# Healthcare workers’ and caregivers’ knowledge, perceptions and experiences of the school-based human papillomavirus (HPV) immunization program: A qualitative study in eThekwini District of the KwaZulu-Natal Province, South Africa

## TL;DR

This study explores healthcare workers and caregivers' knowledge and perceptions of a school-based HPV vaccination program in South Africa, highlighting factors influencing vaccine acceptance.

## Contribution

The study provides insights into local barriers and facilitators of HPV vaccine uptake in a South African district using a WHO-informed qualitative approach.

## Key findings

- Healthcare workers understood HPV vaccine benefits, but caregivers had varied knowledge and misconceptions.
- Caregivers' perceptions ranged from supportive to doubtful, influenced by information, culture, and communication.
- Practical difficulties and cultural beliefs were identified as key barriers to HPV vaccine acceptance.

## Abstract

The introduction of human papillomavirus (HPV) vaccination programs is a significant achievement in preventing cervical cancer and other HPV-related illnesses. This study aimed to explore healthcare workers (HCWs) and caregivers (CGs) knowledge, perceptions and experiences surrounding the school-based HPV immunization program in eThekwini District, KwaZulu-Natal Province, South Africa. CGs refer to parents or other individuals responsible for making vaccination decisions for eligible girls. A qualitative study design was employed that incorporated in-depth, semi-structured interviews with 20 CGs and 20 HCWs from different areas of eThekwini District who are involved in a school-based HPV immunization program. The study was informed by the World Health Organization’s Measuring Behavioral and Social Drivers of Vaccination (BeSD) approach. The BeSD resources include qualitative tools for conducting in-depth interviews that informed our interview guide. Thematic analysis was used to analyze interviews that were recorded, transcribed, and translated. HCWs indicated a thorough understanding of HPV and the vaccine’s benefits, but CGs’ knowledge varied, with some having misconceptions about the vaccine. HCWs largely praised the school-based HPV immunization program initiative but noted practical difficulties. CGs’ perceptions varied from supportive to doubtful, depending on the information they received. Common impediments highlighted included a lack of information, cultural and religious beliefs and communication breakdowns. The study established that factors such as culture, information, and interpersonal experiences influence the knowledge, acceptance, and uptake of the HPV vaccine. The findings are anticipated to guide development of tailored interventions to increase HPV vaccination coverage in South Africa.