Health  Vol.6 No.13 , July 2014
Factors Affecting Japanese HPV-Vaccination: Findings from the Semi-Structured Interviews with Adolescent Girls and Caregivers
Abstract: The objective of the present study was to qualitatively assess the obstructive and facilitative factors affecting adolescent girls and their caregivers when the adolescent had received or was considering receiving the Human Papilloma Virus (HPV) vaccination. Using these data, we propose recommendations for medical and nursing staff concerned with HPV vaccination. Participants were 20 adolescent girls (aged 10 - 19 years) and their caregivers, who had visited any of the 3 pediatric clinics in the Tokyo metropolitan area during a specified period since HPV vaccination began in Japan. The girls and their caregivers were separately interviewed by 2 child and/or family nursing care specialists with a semi-structured interview. The responses were qualitatively analyzed by 2 specialists, and the obstructive and facilitative factors affecting participants’ decision to receive HPV vaccination were extracted from the responses. Among the 20 sets of participants, 7 adolescents had completed HPV vaccination, 9 were going to receive vaccination, and 4 had not received any vaccination. The obstructive/facilitative factors related to considering or receiving HPV vaccination and actual vaccination were extracted and 4 main categories of factors were identified. Facilitators toward HPV-vaccination of daughters included clear future self-image and visions, fear Cervical Cancer (CC) and desire to escape from CC, having discussion with mothers about HPV-vaccination and CC, and to have a boyfriend. Barriers toward vaccination included the mothers’ reluctance to explain the sexual matters about HPV-vaccination to their daughters and difficulty with find the appropriate clinic or hospital to HPV-vaccination. Relevant factors about vaccination included positive family attitudes toward vaccination, having family system allowing consultation and having a public financial support for vaccination for daughters. Our conceptual model adapted from the Katz, et al. conceptual framework integrated the key barriers and facilitators as factors within each of four domains. These four domains have an important link. Especially, the environmental factors and the structural and sociocultural factors domain affect the individual adolescent and the caregiver factors domain, respectively. The results of present study suggest that medical/nursing activities centered on promoting HPV vaccination in Japan should comprehensively cover CC/vaccination/sex education in an integrated fashion, while schools and public health centers should provide opportunities for caregivers and adolescents to jointly participate in awareness education on HPV vaccination.
Cite this paper: Wakimizu, R. , Nishigaki, K. , Fujioka, H. , Maehara, K. , Kuroki, H. , Saito, T. and Uduki, K. (2014) Factors Affecting Japanese HPV-Vaccination: Findings from the Semi-Structured Interviews with Adolescent Girls and Caregivers. Health, 6, 1602-1615. doi: 10.4236/health.2014.613193.

[1]   Foundation for Promotion of Cancer Research (2013) Cancer Statistics in Japan 2013.

[2]   Health, Labour & Welfare Ministry (2013) An Interim Report of Panel to Discuss the Future of Cancer Screening 2013.

[3]   Bosch, F.X., Lorincz, A., Muñoz, N., Meijer, C.J. and Shah, K.V. (2002) The Causal Relation between Human Papillomavirus and Cervical Cancer. Journal of Clinical Pathology, 55, 244-265.

[4]   Wiley, D.J., Douglas, J., Beutner, K., Cox, T., Fife, K., Moscicki, A.B. and Fukumoto, L. (2002) External Genital Warts: Diagnosis, Treatment, and Prevention. Clinical Infectious Diseases, 35, S210-224.

[5]   Schiffman, M. and Castle, P.E. (2003) Human Papillomavirus: Epidemiology and Public Health. Archives of Pathology Laboratory Medicine, 127, 930-934.

[6]   Muñoz, N., Bosch, F.X., Castellsagué, X., Díaz, M., de Sanjose, S., Hammouda, D., Shah, K.V. and Meijer, C.J. (2004) Against Which Human Papillomavirus Types Shall We Vaccinate and Screen? The International Perspective. International Journal of Cancer, 111, 278-285.

[7]   Inoue, M., Sakaguchi, J., Sasagawa, T. and Tango, M. (2006) The Evaluation of Human Papillomavirus DNA Testing in Primary Screening for Cervical Lesions in a Large Japanese Population. International Journal of Gynecological Cancer, 16, 1007-1013.

