The Fenway Institute, United States.
The Fenway Institute and Boston College, United States.
Vaccine. 2018 Jun 18;36(26):3868-3875. doi: 10.1016/j.vaccine.2018.02.043. Epub 2018 May 16.
Young sexual minority individuals have lower human papillomavirus (HPV) vaccine completion rates than the general population, and little is known about how gender minority people perceive HPV vaccination. The aim of this study was to qualitatively identify patient-, provider-, and systems-level barriers and facilitators for HPV vaccination among sexual and gender minority (SGM) people.
Fifteen SGM-identified individuals, ages 23-26, were recruited at an urban community health center in Boston, MA, that specializes in care for SGM. Participants were enrolled in a study that utilized surveys and in-person focus groups. During focus groups, participants were asked to describe their perceived barriers and facilitators for completion of HPV vaccination.
Fourteen participants reported having a sexual minority identity, and five participants reported having a gender minority identity. Participants described the following factors influencing HPV vaccination: (1) at the patient level, low HPV-related knowledge and lack of engagement in care were associated with less vaccination, whereas fear of HPV-related disease motivated vaccination; (2) at the provider level, knowledge and SGM cultural-competence related to HPV was associated with patient willingness to be vaccinated; (3) at the systems level, SGM identity-affirming healthcare settings were associated with increased vaccination, whereas historical trends in HPV vaccine marketing selectively for cisgender women and lack of public awareness of HPV-related disease among SGM were associated with decreased vaccincation.
Our study identified internal and external barriers for HPV vaccination related among SGM patients. These findings highlight the need to increase public awareness about the risks of HPV-related disease among SGM and educate SGM youth about HPV-related disease and vaccine importance. Finally, this study supports the need for future interventions to cultivate SGM-competent providers and SGM identity-affirming healthcare settings as a way to increase HPV vaccination.
年轻的性少数群体（sexual minority）的人接种人乳头瘤病毒（HPV）疫苗的完成率低于一般人群，对于性别少数群体（gender minority）的人如何看待 HPV 疫苗接种，知之甚少。本研究的目的是定性识别 HPV 疫苗接种在性少数群体和性别少数群体（SGM）人群中面临的患者、提供者和系统层面的障碍和促进因素。
在马萨诸塞州波士顿的一家专门为 SGM 提供护理的城市社区卫生中心，招募了 15 名自我认同为 SGM 的个体，年龄在 23-26 岁之间。参与者参加了一项研究，该研究利用调查和面对面的焦点小组。在焦点小组中，参与者被要求描述他们对完成 HPV 疫苗接种的障碍和促进因素的看法。
14 名参与者报告了性少数群体的身份，5 名参与者报告了性别少数群体的身份。参与者描述了以下因素影响 HPV 疫苗接种：（1）在患者层面，HPV 相关知识水平低且不参与护理与接种疫苗的可能性较低有关，而对 HPV 相关疾病的恐惧则促进了疫苗接种；（2）在提供者层面，与 HPV 相关的知识和 SGM 文化能力与患者愿意接种疫苗有关；（3）在系统层面，确认 SGM 身份的医疗保健环境与增加疫苗接种有关，而 HPV 疫苗营销的历史趋势选择性针对顺性别女性以及 SGM 中对 HPV 相关疾病的公众认识不足与疫苗接种减少有关。
我们的研究确定了 SGM 患者 HPV 疫苗接种相关的内部和外部障碍。这些发现强调需要提高 SGM 人群对 HPV 相关疾病风险的认识，并教育 SGM 青少年了解 HPV 相关疾病和疫苗的重要性。最后，这项研究支持未来干预措施的必要性，以培养 SGM 有能力的提供者和 SGM 身份确认的医疗保健环境，以此提高 HPV 疫苗接种率。
