Informing Future HPV Vaccination Efforts in Rural Kenya: Findings From Formative and Message-Testing Research

Theoretical Background and research questions/hypothesis:  Cervical cancer is the largest single cause of life years lost due to cancer in the developing world. It is the leading cause of cancer-related mortality among women in Kenya. Kenya’s Ministry of Health is planning HPV vaccine demonstration projects in 2013, with possible national introduction in 2015. Formative research is critical to identify information needs and communication strategies to prepare communities for vaccine introduction. To inform vaccine communication efforts in Kenya, this study sought to explore HPV vaccine-related knowledge, attitudes, beliefs and communication preferences; and reactions to draft messages and materials.

Methods: We conducted five focus groups with caregivers of young girls (n=56), and 12 interviews with community opinion leaders in four locations of Nyanza Province, Kenya. Qualitative research explored participant views of vaccines, cervical cancer and HPV vaccination; trusted sources and appropriate settings for information dissemination; and reactions to draft posters. We tested a total of six posters, intended to raise awareness of the vaccine and prompt information- or vaccine-seeking behaviors. Moderators alternated the order of presentation to minimize possible bias. Focus group transcripts and interview notes were reviewed and analyzed by a team of four researchers using thematic content analysis. Focus group data were analyzed using NVivo8, and concept matrices were used for interview notes.

Results: Awareness of vaccines and cancer was high among caregivers and opinion leaders. Vaccines were generally well accepted, and cancer was feared as a fatal and untreatable disease. Despite a lack of awareness of cervical cancer and HPV vaccination, participants were eager to vaccinate young girls once informed. A key perceived benefit was protection against cancer; perceived barriers included potential concerns about vaccine safety/side effects (infertility) and intentions of vaccinators. Message testing revealed the need to explain cervical cancer and its impact on the community; emphasize that the vaccine is safe, effective, and has been widely implemented worldwide; clarify the rationale for vaccinating only young girls; indicate government endorsement; and specify vaccine program details.  In addition to vaccine messages for girls, messages about cervical cancer screening for women were welcomed as part of a cervical-cancer prevention effort. Participants were drawn to bright colors and images of children, but it was important that they depict the diversity of young girls targeted for vaccination. Trusted sources of information included political, health/medical, religious, and community leaders; supported by mass media sources (radio, public address system, outdoor advertising). Participants were open to receiving HPV vaccine information at schools, churches, and community gatherings and events.

Conclusions: The success of an HPV vaccination program will depend critically on raising awareness of cervical cancer and the need for vaccination. Communication efforts from trusted sources are needed to build trust in the vaccination effort; to convey the benefits of vaccination; and to minimize perceived barriers and possible concerns.

Implications for research and/or practice: Effective design elements, identified during message testing, can help guide next steps in materials development. Additional recommendations are made to inform Kenya’s communication and mobilization strategies in preparation for vaccine introduction.