'How can I explain it to my daughter if I dont know?: Understanding health communication and routine and HPV vaccine hesitancy in rural Indigenous communities of Guatemala

Guatemala saw a decline in childhood immunisation and HPV vaccine rates even before the COVID-19 pandemic. Indigenous communities, which make up over 40% of the population, face especially low vaccination rates. We sought to understand how to address childhood and HPV vaccine hesitancy to increase uptake among Indigenous communities in rural Guatemala. Using a community-engaged design process, we held (1) 9 Focus Group Discussions (FGDs) with 41 Indigenous community members in 11 communities in 3 departments and (2) 16 In-Depth Interviews (IDIs) with health workers. Based on participants preferences, FGDs/IDIs were conducted in Spanish, Kiche, or Kaqchikel. Community members and health workers indicated individual, interpersonal, and systemic barriers to vaccination within rural Indigenous communities in Guatemala, including limited knowledge, rumours, and a need for improved health worker knowledge and skills. Despite the identified barriers to vaccine uptake, community members and health workers believed that attitude shifts and enhanced access to health information and technology would improve health and lead to improved vaccination rates. Future vaccine campaigns must focus on targeted communication strategies that address the specific beliefs, rumours, lack of community information and health worker knowledge, and reliance on community networks for health and vaccine information.