Designing for insight. A Mixed-Methods Approach to Unpacking HPV Vaccine Uptake in Rural Uganda

Abstract BackgroundLow uptake of the Human Papillomavirus (HPV) vaccine series presents a persistent challenge in preventing cervical cancer in low-resource settings like Uganda. Effective interventions rely on a nuanced understanding of contributing factors. This paper outlines the comprehensive mixed-methods research approach and cross-sectional design employed to investigate factors associated with low HPV vaccine uptake among adolescent girls in Rukiga District, Uganda.MethodsA convergent mixed-methods, cross-sectional design was utilized integrating quantitative and qualitative data collected concurrently between September and November 2022. The study involved 292 caregivers of adolescent girls and 21 key informants (health workers and Village Health Team members) in Rukiga District. A multi-stage sampling technique ensured representativeness for quantitative data. Quantitative data collected via semi-structured questionnaires were analyzed using descriptive statistics, bivariate analysis, and multivariable logistic regression in SPSS. Qualitative data, gathered through in-depth interviews, underwent thematic analysis. Robust measures for validity (content, construct, face, member checking) and reliability (Cronbach’s alpha, test-retest, intercoder reliability) were implemented to ensure data quality and trustworthiness.ResultsThe mixed-methods approach successfully facilitated the collection of both statistical insights into vaccination rates and an in-depth understanding of underlying beliefs, barriers, and facilitators. The quantitative component provided measurable associations between various factors and HPV uptake while the qualitative component offered rich contextual explanations for these relationships highlighting the "how" and "why" behind observed trends.ConclusionThe employed mixed-methods cross-sectional design proved effective in comprehensively investigating the complex factors influencing HPV vaccine uptake in a rural Ugandan setting. This methodological approach allowed for triangulation of data, enhancing the validity and depth of findings. Lessons learned from this design can inform future research aiming to understand multi-faceted public health challenges in similar contexts.