A Qualitative Study of Parental Knowledge and Perceptions of Human Papillomavirus and Cervical Cancer Prevention in Rural Central Java, Indonesia: Understanding Community Readiness for Prevention Interventions

Abstract

Background: Cervical cancer (CC) is a leading cause of cancer deaths among Indonesian women. Pilot prevention<br />programs, including human papillomavirus (HPV) vaccination for young adolescent girls, and cervical screening for<br />women, have been implemented. However, many communities are yet to receive these interventions, nor targeted<br />education regarding CC prevention. This study explored community readiness and acceptance of HPV vaccination<br />and CC screening, as well as knowledge and perceptions of HPV and CC, to determine facilitators and barriers to<br />upscaling CC prevention in rural Central Java. Methods: Qualitative data collection in October 2015 consisted of four<br />focus group discussions with married women and men, and 22 semi-structured interviews with married women. All<br />57 participants, 39 women and 15 men, lived in Purworejo Regency in rural Central Java. Results: Most participants<br />had no knowledge of HPV or the causal link between HPV and CC. However, most participants were supportive of<br />vaccinating their children against HPV. Most participants had heard of cervical cancer, although understandings of<br />symptoms and causes were very poor. Less than half of the women interviewed had undergone CC screening. Multiple<br />barriers to screening were reported, including: a dislike of pelvic exams; embarrassment at being screened by a male;<br />anxiety over the cost; fearing a positive result; and being asymptomatic and thus not perceiving the need for screening.<br />Conclusions: Extensive community education about HPV and CC, targeting women and men, adolescents, health<br />workers and teachers, is crucial to support the introduction of the HPV Demonstration Program and the upscaling of<br />CC screening. Low incomes among rural families underline the need for the HPV vaccine to be provided free within<br />the National Immunization Program, and for CC screening to be free at primary health clinics.