The Netherlands

Target communities: Turkish and Moroccan community

Vaccine(s): Human Papilomavirus (HPV)

Description of the target community

Stateline data shows 13.872 Turkish and 19.163 Moroccan girls (10-15 years of age) are residing in The Netherlands in first- and second-generation migration background women 0 to 20 years old . They are first- and second-generation migrants, which means that they are born abroad (1st generation) or in the Netherlands (2nd generation) and have at least one parent who was born Many of them came in 1960s settling in small towns. Now they are living throughout the country, but mostly in four biggest cities of the Netherlands.

Vaccine uptake

Although the HPV vaccine uptake is currently unknown in the target community, there are sufficient signals to suggest that the coverage is lower than in the national population. For example, participation in the MenACWY vaccination program is less frequent when parents of adolescents were born abroad (52% Morocco to 88% the Netherlands)3Study data not published yet. In addition, Rondy et al (2010) shows in a study for a HPV catch up campaign in 2009 that girls with both parents born in Turkey or both parents born in Morocco have substantially lower HPV vaccine uptake (respectively 37% (Turkish girls) and 24% (Moroccan girls)), than girls with both parents born in the Netherlands (51,8%). The same results can be seen for girls with one parent born in Turkey (44%) and for girls with one parent born in Morocco (36,3%)4Rondy, M., Van Lier, A., Van de Kassteele, J., Rust, L., & De Melker, H. (2010). Determinants for HPV vaccine uptake in the Netherlands: a multilevel study. Vaccine, 28(9), 2070-2075..

Contextual factors:

Within the Netherlands, Turkish and Moroccan girls are less likely to go to higher secondary education and are more likely to drop out without a secondary-school These girls are also more likely – compared to their Dutch counterparts – to experience multiple other problems, like internalizing and externalizing behavioral issues and problems within their homelife and the life outside of the Also, language barriers still play a role in this group. Parents do not always have enough language skills to understand the information provided on HPV vaccinations.

Health system barriers:

Many Turkish and Moroccan adolescent girls and their parents have negative beliefs and attitudes about HPV-vaccine safety and effectiveness and the conviction that HPV can be extremely harmful, which lead parents and female adolescents to refuse or delay vaccinating for HPV.8Van Lier E, Geraedts J, Oomen P et al. Immunisation coverage and annual report national immunisation programme in the Netherlands 2017. RIVM report 2018–0008., (2018). 9Rondy M, Van Lier A, Van de Kassteele J, et al. Determinants for HPV vaccine uptake in the Netherlands: a multilevel study. Vaccine. 2010;28(9):2070–2075. The ability of the Dutch health system to address the HPV vaccination beliefs and attitudes of Turkish and Moroccan female adolescents and their parents depends largely on the knowledge, skills, motivation and deployment of the healthcare professionals responsible for organizing and delivering the vaccination services and on the readiness of the health system to deliver vaccination services to specific communities. Service-specific readiness refers to the capacity of health facilities to provide the vaccination service, measured through for example trained staff and for intrapersonal and cross-cultural communication guidelines.10Gefenaite G, Smit M, Nijman HW, et al. Comparatively low atten-dance during human papillomavirus catch-up vaccination among teenage girls in the Netherlands: insights from a behavioral survey among parents. BMC Public Health. 2012;12(1):49811Van Keulen HM, Otten W, Ruiter RA, et al. Determinants of HPV vaccination intentions among Dutch girls and their mothers: a cross-sectional study. BMC Public Health. 2013;13(1):111.12Hofman R, van Empelen P, Richardus JH, et al. Predictors of HPV vaccination uptake: a longitudinal study among parents. Health Educ Res. 2013;29(1):83–96.