PO.PR01.01 · 预防研究
美洲印第安人和阿拉斯加原住民社区对HPV疫苗接种的看法：来自共享部落诊所环境中医务人员和家长的见解
American Indian and Alaska Native community perspectives on HPV vaccination: Insights from providers and parents in a shared tribal clinic setting
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
引言
人乳头瘤病毒（HPV）疫苗接种可预防导致大多数宫颈癌的HPV型别感染，然而美洲印第安人和阿拉斯加原住民（AI/AN）青少年由于结构性和社区层面的障碍，接种率仍然过低。这项混合方法试点研究评估了Riverside-San Bernardino县印第安人卫生（RSBCIHI）诊所系统中医务人员和家长的多层面因素。
方法
本研究旨在通过整合来自同一部落诊所环境（一个实证数据有限的地区）中医务人员和家长的观点，识别HPV疫苗接种的多层面障碍。调查项目评估了HPV疫苗提供的医务人员层面障碍，包括影响接种的沟通挑战。同时，与AI/AN家长和照护者开展试点定性焦点小组，探讨影响疫苗决策的个人和社区因素。主题分析识别出与实施优化相关的新出现的社会文化因素。
结果
2025年10月，对15名临床工作人员进行了基线调查，包括医疗助理（60%）、医生（13%）、执业护士（13%）和注册护士（13%）。虽然92%的医务人员认为HPV疫苗接种“非常重要”，但系统层面的障碍包括应对家长犹豫的培训有限（61%）和提醒系统不一致（47%）。家长中报告的挑战包括就诊时与医务人员相处时间有限（55%）、文化或信任相关的担忧（48%）以及疫苗安全担忧（67%评为一定程度的障碍）。超过半数医务人员（53%）在该诊所工作不足一年，表明员工流动率高。家长焦点小组结果（n=3）揭示了根植于对医疗服务提供者不信任、疫苗错误信息以及希望医务人员就敏感话题加强沟通的犹豫。
讨论
本研究识别了RSBCIHI部落诊所系统中HPV疫苗接种的若干结构性和人际障碍。医务人员调查中新出现的主题包括就诊时间有限、提醒系统不一致、疫苗安全担忧和员工频繁流动。家长观点进一步凸显了根植于疫苗错误信息、与医疗服务提供者信任有限以及讨论包括性健康和疫苗接种在内的敏感话题时感到不适的犹豫。综合来看，这些医务人员和家长层面的障碍说明了影响AI/AN HPV疫苗接种率的多层面挑战，这将为未来的可持续策略提供参考，以增强原住民社区的疫苗信心和文化适配的癌症预防工作。
查看英文原文 English abstract
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.
利益披露 Disclosure
D. K. Jones, None..
C. Soto, None..
P. Farabaugh, None.