Iranian women’s perceptions of human papillomavirus and barriers to vaccination: a qualitative study based on the health belief model
Human papillomavirus (HPV) is a common sexually transmitted infection (STI) and the main cause of precancerous changes in the cervix. Despite the undeniable role of HPV vaccines in preventing cervical cancer, the vaccination rate has remained low. The perception of a disease can predict preventive behaviors such as vaccination. This qualitative study aimed to explore women's perceptions of HPV and its vaccine. In-depth, semi-structured interviews were conducted in four focus groups (FG) with 23 eligible women (aged 15-45), who had no prior history of cervical cancer, HPV infection, and vaccination. Interviews were recorded, transcribed verbatim, and analyzed using a directed content analysis approach based on the Health Belief Model (HBM). Perceived sensitivity, the risk of HPV infection, benefits and barriers of HPV vaccination, cue to action, self-care, and new category named social support were the main categories that emerged. Two main concerns for women included worries about the virus leading to cancer as well as marital and sexual relationship tension in case the husband contracts an infection. Main barriers to vaccination included informational, psychological, socio-cultural, and economic barriers. Self-protection acts, stress management, and medical care were the women's main perceptions of self-care and they expressed a need for informational, emotional, and financial support. The results of our study indicate that educating women and their families, improving people's sexual health awareness, integrating the vaccine into the national vaccination program, and establishing sexual health counselling units at healthcare centers are essential actions for encouraging women to get vaccinated and preventing HPV infection and its related adverse outcomes such as cancers.