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Background:Delivery of HPV vaccine in India will require understanding parental attitudes toward vaccination.
Objectives: To examine HPV vaccine knowledge, attitudes, and perceived barriers to vaccine uptake among parents in India.
Methods: Semi-structured interviews were conducted with 36 parents in rural Andhra Pradesh, India. Interviews were transcribed and translated. Content analysis identified themes related to vaccine acceptability.
Results: Parents had poor knowledge of vaccines, HPV, and cervical cancer. None reported awareness of HPV and only 2 knew about genital warts. All but 7 had heard of cervical cancer, although, none knew it was caused by a sexually transmitted infection. Despite poor knowledge most parents reported willingness to vaccinate their children against HPV, especially with a health worker recommendation. The most common barriers to HPV vaccination were: missing work to receive the vaccine and its cost. All parents reported high uptake for free vaccine. Eighteen parents reported willingness to pay for vaccine and 12 parents qualified their affirmation. One parent, for example, said, "Those who have money will be ready to buy the vaccine and give to their children and those who don’t have money will not show any interest." While almost all parents reported acceptance of girls-only vaccination, most believed the vaccine should also be given to boys.
Conclusions: Knowledge about HPV was poor among parents in this area of India. Pragmatic issues such as vaccine cost and missing work and consequently wages to get vaccinated were the principal barriers to vaccination identified.
Implications for Programs, Policy, and/or Research: These findings suggest that educational programs and efforts to minimize cost of HPV vaccine will be central to implementation of successful HPV immunization programs in this part of India. The interest in HPV vaccine for both daughters and sons is in line with the recent FDA approval of vaccination for males in the US.