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African American Parents' Perspectives on Delaying and Refusing HPV Vaccination
Frederick Redeaux
San Diego State University, School of Nursing
NURS356, Pediatric Nursing
Dr. Kristiana Cullum
October 7, 2023
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This paper aims to evaluate, summarize, and critique the article, “‘Why is it so
necessary?’: African American Parents' Perspectives on Delaying and Refusing HPV
Vaccination” (Washington et al., 2023). The purpose of this study was to describe the
perspectives of African American parents who had delayed or refused the human papillomavirus
(HPV) vaccination for their children, despite recommendations from their healthcare providers, to
identify the factors related to vaccine hesitancy. This topic is pertinent to pediatric nursing
globally because the HPV vaccine is the only vaccine we currently have available to protect
against any form of cancer and it is typically recommended at age eleven or twelve before a child
becomes sexually active and potentially exposed to HPV. HPV is the leading cause of anal,
cervical, vaginal, vulvar, penile, and oral cancers (Washington et al., 2023). Thus the HPV
vaccine is one of the greatest tools we have in pediatric nursing to reduce overall cancer rates in
the adult populations and reasons for hesitancy should be assessed and addressed. I will use this
information as a pediatric nurse to adjust my approach to education sessions with AfricanAmerican families in hopes of improving HPV vaccination rates in this population
The research was conducted in the form of focus groups with 20 predominantly (95%)
African-American parents from the Wayne, Oakland, Macomb, Genesee, and Monroe counties of
Michigan. To meet the criteria for selection participants had to be older than 21, English
speaking, residents of the aforementioned counties, the parent or guardian who made the health
care decisions for a child aged 11-17, have reported receiving a health care provider’s
recommendation to vaccinate or discussed vaccination with a provider, and refused or delayed the
HPV vaccine(Washington et al., 2023). In the focus groups, participants were asked a variety of
questions to identify the influences behind their choice to delay or refuse the vaccine. These
influences were divided into three categories based on the question type: Contextual, individual
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and group, and vaccine-specific. Their responses were transcribed and analyzed using the cloudbased program, Dedoose, designed to test previous hypotheses against gathered data. Researchers
crafted two codes to run on this platform based on the overarching themes identified in an
analysis of the focus group transcriptions and tested these codes for reliability using Cohen’s
Kappa, a quantitative measure of reliability for two raters rating the same thing, which corrects
for how often the raters might agree by chance. This test returned a score of 1 which indicates
near-perfect agreement between raters and excellent reliability(Washington et al., 2023). The
contextual influences identified were perceived racial discrimination and historical factors. Some
participants felt their children were being singled out for the HPV vaccine at a younger age than
other children due to racial stigma and stereotypes concerning the over-sexualization of African
Americans and reported feeling angry that their 9-year-old child was being offered a vaccine to
prevent a sexually transmitted infection. Distrust of medical and government entities was also an
influencing factor given the historical context of the water crisis in Michigan which
predominantly impacted communities of color. participants recalled scientists and the government
claiming the water was safe to drink when it ended up being contaminated and now find it hard to
trust these authorities when it comes to other matters such as vaccinations(Washington et al.,
2023).
Individual and group influences identified included the perceived need for vaccination,
potential adverse effects, and healthcare provider attitudes and communication. participants
reported perceiving their children as too young for sexual activity and, as a result, too young to
need HPV vaccination. Participants also reported feeling overwhelmed by the vaccine schedule
for their children at this age and did not feel like they were given enough information regarding
HPV to justify adding on another vaccine and risking adverse effects. Finally, participants
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reported poor provider communication factored into their hesitancy to vaccinate for HPV as they
felt rushed and belittled by their providers and were not given an adequate opportunity to discuss
the vaccine and its benefits(Washington et al., 2023). The vaccine-specific influence that was
reported among all participants was information needs related to vaccine decision-making.
Parents reported wanting to know more about the long-term effects of the vaccine such as its
impacts on fertility and future health but were unable to receive this information at their doctor's
office. As a result, they often turned to other resources to find their information such as the
Vaccine Adverse Reporting System which illustrates a negatively skewed picture of the harmful
effects of vaccines(Washington et al., 2023).
