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Brohman I, Blank G, Mitchell H, Dubé E, Bettinger JA. Opportunities for HPV vaccine education in school-based immunization programs in British Columbia, Canada: A qualitative study. Hum Vaccin Immunother 2024; 20:2326779. [PMID: 38517252 PMCID: PMC10962613 DOI: 10.1080/21645515.2024.2326779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/01/2024] [Indexed: 03/23/2024] Open
Abstract
Despite the availability of school-based immunization programs (SBIPs) in Canada, human papillomavirus (HPV) vaccine uptake remains suboptimal. Vaccine education may improve vaccine uptake among adolescents. The objective of this qualitative study was to identify opportunities for HPV vaccine education in British Columbia, Canada, by exploring the perspectives of students, parents, school staff, and public health nurses on the current SBIP. Individual semi-structured interviews were conducted with adult participants and focus groups were conducted with grade 6 students between November 2019 and May 2020. The interviews and focus groups were transcribed and then analyzed using reflexive thematic analysis. Opportunities for HPV vaccine education were identified in three themes: 1) making SBIPs student-centered; 2) adopting a collaborative and interdisciplinary approach to vaccine education; and 3) actualizing parent education opportunities. Broad support existed for a formal, collaborative HPV grade 6 vaccine curriculum delivered by teachers and public health nurses to provide evidence-based health information. Participants voiced that the curriculum should integrate students' perspectives on topics of interest and address needle associated pain and anxiety. Parents were identified as the primary vaccine decisionmakers, therefore, participants stated it was crucial to also provide parent-directed vaccine education as part of SBIP. Our findings support the development of a collaborative HPV vaccine curriculum directed to and informed by students and parents to buttress current SBIPs in British Columbia.
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Affiliation(s)
- Isabella Brohman
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Gabriel Blank
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Hana Mitchell
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Eve Dubé
- Department of Anthropology, Laval University, Laval, QC, Canada
| | - Julie A. Bettinger
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Kemble H, Foster M, Blamires J, Mowat R. Children and young people's self-reported experiences of asthma and self-management nursing strategies: An integrative review. J Pediatr Nurs 2024; 77:212-235. [PMID: 38598994 DOI: 10.1016/j.pedn.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/16/2024] [Accepted: 03/17/2024] [Indexed: 04/12/2024]
Abstract
AIM To explore children and young people's (CYP) (5-24 years of age) self-reported experiences of asthma self-management strategies (ASMS) with nursing involvement across various settings. BACKGROUND Childhood asthma is an increasingly significant health issue, highlighting the importance of acquiring self-management skills to optimise future health outcomes. Registered nurses play a pivotal role in delivering appropriate, personalized self-management support. METHODS This integrative review searched four electronic databases: Cumulated Index to Nursing and Allied Health Literature via Elton B. Stephens Company, Medical Literature Analysis and Retrieval System Online (MEDLINE), Object, View and Interactive Design (OVID), and PubMed, that followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis flowchart. Included studies were critically appraised using the Joanna Briggs Institute critical appraisal tools. Braun and Clarks thematic analysis was used to generate themes, and sub-themes. FINDINGS Fifteen studies were included for review. Thematic analysis generated three themes being healthy literacy; health and wellbeing; and tools and working together. CONCLUSIONS Asthma continues to have negative physical, psychological, and social implications among CYP. CYP are both willing and capable of engaging in ASMS and learning self-management skills, however, continue to have unmet self-management needs. IMPLICATIONS TO PRACTICE Strategies must bolster health literacy, improve physical and psychological health, and harness interactive, youth-centric, and informative tools to facilitate communication and decrease the burden of self-management. Applications pose a promising avenue for self-management support. This age group remains under-explored and future research should enable meaningful engagement with CYP to better understand their perspectives and improve strategy success.
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Affiliation(s)
- H Kemble
- Auckland University of Technology, School of Clinical Sciences, Auckland, New Zealand; Auckland University of Technology, School of Clinical Sciences (Nursing), 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand
| | - M Foster
- Auckland University of Technology, School of Clinical Sciences, Auckland, New Zealand; Edith Cowan University, School of Nursing and Midwifery, Perth, Western Australia, Australia; Auckland University of Technology, School of Clinical Sciences (Nursing), 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand.
| | - J Blamires
- Auckland University of Technology, School of Clinical Sciences, Auckland, New Zealand; Auckland University of Technology, School of Clinical Sciences (Nursing), 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand.
| | - R Mowat
- Auckland University of Technology, School of Clinical Sciences, Auckland, New Zealand; Auckland University of Technology, School of Clinical Sciences (Nursing), 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand.
