9–17 year old) who had not initiated the HPV vaccine series for their child

Latin America

To elucidate Latino immigrant parents’ barriers to obtaining the HPV vaccine for their children

5 focus groups, 5–10/group

Three major findings were: (1) low levels of awareness and knowledge of HPV and the HPV vaccine, (2) increased confidence that parent can access the vaccine for their eligible child and (3) lack of provider recommendation as the main barrier to vaccination.

Increased provider recommendation for the HPV vaccine while providing tailored HPV information to parents.

Stephens & Thomas, 2014 [30]

USA

n = 31, women, with a daughter between 11 and 18 years old

Haiti

To identify cultural beliefs influencing immigrant Haitian mothers’ willingness to vaccinate their daughters against HPV

Survey assessing HPV and HPV vaccine knowledge, followed by a semistructured interview.

Mothers had low levels of HPV and HPV vaccine knowledge, and asked for more information. Concerns centered on cultural values regarding adolescent sexuality and HIV/AIDS stigmas specific to Haitian communities.

Vaccination uptake could increase if recommended by a physician. Uptake efforts should emphasize physician involvement and incorporate culturally relevant health concerns.

Kobetz et al., 2011 [21]

USA

n = 41 women aged 21–75

Haiti

To examine Haitian women’s perceptions of, and barriers to, HPV vaccination

5 focus groups, 8/group

Amongst those participants who had heard of HPV, many held misconceptions about virus transmission and did not understand the role of HPV in the development of cervical cancer. All participants showed support for vaccines as beneficial for health.

Addressing gaps such as lack of educational information available in Haiti language about HPV and cervical cancer.

McComb et al., 2018 [10]

Canada

n = 11, women aged 18–26

Africa, Asia, South America

Exploring underlying reasons for lower uptake of (HPV) vaccine among new immigrants and refugees

Semi-structured interviews

Participants had limited knowledge about HPV and the HPV vaccine. Most women perceived that their risk of HPV was low, however showed willingness to receive the vaccine if it were recommended by their physician.

Efforts are required to increase knowledge about HPV among immigrant and refugee women and support for physicians to discuss and offer vaccination to this population.

Yi et al., 2013 [28]

USA

n = 113, women aged 18 or older

Vietnam

To determine receipt of HPV vaccine and assess if limited English proficiency and knowledge related to HPV vaccine were associated with HPV vaccine uptake

semi structured interviews

Women who were less proficient in English were less likely to receive the HPV vaccination. Participants lacked knowledge of HPV.

There is a need for public health evaluation and education programs on HPV and cervical cancer designed for Vietnamese-American women

Lee & Lee, 2017 [24]

USA

n = 16, women, aged 21 and older

Korea

This study aimed to identify major barriers to Papanicolaou (Pap) test uptake and HPV vaccine acceptability.

3 focus groups with 16 women

Three major themes emerged as barriers: 1) limited knowledge about cervical cancer and preventive behaviors, 2) culture-specific barriers, and 3) low accessibility to health care services.

Culturally tailored cervical cancer education is needed to promote Pap test uptake and HPV vaccination in this population.

Luque et al., 2010 [23]

USA

n = 80, women, aged 18 to 55

n = 17, HCW’s, average age 42.

Mexico, Hondurus, Peurto Rico, USA

To explore knowledge, attitudes, and beliefs regarding HPV, the HPV vaccine, and cervical cancerscreening

Surveys

Mexicans and Hondurans had different perceptions of risk factors and lower levels of HPV knowledge than Puerto Ricans or Anglo-Americans.

Target areas for health education based on resulting cultural models of illness need to be identified

Scarinci et al., 2007 [20]

USA

n = 55, women, aged 17 and 39 years old

Latinas and African Americans

To examine the acceptability of preventive HPV vaccination among Latina immigrants and African American women

8 focus groups were conducted

The motivating factors for vaccine use included (1) receiving education/information about the vaccine through healthcare providers, (2) affordable prices, (3) good results in trials, and (4) knowing others who had already gotten vaccinated.

These findings suggest that unique educational strategies need to be developed, based on the needs and perceptions of the targeted audience, in order to achieve wide-spread acceptability of this vaccine.