“Difference Does Matter with HPV Vaccine Mass Immunisation Programs. Critical Issues for Mass Immunisation of HPV Vaccine in Mixed Culture Communities from the Australian Experience”

Background:
Australia was the first nation to implement a HPV mass immunisation program to adolescents.Its experiences showed that cultural difference and geography does matter and how attitudes, social norms and experiences of both consent givers and health providers impact on vaccine uptake, education resources and infrastructure needs.

Objectives:
This study investigated the influence of culture on the attitudes and intentions of parents from three diverse cultural groups in Australia towards HPV vaccination among preadolescent children; family physicians (GPs) and Aboriginal Health Workers [AHWs].

Methods:
Participants for the qualitative semi-structured interviews were purposively selected according to ethnicity, gender, age :(i) Australian parents [male and female] of Anglo, Aboriginal and Chinese descendency (ii) practicing GPs; and AHWs. This sample is not representative of the wider cultural group. Recruitment was through hospital clinics; AHW networks; related cultural and medical associations.

Results:
Challenges facing uptake of HPV vaccine were varied reflecting Australia's cultural and geographic diversity and its influence on (i) HPV vaccine communication and education (ii) informed consent (iii) vaccine uptake. GPs and AHWs demonstrated a positive attitude but conceded it was difficult to explain to some parents why sexually naïve children will benefit from a vaccine for a sexually transmitted virus. Parents displayed diverse social and cultural values, attitudes and information needs toward the vaccine that influenced HPV education and communication interventions; and intentions to consent.

Conclusions:
There has been a low uptake of the third dose of the quadrivalent HPV vaccine in some regions of Australia. Culturally sensitive messages and planning will play a key role in HPV vaccine education, delivery and uptake. Successful implementation and uptake of the HPV vaccine in multicultural nations is complex and challenging. It requires a coordinated national effort and understanding of the role of culture and diversity as integral to successful HPV vaccine mass immunisation programs.