Publication Date

2018-11-30

Availability

Open access

Embargo Period

2018-11-30

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PHD)

Department

Nursing (Nursing)

Date of Defense

2018-11-02

First Committee Member

Rosina Cianelli

Second Committee Member

Natalia Andrea Villegas Rodriguez

Third Committee Member

Yui Matsuda

Fourth Committee Member

Nilda Pergallo Montano

Abstract

The human papillomavirus (HPV) is the most common sexually transmitted infection (STI) among sexually active men and women in the U.S. HPV can lead to several types of cancers (e.g., cervical, penile, and anal cancers) that affect the Hispanic community disproportionately. In the U.S., Hispanic women have the highest rate of HPV incidence and the second highest death rate due to HPV-related cervical cancer, and Hispanic men are most affected by HPV-related penile cancers. In 2006, the HPV vaccine (HPVV) was released and recommended for girls and boys between the ages of nine and 26. Unfortunately, more than a decade later the HPV vaccination rates for Hispanics (45.9% for Hispanic female and 37.2% for Hispanic male adolescents) remain below the Healthy People 2020 goal (80%) and HPV-related cancer rates remain high. As expected, Hispanic parents have been found to influence HPV vaccination among their children. Therefore, the purpose of this qualitative descriptive study was to identify salient factors for Hispanic parents considering the HPVV for their children and determine important components and strategies for implementing HPV-prevention interventions for this population. The theoretical basis for this study was the Theory of Planned Behavior (TPB). Convenience and snowball sampling were used to recruit participants in Homestead and nearby suburban areas. Inclusion criteria for study participants were parents between ages 18 and 50 years who self-identified as Hispanic and reported being sexually active three months prior to recruitment. The final sample included 23 Hispanic parents, ages 22 to 49 years, who had an annual household income ranging from $8,400 to $48,000. Most participants were born in Mexico, followed by the U.S. and Guatemala. Four focus groups were conducted, with two groups consisting only of mothers, one group only of fathers, and one mixed group. A directed content analysis of the data was performed based on the TPB as well as the other themes that emerged spontaneously. Seven overarching themes related to the TPB were identified: background factors, attitudes towards the behavior, perceived norms, perceived behavioral control, actual control, intention, and behavior. The following two overarching themes not related to the TPB also were identified: parental motivation and the HPVV as optional or mandatory. Additionally, three themes related to designing and implementing an HPV-prevention intervention were identified: intervention preferences for adults, youth, and families. Analysis indicated that nine factors positively influenced Hispanic parents’ decision about obtaining the HPVV for their children: HPVV awareness and knowledge, perceived social pressure from healthcare providers (HCPs), perceived social pressure from acquaintances, family as referent, positive attitudes towards HPV vaccination, cultural beliefs (familismo, simpatia, confianza, and respeto), the changing nature of sexual taboos, and paternal motivation. In contrast, eight factors negatively influenced Hispanic parents’ decision about obtaining the HPVV for their children: negative attitudes towards HPV vaccination, cultural beliefs (marianismo and machismo), sexual taboos, child age, fear of the unknown, past experiences, lack of HPVV supply, and low perceived risk for contracting HPV. The findings also provided several possible strategies for developing and evaluating future HPV-prevention interventions based on participants’ preferences. The three most popular strategies were HCP-facilitated informational sessions (known by participants as charlas) held in the community after working hours; informational presentations at high school freshmen orientations; and short informational videos played at health clinic waiting/examination rooms. These study findings provide important insight into the salient factors for HPVV uptake among Hispanics and have implications for practice, policy, education, and research. In the practice setting, nurses should apply the concepts of cultural diversity and sensitivity to effectively deliver HPVV health messages to Hispanics in a culturally appropriate manner. Nurses also should urge legislators to provide universal HPV vaccination coverage for all children and young adults who could be affected by HPV and its sequelae. Additionally, nurses can help educate Hispanic parents and their children by partnering with schools to implement several methods of HPVV information dissemination. Finally, nurse researchers should continue to develop and evaluate HPV-prevention interventions that could help increase HPVV uptake among Hispanics. Researchers also should explore alternative forms of vaccine administration that could be less deterring than the current two-injection method.

Keywords

HPV Vaccine; Human Papillomavirus Vaccine; Hispanics/Latinos; Parents; Salient Factors; Theory of Planned Behavior

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