Parent, Child, and Provider Perspectives on HPV Vaccination in 4-8-Year-Olds: A Mixed Methods Study.

Despite the proven safety and effectiveness of HPV vaccines, fewer than 50% of adolescents in the U.S. complete the full vaccine series. Initiating HPV vaccination at age nine improves completion rates, prompting exploration of vaccination in children younger than nine. However, perceptions among parents, children, and providers regarding early childhood HPV vaccination remain poorly understood. We conducted semi-structured interviews with a subset of participants in an open-label clinical trial evaluating the 2-dose 9-valent HPV vaccine in children aged 4-8 years old. Interviews included five parents, three parent-child dyads, and two healthcare providers. Parent and provider interviews lasted approximately 30 min; child interviews, 15 min. A cross-sectional survey was also administered to parents at trial enrollment. Data from 100 parent-child dyads were analyzed. The mean child age was 6 years; parents averaged 36 years. Most parents were female (83%); racially, 57% identified as African American, 15% Hispanic, 4% White, 2% Asian, and 22% Other. Parents perceived their children as vulnerable to serious illnesses, including HPV-related cancers, and viewed vaccination as beneficial. Trust in providers, providers' commitment to their children's well-being, positive research staff interactions played a key role in successful trial enrollment. Parents emphasized community protection and endorsed early vaccination. Providers highlighted cancer prevention in counseling and supported bundling HPV vaccination at four-year-old schedule to improve uptake and completion. HPV vaccination in children aged 4-8 was well accepted by parents, feasible for providers, and manageable for children. Trust, education, and strategic integration into routine care may facilitate broader acceptance of early HPV vaccination.