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Barriers and facilitators to human papillomavirus vaccination among Chinese adolescent girls in Hong Kong: a qualitative–quantitative study
  1. T T C Kwan1,
  2. K K L Chan1,
  3. A M W Yip1,
  4. K F Tam1,
  5. A N Y Cheung2,
  6. P M C Young3,
  7. P W H Lee4,
  8. H Y S Ngan1
  1. 1
    Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, University of Hong Kong, Hong Kong, China
  2. 2
    Department of Pathology, University of Hong Kong, Hong Kong, China
  3. 3
    School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
  4. 4
    Division of Clinical Health Psychology, Department of Psychiatry, University of Hong Kong, Hong Kong, China
  1. Professor H Y S Ngan, Department of Obstetrics and Gynaecology, 6/F, Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China; hysngan{at}


Objectives: To explore perceptions towards cervical cancer, human papillomavirus (HPV) infection and HPV vaccination and to identify factors affecting the acceptability of HPV vaccination among Chinese adolescent girls in Hong Kong.

Methods: Six focus groups were conducted with Chinese adolescent girls (median age 16 years, age range 13–20, n  =  64) in Hong Kong in April 2007. Thematic analysis was employed to identify major themes related to cervical cancer and HPV vaccination. A supplementary questionnaire was administered to all participants before and after group discussion to assess their knowledge, attitudes and intention to be vaccinated and to collect demographic information.

Results: Participants’ knowledge on cervical cancer was limited and HPV was largely unheard of. They had difficulty understanding the mechanism linking cervical cancer with HPV infection. Participants held a favourable attitude towards HPV vaccination but the perceived timing of vaccination varied. Barriers to vaccination include high monetary cost, uncertain length of vaccine effectiveness, low perceived risk of HPV infection, no immediate perceived need of vaccination, anticipated family disapproval and fear of the pain of injection. Factors conducive to vaccination include perceived family and peer support and medical reassurance on safety and efficacy of vaccine. The differences on knowledge, attitudes, intention to be vaccinated now and willingness to conform to significant others before and after the discussion were statistically significant, with an increased tendency towards favouring vaccination after the focus group.

Conclusions: Participants favoured HPV vaccination despite not feeling an immediate need to be vaccinated. Interventions could focus on providing professional information on HPV vaccination and raising adolescents’ perceived need to take preventive measures against HPV infection.

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  • Contributors: TK, design, implementation, facilitator, analysis, chief writer of the manuscript; KC, conception, design, co-editor; AY, facilitator; KT, design, co-editor; AC, design, co-editor; PY, facilitator; PL, project supervisor, facilitator, analysis, co-writer, co-editor; HN, research team leader, design, co-editor; TK and KC are co-first authors; HN and PL are senior and co-corresponding authors.

  • Funding: This research was jointly funded by the Wong Check She Charitable Foundation and the Research Fund from the Department of Obstetrics and Gynaecology, The University of Hong Kong.

  • Competing interests: None declared.

  • Ethics approval: Before commencement of the study, approval from the Ethics Committee of the Joint Board of The University of Hong Kong and Queen Mary Hospital was obtained.