et al . et al . et al . et al .
Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective

Human papillomavirus vaccine introduction in Vietnam: formative research findings

Nguyen Quy Nghi A , D. Scott LaMontagne B F , Allison Bingham B , Mirriam Rafiq C , Le Thi Phuong Mai D , Nguyen Thi Phuong Lien D , Nguyen Cong Khanh D , Duong Thi Hong D , Dang Thi Thanh Huyen E , Nguyen Thi Thi Tho D and Nguyen Tran Hien D E

A PATH, Unit 01-02, Floor 2, Hanoi Towers, 49 Hai Ba Trung, Hoan Kiem District, Hanoi, Vietnam.

B PATH, P.O. Box 900922, 2201 Westlake Ave N, Suite 200, Seattle, WA 98109, USA.

C University of California, Berkeley, School of Public Health, Center for Global Public Health, 737 University Hall #7360, Berkeley, CA 94720-7360, USA.

D National Institute of Hygiene and Epidemiology, Ministry of Health of the Socialist Republic of Vietnam, 1 Yersin Street, Hanoi, Vietnam.

E National Expanded Program on Immunization, National Institute of Hygiene and Epidemiology, Ministry of Health of the Socialist Republic of Vietnam, 1 Yersin Street, Hanoi, Vietnam.

F Corresponding author. Email:

Sexual Health 7(3) 262-270
Submitted: 20 November 2009  Accepted: 12 March 2010   Published: 19 August 2010


Background: Formative research is a useful tool for designing new health interventions. This paper presents key findings from formative research conducted in Vietnam to guide human papillomavirus (HPV) vaccine introduction. Methods: We explored the sociocultural environment, health system capacity and the policy-making process using a combined quantitative and qualitative methodology. Data collection was done through literature review, in-depth interviews, focus group discussions, observation checklists and a structured questionnaire on knowledge, attitudes and practices. Populations of interest included 11- to 14-year-old girls, their parents, community leaders, teachers, health workers, health and education officials, and policy-makers at all levels. Results:Although HPV vaccines are new, we found high potential acceptance among parents and girls. HPV vaccine introduction was also favourably supported by health professionals if assurances for system preparedness, e.g. cold chain and human resources, were made. There were no significant barriers from the policy perspective that would prevent the introduction of a new vaccine. However, several concerns related to this new vaccine would need to be adequately addressed before implementation. Conclusion: Our findings provide options for potential vaccine delivery strategies, appropriate communication strategies and targeted advocacy strategies to introduce HPV vaccines in the Vietnamese context.

Additional keywords: health system, policy.


The authors thank the following individuals for their contribution to this study: Phan Dang Than, Luu Phuong Dung, Nguyen Cong Luat, Le Thi Nga, Michelle Gardner, Vu Minh Huong, Trinh Thu Huong, Amynah Janmohamed, Carol Levin, Vivien Tsu, Scott Wittet and Pham Huy Tuan Kiet. We also express our gratitude to the government of Vietnam; the head of the National Expanded Program on Immunization; regional health officials; the leaders of the Provincial Health Services and Preventive Medicine Centers in Thai Binh, Nghe An, Dong Thap, Hanoi and Ho Chi Minh City; the leaders of the District Preventive Medicine Centres in Hung Ha, Tien Hai (Thai Binh), Hung Nguyen, Anh Son (Nghe An), Thanh Binh, Thap Muoi (Dong Thap), Cu Chi (Ho Chi Minh City) and Tu Liem (Hanoi); and local leaders and officials, including the district and commune People’s Committees, heads of commune health stations and immunisation staff, leaders of the education service, school health staff and teachers, and members of the Women’s Unions. Generous funding for this work was provided through a grant to PATH from the Bill & Melinda Gates Foundation.


[1] World Health Organization (WHO), Department of Immunization, Vaccines and Biologicals. Vaccine introduction guidelines. Adding a vaccine to a national immunization programme: decision and implementation. Geneva: WHO; 2005. Available online at: [verified April 2010].

