{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:58:52Z","timestamp":1782349132902,"version":"3.54.5"},"reference-count":30,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Global Impact - Vaccine Confidence Fund","award":["VCF-001"],"award-info":[{"award-number":["VCF-001"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,12,12]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess human papillomavirus (HPV) vaccine awareness and uptake among caregivers in rural Indigenous communities in Guatemala and to identify sociodemographic predictors of vaccine unawareness and non-uptake.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional survey was conducted across 12 rural Indigenous communities in Guatemala\u2019s Central Highlands. Using a community-engaged research approach, trained multilingual health workers administered surveys in Spanish, Kaqchikel or K\u2019iche\u2019. Eligible participants were adults who served as primary caregivers to children. The survey assessed HPV vaccine awareness, vaccine attitudes and uptake among those with daughters aged 8 or older. Logistic regression was used to examine predictors of vaccine unawareness and bivariate analysis explored differences in vaccine uptake.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 602 participants (92.5% identified as Indigenous), 95% expressed willingness to vaccinate a child against cervical cancer, yet only 56% had heard of the HPV vaccine. Of the 175 participants with eligible daughters, only 33.7% reported vaccination. Indigenous identity, older age and illiteracy were significantly associated with HPV vaccine unawareness. Speaking an Indigenous language at home was associated with greater awareness. Departmental differences were significant: participants from Solol\u00e1 were more likely to be unaware of the vaccine, while those from Sacatep\u00e9quez had higher awareness and uptake. Community partners noted that access to information, geographic connectivity and social desirability may influence both awareness and response accuracy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite strong willingness to vaccinate, significant knowledge gaps persist among Indigenous caregivers. Tailored, community-informed education strategies\u2014delivered through trusted channels and adapted linguistically and culturally\u2014are urgently needed to increase awareness and uptake of the HPV vaccine in underserved Guatemalan communities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-107602","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T16:10:34Z","timestamp":1767111034000},"page":"e107602","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["HPV vaccine awareness and uptake in rural Indigenous communities in Guatemala: a cross-sectional study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7142-8704","authenticated-orcid":false,"given":"Luc\u00eda","family":"Abascal Miguel","sequence":"first","affiliation":[{"name":"Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rubi","family":"Gait\u00e1n Barrillas","sequence":"additional","affiliation":[{"name":"Chimaltenango Department, Maya Health Alliance Wuqu\u2019 Kawoq, Tecp\u00e1n Guatemala, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6992-5958","authenticated-orcid":false,"given":"Jamie Sewan","family":"Johnston","sequence":"additional","affiliation":[{"name":"Stanford Center for Health Education, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Ward","sequence":"additional","affiliation":[{"name":"Pediatrics, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Kraemer Diaz","sequence":"additional","affiliation":[{"name":"Maya Health Alliance Wuqu\u2019 Kawoq, Tecpan, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8711-3029","authenticated-orcid":false,"given":"Nadia","family":"Diamond-Smith","sequence":"additional","affiliation":[{"name":"Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA"},{"name":"Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,12,30]]},"reference":[{"key":"2026010703485417000_15.12.e107602.1","unstructured":"Guatemala: human papillomavirus and related cancers, fact sheet 2023. 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How can I explain it to my daughter if I don\u2019t know?\u2019: Understanding health communication and routine and HPV vaccine hesitancy in rural Indigenous communities of Guatemala\" to Journal of Global Health. J Glob Health."},{"key":"2026010703485417000_15.12.e107602.19","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-021-12147-z","article-title":"HPV vaccine: uptake and understanding among global Indigenous communities - a qualitative systematic review","volume":"21","author":"Poirier","year":"2021","journal-title":"BMC Public Health"},{"key":"2026010703485417000_15.12.e107602.20","unstructured":"Rivas AM . Vacunas contra el VPH: una administraci\u00f3n desordenada y sin campa\u00f1as. Agencia Ocote; 2022. Available: https:\/\/www.agenciaocote.com\/blog\/2022\/01\/21\/vacunas-contra-el-vph-una-administracion-desordenada-y-sin-campanas\/"},{"key":"2026010703485417000_15.12.e107602.21","doi-asserted-by":"crossref","unstructured":"Muslin C . 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