Young adult perspectives on deciding to get human papillomavirus (HPV) vaccination in urban and rural communities: A qualitative research study

Human papillomavirus (HPV) vaccination coverage in the US is lower than other recommended adolescent vaccines. Coverage is consistently lower in rural areas, compared to urban areas. Despite this, there exists relatively little evidence on perspectives of HPV vaccination during adolescence/young adulthood. We conducted 56 interviews with young adults about their experiences, perspectives, and decision-making with HPV vaccination. Young adults aged 18-21 years who, as adolescents, may have initially refused or delayed (or their parents may have refused or delayed) and subsequently accepted HPV vaccination who resided in rural Wisconsin or urban Minnesota were eligible to participate. Interviews included questions and prompts about decision-making processes and perspectives about HPV vaccination, such as "How did you feel about the HPV vaccine before you got vaccinated?" and "What changes happened that factored into you getting the shot?" In a thematic analysis, young adults valued: information-gathering about vaccines, the opportunity to make vaccine decisions on their own (or with support of parents), and a trusting relationship with their healthcare provider. They expressed a wide range of perspectives on vaccine acceptance and hesitancy. Young adults were more concerned about needles, pain, and discomfort than other adverse outcomes following vaccination. A higher proportion of young adults in urban areas (compared to rural areas) mentioned the importance of trust in their healthcare provider. Strategies to increase HPV vaccine uptake and acceptance may consider young adults' perspectives, including the importance of the information-gathering process and relationships with their healthcare providers.