Background

In England HPV vaccination is offered to all girls age 12–13 years, free-at-the-point-of-receipt, mostly in schools. Coverage is good, but around 20 % of girls remain unvaccinated. This research sought to explore reasons for being un-/under vaccinated.

Methods

An ethnically diverse sample of girls aged 15–16 years attending one of twelve London schools completed a survey three years after being offered HPV vaccination. Girls reported their HPV vaccine status and those who were unvaccinated (had not received any doses of the vaccine) or under vaccinated (had not completed the recommended 3-dose course) recorded reasons for their un-/under vaccinated status. Reasons were reported using free-text and content analysis was used to analyse responses.

Results

Around 74 % of un-/under vaccinated girls provided a reason for their vaccination status (n = 259). Among unvaccinated girls, the most common reasons related to lack of perceived need for vaccination, concerns about safety and lack of parental consent. Girls who were under vaccinated gave practical reasons, including the need for more information (e.g. not knowing that multiple doses were needed), administrative issues (e.g. school absence), health and procedural concerns (e.g. fear of needles). Descriptively, there were few differences in the reasons given between girls from different ethnic backgrounds. Girls from Black and Asian backgrounds more commonly thought that the vaccine was not needed. Lack of parental consent without providing further explanation was most often cited by girls from Black backgrounds.

Conclusions

Safety concerns and lack of perceived need should be addressed to encourage informed uptake of HPV vaccination. Immunisation programme coordinators may be able to increase series completion by tackling practical problems facing under vaccinated girls.

Table 2

Reasons provided by unvaccinated and under vaccinated participants to explain their vaccination status

Major theme (subthemes)	Examples	n (%) Unvaccinated	n (%) Under vaccinated
		n = 202	n = 57
Lack of parental consent (without explanation)	My parents don’t want me to get it	30 (14.9)	1 (1.8)
Lack of parental consent (with explanation)	Provided below under major themes	52 (25.7)	3 (5.3)
Safety concerns (concern about side effects or long term effects, the novelty of the vaccine, wanting more research, seeing press reports about the death of a girl from HPV vaccine, prefer to delay vaccination)	I was scared about the long-term effects as the vaccine hasn't been around for long My Mum felt it was as if we were being tested on	51 (25.3)	2 (3.5)
The vaccine isn’t needed (not sexually active, not planning on being sexually active, no history of cervical cancer in the family, don’t need it)	Because I am not sexually active and will not be until I get married My Mum didn’t think it was necessary for me to have the vaccine since I won’t be sleeping around	38 (18.8)	1 (1.8)
Administrative reasons (being absent from school, moving schools, being out of the country, recent migration, not having a consent form, didn’t want the vaccine in school, not offered vaccination doses).	I wasn’t in school the day the 3rd injections happened My parents …preferred me to have it at the doctors, not school.	26 (12.8)	29 (50.9)
Need for more information (was not aware of the vaccine, didn’t understand it, not enough information)	I didn’t know about it My Mum wasn’t sure what it was	8 (4.0)	6 (10.5)
Procedural issues (afraid of or dislike needles, pain)	I’m scared of needles	22 (10.9)	3 (5.3)
General vaccination beliefs (don’t believe in vaccinations, don’t’ believe in manmade treatments)	…I wouldn’t want a man-made treatment Mum didn’t think it was natural to have it	5 (2.5)	0 (0)
Health reasons (existing health condition, got ill after previous dose, allergic to ingredients, unwell when vaccine offered).	I have not had it because I suffer from other conditions and therefore was more likely for me to have a negative reaction. My Mum… thinks I might be allergic to HPV vaccine	9 (4.5)	5 (8.8)
Other reasons (don’t know/can’t remember, didn’t want it with no explanation, other)	Because I didn’t want to	22 (10.9)	11 (19.3)