br Interview guide br Participants were asked a comprehensiv
3.3. Interview guide
Participants were asked a comprehensive sequence of questions regarding cervical cancer screening and HPV. Questions about cervical cancer screening explored experiences with Pap tests (including fre-quency, follow-up care, and treatment), access to specialty care, and relationships with health care providers. Questions about HPV covered awareness, knowledge, and decision-making regarding the virus and the vaccine.
Interviews were digitally recorded and transcribed verbatim. Spanish language interviews were transcribed and then translated into English prior to analysis. Qualitative data analysis software HyperRESEARCH 3.7.3 was used to assist with the analysis and coding of each transcript. Researchers shared memos and observer comments in HyperRESEARCH to maintain self-reflexivity and facilitate a team-based qualitative data analysis approach (Rubin and Rubin, 2012). In 2008, Corbin and Strauss provided a mechanism for researchers to in-corporate a theoretical framework while maintaining the benefits of a grounded Ethylmalonyl Coenzyme A approach. The reproductive justice framework pro-vided the conceptual lens for data analysis. An inductive analytic ap-proach was utilized by researchers to highlight the voices and experi-ences of each participant (Corbin and Strauss, 2008). Researchers employed a constant comparative method to identify patterns and themes across the interviews (Corbin and Strauss, 2008). The re-productive justice framework and line-by-line open coding was used to develop an initial codebook. Researchers coded social, economic, and environmental concepts, such as gender, sexual orientation, race/eth-nicity, SEP, immigration status, age, and ability (See Fig. 1). In line with an intersectional approach, Fig. 1 demonstrates how researchers sys-tematically compared themes across subgroups using axial coding to identify patterns and concepts emerging from the data. The research team met frequently to discuss coding and ensure unanimous agree-ment of coded transcripts. Finally, researchers collectively identified Social Science & Medicine 232 (2019) 289–297
Fig. 1. A reproductive justice approach to HPV vaccination and cervical cancer screening. r> themes and conclusions based on these data.
Participants ranged in age from 19 to 78 years, with an average age of 49.3 ± 14.7 years. The majority of participants (53.6%; n = 37) identified as White with 33.3% (n = 23) identifying as African American/Black and 8.7% (n = 6) as Hispanic. The demographic characteristics of participants generally approximated the overall de-mographics of South Carolina (U.S. Census Bureau, 2016). In addition, 16.4% of participants (n = 11) were immigrants from various coun-tries, including Honduras, Mexico, Jamaica, and Bulgaria, among others. Additional demographic information is presented in Table 1. In the analysis, three primary themes emerged regarding HPV, HPV
Selected demographic characteristics.
Listed as n (%). Frequencies that do not sum to total represent rounding or missing data.
B. Sundstrom, et al.
vaccination, and cervical cancer: misinformation, social norms, and the role of the biomedical paradigm. Fig. 1 contextualizes themes and sub-themes by social, economic, and environmental concepts, including gender, sexual orientation, race/ethnicity, SEP, immigration status, age, and ability.
4.1. Misinformation about HPV, HPV vaccination, and cervical cancer
4.1.1. The impact of “othering” women with HPV and related diagnoses Participants described HPV and HPV-related cervical cancer as
something “other people” face. Many participants underestimated the prevalence of HPV and cervical cancer. According to a 38 year-old African American participant, “with cervical cancer, genome may sound horrible but I don't know that a lot of people get it. I know that it’s hard to detect and it's horrible, but I don't know that tons of women get it.” Some participants also described misinformation that condoms could fully protect against the transmission of HPV. According to a 45 year-old African American participant, “you should always use protection during sex … I feel like that's the only way that you can ward oﬀ against the HPV virus.” Many participants believed that lifestyle choices, such as monogamy, could prevent HPV and cervical cancer. A 49 year-old white participant described this perspective, “well, I only have one partner, so I don't think I would necessarily need it [HPV vaccination]. If I were single and active then yeah, I'd get it.” Overall, participants underestimated the prevalence of cervical cancer and overestimated their personal ability to prevent it without the HPV vaccination.