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Gallant AJ, Johnson C, Steenbeek A, Parsons Leigh J, Halperin SA, Curran JA. Stakeholders' experiences with school-based immunization programs during the COVID-19 pandemic in the Canadian Maritimes: A qualitative study. PUBLIC HEALTH IN PRACTICE 2024; 7:100505. [PMID: 38807702 PMCID: PMC11130716 DOI: 10.1016/j.puhip.2024.100505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/26/2024] [Accepted: 05/09/2024] [Indexed: 05/30/2024] Open
Abstract
Background School-based immunization programs (SBIP) support access to routine vaccines for adolescents. Across Canada, the COVID-19 pandemic and subsequent public health measures affected SBIP and vaccine uptake. The objectives of this study were to explore 1.) stakeholders' experiences with SBIP and changes to programs during COVID-19 in Nova Scotia, Prince Edward Island and New Brunswick, and 2.) how the pandemic affected parents' and adolescents' vaccine views. Study design Semi-structured interviews with decision makers, healthcare providers, teachers, parents and adolescents between February-August 2023. Methods The COM-B model and Theoretical Domains Framework informed interview guides. Deductive and inductive analyses saw participant quotes mapped to relevant model components and domains by two coders. Belief statements were generated within each stakeholder group then compared to identify themes and subthemes. Results Participants (n = 39) identified five themes: 1) enablers to SBIP delivery, 2) barriers to SBIP delivery, 3) desired changes to SBIP delivery, 4) student anxiety, and 5) vaccination views and changes since the COVID-19 pandemic. Public health measures facilitated more space for clinics, as did taking smaller cohorts of students. School staff-healthcare provider relationships could help or hinder programs, particularly with high turnover in both professions during the pandemic. Adolescents played a passive role in vaccine decision making, with mothers often being the sole decision maker. We did not identify any changes in hesitancy towards routine vaccines since the pandemic. Conclusions We identified a range of barriers and enablers to SBIP, many of which were exacerbated by the pandemic. Efforts are needed to ensure SBIP and catch-up programming remains accessible for all adolescents to catch-up on missed vaccines before graduation. Parents and adolescents' vaccination views suggest changes in vaccine coverage since the pandemic may be due to accessibility of services rather than vaccine hesitancy. Future research is needed to engage adolescents in their vaccine decisions.
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Affiliation(s)
- Allyson J. Gallant
- Faculty of Health, Dalhousie University, 5968 College Street, PO BOX 15000, Halifax, NS, B3H 4R2, Canada
| | - Catie Johnson
- School of Communication Sciences and Disorders, Dalhousie University, Halifax, NS, Canada
| | | | | | - Scott A. Halperin
- Dalhousie University, Canadian Center for Vaccinology, Halifax, NS, Canada
| | - Janet A. Curran
- School of Nursing, Dalhousie University, Halifax, NS, Canada
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Choi J, Gabay EK, Cuccaro PM. School Teachers' Perceptions of Adolescent Human Papillomavirus (HPV) Vaccination: A Systematic Review. Vaccines (Basel) 2024; 12:361. [PMID: 38675743 PMCID: PMC11053788 DOI: 10.3390/vaccines12040361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
School nurses are uniquely positioned to educate students about immunizations, including human papillomavirus (HPV) vaccination, but schools are often without a nurse for different reasons. In lieu of nurses, teachers who closely interact with students and are traditionally well-trusted by parents may be able to communicate about HPV vaccination, alleviating parental vaccine hesitancy. This systematic review explores school teachers' perspectives on adolescent HPV vaccination and factors influencing their willingness to make vaccine recommendations. We searched three databases with appropriate medical subject headings and keywords to identify relevant studies. We reviewed fifteen studies and provided an extensive summary and a comparison of the results across the studies. Teachers had low to moderate levels of HPV knowledge with low self-efficacy to counsel parents about the HPV vaccine and expressed concerns about the vaccine condoning adolescent sexual activity, vaccine side effects, and parental disapproval. Nonetheless, some teachers showed interest in learning about vaccine effectiveness in preventing HPV-associated cancers and wanted guidance on vaccine communication with parents, viewing schools as adequate venues to promote and deliver HPV vaccines. Schools should consider educating teachers on HPV and HPV vaccination, with a focus on effective vaccine communication practices to increase adolescent HPV vaccine uptake.
