Drawing on 38 in-depth qualitative interviews with college women and college health clinicians, we collected human papillomavirus (HPV) vaccine decision narratives to identify the implicit and explicit values underlying HPV vaccine decision making. Narratives of vaccine acceptance and resistance were identified. Vaccine acceptance narratives consisted of four themes: supportive family messages, explicit health care provider endorsement, peer descriptive norms reducing stigma of vaccination, and disease framing (e.g., cancer, HPV) shaping vaccine benefit perceptions. Vaccine resistance narratives consisted of five themes: skepticism of vaccine safety, invoking alternative prevention strategies, articulating stigmatizing HPV messages, overcoming self-efficacy barriers (e.g., cost, availability, time, and fear of parental disclosure), and delay strategies. Common to all decision narratives was that relationship status framed college women’s perceptions of HPV susceptibility. Theoretical and practical implications for designing HPV vaccine messages aimed at college-aged women are discussed.
Allen, J.D., Mohllajee, A.P., Shelton, R.C., Othus, M.K.D., Fontenot, H., & Hanna, R. ( 2009). Stage of adoption of the human papillomavirus vaccine among college women. Preventive Medicine, 48(5), 420-425. doi:10.1016/j.ypmed.2008.12.005
2.
Andrews, M., Squire, C., & Tamboukou, M. ( 2009). Doing narrative research. London: Sage.
3.
Babtiste, I. ( 2001). Qualitative data analysis: Common phases, strategic differences . Forum: Qualitative Social Research, 2(3), Art. 22. Retrieved from http://www.qualitative-research.net/index.php/fqs/issue/view/24
4.
Barth, K.R., Cook, R.L., Downs, J.S., Switzer, G.E., & Fischhoff, B. ( 2002). Social stigma and negative consequences: Factors that influence college students’ decisions to seek testing for sexually transmitted infections. Journal of American College Health, 50(4), 153-159. Retrieved from http://www .ncbi.nlm.nih.gov/pubmed/11910948?dopt=Citation
5.
Boone, T.L., & Lefkowitz, E.S. (2004). Safer sex and the health belief model: Considering the contributions of peer norms and socialization factors. Journal of Psychology & Human Sexuality, 16(1), 51-68. doi:10.1300/j056v16n01_04
Burchell, A.N., Winder, R.L., de Sanjose, S., & Franco, E.L. ( 2006). Epidemiology and transmission dynamics of genital HPV infection. Vaccine, 24, S52-S61. doi:10.1016/j. vaccine.2006.05.031
8.
Caskey, R., Lindau, S.T., & Alexander, G.C. (2009). Knowledge and early adoption of the HPV vaccine among girls and young women: Results of a national survey . Journal of Adolescent Health, 45(5), 453-462. doi:10.1016/j.ado-health.2009.04.021
9.
Chapman, G.B., & Coups, E.J. ( 1999). Predictors of influenza vaccine acceptance among healthy adults. Preventive Medicine, 29, 249-262. doi:10.1006/pmed.1999.0535
10.
Cialdini, R.B., & Reno, R.R. ( 1990). A focus theory of normative conduct: Recycling the concept of norms to reduce littering in public places. Journal of Personality and Social Psychology, 58(6), 1015-1026. doi:10.1037/0022-3514.58.6.1015
11.
Cohen, J. ( 1960). A coefficient agreement for nominal scales. Educational and Psychological Measurement, 20, 37-46.
12.
Constantine, N.A., & Jerman, P. ( 2007). Acceptance of human papillomavirus vaccination among Californian parents of daughters: A representative statewide analysis. Journal of Adolescent Health, 40, 108-115. doi:10.1016/j. jadohealth.2006.10.007
13.
Denzin, N.K. ( 2006). Sociological methods: A sourcebook (5th ed.). New Brunswick, NJ: Aldine Transaction.
14.
Downs, J.S., Bruine de Bruin, W., & Fischhoff, B. ( 2008). Parents’ vaccination comprehension and decisions . Vaccine, 26, 1595-1607. doi:10.1016/j.vaccine.2008.01.011
15.
Downs, J.S., Murray, P.J., Bruine de Bruin, W., Penrose, J., Palmgren, C., & Fischhoff, B. ( 2004). Interactive video behavioral intervention to reduce adolescent females’ STD risk: A randomized controlled trial. Social Science & Medicine, 59, 1561-1572. doi:10.1016/j.socscimed.2004.01.032
16.
Dunne, E.F., Unger, E.R., Sternberg, M., McQuillan, G., Swan, D.C., Patel, S.S., & Markowitz, L.E. (2007). Prevalence of HPV infection among females in the United States. Journal of American Medical Assocation, 297, 813-819. doi:10.1001/jama.297.8.813
17.
Franco, E.L., Bosch, F.X., Cuzick, J., Schiller, J.T., Garnett, G.P., Meheus, A., & Wright, T. ( 2006). Chapter 29: Knowledge gaps and priorities for research on prevention of HPV infection and cervical cancer. Vaccine , 24 (Suppl. 3), 242-249. doi:10.1016/j.vaccine.2006.06.038
18.
