Barriers and facilitators in implementing human papillomavirus vaccination for adolescent girls: qualitative insights from healthcare implementers in the Korail slum, Dhaka, Bangladesh

Abstract

Introduction: Cervical cancer remains as a significant global health issue, ranking fourth among cancers among women. Low- and middle-income countries (LMICs) account for over 90% of related deaths due to limited access to prevention and treatment. The Human Papilloma (Virus) vaccine offers up to 97% protection against cervical cancer when given to women during adolescence, yet the uptake remains alarmingly low in disadvantaged communities. This study explores the qualitative insights from the implementors to identify the barriers and facilitators to HPV vaccination in the urban Korail slum in Dhaka, Bangladesh. Method: A qualitative exploratory design was employed, involving Key Informant Interviews (KIIs) with nine healthcare implementers, including vaccinators, school principals, and field-level supervisors. Data were analyzed using thematic analysis framed by the Consolidated Framework for Implementation Research (CFIR), highlighting contextual and systemic challenges in the Korail slum setting. Findings: The study identified significant facilitators, including high awareness among healthcare workers involved in HPV vaccination, parents and school teachers about cervical cancer prevention, free vaccine provision, and trust in schools as vaccination sites. Training programs boosted implementers' confidence, while stakeholder engagement involving local leaders, parents, and school teachers enhanced vaccine uptake. However, barriers such as misinformation among community members, the sociocultural stigma among adolescent girls and their parents, logistical constraints, and financial challenges faced by the healthcare workers impeded widespread coverage. Logistical hurdles, including the lack of male assistants and transportation support for healthcare workers, added operational inefficiencies. Conclusion: The study highlights the need to address sociocultural barriers through tailored, community-driven strategies. Enhancing implementers' capacity, combating misinformation with culturally sensitive campaigns, and ensuring sustained logistical support are pivotal to improving vaccine uptake. These insights contribute to refining HPV vaccination programs in resource-constrained settings, aligning with global goals to reduce cervical cancer-related morbidity and mortality. Future interventions should focus on sustainable models and scaling successful practices to similar LMIC contexts.