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Affiliation(s)
- Jihye Choi
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA;
- Center for Health Promotion and Preventive Research, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA;
| | - Efrat K. Gabay
- Center for Health Promotion and Preventive Research, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA;
| | - Paula M. Cuccaro
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA;
- Center for Health Promotion and Preventive Research, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA;
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Stacey D, Lewis KB, Smith M, Carley M, Volk R, Douglas EE, Pacheco-Brousseau L, Finderup J, Gunderson J, Barry MJ, Bennett CL, Bravo P, Steffensen K, Gogovor A, Graham ID, Kelly SE, Légaré F, Sondergaard H, Thomson R, Trenaman L, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2024; 1:CD001431. [PMID: 38284415 PMCID: PMC10823577 DOI: 10.1002/14651858.cd001431.pub6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Patient decision aids are interventions designed to support people making health decisions. At a minimum, patient decision aids make the decision explicit, provide evidence-based information about the options and associated benefits/harms, and help clarify personal values for features of options. This is an update of a Cochrane review that was first published in 2003 and last updated in 2017. OBJECTIVES To assess the effects of patient decision aids in adults considering treatment or screening decisions using an integrated knowledge translation approach. SEARCH METHODS We conducted the updated search for the period of 2015 (last search date) to March 2022 in CENTRAL, MEDLINE, Embase, PsycINFO, EBSCO, and grey literature. The cumulative search covers database origins to March 2022. SELECTION CRITERIA We included published randomized controlled trials comparing patient decision aids to usual care. Usual care was defined as general information, risk assessment, clinical practice guideline summaries for health consumers, placebo intervention (e.g. information on another topic), or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened citations for inclusion, extracted intervention and outcome data, and assessed risk of bias using the Cochrane risk of bias tool. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made (informed values-based choice congruence) and the decision-making process, such as knowledge, accurate risk perceptions, feeling informed, clear values, participation in decision-making, and adverse events. Secondary outcomes were choice, confidence in decision-making, adherence to the chosen option, preference-linked health outcomes, and impact on the healthcare system (e.g. consultation length). We pooled results using mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs), applying a random-effects model. We conducted a subgroup analysis of 105 studies that were included in the previous review version compared to those published since that update (n = 104 studies). We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the certainty of the evidence. MAIN RESULTS This update added 104 new studies for a total of 209 studies involving 107,698 participants. The patient decision aids focused on 71 different decisions. The most common decisions were about cardiovascular treatments (n = 22 studies), cancer screening (n = 17 studies colorectal, 15 prostate, 12 breast), cancer treatments (e.g. 15 breast, 11 prostate), mental health treatments (n = 10 studies), and joint replacement surgery (n = 9 studies). When assessing risk of bias in the included studies, we rated two items as mostly unclear (selective reporting: 100 studies; blinding of participants/personnel: 161 studies), due to inadequate reporting. Of the 209 included studies, 34 had at least one item rated as high risk of bias. There was moderate-certainty evidence that patient decision aids probably increase the congruence between informed values and care choices compared to usual care (RR 1.75, 95% CI 1.44 to 2.13; 21 studies, 9377 participants). Regarding attributes related to the decision-making process and compared to usual care, there was high-certainty evidence that patient decision aids result in improved participants' knowledge (MD 11.90/100, 95% CI 10.60 to 13.19; 107 studies, 25,492 participants), accuracy of risk perceptions (RR 1.94, 95% CI 1.61 to 2.34; 25 studies, 7796 participants), and decreased decisional conflict related to feeling uninformed (MD -10.02, 95% CI -12.31 to -7.74; 58 studies, 12,104 participants), indecision about personal values (MD -7.86, 95% CI -9.69 to -6.02; 55 studies, 11,880 participants), and proportion of people who were passive in decision-making (clinician-controlled) (RR 0.72, 95% CI 0.59 to 0.88; 21 studies, 4348 participants). For adverse outcomes, there was high-certainty evidence that there was no difference in decision regret between the patient decision aid and usual care groups (MD -1.23, 95% CI -3.05 to 0.59; 22 studies, 3707 participants). Of note, there was no difference in the length of consultation when patient decision aids were used in preparation for the consultation (MD -2.97 minutes, 95% CI -7.84 to 1.90; 5 studies, 420 participants). When patient decision aids were used during the consultation with the clinician, the length of consultation was 1.5 minutes longer (MD 1.50 minutes, 95% CI 0.79 to 2.20; 8 studies, 2702 participants). We found the same direction of effect when we compared results for patient decision aid studies reported in the previous update compared to studies conducted since 2015. AUTHORS' CONCLUSIONS Compared to usual care, across a wide variety of decisions, patient decision aids probably helped more adults reach informed values-congruent choices. They led to large increases in knowledge, accurate risk perceptions, and an active role in decision-making. Our updated review also found that patient decision aids increased patients' feeling informed and clear about their personal values. There was no difference in decision regret between people using decision aids versus those receiving usual care. Further studies are needed to assess the impact of patient decision aids on adherence and downstream effects on cost and resource use.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Meg Carley
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robert Volk
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elisa E Douglas
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael J Barry