Hecht, M.L., & Krieger, J.K. ( 2006). The principle of cultural grounding in school-based substance use prevention: The Drug Resistance Strategies Project. Journal of Language and Social Psychology, 25, 301-319. doi:10.1177/ 0261927X06289476
19.
Hecht, M.L., & Miller-Day, M. (2009). Drug resistance strategies project: Using narrative theory to enhance adolescents’ communication competence. In K. Cissna & L. Frey (Eds.), Handbook of applied communication: Exemplary programs (pp. 535-558). New York: Routledge.
20.
Hunter, J.L. ( 2005). Cervical cancer educational pamphlets: Do they miss the mark for Mexican immigrant women’s needs?Cancer Control Journal, 12(Supp 2), 42-50.
21.
Kahn, J.A. ( 2005). Adolescent decision-making and health behaviors: The influence of contextual factors on the use of new technologies to prevent HPV-related diseases. Paper presented at the Workshop on the Synthesis of Research on Adolescent Health and Development, Washington, DC. Retrieved from http://www.bocyf.org/090805.html
22.
Kahn, J.A. ( 2007). Maximizing the potential public health impact of HPV vaccines: A focus on parents. Journal of Adolescent Health , 40, 101-103. doi:10.1016/j.jadohealth. 2006.12.002
23.
Kahn, J.A., Rosenthal, S.L., Hamann, T., & Berstein, D.I. (2003). Attitudes about human papillomavirus vaccine in young women. International Journal of STD & AIDS, 14(5), 300-306. doi:10.1258/095646203321605486
24.
Kahn, J.A., Rosenthal, S.L., Jin, Y., Huang, B., Namakydoust, A., & Zimet, G. ( 2008). Rates of human papillomavirus vaccination, attitudes about vaccination, and human papillomavirus prevalence in young women. American College of Obsetrics & Gynecology, 111(5), 1103-1110. doi:10.1097/ AOG.0b013e31817051fa
25.
Keating, K.M., Brewer, N.T., Gottlieb, S.L., Liddon, N., Ludema, C., & Smith, J.S. ( 2008). Potential barriers to HPV vaccine provision among medical practices in an area with high rates of cervical cancer. Journal of Adolescent Health, 43(4), S1-S68. doi:10.1016/j.jadohealth.2008.06.015
26.
Larkey, L.K., & Hecht, M.L. ( 2010). A model of effects of narrative as culture-centric health promotion. Journal of Health Communication, 15(2), 114-135. doi:10.1080/ 10810730903528017
27.
Lather, P. ( 1991). Getting smart: Feminist research and pedagogy with/in the postmodern. New York: Routledge .
28.
Lefkowitz, E.S., Boone, T.L., & Shearer, C.L. ( 2004). Communication with best friends about sex-related topics during emerging adulthood. Journal of Youth and Adolescence , 33(4), 339-351. doi:10.1023/B:JOYO.0000032642.27242.c1
29.
Lefkowitz, E.S., & Espinosa-Hernandez, G. (2007). Sex-related communication with mothers and close friends during the transition to university. Journal of Sex Research, 44(1), 17-27.
30.
Lincoln, Y., & Guba, E. ( 1985). Naturalistic inquiry. New York: Sage.
31.
Lofters, A., Glazier, R.H., Agha, M.M., Creatore, M.I., & Moineddin, R. ( 2007). Inadequacy of cervical cancer screening among urban recent immigrants: A population-based study of physian and laboratory claims in Toronto, Canada. Preventive Medicine, 44, 536-542. doi:10.1016/j. ypmed.2007.02.019
32.
Macdonald, M.E., Rigillo, N., & Brassard, P. ( 2010). Urban Aboriginal understandings and experiences of tuberculosis in Montreal, Quebec, Canada. Qualitative Health Research. Advance online publication. doi:10:1177/ 1049732309360538
33.
Markowitz, L.E., Dunne, E.F., Saraiya, M., Lawson, H.W., Chesson, H., & Unger, E.R. ( 2007). Quadrivalent human papillomavirus vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report, 56, 1-24. Retrieved from http://www.cdc.gov/mmwr/pdf/rr/rr5602.pdf
34.
McCoyd, J.L. ( 2008). I’m not a saint: Burden assessment as an unrecognized factor in prenatal decision making. Qualitative Health Research , 18, 1489-1500. doi:10.1177/ 1049732308325642
35.
Miller-Day, M. ( 1998). The qualitative research journey: How did I get here and where am I going? In M. Miller-Day (Ed.), Communication among grandmothers, mothers, and adult daughters: A qualitative study of maternal relationships. Mahwah, NJ: Routledge.
36.
Miller-Day, M. ( 2008a). Talking to youth about drugs: What do late adolescents say about parental strategies?Family Relations, 57(1), 1-12. doi:10.1111/j.1741-3729.2007.00478.x
37.
