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Graduation Date

Spring 5-9-2026

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Nursing

First Advisor

Robin M. Lally

Second Advisor

Kristin Dickinson

Abstract

Sexual and gender diverse (SGD) men bear a disproportionate burden of HPV-related cancers, yet uptake of vaccination and screening remains critically low. The social psychological processes underlying this disparity are poorly understood, and the existing literature is limited by provider-focused perspectives, atheoretical interventions, and population constructs that obscure who is actually being studied. The purpose of this dissertation was to advance understanding of HPV-related cancer prevention and detection among SGD men by examining the problem at three levels: provider education, research methodology, and patient experience. An integrative review synthesized evidence on educational programs for healthcare professionals and health sciences students addressing cancer screening for sexual and gender minority populations. Findings revealed that existing programs are few, methodologically heterogeneous, and largely atheoretical, establishing a significant provider-side gap in HPV prevention readiness. A scoping review of 222 articles across 43 countries then examined how the term "men who have sex with men" (MSM) is used and defined in HPV-related cancer research. Results showed that MSM functions predominantly as an assumed rather than defined category, with fewer than 6% of articles specifying all four components of gender and sexuality. The resulting evidence disproportionately captures cisgender gay men while presenting findings as broadly applicable, raising concerns about representational adequacy and generalizability. These findings informed a constructivist grounded theory study based on semi-structured interviews with 12 SGD men. Guided by symbolic interactionism and intersectionality, the analysis generated the theory of Making HPV Visible, which explains how HPV is rendered structurally invisible through four intersecting conditions: an HIV-centric sexual health infrastructure, institutional cis-heteronormativity, precarity of clinical access, and provider knowledge gaps. When visibility is achieved, it unfolds through three phases—building conditions for visibility, making HPV visible, and translating visibility into action—each characterized by structural fragility, temporal vulnerability, and cognitive transience. The theory reframes HPV prevention failure among SGD men as a deficit of structural visibility rather than individual motivation. Findings carry implications for nursing practice, health policy, provider education, and the design of interventions that address systemic rather than individual-level barriers to HPV-related cancer prevention.

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