To get the shot or not: HPV vaccines and American Indian Female Student Decision-Making

Purpose: This paper identifies human papillomavirus (HPV) vaccine decision-making among American Indian female college students. Background: HPV, well documented to cause cervical cancer and genital warts, is reported to be the most common sexually transmitted infection in the United States. Vaccines have been developed that initially targeted female youth between the ages of 12-26, however preliminary research indicates that many American Indians do not participate in HPV vaccination programs despite high risk for HPV and cervical cancer. There are few targeted efforts to vaccinate and educate American Indians, thus HPV prevention opportunities are missed. Methods: Eight focus groups were held with American Indian college students attending four Southwest universities. Sessions were coordinated in 2009 at Student Unions or American Indian Studies Programs using questions and prompts guided by the literature. Measures included HPV vaccine and virus knowledge, perceived risk, barriers and behaviors. Participants included 57 American Indians, 23 males, 34 females, ages 19-26. Sessions were audio recorded and transcribed verbatim. Transcriptions of all female participants were identified and analyzed independently. Identified common themes were coded and formed into categories following Grounded Theory analytical procedures. Relationships between HPV vaccine decision-making categories were analyzed. Findings: Six themes were identified explaining HPV vaccine decision-making by college females: knowledge, access, fear, culture, history, and risk perception. Implications: Understanding the HPV decision-making of American Indian females will help improve HPV vaccination acceptability among this group. Recommendations for culturally sensitive educational programs designed to improve vaccination rates and sexual health among American Indian females are provided.