Vaccination of adolescent girls against Human Papillomavirus (HPV) in Embakasi West, Kenya: the role of family ties and value systems in decision making.

Background and ObjectiveUptake of the HPV vaccine among adolescent girls in Embakasi West sub-County, Kenya has lagged behind since the introduction of the vaccine in 2019. While family, friends and community form a strong and influential support system for individuals, their influence on HPV vaccine uptake is undocumented. Materials and MethodsA mixed methods study was undertaken in Embakasi West Sub-County, Nairobi, Kenya in which 371 school-going girls responded to a self-administered questionnaire, along with three caregiver and two adolescent focus group discussions, and 13 key informant interviews. The influence of family, peers, religion and culture on uptake of the HPV vaccine were examined. Quantitative data were analysed using descriptive and inferential statistical analysis while qualitative data were thematically analysed. ResultsMajority (92.2%) of respondents had siblings, 74.4% resided with both parents, and 30.7% identified as Pentecostal Christians. Half (50.1%) of respondents reported their parents wanted them to be vaccinated, 79.2% could discuss HPV with their parents but 41.5% had not had such discussions. Overall, 20.8% of respondents had an HPV-vaccinated relative while 19.8% had received negative information about the vaccine. Religious and cultural acceptability of the vaccine was at 52.8% and 48.2% respectively. Parent attitude towards adolescent vaccination, (p<0.001), discussing HPV in the home (p<0.001), having a vaccinated family member (p=0.01), positive attitude of peers (p=0.02), beliefs about culture (p<0.001) and religion (p<0.001) were significantly associated with vaccine uptake. However, limited HPV-related discussion in the home negatively affected uptake (OR 0.230 95% CI [0.098-0.541], p=0.001). Caregiver knowledge and understanding were seen as means to overcome family opposition, religion and cultural beliefs. ConclusionSubstantial consideration is given to family values in the medical decision-making process of caregivers for their children. Interventions that focus on enhancing caregiver-child dialogue could be used to drive uptake of the HPV vaccine.