A Qualitative Study of Parental Knowledge and Perceptions of Human Papillomavirus and Cervical Cancer Prevention in Rural Central Java, Indonesia: Understanding Community Readiness for Prevention Interventions

Background: Cervical cancer (CC) is a leading cause of cancer deaths among Indonesian women. Pilot preventionprograms, including human papillomavirus (HPV) vaccination for young adolescent girls, and cervical screening forwomen, have been implemented. However, many communities are yet to receive these interventions, nor targetededucation regarding CC prevention. This study explored community readiness and acceptance of HPV vaccinationand CC screening, as well as knowledge and perceptions of HPV and CC, to determine facilitators and barriers toupscaling CC prevention in rural Central Java. Methods: Qualitative data collection in October 2015 consisted of fourfocus group discussions with married women and men, and 22 semi-structured interviews with married women. All57 participants, 39 women and 15 men, lived in Purworejo Regency in rural Central Java. Results: Most participantshad no knowledge of HPV or the causal link between HPV and CC. However, most participants were supportive ofvaccinating their children against HPV. Most participants had heard of cervical cancer, although understandings ofsymptoms and causes were very poor. Less than half of the women interviewed had undergone CC screening. Multiplebarriers to screening were reported, including: a dislike of pelvic exams; embarrassment at being screened by a male;anxiety over the cost; fearing a positive result; and being asymptomatic and thus not perceiving the need for screening.Conclusions: Extensive community education about HPV and CC, targeting women and men, adolescents, healthworkers and teachers, is crucial to support the introduction of the HPV Demonstration Program and the upscaling ofCC screening. Low incomes among rural families underline the need for the HPV vaccine to be provided free withinthe National Immunization Program, and for CC screening to be free at primary health clinics.