The critical role of health literacy for Human Papilloma Virus (HPV) vaccine uptake in Hispanic communities

By Dr. Eva M. Moya and Araceli Garcia, BA

Living at the United States-Mexico border presents unique health barriers and opportunities for the Hispanic community. Health disparities, lack of preventative health care, accessibility to health care, distrust in the health system, high rates of those underinsured and uninsured, as well as cultural beliefs pose barriers to access to health services. To initiate a change in preventive care, and with it an increase in favorable prognosis, it is essential for health literacy to reach underserved communities with tailored educational messages and programs.

Lack of culturally and linguistic services can be barriers to access. Effective cultural and linguistic health communication can increase the likelihood of individuals to recognize and timely respond to any health care concerns. However, effective communication can be difficult to accomplish, as underserved populations are often hard to reach. Cultural and linguistically tailored communication approaches can yield to effective and trusted communication with these communities.

One diagnosis that is disproportionally present at a 40% higher rate for the Hispanic community than non-Hispanic Whites are Human Papillomavirus (HPV) related cancers (i.e., oropharyngeal, cervical, anal, vaginal, vulva, penile). It is through a successfully complete dosage of the HPV-vaccine that individuals can get the most protection against the virus and its related cancers in the long term. Regardless of its benefits and approval from the Food and Drug Administration, HPV-vaccination rates remain low.

The current study sought to identify the most prevalent barriers to HPV, screening, treatment, and vaccine among a predominant Hispanic community in El Paso, Texas, to increase vaccine uptake. HPV-related cancer survivors and caregivers were invited to complete tailored bilingual Quality of Life questionnaires and an interview about their cancer journey. The major themes identified were barriers to preventive services and treatment, role of healthcare providers, treatment barriers and challenges associated with caregiving, HPV prevention and health recommendation, and COVID-19 disruptions to health services.

Cancer survivors and caregivers reported limited knowledge, gaps in knowledge, and misinformation about HPV, HPV prevention, and access to healthcare services even after a lived cancer experience. Some of these included incorrectly identifying the eligible ages for vaccination, disagreeing on screening recommendations, believing HPV vaccine is only for girls, tying the vaccine eligibility to sexual activity (i.e., only meant for those who are sexually active, only administered before any sexual activity), and believing the HPV vaccine is still experimental. It was also reported that the vaccine cost and lack of health insurance made vaccine uptake and completion hard to access.

Survivors identified health care provider as being in the forefront of communication, prevention efforts, and education. However, survivors described negative experiences with providers who were cold and lacked compassion, as well as having judgments of their HPV diagnosis and assuming how it was contracted. Caregivers described health care providers as the source for education and guidance and reported but that there is a need for them to promote trust, minimizing shame, and having non-judgmental interactions with their patients.

These findings highlight the need for medical information to reach underserved communities, improve health literacy, and promote vaccine accessibility and availability. Both survivors and caregivers recommend that educational programs include the testimonies of other survivors and caregivers like themselves. Including lived experiences will reduce shame and fear of those in similar situations, as well as making preventive measures and vaccine promotion much more motivational. There is a missed opportunity with health care providers who should prioritize health education with their patients in a non-biased way that can provide support and reduce misconceptions of HPV infections, the HPV vaccine, and overall health care. Another avenue for health literacy programs can consist of the support of Community Health Workers who are already trusted by the community and who could potentially reach those individuals who are not already connected to services of care.

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Article Details
Hispanic Survivors and Caregivers of Human Papillomavirus–Associated Cancers: Lived Experiences in a U.S.–Mexico Border Community
Alondra Avila, MA, Jacquelin Cordero, LMSW, Osinachi Ibilah, LMSW, Gabriel Frietze, PhD, and Eva M. Moya, LMSW, PhD
First published online December 13, 2022
DOI: 10.1177/10901981221139179
Health Education & Behavior

About the Authors

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Dr. Eva M. Moya, is the Interim Chair and Associate Professor of the Social Work Department in the College of Health Sciences at the University of Texas at El Paso. Dr. Moya is a specialist in border health, with more than 40 years of professional experience in the U.S.-Mexico border region. Her expertise includes border health, tuberculosis and stigma, HIV/AIDS, experiences of the home-free, HPV, community health workers, food security, and the photovoice method of research.

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Araceli Garcia, is a Research Assistant for the Border Biomedical Research Center (BBRC). She obtained her Bachelor of Art in Psychology from the University of Texas at El Paso. Her research interests are in mental health treatment disparities in underserved populations (Latinx, criminally-involved individuals, home-free). She is currently involved in the BBRC Behavioral Project which assesses HPV-related knowledge, attitudes, and practices in a Hispanic community sample to identify barriers and facilitate HPV vaccine uptake.