[8]   Winer, R.L., Kiviat, N.B., Hughes, J.P., Adam, D.E., Lee, S.K., Kuypers, J.M. and Koutsky, L.A. (2005) Development and Duration Of Human Papillomavirus Lesions, After initial Infection. The Journal of Infectious Diseases, 191, 731-738.

[9]   Stanley, M., Lowy, D.R. and Frazer, I. (2006) Chapter 12: Prophylactic HPV Vaccines: Underlying Mechanisms. Vaccine, 24, S106-S113.

[10]   Garland, S.M., Hernandez-Avila, M., Wheeler, C.M., Perez, G., Harper, D.M., Leodolter, S., Tang, G.W., Ferris, D.G., Steben, M., Bryan, J., Taddeo, F.J., Railkar, R., Esser, M.T., Sings, H.L., Nelson, M., Boslego, J., Sattler, C., Barr, E. and Koutsky, L.A. (2007) Quadrivalent Vaccine against Human Papillomavirus to Prevent Anogenital Diseases. The New England Journal of Medicine, 356, 1928-1943.

[11]   Paavonen, J., Naud, P., Salmerón, J., Wheeler, C.M., Chow, S.N., Apter, D., Kitchener, H., Castellsague, X., Teixeira, J.C., Skinner, S.R., Hedrick, J., Jaisamrarn, U., Limson, G., Garland, S., Szarewski, A., Romanowski, B., Aoki, F.Y., Schwarz, T.F., Poppe, W.A., Bosch, F.X., Jenkins, D., Hardt, K., Zahaf, T., Descamps, D., Struyf, F., Lehtinen, M. and Dubin, G. (2009) Efficacy of human papillomavirus (HPV)-16/18 AS04-Adjuvanted Vaccine against Cervical Infection and Precancer Caused by Oncogenic HPV Types (PATRICIA): Final Analysis of a Double-Blind, Randomised Study in Young Women. Lancet, 374, 301-314.

[12]   Harper, .D.M., Franco, E.L., Wheeler, C.M., Moscicki, A.B., Romanowski, B., Roteli-Martins, C.M., Jenkins, D., Schuind, A., Costa Clemens, S.A. and Dubin, G. (2006) Sustained Efficacy up to 4.5 Years of a Bivalent L1 Virus-Like Particle Vaccine against Human Papillomavirus Types 16 and 18: Follow-Up from a Randomised Control Trial. Lancet, 367, 1247-1255.

[13]   Harper, D.M. (2008) Impact of Vaccination with Cervarix (Trade Mark) on Subsequent HPV-16/18 Infection and Cervical Disease in Women 15-25 Years of Age. Gynecologic Oncology, 110, S11-S17.

[14]   David, M.P., Van Herck, K., Hardt, K., Tibaldi, F., Dubin, G., Descamps, D. and Van Damme, P. (2009) Long-Term Persistence of Anti-HPV-16 and -18 Antibodies Induced by Vaccination with the AS04-Adjuvanted Cervical Cancer Vaccine: Modeling of Sustained Antibody Responses. Gynecologic Oncology, 115, S1-S6.

[15]   Hayashi, Y., Shimizu, Y., Netsu, S., Hanley, S. and Konno, R. (2012) High HPV Vaccination Uptake Rates for Adolescent Girls after Regional Governmental Funding in Shiki City, Japan. Vaccine, 30, 5547-5550.

[16]   Kobayashi, H., Nakajima, Y. and Akasaki, M. (2012) Factors Influencing Coverage of Human Papillomavirus Vaccination: Questionnaire Survey of Local Governments in Nara Prefecture about the HPV Vaccination Program and Communication Campaigns to Promote the Program. Progress in Medicine, 32, 753-759.

[17]   Miyagi, E. (2011) Research Report Supported by Health and Labour Sciences Research Grant.

[18]   Hughes, J., Cates, J.R., Liddon, N., Smith, J.S., Gottlieb, S.L. and Brewer, N.T. (2009) Disparities in How Parents Are Learning about the Human Papillomavirus Vaccine. Cancer Epidemiology, Biomarkers & Prevention, 18, 363-372.

[19]   McRee, A.L., Reiter, P.L. and Brewer, N.T. (2012) Parents’ Internet Use for Information about HPV Vaccine. Vaccine, 30, 3757-3762.

