Culturally Humble Communication and HPV Vaccination Decisions: Healthcare Experiences and Decision-Making Among Sexual and Gender Minority Adults in the United States and Canada

Background/Objectives: Sexual and gender minority (SGM) adults face barriers to HPV prevention related to healthcare access, limited information, and provider assumptions about their identities and healthcare needs. Guided by the cultural humility framework, this study examined SGM adults’ healthcare experiences and HPV vaccination beliefs in the United States and Canada. Methods: Fifty-one SGM adults (23 in Canada and 28 in the United States) completed an online qualitative survey addressing healthcare experiences, communication during sensitive encounters, HPV knowledge and vaccination, and healthcare decision-making. Responses were analyzed using thematic analysis and inductive qualitative content analysis informed by constant comparative techniques. Results: Participants described both affirming care and negative experiences involving identity-based assumptions, misgendering, discrimination, and barriers to appropriate care. They preferred providers to ask about clinically relevant circumstances rather than infer them from identity, explain sensitive questions and procedures, use precise language, protect privacy, obtain ongoing consent, and allow patients meaningful choices during care. Although most viewed HPV vaccination favorably, fewer than half reported receiving at least one dose. Low perceived susceptibility was a common reason for non-vaccination, along with limited information, cost, access, and concerns about stigma. Canadian participants more often encountered HPV vaccination through school-based programs, whereas U.S. participants more often described provider recommendations and other sources of information. Conclusions: Favorable views of HPV vaccination did not consistently translate into (reported) receipt of at least one vaccine dose. Participants’ accounts identify culturally humble communication practices that may improve discussions of HPV prevention by helping providers obtain clinically relevant information without relying on identity-based assumptions, although their effects on vaccination decisions and uptake require further evaluation. Exploratory comparisons between U.S. and Canadian participants also identified differences in how they encountered information about HPV vaccination and opportunities to receive it.