N N N N NN N NN N NN*Note: CS La Legua was selected based on its rural location. doi:10.1371/journal.pone.0048017.tFigure 1. Conceptual model for parental decision-making for HPV vaccine in Piura. The figure illustrates how a variety of different perceptions, experiences, knowledge, and attitudes provide a background context and influence a mother and/or father’s decision to vaccinate their daughter. Divided into phases, the decision-making model demonstrates that if the basis of this decision is sufficiently positive, parents may proceed to accept vaccination; however, if doubts remain, parents may seek further information or opinions and may modify their decision, crystallizing it into refusal or acceptance. Model tested in northern Peru. doi:10.1371/journal.pone.0048017.gPLOS ONE | www.plosone.orgParental Acceptance of HPV Vaccine in PeruFactors that Favored Acceptance of HPV VaccineCommunity sensitization meetings with parents. Immediately following meetings on cervical cancerand the HPV vaccine, many parents agreed to give their consent. This was true in both urban and rural areas, but particularly pronounced in rural areas. Following what they heard in the educational session or read in the PNPP web informed consent and reflected on at home, they felt that these meetings helped them understand the issues, allowed them to ask questions, and encouraged them to accept the vaccination. Nonetheless, afterwards they also asked other people about their perspectives and talked to their husband or wife. Some mentioned that they made a decision after the informational meeting and felt a meeting like that should always be offered. Some parents heard about the vaccine for the first time at this meeting. Some parents said that their daughters talked to them about what they had been taught about cervical cancer and the HPV vaccine.Vaccines are a well-recognized and accepted form of prevention. The parents who accepted HPV R1503 custom synthesis vaccination saidI had not heard of the vaccine for the cervix. For my part I was afraid that it was going to be a dangerous thing because sometimes they get vaccinated and sometimes they die, they become ill or die. And that is the fear that I tell you about as a mom, I was afraid to have them give her the vaccine. So we did not want to accept it. Between us we wondered if it would give a good result. We were so hesitant. The teacher told us not to be afraid as the cervical cancer vaccine is important to them. And we let ourselves be persuaded by the teacher. (rural mother)HPV vaccines are expensive, so we should take advantage of the free opportunity. Many parents, especially those inurban areas, mentioned that they decided to accept HPV vaccination because it was being given free to 5th grade girls. Since the vaccine was too expensive for them to afford through the private sector, they did not want to miss this chance. Parents learned about this opportunity from teachers, health personnel, and their daughters. Yes, they announced that it was a privilege to have the pilot project start in the city, because the vaccine was very expensive and they were giving it in areas with economic shortages… Apart from the information they gave about a better future, it was due to the part that they were helping the population’s health by giving something that was so expensive, making it free… and, well, if it doesn’t cost anything for people with no resources, (you have to) take advantage.” (urban mother)Positive media reports about HPV vacci.N N N N NN N NN N NN*Note: CS La Legua was selected based on its rural location. doi:10.1371/journal.pone.0048017.tFigure 1. Conceptual model for parental decision-making for HPV vaccine in Piura. The figure illustrates how a variety of different perceptions, experiences, knowledge, and attitudes provide a background context and influence a mother and/or father’s decision to vaccinate their daughter. Divided into phases, the decision-making model demonstrates that if the basis of this decision is sufficiently positive, parents may proceed to accept vaccination; however, if doubts remain, parents may seek further information or opinions and may modify their decision, crystallizing it into refusal or acceptance. Model tested in northern Peru. doi:10.1371/journal.pone.0048017.gPLOS ONE | www.plosone.orgParental Acceptance of HPV Vaccine in PeruFactors that Favored Acceptance of HPV VaccineCommunity sensitization meetings with parents. Immediately following meetings on cervical cancerand the HPV vaccine, many parents agreed to give their consent. This was true in both urban and rural areas, but particularly pronounced in rural areas. Following what they heard in the educational session or read in the informed consent and reflected on at home, they felt that these meetings helped them understand the issues, allowed them to ask questions, and encouraged them to accept the vaccination. Nonetheless, afterwards they also asked other people about their perspectives and talked to their husband or wife. Some mentioned that they made a decision after the informational meeting and felt a meeting like that should always be offered. Some parents heard about the vaccine for the first time at this meeting. Some parents said that their daughters talked to them about what they had been taught about cervical cancer and the HPV vaccine.Vaccines are a well-recognized and accepted form of prevention. The parents who accepted HPV vaccination saidI had not heard of the vaccine for the cervix. For my part I was afraid that it was going to be a dangerous thing because sometimes they get vaccinated and sometimes they die, they become ill or die. And that is the fear that I tell you about as a mom, I was afraid to have them give her the vaccine. So we did not want to accept it. Between us we wondered if it would give a good result. We were so hesitant. The teacher told us not to be afraid as the cervical cancer vaccine is important to them. And we let ourselves be persuaded by the teacher. (rural mother)HPV vaccines are expensive, so we should take advantage of the free opportunity. Many parents, especially those inurban areas, mentioned that they decided to accept HPV vaccination because it was being given free to 5th grade girls. Since the vaccine was too expensive for them to afford through the private sector, they did not want to miss this chance. Parents learned about this opportunity from teachers, health personnel, and their daughters. Yes, they announced that it was a privilege to have the pilot project start in the city, because the vaccine was very expensive and they were giving it in areas with economic shortages… Apart from the information they gave about a better future, it was due to the part that they were helping the population’s health by giving something that was so expensive, making it free… and, well, if it doesn’t cost anything for people with no resources, (you have to) take advantage.” (urban mother)Positive media reports about HPV vacci.
