Understanding the HPV vaccine decision making among caregivers of schoolgirls in Mpumalanga and Free State: A Secondary Analysis of qualitative data

Abstract

Introduction: Human papillomavirus (HPV) is linked to cervical cancer, which is the second most common cancer among females in South Africa. Cervical cancer is regarded as a significant public health concern, and vaccination against HPV reduces its risk. In 2014, South Africa introduced a school-based HPV programme to immunise Grade 4 girls. This study explored the perceptions and beliefs that influence caregivers' decisions regarding the HPV vaccine for schoolgirls eligible under the national programme. Method: This secondary data analysis analysed qualitative data collected for the study “Understanding HPV vaccine decision making in South Africa: a qualitative study of vaccine hesitancy in two provinces.” Transcripts from in-depth interviews with caregivers of schoolgirls eligible for vaccination in Lejweleputswa (Free State) and Bushbuckridge (Mpumalanga) were analysed and coded. These included caregivers of schoolgirls involved in the national school-based programme and caregivers of grade 10 girls part of the single-dose catch-up campaign. The interviews were conducted between September and November 2019. A total of 18 transcripts were analysed using the Health Belief Model framework to interpret the coded data. Results: All participants (n = 18) in the study were female. The most common motivators for vaccine acceptance in this population were cervical cancer prevention, as this was seen as the main benefit, and recommendations from healthcare professionals (the most frequent cue to action). The primary barriers contributing to vaccine hesitancy were limited access to information and a lack of awareness and understanding of HPV and cervical cancer. Most caregivers held positive attitudes towards the vaccine. However, concerns about its safety persisted, along with barriers such as poor communication between caregivers and the national programme, as well as cultural or religious factors that hindered vaccine uptake. Conclusion: This study provided a clearer understanding of the factors, both facilitators and barriers, that influence caregivers' decisions regarding the HPV vaccine and vaccine hesitancy within this population. It is recommended that trusted sources, such as healthcare professionals, provide more information. Additional Melissa Moselane MSc (Med) Vaccinology Masters Report Final version September 2025 iv detailed information from the national programme should accompany the consent forms to improve the community's understanding and encourage vaccine uptake.