[20]   Marchand, E., Glenn, B.A. and Bastani, R. (2012) Low HPV Vaccine Coverage among Female Community College Students. Journal of Community Health, 37, 1136-1144.

[21]   Darden, P.M., Thompson, D.M., Roberts, J.R., Hale, J.J., Pope, C., Naifeh, M. and Jacobson, R.M. (2013) Reasons for Not Vaccinating Adolescents: National Immunization Survey of Teens, 2008-2010. Pediatrics, 131, 645-651.

[22]   Kester, L.M., Zimet, G.D., Fortenberry, J.D., Kahn, J.A. and Shew, M.L. (2013) A National Study of HPV Vaccination of Adolescent Girls: Rates, Predictors, and Reason for Non-Vaccination. Maternal and Child Health Journal, 17, 879- 885.

[23]   Sotiriadis, A., Dagklis, T., Siamanta, V., Chatzigeorgiou, K. and Agorastos, T. (2012) Increasing Fear of Adverse Effects Drops Intention to Vaccinate after the Introduction of Prophylactic HPV Vaccine. Archives of Gynecology and Obstetrics, 285, 1719-1724.

[24]   Teitelman, A.M., Stringer, M., Nguyen, G.T., Hanlon, A.L., Averbuch, T. and Stimpfel, A.W. (2011) Social Cognitive and Clinical Factors Associated with HPV Vaccine Initiation among Urban, Economically Disadvantaged Women. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 40, 691-701.

[25]   Chou, B., Krill, L.S., Horton, B.B., Barat, C.E. and Trimble, C.L. (2011) Disparities in Human Papillomavirus Vaccine Completion among Vaccine Initiators. Obstetrics & Gynecology, 118, 14-20.

[26]   Liddon, N.C., Leichliter, J.S. and Markowitz, L.E. (2012) Human Papillomavirus Vaccine and Sexual Behavior among Adolescent and Young Women. American Journal of Preventive Medicine, 42, 44-52.

[27]   Glaser, B.G. and Strauss, A.L. (1967) The Discovery of Grounded Theory: Strategies for Qualitative Research. Aldine, Chicago.

[28]   Oda, H., Kasuga, T., Yamamoto, N., Kasuga, T. and Miyaji, N. (2002) Shitsuteki Kenkyu Nyumon. Shunjusha, Tokyo.

[29]   Katz, I.T., Ware, N.C., Gray, G., Haberer, J.E., Mellins, C.A. and Bangsberg, D.R. (2010) Scaling up Human Papillomavirus Vaccination: A Conceptual Framework of Vaccine Adherence. Sex Health, 7, 279-286.

[30]   Van Hecke, A., Beeckman, D., Grypdonck, M., Meuleneire, F., Hermie, L. and Verhaeghe, S. (2013) Knowledge Deficits and Information-Seeking Behavior in Leg Ulcer Patients: An Exploratory Qualitative Study. Journal of Wound, Ostomy & Continence Nursing, 40, 381-387.

[31]   McRee, A.L., Gottlieb, S.L., Reiter, P.L., Dittus, P.J., Halpern, C.T. and Brewer, N.T. (2012) Human Papillomavirus Vaccine Discussions: An Opportunity for Mothers to Talk with Their Daughters about Sexual Health. Sexually Transmitted Diseases, 39, 394-401.

[32]   Waller, J., Marlow, L.A. and Wardle, J. (2006) Mothers’ Attitudes towards Preventing Cervical Cancer through Human Papillomavirus Vaccination: A Qualitative Study. Cancer Epidemiology, Biomarkers & Prevention, 15, 1257-1261.

[33]   Shafer, A., Cates, J.R., Diehl, S.J. and Hartmann, M. (2011) Asking Mom: Formative Research for an HPV Vaccine Campaign Targeting Mothers of Adolescent Girls. Journal of Health Communication, 16, 988-1005.

[34]   The Information Center for Health and Social-Care (2006) Cervical Screening Programme—England, 2005-2006.

[35]   Gamble, H.L., Klosky, J.L., Parra, G.R. and Randolph, M.E. (2010) Factors Influencing Familial Decision-Making Regarding Human Papillomavirus Vaccination. Journal of Pediatric Psychology, 35, 704-715.