“If I know about it of course I would give my son and daughter”, barriers to and enablers of accessing human papillomavirus vaccination among women from refugee and asylum-seeking backgrounds resettling in Melbourne, Australia – A qualitative study

Abstract

Background

Women from refugee and asylum-seeking backgrounds have lower human papillomavirus vaccination (HPVV) rates than host country populations. Improving HPVV rates is important in the prevention of cervical cancer. This qualitative study gained an in-depth understanding of refugee and asylum-seeking women's barriers to and enablers of accessing HPVV services and information for their children post-resettlement in Melbourne, Australia.

Methods

A qualitative study using semi-structured interviews was conducted with a purposive sample of women from Myanmar, Iraq, Syria and women seeking asylum from different countries. A bi-cultural worker assisted in recruitment and interpreting during data collection. Between December 2021 and September 2023 interviews were conducted in the participants first language with a bi-cultural worker or volunteer interpreting into English during the interview. Audio recordings of English dialogue were transcribed verbatim. Reflexive thematic analysis was used to analyse and report data.

Results

Thirty-one refugees and 12 women seeking asylum from eleven countries were interviewed. Barriers to and enablers of HPVV were identified. 1) Barriers to awareness and knowledge of HPVV included: limited awareness of HPVV, lack of access to HPV vaccine information in the pre-arrival context, uncertainty about HPV vaccine safety and effectiveness, gender association with HPVV, negative influence of COVID vaccination on HPV vaccine perceptions. Enablers included: Understanding future benefits: prevention is better than cure 2) Barriers to sociocultural influences included: necessity for HPVV at recommended age, Enablers included: promoting peer support 3) Barriers to health information seeking included: missed opportunities for information delivery at schools and language classes, inconsistent messaging. Enablers included: trust in the education programs, health care provider recommendation, desire for new knowledge.

Conclusion

Improving HPVV access requires a multi-faceted approach to enhance women's awareness and knowledge. Key strategies include providing routine HPVV education through resettlement services and school programs, supporting healthcare providers in educating women unfamiliar with HPVV, and delivering clear messaging about the recommended age and addressing gender-related misconceptions.