UC Irvine

HPV cancer disparities are due to multiple factors exerting influence at various levelsover a lifetime. In an effort to understand which modifiable factors explain the most variance in HPV vaccine delay and refusal and how they affect vaccination decisions, my mixed-methods dissertation explored HPV vaccination disparities between foreign-born and US-born Mexican American young adult female patients from federally qualified health centers. I found individual (i.e., knowledge, perceptions, provider trust, cultural/religious beliefs), interpersonal (i.e., family/cultural norms, provider communication), and community (i.e., access to care, exposure to negative HPV messages) factors contributed to HPV vaccine refusal among Hispanic patients. My findings underscore the influence interpersonal factors (e.g., HPV vaccine provider communication, cultural norms, family ties) have on HPV vaccine refusal in the Hispanic community. The formative phase of my study uncovered participants desired improved provider encounters (e.g., longer conversations, less jargon, an understanding of how HPV affects Hispanic women) when learning about HPV and the HPV vaccine. Qualitative findings also uncovered foreign-born participants described challenges in navigating the healthcare for the first time as an insured patient. Foreign-born participants described family values and cultural norms as ‘too antiquated’, which kept them from talking to their mothers or family members about health topics, including HPV. Quantitative findings support the validity of a mother-daughter communication and social support scale and highlight the influence multilevel factors have on HPV vaccine uptake and completion. Individual- (i.e., HPV vaccine hesitancy, HPV conspiracy beliefs), interpersonal- (i.e., strength of provider recommendation, mother-daughter communication and social support), community- (i.e., number of times the HPV vaccine is offered, clinic wait times) level factors were all associated with HPV vaccine uptake. Individual- (i.e., HPV vaccine hesitancy, HPV vaccine conspiracy beliefs) interpersonal- (i.e., HPV mother-daughter communication and social support) and community- (i.e., exposure to negative HPV messages) level factors were also associated with HPV vaccine completion.