| Summary: | Primary prevention of Human Papillomavirus (HPV) infection through vaccination of young women before sexual debut is recommended by the World Health Organisation. HPV vaccination programmes are being implemented throughout the world, including the United Kingdom, and have the potential to reduce substantially cervical cancer mortality over the long term. To prevent existing inequalities in cervical cancer mortality from widening equitable provision of HPV immunisation is required. Using a mixed methods approach, the aim of this thesis was to examine inequalities of uptake of HPV vaccination by young women. Quantitative research methods were used to ascertain whether inequalities existed and identify factors associated with inequalities in uptake. A systematic review and metaanalysis indicated differences in HPV vaccine initiation by ethnicity and healthcare coverage, but no strong evidence for differences by socioeconomic variables. In the predominantly school-based HPV vaccination programme in the south west of England, uptake was not shown to vary markedly by social deprivation. However, associations with ethnicity and substantially lower uptake in non-mainstream educational settings were observed. Qualitative studies were undertaken to understand factors affecting lower HPV vaccine uptake. A qualitative systematic review and evidence synthesis indicated that decision making about HPV vaccination of young women in high-income countries is dominated by policy makers, healthcare professionals, and parents. Based on cultural perceptions about sexual activity, parents may decide not to allow their daughters to be vaccinated. A case study showed unresolved tension for responsibility of key aspects of the HPV vaccination programme in the south west of England prevents uptake. Overall, the findings from this thesis can be used to inform the development of interventions to increase uptake and address inequalities. A complex intervention, which addresses procedures for consent, increases access by setting of vaccine delivery, and overcomes cultural and literacy barriers faced by minority ethnic groups is recommended.
|
|---|