[2] Garnett GP,  Kim JJ,  French K,  Goldie SJ. Chapter 21: Modelling the impact of HPV vaccines on cervical cancer and screening programmes. Vaccine 2006; 24 S178–86.
CrossRef |

[3] Zimet GD,  Liddon N,  Rosenthal SL,  Lazcano-Ponce E,  Allen B. Chapter 24: Psychosocial aspects of vaccine acceptability. Vaccine 2006; 24 S201–9.
CrossRef |

[4] National Expanded Program on Immunization (NEPI), Ministry of Health of the Socialist Republic of Vietnam. The expanded program on immunization: twenty years of achievements in Vietnam. Hanoi: NEPI, Ministry of Health of the Socialist Republic of Vietnam; 2006.

[5] WHO, United Nations Children’s Fund (UNICEF). Review of national immunization coverage 1980–2007, Vietnam. Geneva: WHO, UNICEF; 2008.

[6] Kaljee LM,  Pack R,  Pach A,  Nyamete A,  Stanton BF. Sociobehavioural research methods for the introduction of vaccines in the diseases of the most impoverished programme. J Health Popul Nutr 2004; 22 293–303.
PubMed |

[7] Jheeta M,  Newell J. Childhood vaccination in Africa and Asia: the effects of parents’ knowledge and attitudes. Bull World Health Organ 2008; 86 419–20.
CrossRef | PubMed |

[8] Breinbauer C , Maddaleno H . Youth: choices and change. Promoting healthy behaviors in adolescents. Washington, DC: Pan American Health Organization; 2005.

[9] DeRoeck D. The importance of engaging policy-makers at the outset to guide research on and introduction of vaccines: the use of policy-maker surveys. J Health Popul Nutr 2004; 22 322–30.
PubMed |

[10] Sherris J,  Friedman A,  Wittet S,  Davies P,  Steben M,  Saraiya M. Chapter 25: Education, training, and communication for HPV vaccines. Vaccine 2006; 24 S210–8.
CrossRef |

[11] Bingham A,  Janmohamed A,  Bartolini R,  Creed-Kanashiro H,  Katahoire A,  Khan I, et al. An approach to formative research in HPV vaccine introduction planning in low-resource settings. Open Vaccine J 2009; 2 1–16.
CrossRef |

[12] Green LW , Kreuter MW . Health program planning: an educational and ecological approach. New York: McGraw-Hill; 2005.

[13] Kuzel AJ . Sampling in qualitative inquiry. In Crabtree BF, Miller WL, editors. Doing qualitative research. Newbury Park: Sage Publications; 1992. pp. 33–46.

[14] Carey JW , Gelaude D . Systematic methods for collecting and analyzing multidisciplinary team-based qualitative data. In Guest G, MacQueen KM, editors. Handbook for team-based qualitative research. Lanham: AltaMira Press; 2008, pp. 227–74.

[15] NVivo qualitative data analysis software Version 7.0 [computer program]. Melbourne: QSR International Pty Ltd; 2006.

[16] MacQueen KM , McLellan-Lemal E , Bartholow K , Milstein B . Team-based codebook development: structure, process, and agreement. In Guest G, MacQueen KM, editors. Handbook for team-based qualitative research. Lanham: AltaMira Press; 2008.

[17] Cokelet E , Wilson R . Advocacy to improve global health: strategies and stories from the field. Washington, DC: PATH; 2009.

[18] Barbour RS. Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? BMJ 2001; 322 1115–7.
CrossRef | CAS | PubMed |

[19] Miles MB , Huberman AM . Qualitative data analysis: an expanded sourcebook. Thousand Oaks: Sage Publications, Inc.; 1994.

[20] Frankel RM . Standards of qualitative research. In Crabtree BF, Miller WL, editors., Doing qualitative research. 2nd edn. Thousand Oaks: Sage Publications, Inc.; 1999, pp. 333–46.

[21] Microsoft Excel 2003 [computer program]. Redmond: Microsoft Corporation; 2003.

[22] Microsoft Access 2003 [computer program]. Redmond: Microsoft Corporation; 2003.

[23] Epi Info 2000 Version 6.0 [computer program]. Atlanta: Centers for Disease Control and Prevention; 2000.

[24] SPSS for Windows Version 10.0 [computer program]. Chicago: SPSS; 2006.

[25] Approving the national strategy on reproductive health care for the period 2001–2010, Decision No. 136/2000/QD-TTg (November 28, 2000). Hanoi: The Socialist Government of Vietnam; 2000.

