Edinburgh Napier University

  Background: School nurses play important roles in delivering human papillomavirus (HPV) vaccination programme in United Kingdom. International research indicates lower HPV vaccination uptake rates among Black, Asian and Minority Ethnic (BAME) groups (Fisher et al. 2013) and suggests socio-cultural factors influence vaccine refusal (Boyce and Holmes 2013). However, little is known about how young people from BAME communities understand risks associated with HPV and engage with the programme.
Aim: To explore young people from BAME communities’ understandings of HPV infection and vaccination.
Methods: A critical qualitative exploratory study utilising Foucauldian discursive analysis. Seven focus groups and four paired interviews conducted June-October 2015, with 40 young people aged 16-26 from BAME communities: Black African, Arab, Muslim, and Sikh. Stimulus material utilised to explore understandings of HPV, experiences of vaccine programme, views on universal vaccination.
Results: Participants related narratives of decision-making in relation to vaccination programme, and lack of public health discourse on HPV in schools. Most participants had little understanding of HPV or of its connection with cervical smear tests. For young men, there was a prevailing discourse of being detached observers of HPV vaccination. White Northern hemisphere norms and assumptions about age of sexual debut were challenged by a range of attitudes across BAME groups. Narratives of obligation and identity of those from religious backgrounds permeated personal evaluations and added social constraints on whether to discuss or pursue the vaccine.
Discussion: Understandings of HPV and engagement with the vaccine programme are embedded within social identities and practices such as gender, culture, religion, intimate relationships. Vaccination within BAME populations may be hindered by public health strategies which do not take account of these factors.
Conclusion: Efforts to raise the profile of HPV and increase vaccination rates among BAME populations will require greater partnership working with BAME youth, parents and community leaders.