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Cited by 32Cervical Cancer and HPV ResearchVaccine Coverage and HesitancyWomen's cancer prevention and management

Challenges to Human Papillomavirus Vaccine Acceptability among Women in South India: An Exploratory Study

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Shah, Pooja, Shetty, Veena, Ganesh, Maithri, Shetty, Avinash K.·2021·The American Journal of Tropical Medicine and Hygiene
DOI 10.4269/ajtmh.20-1650PMC PMC8592141
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Abstract

ABSTRACT.: Cervical cancer is the second leading cause of cancer and one of the leading causes of cancer-related death in women in India. Human papillomavirus (HPV) vaccine uptake in India is low due to cost, low awareness of HPV, social stigma, and other factors. We assessed the awareness, attitudes, and beliefs regarding HPV and HPV vaccination and explored the barriers and challenges to HPV vaccine intent among women in Mangalore, India. An exploratory study was conducted using two focus group discussions (FGDs) and six in-depth one-on-one interviews. FGD-1 comprised nine women aged 18 to 26 years, and FGD-2 comprised seven women aged 27 to 45 years. The FGDs were recorded, transcribed, and analyzed using thematic content analysis. Themes identified were limited knowledge of HPV and vaccine, stigma associated with receiving HPV vaccine, vaccine safety concerns, and cost as a barrier to receiving vaccine. Participants expressed desire for physician and government recommendation of the HPV vaccine to validate vaccine intent. Contrasting themes between the two FGDs include support for vaccination at a younger age and lower perception of stigma and judgment in the 18- to 26-year-old group; however, participants in the 27- to 45-year-old group support vaccination at an older age and endorse greater fear of stigma and judgment associated with obtaining vaccination. Education regarding HPV-associated diseases and the HPV vaccine for the general public, physicians, and government officials in conjunction with lowering vaccine cost, improving vaccine access, and encouraging strong physician recommendations are key strategies to scale up HPV vaccine implementation in India.

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  • Knowledge is likely even poorer amongst less educated women and women from rural areas.

    “Knowledge is likely even poorer amongst less educated women and women from rural areas [22–25].”

    From Acceptability of HPV vaccination for cervical cancer prevention amongst emerging adult women in rural Mysore, India: a mixed-methods study (2024) · cites this paper as [24]

    The Results section reports participants’ view that HPV and vaccine awareness was particularly low in rural communities. The Discussion says the study oversampled healthcare workers, who likely knew more than the general public, but it does not assess knowledge by education level. The claim about less educated women is therefore not established by this paper. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • The socio-ecological model (SEM) was used as the theoretical framework to map and interpret influences on HPV vaccination awareness and uptake among adolescent girls in India.

    “The theoretical framework used for the review is the socio-ecological model (SEM) to map and interpret the various influences on HPV vaccination awareness and uptake among adolescent girls in India47,48.”

    From Barriers to HPV vaccination among adolescent girls in India: A scoping review (2026) · cites this paper as [48]

    The Introduction and Results describe family, community, cost, and information-related influences on HPV vaccine awareness and acceptability in India. But this source studied women aged 18–45, not adolescent girls, and its Discussion says it did not use a theory-driven methodology. It therefore supports the relevance of several influences, not the attribution of an SEM framework to this study. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Limited knowledge is often accompanied by misinformation and myths, including the belief that HPV vaccines lead to infertility.

    “The limited knowledge is often accompanied by misinformation and myths, including the belief that HPV vaccines lead to infertility hence, they prefer vaccinating their daughters at an older age46.”

    From Barriers to HPV vaccination among adolescent girls in India: A scoping review (2026) · cites this paper as [46]

    The Results report limited HPV knowledge and misconceptions about vaccination age. They do not report a belief that HPV vaccines cause infertility; the older-age preference is discussed in relation to perceived sexual activity and cancer risk, not infertility. No page numbers are available in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Cultural factors, including stigma surrounding STIs and fear of judgment from family and community members, may negatively impact vaccine acceptability.

    “Cultural factors, including stigma surrounding STIs and fear of judgment from family and community members, may negatively impact vaccine acceptability [7, 24].”

    From Acceptability of HPV vaccination for cervical cancer prevention amongst emerging adult women in rural Mysore, India: a mixed-methods study (2024) · cites this paper as [24]

  • Other barriers include cost, fear of side effects, perceived lack of need, and questions of vaccine efficacy.

    “Other barriers include cost, fear of side effects, perceived lack of need, and questions of vaccine efficacy [24, 26].”

    From Acceptability of HPV vaccination for cervical cancer prevention amongst emerging adult women in rural Mysore, India: a mixed-methods study (2024) · cites this paper as [24]

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Authors
Shah, P., Shetty, V., Ganesh, M., & Shetty, A. K.
Affiliations
  • Wake Forest University Health Sciences (US)
  • K S Hegde Medical Academy (IN)
  • Mangalore University (IN)
Corresponding author
Shetty, Avinash K.
ORCID
Venue
The American Journal of Tropical Medicine and Hygiene
Publisher
American Society of Tropical Medicine and Hygiene
Published
2021-10-06
Volume
105
Issue
4
Pages
966-973
ISSN
  • 0002-9637 (ISSN-L)
  • 1476-1645
DOI
10.4269/ajtmh.20-1650
PMC
PMC8592141
OpenAlex
W3189600776
Cited by
32
References
0
Citations by year
2026: 12 · 2025: 7 · 2024: 7 · 2023: 3 · 2022: 3
FWCI
2.34
Type
journal article
Language
en
Open access
Locations
  • American Journal of Tropical Medicine and Hygiene (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Social Sciences › Health › Vaccine Coverage and Hesitancy
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
Keywords
HPV vaccine, vaccine acceptance, cervical cancer prevention, vaccine hesitancy, HPV awareness, social stigma, vaccine safety concerns, vaccine cost barriers, physician recommendations, women's attitudes, Mangalore, South India
MeSH terms
Adult, Female, Humans, India, Patient Acceptance of Health Care, Risk Factors, Papillomavirus Infections, Papillomavirus Vaccines, Young Adult

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