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | - Carol L Bennett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Paulina Bravo
- Education and Cancer Prevention, Fundación Arturo López Pérez, Santiago, Chile
| | - Karina Steffensen
- Center for Shared Decision Making, IRS - Lillebælt Hospital, Vejle, Denmark
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec, Canada
| | - Ian D Graham
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Shannon E Kelly
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Université Laval, Quebec, Canada
| | | | - Richard Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
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Chandeying N, Thongseiratch T. Systematic review and meta-analysis comparing educational and reminder digital interventions for promoting HPV vaccination uptake. NPJ Digit Med 2023; 6:162. [PMID: 37644090 PMCID: PMC10465590 DOI: 10.1038/s41746-023-00912-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
Global Human papillomavirus (HPV) vaccination rates remain low despite available WHO-approved vaccines. Digital interventions for promoting vaccination uptake offer a scalable and accessible solution to this issue. Here we report a systematic review and meta-analysis examining the efficacy of digital interventions, comparing educational and reminder approaches, for promoting HPV vaccination uptake (HVU). This study also identifies factors influencing the effectiveness of these interventions. We searched PubMed, PsycInfo, Web of Science, and the Cochrane Library from each database's inception to January 2023. Three raters independently evaluate the studies using a systematic and blinded method for resolving disagreements. From 1929 references, 34 unique studies (281,280 unique participants) have sufficient data. Client reminder (OR, 1.41; 95% CI, 1.23-1.63; P < 0.001), provider reminder (OR, 1.39; 95% CI, 1.11-1.75; P = 0.005), provider education (OR, 1.18; 95% CI, 1.05-1.34; P = 0.007), and client education plus reminder interventions (OR, 1.29; 95% CI, 1.04-1.59; P = 0.007) increase HVU, whereas client education interventions do not (OR, 1.08; 95% CI, 0.92-1.28; P = 0.35). Digital intervention effectiveness varies based on participants' gender and the digital platform used. Interventions targeting male or mixed-gender participants demonstrate greater benefit, and reminder platforms (SMS, preference reminders, or electronic health record alerts) are more effective in increasing HVU. Digital interventions, particularly client and provider reminders, along with provider education, prove significantly more effective than client education alone. Incorporating digital interventions into healthcare systems can effectively promote HPV vaccination uptake. Reminder interventions should be prioritized for promoting HVU.
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Affiliation(s)
- Nutthaporn Chandeying
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Therdpong Thongseiratch
- Child Development Unit, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
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Netfa F, King C, Davies C, Rashid H, Tashani M, Booy R, Rachel Skinner S. Perceived facilitators and barriers to the uptake of the human papillomavirus (HPV) vaccine among adolescents of Arabic-speaking mothers in NSW, Australia: A qualitative study. Vaccine X 2023; 14:100335. [PMID: 37409191 PMCID: PMC10318426 DOI: 10.1016/j.jvacx.2023.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/16/2023] [Indexed: 07/07/2023] Open
Abstract
Background Australia has a large immigrant population but there is little data regarding whether human papillomavirus (HPV) vaccination coverage in adolescents varies according to parents' cultural or ethnic background. This work aims to identify facilitators and barriers to HPV vaccination of adolescents as perceived by Arabic-speaking mothers in Western Sydney, South Western Sydney and Wollongong, NSW, Australia. Methods A purposive sampling approach was applied to recruit mothers of adolescents from Arabic speaking backgrounds who had at least one child eligible for the HPV school-based vaccination program. Face-to-face semi-structured well as online interviews were conducted in Arabic between April 2021 and July 2021. The interviews were audio-recorded, transcribed, and translated into English and examined using thematic analysis. Results Sixteen mothers of adolescents from Arabic backgrounds described facilitators and barriers to HPV vaccination. A) Facilitators of HPV vaccination included: knowledge of HPV disease, trust in the school vaccination program, opportunistic recommendations from healthcare workers, information from friends. B) Barriers to accessing HPV vaccination included communication gaps: breakdown in school-parent information flow, lack of access to the Arabic language version of the information sheet, mother - GP communication barriers, mother-child communication gap; and health system gaps: missed opportunities for vaccination. C) Mothers' suggestions to improve HPV vaccination acceptance: to involve religious and cultural leadership, encourage engagement with GPs, and provide school-based education for parents and students. Conclusion Parents could benefit from assistance with HPV vaccination decision making. Interventions via schools, health professionals and religious and cultural organisations could play important roles in HPV vaccination acceptance for Arabic speaking immigrant families and in introducing their adolescent children to this vaccine.
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Affiliation(s)
- Faeza Netfa
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- Kids Research, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Catherine King
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Cristyn Davies
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- Kids Research, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- Sydney Institute for Infectious Diseases, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Harunor Rashid
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Mohamed Tashani
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- Faculty of Medicine, University of Tripoli, Tripoli 13275, Libya
| | - Robert Booy
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - S. Rachel Skinner
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- Kids Research, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
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Stone CA, Garvey LH, Nasser S, Lever C, