Case of paradoxical cultural sensitivity: Mixed method study of web-based health informational materials about the human papillomavirus vaccine in Israel

Nour Abed Elhadi Shahbari, Anat Gesser-Edelsburg, Gustavo S. Mesch

Research output: Contribution to journalArticlepeer-review


Background: Designing web-based informational materials regarding the human papillomavirus (HPV) vaccine has become a challenge for designers and decision makers in the health authorities because of the scientific and public controversy regarding the vaccine's safety and effectiveness and the sexual and moral concerns related to its use. Objective: The study aimed to investigate how cultural sensitivity (CS) is articulated in the explanatory informational materials on the HPV vaccine that are posted on the websites of the Israeli health authorities. In addition, the study examined the effect of transparency on the expression of CS in the informational materials. Methods: The study employed a quantitative and qualitative content analysis of the texts of explanatory informational materials published on the Arabic and Hebrew websites of the Israel Ministry of Health and the Clalit health maintenance organization (HMO). Results: The findings revealed the differences in the dimensions of CS (based on the CS model by Resnicow) between the informational materials targeting the majority Jewish population and those targeting the minority Arab population. Indeed, the research findings point to a paradox. On the one hand, the materials appealing to the conservative Arab population exhibited CS, in that the sexual context of the vaccine was missing. On the other hand, analysis of Resnicow's deep dimensions showed that disregarding the sexual context does not allow the relevant target audience to reflect on the barriers and concerns. In addition, the way the information was provided exhibited a lack of transparency regarding the CS dimensions (surface and deep). Conclusions: The public health authorities have 2 main objectives in the context of vaccinations. One is to raise the vaccination rates and the other is to provide full and culturally sensitive information to give the public the tools to make intelligent decisions. The findings of this study indicated that despite the high uptake rate for HPV vaccination in the Arab population, the health authorities did not exercise full transparency and CS in transmitting the association between engaging in sexual relations and the necessity of the vaccination. Thus, the major challenge for the health authorities is to find ways to implement the objective of communicating information about the vaccination in a way that is transparent and culturally sensitive, even if this raises questions and fears among the public deriving from their culture.

Original languageEnglish
Article numbere13373
JournalJournal of Medical Internet Research
Issue number5
StatePublished - May 2019

Bibliographical note

Publisher Copyright:
© 2019 Nour Abed Elhadi Shahbari, Anat Gesser-Edelsburg, Gustavo S Mesch.


  • Cultural sensitivity
  • HPV vaccine
  • Hebrew and Arabic
  • Israel
  • Qualitative content analysis
  • Quantitative analysis
  • Sexuality
  • Transparency
  • Web-based health informational materials

ASJC Scopus subject areas

  • Health Informatics


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