College of Public Health, University of South Florida, Tampa, FL, USA.
Anthropology, Rollins College, Winter Park, FL, USA.
Ethn Health. 2022 Aug;27(6):1442-1464. doi: 10.1080/13557858.2021.1887820. Epub 2021 Mar 18.
Latinx populations suffer from a disproportionate burden of HPV-related cancers, yet vaccination completion rates nationally among this population remain low, with 46% of females and 35% of males completing the vaccine series. Given the heterogeneity of Latinx populations, sub-populations such as Latinx individuals who live in migrant farmworker communities experience additional system-level barriers to healthcare utilization. Thus, we examined stakeholder perceptions of barriers and facilitators to Human Papillomavirus (HPV) vaccination among Latinx migrant farmworkers. Such information is critical to informing intervention development targeting vaccination uptake and completion, ultimately decreasing HPV-related cancer disparities.
Guided by the PRECEDE-PROCEED model and the Social Ecological Model (SEM), interviews were conducted with diverse stakeholders ( = 13) representative of health, social services, and political sectors. Stakeholders were asked about their perceptions of barriers to and facilitators of HPV vaccination among migrant farmworkers. Interviews were audio-recorded, transcribed, and thematically analyzed. Responses were coded according to components of the SEM.
Micro-level facilitators identified included positive attitudes and vaccine acceptance among parents. Meso-level facilitators included availability of free or low-cost health care clinics, and macro-level facilitators included federal programs (e.g. Medicaid, Vaccine for Children). Micro-level barriers included lack of education and low health literacy. Meso-level barriers included poor patient-provider communication, lack of access (e.g. clinics not stocking/administering the vaccine; limited clinic hours; lack of reminder systems; insufficient organizational structure), public perceptions/attitudes towards HPV vaccination, and lack of healthcare service continuity due to migratory patterns. Macro-level barriers included public perceptions and attitudes towards HPV vaccination, transportation, vaccine availability and coverage for non-citizens, and lack of school entry policy.
Findings suggest that multi-level interventions should be developed to leverage existing facilitators while addressing system-level barriers, ultimately creating a supportive environment for HPV vaccine initiation and completion among this marginalized population comprised of individuals living in migrant farmworker communities.
拉丁裔人群患 HPV 相关癌症的负担不成比例，但该人群的全国疫苗接种完成率仍然很低，女性中有 46%，男性中有 35%完成了疫苗系列接种。鉴于拉丁裔人群的异质性，生活在流动农民工社区的拉丁裔等亚人群在利用医疗保健方面面临额外的系统障碍。因此，我们研究了利益相关者对拉丁裔流动农民工 HPV 疫苗接种的障碍和促进因素的看法。这些信息对于为提高疫苗接种率和完成率而制定干预措施至关重要，最终可减少 HPV 相关癌症的差异。
在 PRECEDE-PROCEED 模型和社会生态模型（SEM）的指导下，对代表卫生、社会服务和政治部门的不同利益相关者（ = 13）进行了访谈。利益相关者被问及他们对流动农民工 HPV 疫苗接种的障碍和促进因素的看法。对访谈进行了录音、转录和主题分析。根据 SEM 的组成部分对回复进行了编码。
微观层面的促进因素包括父母的积极态度和对疫苗的接受。中观层面的促进因素包括提供免费或低成本的医疗保健诊所，宏观层面的促进因素包括联邦计划（例如，医疗补助、儿童疫苗接种计划）。微观层面的障碍包括教育程度低和健康素养低。中观层面的障碍包括医患沟通不畅、缺乏获取途径（例如，诊所不储备/管理疫苗；诊所营业时间有限；缺乏提醒系统；组织结构不足）、公众对 HPV 疫苗接种的看法和态度，以及由于移民模式导致的医疗服务连续性不足。宏观层面的障碍包括公众对 HPV 疫苗接种、交通、疫苗的可及性和非公民的覆盖率以及缺乏入学政策的看法和态度。
研究结果表明，应制定多层次的干预措施，利用现有促进因素，同时解决系统层面的障碍，最终为这一由生活在流动农民工社区的个人组成的边缘化人群创造一个支持 HPV 疫苗接种启动和完成的环境。
