A qualitative exploration of motivations and barriers in the decision-making regarding the uptake of HPV vaccine among caregivers of adolescent girls in Dhaka Korail slums

Abstract

Introduction: Cervical cancer, primarily caused by the human papillomavirus (HPV), remains a health concern globally, particularly in low- and middle-income countries like Bangladesh. HPV vaccination is a proven preventive measure, yet the implementation of HPV vaccination in urban slums such as Dhaka’s Korail slum is challenging. This study aims to explore the motivations and barriers influencing caregivers’ decision-making regarding HPV vaccination for their adolescent daughters aged 10–14 years. Method: The study population is caregivers of adolescent girls aged 10-14 years living in Korail slum Dhaka, Bangladesh. A qualitative study was conducted by using the Behavioral and Social Drivers (BeSD) framework developed by WHO to guide data collection and analysis. In-depth interviews were carried out with eight caregivers, selected through purposive and snowball sampling methods. Data were analyzed thematically to identify interactional factors shaping vaccination decisions. Findings: Caregivers demonstrated low awareness of cervical cancer and HPV vaccination. Motivators for vaccination included trust in school authorities, influence from family and peers, and perceived health benefits for their daughters. Barriers included misinformation, concerns about vaccine side effects, inadequate communication from implementers, and cultural perceptions. Mothers were often the primary decision-makers, with HPV vaccination viewed as a “feminine matter”. Conclusion: The research highlights the urgency for targeted communication strategies to improve caregivers’ understanding of HPV vaccination. Engaging trusted figures such as schoolteachers and community health workers is important to address misconceptions and build trust with caregivers. Specific interventions should focus on enhancing the understanding of HPV vaccination and cervical cancer in urban slum communities, to increase HPV vaccination uptake and prevent cervical cancer in future generations.