Table 2.

Quotes from qualitative interviews from unvaccinated Mexican American young adult women by theme and nativity status

Mexican-Born	U.S.-Born
Individual
Knowledge It’s very much education. I’m not opposed to it [HPV vaccine], as far as like religion or any of that, but just want to be well aware of what it is. Why we should get it? You know? How would it affect us? Like, the good and bad. But I don’t think I feel well educated about it to know like, oh, OK, that’s something that I do want to do. But like anything, right? As far as like, you want to be educated on birth control, you want to be educated on other things Motherhood I want to know how it benefits me or how will it benefit my children. I would want to know more information about that	Perceptions I don’t really like vaccines. … I believe like, even if you get the vaccine or whatever, your body is already immune to it. So, I don’t really think vaccines will help you prevent any type of disease. I’m scared of the pain. I’m not really an injection [person], so I start freaking out I haven’t had sex. I don’t see the need of needing it. It’s a good thing to have to protect against cervical cancer and all that, but as of now, I don’t need it because I’m not active I trust my body. To be honest, I don’t feel comfortable having it [HPV vaccine] in my body. I feel like I don’t need it. I’m not even active [sexually] like that. I don’t want to put something in my body if I don’t know how it’s going to affect me. I’d rather not risk it. I’m actually kind of scared to even do it Motherhood I think now that I am an adult with a child, my opinion has changed a lot in a lot of ways. Like, I appreciate the services provided by the state. I grew up with a lot of women that took care of themselves, and I didn’t realize how important it is. Now, if I got it [HPV vaccine] offered at a clinic, I would say yes because I feel more responsible for my own health. I started carrying about myself more because it’s not all about me anymore. It’s about him [son], too. And my health is his … how he thrives in his life. I definitely think my thoughts have changed because of him The first time I heard about it [HPV virus] was when I was pregnant with my first pregnancy. I didn’t know what HPV was, to be honest. They just said that it’s something that happens. I didn’t hear about the vaccine [HPV] until I was pregnant with my second. I was supposed to get it after I delivered, but I totally forgot about it. They were just trying to get me in and out. It’s hard because I did get pregnant back-to-back
Interpersonal
Quality provider communication It usually never really goes into something very in depth, you know. It’s very much like, when I go to a new place, it’s like, “Oh, we noticed you haven’t gotten it, would you like to get it today?” And that’s kind of what it is. It never, ever really goes into like, “Oh, this is what it will do, this is what it will cause, this is why you would be getting it.” And my experience at UCI has mainly been for another issue that I’ve been dealing with for a long time. So honestly, when it was offered to me at UCI, it was just not my priority. And I also did not ask, nor was it explained to me what it what it really does, you know? I feel like with Hispanic women, we don’t go to the doctor until it’s something really bad. And I feel like clinics just push a lot on us. Clinics should provide more on how to inform women on how to take care of them in advance. So, we can take some time to think about it and it’s not offered in the moment. Sometimes we need a little more information and a little more explanation Mother–daughter communication My mom is very skeptical of vaccines and stuff like that. She thinks home remedies and stuff like that help. Sometimes she thinks certain home remedies will help me, but I like to listen to my physicians because I know everybody’s body is different. There are certain things that may work out for somebody that won’t work out for me. I don’t really like to communicate with her about my health because she is skeptical about certain things. And my doctors know more about what is going on with my body. And like I said, everybody’s body is different Family and cultural norms I think we are very much a united culture. I have friends whose moms won’t let them do this, won’t let them do that [vaccinate]. It’s very much like we want to avoid that conflict, you want to avoid breaking that bond. So, you kind of feel like you have to choose your family. I also have friends whose moms don’t want to be on birth control, and so my friends are not on birth control. You know, you just keep it … to maintain unity and keep the family together, I guess Hispanic parents are often not educated on any of those types of things [vaccines]. I think they don’t know much about the topic so they would see it as something negative. Like, oh, you are getting the vaccine because you have something or you did something [sex]. They are not open to talk about those things in our culture	Quality provider communication I’ve heard the statistics and all that. But I’ve never really had anybody really push me to do so [vaccinate for HPV] The first time I was offered the HPV vaccine, I just said no, because I didn’t understand what the doctor said. Some of the terms I didn’t understand, and she just spoke brief about it. I was shy at the time, too shy to ask any questions. I saw her [provider] in a hurry, and I was like, “Oh yeah, I understand,” but in reality, I didn’t. I just said that because she seemed in a hurry [referring to how she prefers to learn more about HPV] I really like when they hear you out and they try to explain certain things. That feeling that you get, when you ask a question, it’s not a dumb question, and they take their time. You honestly see when something is genuine and when something is rushed. When they just try to get you in and get you out and see the next patient. When you can see why they got into being a doctor, that hospitality care they give to their patients Mother–daughter communication Somebody needs to explain it well enough and not, like, you know, be rude about it. My mom would want to know all the side effects and stuff like that … like, if she has any questions, for the doctor or nurse not to get mad for asking a lot of questions Family and cultural norms As a Mexican American girl, coming from Mexican parents, I think they … well, at least mine are, like, scared to get that because they don’t know what we are putting into our bodies that are going to affect us later on and how we’re gonna react later on. That it’s gonna affect us in some way, shape, or form. My parents have never gotten that vaccine. That’s why they don’t really talk to us about getting vaccinated and things like that. Maybe it’s like, fear or later in the future Always growing up I’ve been told not to trust the doctor and shots and to just pray. I think it’s more of the fear and lack of trust. At least in my family, it’s all about trusting God and praying that it [cancer] wouldn’t happen to you, so just pray. It’s too risky [to vaccinate]. I feel like my friends would say the same thing I feel like the younger generation really doesn’t get into vaccines and all that just because like our family, like older people didn’t get it I think in the Mexican culture, there are some things that are taboo and not discussed. In Mexico, they are raised a different way and they come from a different educational background. In the Mexican culture, there’s a lot of misinformation and misunderstanding about a lot of things, and that influences our decision to not vaccinate for HPV. Things like sex and birth control are topics that are hard to bring up. I couldn’t talk about those things in high school like I can now with my mom because I was a minor at the time
Community
Access to quality care and adverse health care encounters Honestly, it has been the best experience I’ve had so far dealing with medical care in my adulthood. [on booking an appointment] I think it’s not as convenient because of how things are right now. So, it’s very hard to get an appointment. I have to book a little bit over a month in advance It’s harder with insurance. There’s certain insurances clinics won’t take. So, it’s really inconvenient. You need to call the insurance to change the provider. That’s one of the hardest things. You have to double check what can accept what insurances Misinformation I guess in the Latina community, we don’t really talk about those things [HPV], which it shouldn’t be like that. There’s myths about; if you get this vaccine, you might get this or that. They always come up with myths. Like right now, with the coronavirus one, if you get it, you’re gonna die	Access to quality care and adverse health care encounters [regarding rude staff] At one point, I had questions [about HPV]. But I was like, nah, forget it. I felt uncomfortable asking them Misinformation I’ve heard something negative about it. It gives you cancer later in life [HPV vaccine]