Abstract
Sirs: We read with interest previous articles published in this journal regarding attitudes to the human papillomavirus (HPV) vaccine among various groups.1–3 Less is known about the impact of ethnicity and religion on vaccine uptake. Previous investigators have predicted a lower uptake in ethnic minority groups.4,5 Cervical smear uptake has been shown to be poor in ethnic minority groups, 6 thus a low vaccine uptake could put this group at a significant risk of developing subsequent cervical cancer.
We conducted a questionnaire survey in Southampton to assess awareness and attitudes towards the HPV vaccine in Indian/Pakistani mothers with children of any age. The original questionnaire used by Brabin et al. 4 was translated into Gujarati, Punjabi and Hindi and validated by professional translators. Questions explored knowledge and attitudes about HPV and the vaccine. Key factors influencing parental decision to vaccinate were assessed on a Likert scale. Information was obtained regarding social and demographic background. The questionnaires were distributed in local religious venues using convenience sampling and posted back to the researcher anonymously in prepaid envelopes.
In total, 221 questionnaires were distributed, of which only 50 completed questionnaires were returned (23%). Data were analysed using SPSS 16. Logistic regression was used to establish whether the predictor variables in the questionnaire were significantly associated with vaccine acceptance.
The majority of the respondents were professionals aged 41 years and over. Eighty per cent of this group stated literacy in English. Mothers had poor HPV knowledge, with 60% knowing fewer than two of the facts provided. Many were highly sceptical of the safety and efficacy of the vaccine (odds ratio [OR] 0.25, 95% confidence interval [CI] 0.06–1.00; P = 0.05). Postvaccine increase in sexual promiscuity was not a concern for the majority of mothers (OR 9.38, 95% CI: 1.50–58.56; P = 0.02).
There was a trend towards endorsing vaccination at a later age than recommended in the national programme (only 38% agreed with the recommended age). This was largely influenced by parental beliefs that their children are not at risk for HPV as a result of delayed sexual debut. There was much disagreement to children accessing the vaccine without parental consent.
Overall the response to the vaccine was favourable; however, the predicted uptake of HPV vaccination was marginally lower at 69% compared with Caucasian groups (70–80%) in previous studies. The major limitation of the study was the low response rate, consistent with the response rate seen in these groups in a previous study. 4
Our results show that this group is poorly informed about HPV and cervical cancer generally. Barriers to vaccination in these hard-to-reach groups can be overcome by targeted educational campaigns, including information about HPV, vaccine safety and efficacy when administered at the recommended age.