Participants linked resistance to the HPV
Participants linked resistance to the HPV vaccine for boys and young men with gender norms. One 30 year-old African American participant stressed, “people need to be aware, especially … our young men because they're a little more brave than females are because they sort of kind of feel invincible.” Participants identified gender bias against Acarbose linked to gender norms and identity. One 32 year-old African American participant explained:
There is no man that I have known in life that would be that ahead of the game with protecting themselves … So I would be very sur-prised to see anyone that would take their son … But the way I see them viewing sexual health, I would be very surprised if that caught on at all.
Participants’ gender impacted their health knowledge and nega-tively impacted their decisions regarding the HPV vaccine.
4.2.3. Intergenerational communication and family history of cervical cancer
The meaning of the HPV vaccine and cervical cancer screening diﬀered across generations. According to a 47 year-old white partici-pant who immigrated to the United States, “I've seen it [HPV vaccine] but not really discussed it in relation to myself. I've discussed it more in relation to my daughters. I have three girls.” Similarly, a 40 year-old Latina participant who immigrated from Mexico explains generational diﬀerences as cultural, “But in Mexico, in the ranches it's very-hushed … moms don't talk about it with their kids.” Many participants who were above the target age for HPV vaccination (ages 27 and above) described a lack of knowledge about the HPV vaccine even though they supported it in principle. According to a 47 year-old white participant, “this day and age, girls might be starting to be active [sexually] earlier
… So maybe it’s a good idea to start preventive care earlier than I would have growing up.” Although most older participants, ages 50 and above, were active in the lives of their children and grandchildren and were in a position to oﬀer health recommendations, they often dis-missed HPV and cervical cancer screening as “something younger people would experience.”
Family history of cervical cancer also impacted participants' knowledge, attitudes, and behaviors related to cervical cancer and the HPV vaccine. According to a 37 year-old white participant, “my great-grandmother died from cervical cancer, and they're [health care pro-viders] pretty sure that's [HPV] probably what the cause was, I mean, now, so that's what most of it's caused by.” Participants with a family
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history of cervical cancer strongly supported the HPV vaccine for themselves and their children.
4.3. The role of the biomedical paradigm in HPV vaccination and cervical cancer screening
4.3.1. Barriers to reproductive health care
Participants described barriers to accessing HPV vaccination and cervical cancer screening, including cost, health insurance, and life changes. Many participants described interruptions in access to health care, including yearly exams and screening. According to a 54 year-old white participant who also reported not having a primary health care physician, “I've not had a gynecological exam in probably five years.” Many participants described cost and lack of health insurance as bar-riers to care. According to a 49 year-old white participant who lacked health insurance coverage:
Most challenging was that there isn't very good accessibility to women in lower poverty and no insurance situations, who maybe don't have insurance to go to a private doctor to get the regular health care. It has been diﬃcult, actually, to get the health care that I needed. To get mammograms and Pap smears and that sort of thing.
Participants believed that pregnancy increased access to health care. A 39 year-old Hispanic participant who immigrated to the United States described her experience, “The Pap smear? Yes. I had it done, but I haven't had it done again since she [my daughter] was born.” Other barriers to health care included residing in rural areas and limited ac-cess to health care facilities.