Influences on rural HPV vaccine hesitancy: A multi-level mixed methods study

Human Papillomavirus (HPV) is the most common sexually transmitted infection and the leading cause of cervical and oropharyngeal cancers. Vaccination can prevent over 90% of HPV- attributed cancers among those aged 9-26. Rural populations are less likely to receive the complete HPV protocol than urban. The purpose of this convergent mixed methods study was to explore in depth the perspectives that influence hesitancy for HPV vaccination among rural youth, caregivers, and primary care providers in rural Michigan. A mixed methods analysis was conducted to integrate quantitative (cross-sectional PCP survey) and qualitative data (youth, parent focus groups) in a joint display table. Youths and parents reported limited unbiased HPV vaccine information; yet, all responding physicians reported educating their patients about the HPV vaccine. Inductive descriptive analyses revealed that youth wanted a greater role in decision-making about the HPV vaccine, while parents were the PCPs primary focus. Integrative analyses of both qualitative and quantitative data identified parental out-of-pocket costs as significant predictors of lower HPV vaccine uptake. Clinic structural supports were significantly associated with higher HPV vaccine uptake. Adapting evidence-based dissemination approaches to rural primary care physicians could decrease HPV vaccine hesitancy. Youths could be engaged as HPV vaccine champions. Accessing community resources could increase access.