Elsevier

Vaccine

Volume 29, Issue 47, 3 November 2011, Pages 8760-8765
Vaccine

A qualitative analysis of South African women's knowledge, attitudes, and beliefs about HPV and cervical cancer prevention, vaccine awareness and acceptance, and maternal-child communication about sexual health

https://doi.org/10.1016/j.vaccine.2011.07.116Get rights and content

Abstract

In South Africa, cervical cancer is the second leading cause of death among women. Black South Africa women are disproportionately affected by cervical cancer and have one of the highest mortality rates from this disease. Although the body of literature that examines HPV and cervical cancer prevention is growing in the developing world; there is still a need for a better understanding of women's knowledge and beliefs around HPV and cervical cancer prevention. Therefore, this formative study sought to examine women's attitudes, beliefs and knowledge of HPV and cervical cancer, HPV vaccine acceptance, maternal-child communication about sexuality, and healthcare decision-making and gender roles within an urban community in South Africa.

Women ages 18–44 were recruited from an antenatal clinic in a Black township outside of Johannesburg during the fall of 2008. Twenty-four women participated in three focus groups. Findings indicated that the women talked to their children about a variety of sexual health issues; had limited knowledge about HPV, cervical cancer, and the HPV vaccine. Women were interested in learning more about the vaccine although they had reservations about the long-term affect; they reinforced that grandmothers played a key role in a mother's decisions’ about her child's health, and supported the idea that government should provide the HPV vaccine as part of the country's immunization program.

Our findings indicate the need to develop primary prevention strategies and materials that will provide women with basic cervical cancer prevention messages, including information about HPV, cervical cancer, the HPV vaccine, screening, and how to talk to their children about these topics. Prevention strategies should also consider the cultural context and the role that grandmothers play in the family unit.

Section snippets

Backround

In most of the developing world (i.e., less industrialized), cervical cancer remains the top cause of cancer-related deaths among women—a public health threat that is exacerbated by high rates of poverty, poor medical infrastructure, and low or limited access to healthcare and other resources. For example, according to a recent World Health Organization (WHO) report, Central and South America, Eastern Africa, South Asia and Southeast Asia had the highest age-adjusted incidence rates of cervical

Study design and sample

Participants were recruited from an antenatal clinic in a Black township within Johannesburg, South Africa, in the fall of 2008. To be eligible for the study, participants had to be female, be 18–44 years old, read and speak English, and have at least one child. We recruited 120 women to participate in the parent study, which examined women's attitudes, knowledge and practices around HPV and cervical cancer [3]. Of those 120 women, 86 were eligible. As part of the parent study, eligible

Results

Three focus groups were conducted, with a total of 24 participants. All participants had at least some education, with 50% having completed secondary school (i.e., high school equivalent); all had at least one child, 53% had a daughter; and 87% lacked medical aid (equivalent of medical insurance in U.S.). At the beginning of the focus group, the lead facilitator asked participants to introduce themselves and to share information about their children: their biological sex, their ages, and the

Discussion

This is one of the first qualitative studies to examine knowledge of and attitudes about HPV and cervical cancer, as well as knowledge and acceptance of the HPV vaccine, among black women in an urban setting in South Africa. Key findings from this study include:

  • 1)

    Participants talked to their children about a variety of sexual health issues. However, they identified differences in gender role expectations for adolescents who engage in premarital sexual activity, with girls facing the “burden” of

Strengths and limitations

This study has several limitations that should be noted. Due to the study's exploratory nature, reported findings are descriptive in nature. Also, given the non-random nature of participant selection, our findings are not generalizable to all women. Although twenty-four women participated in the three focus groups, we believe we reached the point of saturation, as no new themes or ideas were generated. As is usual in focus groups, some participants were more vocal than others. These focus

Conclusion

The current study highlights some of the social and cultural issues that women face in terms of gender roles and addressing their children's health as well as their own sexual health. Our findings indicate the need to develop primary prevention strategies and materials that will inform women about the basics of cervical cancer prevention, including information about HPV, cervical cancer, the HPV vaccine, screening, and how to talk to their children about these topics. In addition, point-of-use

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