Table 3 Stakeholder-reported barriers to county-level HPV vaccine initiation
Thematic category | County-level vaccine rate | Emphasis | Representative quotes |
|---|---|---|---|
Healthcare access | Highest | Transportation | I know the transportation can be an issue in our community sometimes for people even that live locally to get to the health department.—Healthcare provider |
Middle | Transportation and limited healthcare professionals | There’s already transportation issues, and time issues where if it’s a single parent who has to take two buses to the doctor.—Area Health Education Center staff We are limited in our – the amount of pediatricians that we have.—DOH clinical staff | |
Lowest | Limited healthcare professionals | We have limited numbers of physicians there [in the area] … maybe five family physicians at the most.—DOH nonclinical staff | |
Clinician practices | Highest | Recommendation variability | A lot of the pediatricians they don’t want to give the vaccine. I was told last year, she doesn’t need it now and she was – she was 10 last year. So, she could have gotten the vaccine but even the pediatrician was like, “Oh no, you have to wait.”—DOH nonclinical staff |
Middle | Refer to health department | It’s so expensive. I don’t know that there’s very many [pediatricians] that keep it in stock … most of them will send them here.—DOH clinical staff | |
Lowest | Refer to health department | Pediatricians do not offer HPV vaccine and just refer patients to health department.—Health educator | |
Community partnerships | Highest | School | Definitely within the school system and county officials, we have some difficulties there, trying to promote anything that is outside of an abstinence-only model. So, we have difficulty promoting in that way or having the support to promote, you know, on a larger scale.—Healthcare provider |
Middle | School | We don’t really do vaccines at schools because the parents aren’t very receptive to that here. … We can offer it, but it don’t usually happen because of the parents and school board.—DOH clinical staff | |
Lowest | Church | They’re [the church] not going to talk about anything that’s seen as sexual, and the HPV is really seen as a sexual disease when it’s not just about sex.—UF Institute of Food and Agricultural Science Extension agent | |
Limited knowledge | Highest | Healthcare provider | We believe that the providers needed a bit more education about the HPV vaccine before they were more comfortable with promoting it.—Health educator |
Middle | Parents | Some people are just afraid because they’re unfamiliar, because they didn’t get it when they were a child.—DOH nonclinical staff | |
Lowest | Parents/community | [In the community] I would just say lack of knowledge and the understanding of it.—Public school faculty/staff | |
Cultural barriers | Highest | Vaccine exemption | Oh, actually, there is one thing I think is important for you to know. Our county is, I believe, the highest county in the state for religious exemption, and that’s a huge barrier for us to, you know, immunize kids, because they’re not only refusing HPV.—Healthcare provider |
Middle | Vaccine exemption | We have a high percentage of religious exemptions, and it’s not from religion, it’s from personal exemptions. It’s a false messaging from vaccines in general. … [Parents] are leery of any vaccine.—DOH clinical staff | |
Lowest | Religious beliefs | I think as far as barriers go, one, the religious thing. This is a very religious community and HPV’s not the only thing that we struggle with educating the community on.—Public school faculty/staff |