社会和文化建构过程对中国女性 HPV 疫苗犹豫的影响：一项定性研究。
Social and cultural construction processes involved in HPV vaccine hesitancy among Chinese women: a qualitative study.
机构信息
Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
Department of Communication Studies, School of Communication, Hong Kong Baptist University, Kowloon Tong, Hong Kong.
出版信息
Int J Equity Health. 2019 Sep 18;18(1):147. doi: 10.1186/s12939-019-1052-9.
BACKGROUND
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.
METHODS
We adopted a qualitative approach and conducted in-depth individual semistructured interviews with 40 women in Hong Kong between May and August 2017.
RESULTS
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.
CONCLUSIONS
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.
背景
HPV 疫苗是一种预防 HPV 感染的预防性疫苗。世界卫生组织推荐使用这种疫苗，临床证明它是预防宫颈癌和其他 HPV 相关癌症及慢性生殖器疾病流行的最有效措施之一。然而，香港女性对 HPV 疫苗的接种率并不高——2014 年，只有约 2.9%的少女和 9.7%的女大学生接种了 HPV 疫苗。基于批判医学人类学的理念，我们旨在确定是否存在个体、社会和文化等不同的影响因素，这些因素都参与了是否接种 HPV 疫苗的决策过程。
方法
我们采用定性方法，于 2017 年 5 月至 8 月期间对香港的 40 名女性进行了深入的个人半结构式访谈。
结果
我们注意到以下因素相互交织，影响了决策过程：对 HPV 和 HPV 疫苗的认知；HPV 疫苗的价值认知，而这又受到疫苗成本、婚姻计划和性经历的影响；妇科疾病史、HPV 疫苗接种相关的耻辱感、HPV 疫苗信息的获取、对 HPV 疫苗的不信任以及医疗实践中缺乏预防保健。
结论
HPV 疫苗是在父权制价值观体系下以“女性化”和“道德化”的方式推广的，这进一步将疾病负担转嫁给了女性，导致女性在追求接种 HPV 疫苗作为预防保健行为方面出现健康不平等。我们认为，这最终导致了对 HPV 的不完全理解，从而影响了决策过程。采用资本主义逻辑的“混合经济”医疗体系也塑造了薄弱的医患关系，导致对私人执业医疗体系的不信任，这影响了参与者获取 HPV 疫苗信息以做出决策的机会。
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