American Indian and Alaska Native community perspectives on HPV vaccination: Insights from providers and parents in a shared tribal clinic setting

INTRODUCTION Human papillomavirus (HPV) vaccination prevents infection of HPV types that cause most cervical cancers, yet American Indian and Alaska Native (AI/AN) youth remain disproportionately under-vaccinated due to structural and community-level barriers. This mixed-methods pilot study assessed multilevel factors among providers and parents within the Riverside-San Bernardino County Indian Health (RSBCIHI) clinic system. METHODS This study aimed to identify multilevel barriers to HPV vaccination by integrating provider and parent perspectives from the same Tribal clinic setting, an area with limited empirical data. Survey items assessed provider-level barriers to HPV vaccine delivery, including communication challenges influencing uptake. Concurrently, pilot qualitative focus groups with AI/AN parents and caregivers explored individual and community influences on vaccine decision-making. Thematic analysis identified emergent sociocultural factors relevant to implementation refinement. RESULTS In October 2025, a baseline survey was administered among 15 clinical staff, including medical assistants (60%), physicians (13%), nurse practitioners (13%), and registered nurses (13%). While 92% of providers viewed HPV vaccination as “very important,” system-level barriers included limited training on addressing parental hesitancy (61%) and inconsistent reminder systems (47%). Reported challenges among parents included limited time with providers during visits (55%), cultural or trust-related concerns (48%), and vaccine safety concerns (67% rated as somewhat of a barrier). Over half of providers (53%) had worked in the clinic for less than one year, indicating high staff turnover. Parent focus group findings (n=3) revealed hesitancy rooted in healthcare provider mistrust, vaccine misinformation, and a desire for increased provider communication on sensitive topics. DISCUSSION This study identified several structural and interpersonal barriers to HPV vaccination within the RSBCIHI Tribal clinic system. Emergent themes from provider surveys included limited time during visits, inconsistent reminder systems, vaccine safety concerns, and frequent staff turnover. Parent perspectives further highlighted hesitancy rooted in vaccine misinformation, limited trust with healthcare providers, and discomfort discussing sensitive topics including sexual health and vaccinations. Together, these provider- and parent-level barriers illustrate the multilevel challenges influencing AI/AN HPV vaccination uptake, which will inform future sustainment strategies to strengthen vaccine confidence and culturally adapted cancer prevention efforts in Native communities.