[26] Approving the strategy for protection and care of the people’s health in the 2001–2010 period, Decision No. 35/2001/QD-TTg (March 19, 2001). Hanoi: The Socialist Government of Vietnam; 2001.

[27] Approving the program on preventing and combating some non-contagious diseases in the 2002–2010 period, Decision No. 77/2002/QD-TTg (June 17, 2002). Hanoi: The Socialist Government of Vietnam; 2002.

[28] Approving the national target program on prevention and control of a number of social diseases, dangerous epidemics, and HIV/AIDS in the 2006–2010 period, Decision No. 108/2007/QD-TTg (July 17, 2007). Hanoi: The Socialist Government of Vietnam; 2007.

[29] WHO, United Nations Population Fund. Preparing for the introduction of HPV vaccines: policy and programme guidance for countries. Geneva: WHO; 2006. Available online at: [verified April 2010].

[30] Minh Thang N,  Bhushan I,  Bloom E,  Bonu S. Child immunization in Vietnam: situation and barriers to coverage. J Biosoc Sci 2007; 39 41–58.
CrossRef | PubMed |

[31] Inter-ministerial circular on vaccination activities in elementary and primary school, No. 12/2001/TTLT/BYT-BGDDT. Hanoi: Ministry of Health and Ministry of Education and Training, Socialist Republic of Vietnam; 2001.

[32] Thiem VD,  Danovaro-Holliday MC,  Canh Do G,  Son ND,  Hoa NT,  Thuy DT. The feasibility of a school-based VI polysaccharide vaccine mass immunization campaign in Hue City, central Vietnam: streamlining a typhoid fever preventive strategy. Southeast Asian J Trop Med Public Health 2006; 37 515–22.
PubMed |

[33] Loi TT,  Nhung BTH. Screening cervical cancer of perimenopausal women in Ho Chi Minh City. HCMC J Med 2004; 8(Suppl 1): 116–9.

[34] Dinh TA,  Rosenthal SL,  Doan ED,  Trang T,  Pham VH,  Tran BD, et al. Attitudes of mothers in Da Nang, Vietnam toward a human papillomavirus vaccine. J Adolesc Health 2007; 40 559–63.
CrossRef | PubMed |

[35] Sarin R. HPV vaccine for primary prevention of cervical cancer in developing countries: the missing links. J Cancer Res Ther 2008; 4 105–6.
CrossRef | PubMed |

[36] Nichter M. Vaccinations in the third world: a consideration of community demand. Soc Sci Med 1995; 41 617–32.
CrossRef | CAS | PubMed |

[37] Expanded Programme on Immunization The social science and immunization research project. Wkly Epidemiol Rec 1998; 73 285–8.
PubMed |

[38] Kaufmann AM,  Schneider A. New paradigm for prevention of cervical cancer. Eur J Obstet Gynecol Reprod Biol 2007; 130 25–9.
CrossRef | PubMed |

[39] Constantine NA,  Jerman P. Acceptance of human papillomavirus vaccination among Californian parents of daughters: a representative statewide analysis. J Adolesc Health 2007; 40 108–15.
CrossRef | PubMed |

[40] Brabin L,  Roberts SA,  Stretch R,  Baxter D,  Chambers G,  Kitchener H, et al. Uptake of first two doses of human papillomavirus vaccine by adolescent schoolgirls in Manchester: prospective cohort study. BMJ 2008; 336 1056–8.
CrossRef | PubMed |

[41] Leader AE,  Weiner JL,  Kelly BJ,  Hornik RC,  Cappella JN. Effects of information framing on human papillomavirus vaccination. J Women’s Health 2009; 18 225–33.
CrossRef |

[42] Van Damme P,  Pecorelli S,  Joura EA. The introduction of policies for human papillomavirus vaccination in Europe. J Public Health 2008; 16 291–8.
CrossRef |

[43] Katahoire A,  Jitta J,  Kivumbi G,  Murokora D,  Arube Wani J,  Siu G, et al. An assessment of the readiness for introduction of the HPV vaccine in Uganda. Afr J Reprod Health 2008; 12 159–72.
CAS | PubMed |

A AWe also gathered quantitative knowledge, attitudes and practices data through a KAP survey in the sociocultural research. However, this paper focuses on the qualitative research findings. Other results will be presented in a separate publication (currently in preparation).

Rent Article (via Deepdyve) Export Citation Cited By (21)