Aboriginal and Torres Strait Islander adolescent and parent perspectives on human papillomavirus vaccination through the School Immunisation Program in Queensland, Australia: a qualitative study

Aboriginal and Torres Strait Islander peoples experience a greater burden of cervical cancer than other Australians. Human papillomavirus (HPV) vaccination can prevent cervical cancer, but uptake remains inequitable. We aimed to understand factors influencing Queensland Aboriginal and Torres Strait Islander adolescents participation in the school-based HPV vaccination program. Using an Indigenist research approach and guided by a socio-ecological model for health promotion, Aboriginal and Torres Strait Islander voices were centred. In 2020-2021, we conducted Yarns (a culturally appropriate qualitative method) with 65 Aboriginal and Torres Strait Islander adolescents and 20 parents from 10 diverse Queensland schools. Yarns addressed understandings of HPV and HPV vaccination, resources, vaccine consent, vaccination experiences, and suggestions for improvement. Thematic analysis was conducted. Themes related to: HPV vaccination research during the COVID-19 pandemic; factors leading up to the vaccination clinic; and factors on the day of the vaccination clinic. The HPV vaccine was perceived as more trustworthy than the then-new COVID-19 vaccines. Despite varying knowledge of HPV and HPV vaccination, most adolescents and parents supported vaccinations to prevent diseases and benefit their health. Participants reported difficulties completing and returning the consent form and wanted more accessible information and communication, delivered in culturally appropriate ways. Adolescents reported needing privacy during vaccination, ways to manage heightened emotions triggered by the vaccination clinic, and the presence of trusted support people. We provide recommendations to support Aboriginal and Torres Strait Islander adolescents to be vaccinated against HPV, such as flexible consent processes with assistance from Aboriginal and Torres Strait Islander support staff; availability of culturally safe educational materials; the presence of Aboriginal and Torres Strait Islander support staff at clinics, and optimal clinic set-up and scheduling. These recommendations can guide programmatic changes to increase HPV vaccination rates among Aboriginal and Torres Strait Islander adolescents, advancing equity in cervical cancer outcomes.