• Ellen Dias de Oliveira Chiang Department of Anthropology, Emory College, Atlanta, GA, USA.
  • Misha L. Baker Emory University, Rollins School of Public Health, Department of Behavioral Science and Health Education, Atlanta, GA, USA.
  • Daniella Figueroa-Downing Emory University, Rollins School of Public Health, Departments of Epidemiology & Global Health, Atlanta, GA
  • Maria Luiza Baggio Instituto do Câncer do Estado de São Paulo, ICESP, São Paulo, Brazil.
  • Luisa Villa Instituto do Câncer do Estado de São Paulo, ICESP; Department of Radiology and Oncology, School of Medicine, University of São Paulo, Brazil.
  • Jose Eluf Neto Department of Preventive Medicine, School of Medicine, University of São Paulo, Brazil; Fundação Ococentro de São Paulo, FOSP, São Paulo, Brazil.
  • Craig Hadley
  • Robert A. Bednarczyk Emory University, Rollins School of Public Health, Departments of Epidemiology & Global Health; Cancer Prevention and Control Program, Winship Cancer Institute; Emory Vaccine Center, Atlanta, GA.
  • Dabney P. Evans Emory University, Rollins School of Public Health, Departments of Behavioral Science and Health Education & Global Health, Atlanta, GA, USA.
Palavras-chave: Brazil, papillomavirus, vaccination, parental perceptions, adolescent health.


Introduction: In March 2014, Brazil began its national HPV immunization campaign targeting girls ages 9-13. Objective: Describe determinants of parental decisions to vaccinate their daughters against HPV.Method: In this qualitative study, thirty semi-structured interviews were conducted at five health posts in São Paulo, Brazil. Interview questions explored parental opinions of disease prevention methods, vaccines in general, and the HPV vaccine. Interviews were analyzed using grounded theory. Results: Overall, parental knowledge about HPV and the vaccine was low, yet most eligible daughters had been vaccinated. Parents perceived the HPV vaccine to be normal, preventative, and protective. Parents viewed themselves as accountable for their children’s health, and saw the vaccine as a parenting tool for indirect control. Trust in healthcare professionals and an awareness of the dangers of “nowadays” (uncertainties regarding disease and sexual behavior) were also important in vaccine decision-making. These factors held more explanatory power for decisions to vaccinate than parental knowledge levels. This was the first study to qualitatively examine the perception of publically provided HPV vaccination among parents with eligible daughters in Brazil. The findings help interpret the greater than 90% coverage for the first HPV vaccine dose in Brazil. The results indicate that attempts to understand, maintain, or modify vaccination rates require the consideration of context specific factors, which influence both parent perspectives and vaccination decisions. Conclusion: HPV knowledge levels are not predictive of parental decisions to vaccinate daughters. Context specific factors from the sociocultural dimensions of parenting, sexuality, gender, and the healthcare system are more influential in vaccine decision-making.


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