New PhD highlights the need for cultural sensitivity in implementing (HPV) vaccines

Congratulations to Dr. Margaret Heffernan OAM who recently graduated from The University of Melbourne with a Doctor of Philosophy. The title of Margaret’s thesis was ‘Human Papillomavirus (HPV) vaccines: the attitudes and intentions of Australian health providers and parents from three
diverse cultural groups towards HPV vaccination of pre-adolescent children’.

Dr Heffernan’s thesis was supervised by Professor Suzanne Garland, Professor Susan Sawyer (Centre for Adolescent Health), Associate Professor Kirsten McCaffery and Professor Michael Quinn. It explored the attitudes of Australian doctors (General Practitioners in Melbourne, Victoria), and parents toward adolescent human papillomavirus (HPV) vaccination, and in particular the influence of cultural values on parental attitudes. Parents from three different cultural groups were recruited for the study: Anglo: Melbourne, Victoria; Aboriginal: Central Australia and Victoria; and Chinese: Melbourne, Victoria.

In Australia girls in the first year of secondary school are offered 3 doses of the HPV vaccines which offer 80% protection against HPV infection and 90% protection against genital warts. There are over 40 different types of sexually transmitted HPV. These have no symptoms, are highly contagious, and a very common infection to both men and women, especially sexually active teenagers. Two of the high risk HPV types are a known cause of cervical cancer; to be most effective, the HPV vaccines which protect against these two types need to be administered before sexual activity commences.

Interviews with 111 parents revealed that, regardless of their background, they shared common values toward protecting their child’s health through vaccination. However, not all parents were found to support a HPV vaccine being given to their daughters at a young age. There were differences in parent attitudes toward teenage sexuality, and parents’ preferences for age of vaccination were influenced by their culturally derived sexual norms, and the lack of data on the vaccine’s safety and efficacy.

Parents had almost no awareness of important facts about genital HPV infection, and whilst most parents had heard of cervical cancer not all had heard of genital warts. The Government HPV vaccine information resources were regarded as lacking in sufficient detail to help parents understand HPV or the vaccine’s benefit for young girls.

Many women were surprised that their doctors had not previously shared HPV information with them during routine health checks. Whilst the 15 GPs agreed with the HPV vaccines in principle, many of them did not see their role as the main group to educate the public about HPV (unless a woman presented with an abnormal Pap screen result), or specific details of the new vaccines, and many GPs were found to lack sufficient information.

Parents’ reluctance toward vaccination of young adolescent girls highlights improvements that need to be made to the implementation strategies for new vaccines. The GPs’ knowledge levels indicate a review of their information training needs is required before public offerings of future controversial vaccines. In the initial roll-out of the HPV vaccine through schools and clinics, generalisations were made about the resources that would help parents give their consent and for GPs to make recommendations; important cultural, social and system factors were ignored.

Dr Heffernan’s study shows that a universal approach to the introduction of sexually-related vaccines does not satisfy a diverse population’s needs. Australia is now embarking on the next wave of its HPV vaccine program. This study suggests
that before further implementation of the HPV vaccine program in our diverse population, a socio-ecological approach may contribute to informed consent.

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