Views on HPV-vaccination held by parents of Turkish and Moroccan origin in the Netherlands: an exploratory study using Q-methodology

Background: 

Health disparities between people with and without a migration background remain a persistent issue across Europe, with individuals from non-European immigrant backgrounds often experiencing particularly negative outcomes. These populations also face higher risks of infection-related cancers, including those caused by Human Papillomavirus (HPV). Vaccination programs have the potential to mitigate such disparities. In the Netherlands, this potential is undermined by the low uptake among certain groups, especially individuals of Turkish and Moroccan origin, who represent two of the largest non-European ethnic minorities in the country. The underlying reasons for this low uptake are rarely explored in depth. This study, therefore, focuses on parents of Turkish and Moroccan origin living in the Netherlands, exploring their perspectives on HPV vaccination for their children aged 7 to 9 years. Building on the Health Belief Model, the study also considers how potentially gendered norms and expectations may influence parents’ attitudes toward vaccinating sons versus daughters.

Methods: 

Q-methodology, a research technique that combines qualitative and quantitative methods to systematically study people's subjective viewpoints, was used to gain insights into parents' perspectives on HPV vaccination. 29 parents of Turkish or Moroccan origin in the Netherlands with children aged 7–9 were asked to rank 30 statements based on the Health Belief Model between April 2024 and January 2025. After ranking the statements, respondents were asked to explain the reasoning behind their rankings. By-factor analysis was used to identify distinct perspectives. The qualitative material was used to verify and refine the interpretation of the perspectives. 

Results: 

Three distinct perspectives were identified: 1. “Distrust, Uncertainty and Negative experiences as Barriers to Vaccination”, 2. HPV-Specific Vaccine Hesitancy: Concerns About Early-Age Vaccination and Necessity, and 3. Vaccination as key to preventing HPV-related disease. 

Conclusion: 

This study highlights the diversity of parental perspectives on HPV vaccination within Turkish and Moroccan communities in the Netherlands. While some parents support HPV vaccination as a preventive measure, others express great hesitancy. The root of this hesitancy differs somewhat between subgroups of vaccine-hesitant parents of Turkish and Moroccan origin. These findings underscore the need for tailored communication strategies to support informed decision-making and improve vaccine uptake.