br However many participants described the importance of hea
However, many participants described the importance of health care providers supporting and recommending the HPV vaccine. A 51 year-old white participant explained how her provider started a con-versation that helped her make the decision to vaccinate her children, “you know, when your children get to that age, here's something you should really consider and this is why.” Other participants described the persistence of gendered FF-MAS practices in health care settings. According to a 54 year-old white participant, “my daughter and son were at the same pediatrician … I felt like it [the pediatric practice] encouraged me to have the vaccine … For her.”
Researchers conducted in-depth interviews with 70 women between 19 and 78 years old to investigate women's perceptions of cervical cancer prevention, including HPV vaccination. This study answered the call for culture-centered, intersectional approaches to studying health disparities (Agenor et al., 2014; Bellinger et al., 2013; Galbraith et al., 2016). Through a culture-centered approach, this study revealed the voices of women in South Carolina that are often not heard because of marginalization based on race/ethnicity, immigration status, ability/ age, SEP, and gender, sexual orientation, thereby illuminating health inequities and the co-construction of meaning about HPV vaccination and cervical cancer screening (Dutta, 2014; Dutta 2015a; Dutta, 2015b). To summarize, participants described misinformation about the prevalence and risk of HPV and cervical cancer, as well as the ef-fectiveness and safety of the HPV vaccine. Social norms influenced participants' perceptions of HPV vaccination and cervical cancer, in-cluding concerns about sexual activity, the role of identity and gender, and intergenerational communication. Participants described barriers to health care, negotiating cervical cancer screening, and the role of health care providers in perpetuating stigma. Fig. 1identifies a re-productive justice approach to HPV and cervical cancer prevention.
Many participants reported a lack of knowledge about cervical cancer, HPV and the HPV vaccination. Participants underestimated the prevalence of cervical cancer and overestimated their personal ability to prevent eukaryote without receiving the HPV vaccine. This finding reflects extant research that knowledge of HPV and cervical cancer risk is low (Bellinger et al., 2015). This misinformation led some participants to engage in “othering,” whereby individuals impacted by HPV and cer-vical cancer were perceived to diﬀer from themselves in significant
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Ability, Age Implement innovative and accessible approaches to education (e.g., telehealth, social media).
Foster intergenerational communication about cervical cancer prevention, including discussions about family history. Educate clinicians to provide equal access to services for all women and to avoid perpetuating stigma associated with HPV and abnormal Pap tests.
SEP, Immigration Status Move beyond awareness to incorporate the audience's values and needs, including health literacy and patient advocacy, while addressing risks fiandbenets of vaccination, screening and treatment.Implement culturally appropriate community-based interventions that recognize cultural identity, geography, and socioeconomic status impact decisions about vaccination, screening andtreatment.AddressbarrierstoaccessingHPVvaccination and cervical cancer screening, including cost, health insurance coverage, and other economic realities that limit access to care.
Table 2Practical implications of a reproductive justice approach to cervical cancer prevention, including HPV vaccination. Reproductive Justice Concepts To increase women's agency in the development of successful public health interventions and communication campaigns:ThemesGender,SexualOrientationRace/Ethnicity