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Navigating vaccine beliefs: a qualitative pilot study of general vaccine attitudes and HPV awareness among Tongan adults

Year: 2026

Type: article

Abstract: Vaccine hesitancy remains a serious public health challenge. Cultural beliefs layered by low vaccine literacy, misinformation, mistrust, and health inequities exacerbate vaccine hesitancy. Native Hawaiian and Pacific Islanders (NHPIs) in the United States (U.S.) experience inequities in routine vaccination, including HPV vaccine awareness and uptake, despite a higher risk of dying from Human Papillomavirus (HPV)-related cervical cancer compared to other groups. Tongan-specific vaccine information clustered within the broad NHPI category obscures cultural, social, and linguistic nuances that shape vaccine perceptions and attitudes. This pilot study explores the behavioral, social, and cultural factors influencing general vaccine and HPV literacy, attitude, experience, and access among Tongans. Guided by the Socioecological Model and the Social Cognitive Theory, three focus group discussions were conducted in English and in Tongan in February and March 2024, among Tongan adults in Utah, aged 18 and older ( n = 19). There was a generational preference on sources of vaccine information. Younger participants (< 55) relied primarily on social media, while older ones (56–65+) expressed confidence in healthcare providers, emphasizing the value of trust between patients and physicians. At the individual level, 78.9% ( n = 15) of participants lacked awareness of the HPV vaccine and its role in preventing cervical cancer. At the family/household level, conformity with gender-based expectations was predominant, with Tongan women viewed as primary caregivers and health decision-makers, bearing the major responsibility for health decisions in the home, including vaccinations. Within close social circles, vaccine hesitancy was heavily influenced by misinformation. Participants articulated the strong reliance on traditional medicine and religious leaders in Tongan communities while discussions of sexual health and sexually-transmitted diseases are limited by social stigma. At the societal level, participants identified systemic gaps, such as inadequate insurance coverage for preventive and therapeutic services, limited access to culturally and linguistically-appropriate health information, and the under-representation of Tongans among healthcare providers and staff. Our findings underscore the need for culturally-specific and culturally-humble vaccine messaging and strategies at various social-ecological levels among Tongan communities to address vaccine concerns, and to counter vaccine misinformation and barriers, especially toward the HPV vaccine.

Source: BMC Public Health

DOI: 10.1186/s12889-026-29627-9