Perceived Barriers to Human Papillomavirus (HPV) Vaccination Practices among Providers in the IHS, Tribal and Urban Indian Health Facilities

Background: American Indian/Alaska Native (AI/AN) women have high rates of cervical cancer and low rates of cervical cancer screenings. Because of this, the human papillomavirus (HPV) vaccine is of particular importance. To better understand potential barriers to HPV vaccination, we conducted a survey of providers in the Indian Health Service, Tribal and Urban (I/T/U) facilities.

Methods: During December 2009 and January 2010, we utilized existing IHS email distribution lists to distribute an on-line survey to vaccine providers working in I/T/U facilities. To further explore issues identified in the survey, we will conduct semi-structured interviews with providers.

Results: There were 270 completed surveys representing all 12 of the IHS regions. Providers reported administering HPV vaccine to the following age groups: 9-10 years – 38%; 11-12 years – 76%; 13-18 years – 92%; and 19-26 years – 61%. Potential barriers to HPV vaccination among 9 – 18 year olds reported include parent concerns about vaccine safety (57%), parent opposition for moral or religious reasons (48%) and parent concerns that vaccination may encourage earlier or riskier sexual behavior (47%). For women 19 – 26 years, financial barriers to vaccination were reported by 43% of providers.

Conclusions: For 9 – 18 year olds, parental concerns about the vaccine are a potential barrier reported by the majority of providers, and suggest the need for on-going patient education. Although the majority of providers are giving HPV to women 19 – 26 years, financial issues are the main barrier to increasing vaccination in this age group.