ABSTRACT

Objectives

Latinx populations suffer from a disproportionate burden of HPV-related cancers, yet vaccination completion rates nationally among this population remain low, with 46% of females and 35% of males completing the vaccine series. Given the heterogeneity of Latinx populations, sub-populations such as Latinx individuals who live in migrant farmworker communities experience additional system-level barriers to healthcare utilization. Thus, we examined stakeholder perceptions of barriers and facilitators to Human Papillomavirus (HPV) vaccination among Latinx migrant farmworkers. Such information is critical to informing intervention development targeting vaccination uptake and completion, ultimately decreasing HPV-related cancer disparities.

Design

Guided by the PRECEDE-PROCEED model and the Social Ecological Model (SEM), interviews were conducted with diverse stakeholders (n = 13) representative of health, social services, and political sectors. Stakeholders were asked about their perceptions of barriers to and facilitators of HPV vaccination among migrant farmworkers. Interviews were audio-recorded, transcribed, and thematically analyzed. Responses were coded according to components of the SEM.

Results

Micro-level facilitators identified included positive attitudes and vaccine acceptance among parents. Meso-level facilitators included availability of free or low-cost health care clinics, and macro-level facilitators included federal programs (e.g. Medicaid, Vaccine for Children). Micro-level barriers included lack of education and low health literacy. Meso-level barriers included poor patient-provider communication, lack of access (e.g. clinics not stocking/administering the vaccine; limited clinic hours; lack of reminder systems; insufficient organizational structure), public perceptions/attitudes towards HPV vaccination, and lack of healthcare service continuity due to migratory patterns. Macro-level barriers included public perceptions and attitudes towards HPV vaccination, transportation, vaccine availability and coverage for non-citizens, and lack of school entry policy.

Conclusions

Findings suggest that multi-level interventions should be developed to leverage existing facilitators while addressing system-level barriers, ultimately creating a supportive environment for HPV vaccine initiation and completion among this marginalized population comprised of individuals living in migrant farmworker communities.

中文翻译：

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利益相关者对西班牙裔农民工 HPV 疫苗接种的系统层面障碍和促进因素的看法

摘要

目标

拉丁裔人群遭受与 HPV 相关癌症的不成比例的负担，但全国范围内该人群的疫苗接种完成率仍然很低，46% 的女性和 35% 的男性完成了疫苗系列。鉴于拉丁裔人口的异质性，生活在农民工移民社区中的拉丁裔个人等子群体在医疗保健利用方面遇到了额外的系统级障碍。因此，我们调查了利益相关者对拉丁裔农民工接种人乳头瘤病毒 (HPV) 疫苗的障碍和促进因素的看法。这些信息对于告知针对疫苗接种和完成的干预开发至关重要，最终减少与 HPV 相关的癌症差异。

设计

在 PRECEDE-PROCEED 模型和社会生态模型 (SEM) 的指导下，对 代表健康、社会服务和政治部门的不同利益相关者 ( n = 13) 进行了采访。利益相关者被问及他们对农民工接种 HPV 疫苗的障碍和促进因素的看法。采访被录音、转录和主题分析。根据 SEM 的组件对响应进行编码。

结果

确定的微观促进因素包括父母的积极态度和疫苗接受度。中观层面的促进者包括免费或低成本的医疗诊所，宏观层面的促进者包括联邦计划（例如医疗补助、儿童疫苗）。微观层面的障碍包括缺乏教育和健康素养低。中观层面的障碍包括患者与提供者之间的沟通不畅、缺乏获取途径（例如，诊所没有储存/管理疫苗；诊所时间有限；缺乏提醒系统；组织结构不足）、公众对 HPV 疫苗接种的看法/态度以及缺乏医疗保健迁移模式导致的服务连续性。宏观层面的障碍包括公众对 HPV 疫苗接种、交通、疫苗可用性和非公民覆盖率的看法和态度，

结论

研究结果表明，应制定多层次干预措施，以利用现有的促进因素，同时解决系统层面的障碍，最终为生活在农民工社区的边缘化人群中启动和完成 HPV 疫苗创造支持性环境。