Sociocultural issues in the introduction of human papillomavirus vaccine in low-resource settings

Arch Pediatr Adolesc Med. 2009 May;163(5):455-61. doi: 10.1001/archpediatrics.2009.50.


Objectives: (1) To synthesize sociocultural results from diverse populations related to vaccine decision-making, understanding of cervical cancer and its etiology, experience with previous vaccinations, human papillomavirus (HPV) vaccine concerns, and information needed to foster acceptance; (2) to contextualize findings in light of recent studies; and (3) to discuss implications for communication strategies to facilitate vaccine acceptance.

Design: Descriptive qualitative synthesis of sociocultural studies in 4 countries using iterative theme-based analyses.

Setting: Four developing countries: India, Peru, Uganda, and Vietnam.

Participants: Criterion-based sample of 252 focus-group discussions and 470 in-depth interviews with children, parents, teachers/administrators, health workers/managers, and community/religious leaders. A knowledge, attitudes, and practices survey was administered to 879 children and 875 parents in Vietnam.

Results: We found that vaccine decision-making was primarily done by parents, with children having some role. Understanding of cervical cancer and HPV was limited; however, the gravity of cancer and some symptoms of cervical cancer were recognized. Vaccination and government-sponsored immunization programs were generally supported by respondents. Sentiments toward cervical cancer vaccines were positive, but concerns about quality of delivery, safety, adverse effects, and the effect on fertility were raised. Communities requested comprehensive awareness-raising and health education to address these concerns.

Conclusion: Sociocultural studies help elucidate the complexities of introducing a new vaccine from the perspective of children, parents, and communities. Strategies for introducing the HPV vaccine should address community concerns through effective communication, appropriate delivery, and targeted advocacy to make the program locally relevant.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Decision Making
  • Delivery of Health Care
  • Female
  • Health Education
  • Health Knowledge, Attitudes, Practice
  • Humans
  • India
  • Interviews as Topic
  • Papillomavirus Infections / prevention & control
  • Papillomavirus Vaccines* / adverse effects
  • Parents / psychology
  • Patient Acceptance of Health Care / psychology*
  • Peru
  • Socioeconomic Factors
  • Uganda
  • Uterine Cervical Neoplasms / prevention & control
  • Vaccination / adverse effects
  • Vaccination / psychology
  • Vietnam


  • Papillomavirus Vaccines