Overall, this study showed that there are a variety of factors influencing HPV vaccine
hesitancy in African-American parents including perceived discrimination, mistrust of public
health authorities, a limited understanding of its health benefits, poor provider communication,
and unassuaged concerns over the negative short and long term health implications of vaccinating
at a young age. The author concludes that many of this study’s findings are consistent with
previous literature regarding parent’s concerns about vaccine safety and concerns about the young
age recommendation for vaccination(Washington et al., 2023). However, this study is unique
from previous literature in that it focuses specifically on the marginalized African-American
community, which has a disproportionately higher rate of cervical cancer and other HPV-related
cancers(Washington et al., 2023). As such, it provides valuable insight into the influences specific
to this group’s vaccine hesitancy which, if addressed with the pediatric population, could have a
profound impact on mitigating HPV-related cancer rates in the next generation of African
Americans. One influencing factor unique to this study was the perceived racial discrimination
and mistrust of public health authorities due to the historical mistreatment and public health
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failures that African Americans have been subjected to in decades past. Addressing these unique
factors in conjunction with the ones influencing the general population could be pivotal in
improving the health of African Americans over the next few decades.
Seeing as the most recurrent and impactful themes within the literature are mistrust of the
medical community, perceived racial discrimination, and an overall lack of information and
communication, my plan to implement these findings if given an unlimited budget would be to
hold a traveling series of Q&A sessions in predominantly African American communities across
the county. To combat feelings of mistrust and perceived discrimination, the panel for this session
would be made up of prominent African-American researchers, doctors, and community leaders.
This plan would allow African-American parents to have their voices heard and their questions
answered by people who look like them and who can understand through firsthand experience
why a parent might be hesitant to trust their child's health to authorities who have historically
mistreated them. Additionally, if we could recruit an African-American celebrity voice to the
cause as a proponent for HPV vaccination, it could significantly improve vaccination rates in our
current society where social media influence is a powerful tool. Oprah Winfrey, for example, is a
proponent of vaccines and a revered celebrity figure within the African-American community
whose voice would go a long way in establishing trust within the community. If we could contract
her or another celebrity to make a short video addressing the parents and encouraging the vaccine
to be played on social media or during the seminars It could make a big difference to a lot of
parents. This multifaceted campaign would target every influence of HPV vaccine hesitancy
outlined within this literature as it would establish trust, eliminate perceived discrimination, and
allow parents to receive any information they desire regarding the vaccine such as its benefits,
long-term safety, or why it should be administered before a child becomes sexually active.
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This article has its strengths and weaknesses as acknowledged in the discussion section by
the author. Because of the study’s use of convenience sampling and a sample size of just 20
parents from a limited area of the country, it is not necessarily representative of the population in
San Diego County or the United States as a whole, and thus its generalizability is limited. The
review of the literature does indicate a need for this study and leads to the research question as it
is one of the relatively few studies that directly examine HPV vaccine hesitancy in African
American parents who not only have children of vaccination age but also refused a
recommendation of vaccination for their child. The methodology of this study was clearly
presented to the degree that the study could be repeated in San Diego or any other location with
African Americans to improve generalizability in this area. The discussion does include other
variables that may have influenced the results, namely that homogenized demographics of mainly
women and medicare recipients may limit the generalizability and that a focus on parents who
have already chosen to refuse the HPV vaccine limits the discussion to one perspective. Including
parents who chose to vaccinate their children against HPV but share similar backgrounds could
provide valuable insight into the factors that influence decision-making when comparing the two
groups.
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References
Washington, A., Chabaan, J., Fakih, A., Ford, S., Rutledge, L., Lilly, J., Herrera, M. Y., Kim, Y.,
& Thompson, H. S. (2023). "Why is it so necessary?": African American Parents'
Perspectives on Delaying and Refusing HPV Vaccination. Journal of Pediatric Health
Care: official publication of National Association of Pediatric Nurse Associates &
Practitioners, 37(4), 373–380. https://doi.org/10.1016/j.pedhc.2023.01.002