Miller-Day, M. ( 2008b). Translational performances: Toward relevant, engaging, and empowering social science. Forum: Qualitative Social Research , 9(2), Art. 54. Retrieved from http://www.qualitative-research.net/index.php/fqs/article/view/402/872
38.
National Cancer Institute. (2007). Statistics. Retrieved from http://www.cancer.gov/aboutnci/servingpeople/snapshots/cervical.pdf
39.
O’Donoghue, T., & Punch, K. ( 2003). Qualitative education research in actions: Doing and reflecting. New York: Routledge .
40.
Ogilvie, G.S., Remple, V.P., Marra, F., McNeil, S.A., Naus, M., Pielak, K.L., . . . Patrick, D.M. ( 2007). Parental intention to have daughters receive the human papillomavirus vaccine. Canadian Medical Association Journal , 177(12), 1506-1512. doi:10.1503/cmaj.071022
41.
Petronio, S. ( 2007). JACR commentaries on translating research into practice: Introduction. Journal of Applied Communication Research, 35(3), 215-217. doi:10.1080/ 00909880701434190
42.
Riessman, C.K. ( 1993). Narrative analysis. Newbury Park, CA: Sage.
43.
Riessman, C.K. ( 2008). Narrative methods for the human sciences. Thousand Oaks, CA: Sage.
44.
Rodewald, L.E., & Orenstein, W.A. (2009). Vaccinating adolescents-New evidence of challenges and opportunities. Journal of Adolescent Health, 45(5), 427-429. doi:10.1016/j.jadohealth.2009.08.006
45.
Rosenthal, S.L., Weiss, T.W., Zimet, G.D., Ma, L., Good, M.B., & Vichnin, M.D. ( 2010). Predictors of HPV vaccine uptake among women aged 19-26: Importance of a physician’s recommendation. Vaccine. Advance online publication. doi:10.1016/j. vaccine.2009.12.063
46.
Rouner, D., & Lindsey, R. ( 2006). Female adolescent communication about sexually transmitted diseases. Health Communication, 19(1), 29-38. doi:10.1207/s15327027hc1901_4
47.
Schwandt, T. ( 2001). Dictionary of qualitative inquiry (2nd ed.). Thousand Oaks, CA: Sage .
48.
Sherris, J., Friedman, A., Wittet, S., Davies, P., Steben, M., & Saraiiya, M. ( 2006). Chapter 25: Education, training, and communication for HPV vaccines. Vaccine, 24S3, 210-218. doi:10.1016/j.vaccine.2006.05.124
49.
Sjoborg, K., & Eskild, A. ( 2009). Vaccination against human papillomavirus-An impact on preterm delivery? Estimations based on a literature review. Acta Obstetrica et Gynecologica Scandinavica, 86(9), 1027-1028. doi:10.1080/ 00016340802699100
50.
Smith, J.S., Melendy, A., Rana, R.K., & Pimenta, J.M. ( 2008). Age-specific prevalence of infection with human papilliomavirus in females: A global review. Journal of Adolescent Health , 43(4, Supp1. 1), S5.e1-S5.e262. doi:10.1016/j.jadohealth.2008.07.009
51.
Squire, C. ( 2009). Experience-centered and culturally-oriented approaches to narrative. In M. Andrews, C. Squire, & M. Tamboukou (Eds.), Doing narrative research. London : Sage.
52.
Stevens, P.E., & Hildebrandt, E. (2009). Pill taking from the perspective of HIV-infected women who are vulnerable to antiretroviral treatment failure . Qualitative Health Research, 19, 593-604. doi:10.1177/1049732309333272
53.
Strauss, A., & Corbin, J. ( 1998). Basics of qualitative research. Thousand Oaks, CA: Sage.
54.
Telford, R., & Rogers, A. ( 2003). What influences elderly peoples’ decisions about whether to accept the influenza vacciation? A qualitative study. Health Education Research, 18(6), 743-753. doi:10.1093/her/cyf059
55.
Walboomers, J.M.M., Jacobs, M.V., Manos, M.M., Bosch, F.X., Kummer, J.A., Shah, K.V., . . . Munoz, N. ( 1999). Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. Journal of Pathology, 189(1), 12-19. doi:10.1002/(SICI)1096-9896(199909)189:1<12::AID-PATH431>3.0.CO;2-F
56.
White, H. ( 1981). The value of narrativity in the presentation of reality . In W. J. T. Mitchell (Ed.), On narrative. Chicago: University of Chicago Press.
57.
Young, S. ( 2009). FDA panel urges HPV vaccine be given to boys. CNN. Retrieved from http://www.cnn.com/2009/HEALTH/09/09/fda.gardasil.males/index.html
58.
Zimet, G.D., Kahn, J.A., & Shew, M.L. ( 2008). Appropriate use of cervical cancer vaccine. Annual Review of Medicine, 59, 223-236. doi:10.1146/annurev.med.59.092806. 131644
