Social and cultural construction processes involved in HPV vaccine hesitancy among Chinese women: a qualitative study

• Published in: International journal for equity in health Vol. 18; no. 1; p. 147
• Main Authors: Siu, Judy Yuen-Man, Fung, Timothy K F, Leung, Leo Ho-Man
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 18.09.2019; BioMed Central; BMC
• Subjects: Adolescent; Adolescents; Adult; Analysis; Anthropology; Cancer; Cervical cancer; Cervix; Chinese; College students; Construction industry; Cultural Characteristics; Decision Making; Decision making process; Equality; Female; Gender equality; Girls; Health; Health behavior; Health Knowledge, Attitudes, Practice; Hong Kong; HPV vaccination; Human papillomavirus; Humans; Immunization; Infection; Marriage; Middle Aged; Papillomavirus; Papillomavirus infections; Papillomavirus Infections - prevention & control; Papillomavirus vaccines; Papillomavirus Vaccines - administration & dosage; Physician-patient relations; Physicians; Prevention; Preventive medicine; Public health; Qualitative Research; Risk factors; Socioeconomic Factors; Teenage girls; Vaccination; Vaccination - psychology; Vaccine hesitancy; Vaccines; Women; Women college students; Women's health; Womens health; Young Adult; Hong Kong; Australia; Women; Chinese; Human papillomavirus; Decision making process; HPV vaccination; Vaccine hesitancy
• ISSN: 1475-9276; 1475-9276
• DOI: 10.1186/s12939-019-1052-9

HPV vaccine is a prophylactic vaccine to prevent HPV infections. Recommended by the World Health Organization, this vaccine is clinically proven to be one of the most effective preventive measures against the prevalence of cervical cancer and other HPV-associated cancers and chronic genital conditions. However, its uptake rate among women in Hong Kong is insignificant-only approximately 2.9% adolescent girls and 9.7% female university students received HPV vaccination in 2014. With the notion of Critical Medical Anthropology, we aimed to identify if different influential factors, ranging from individual, societal, and cultural, are involved in the decision-making process of whether to receive HPV vaccination. We adopted a qualitative approach and conducted in-depth individual semistructured interviews with 40 women in Hong Kong between May and August 2017. We noted that the following factors intertwined to influence the decision-making process: perceptions of HPV and HPV vaccine; perceived worthiness of HPV vaccines, which was in turn influenced by vaccine cost, marriage plans, and experiences of sexual activities; history of experiencing gynecological conditions, stigma associated with HPV vaccination, acquisition of information on HPV vaccines, distrust on HPV vaccines, and absence of preventive care in the healthcare practice. HPV vaccination is promoted in a manner that is "feminized" and "moralized" under the patriarchal value system, further imposing the burden of disease on women, and leading to health inequality of women in pursuing the vaccination as a preventive health behaviour as a result. We believe that this ultimately results in an incomplete understanding of HPV, consequently influencing the decision-making process. The "mixed-economy" medical system adopting capitalist logic also molds a weak doctor-patient relationship, leading to distrust in private practice medical system, which affects the accessibility of information regarding HPV vaccination for participants to make the decision.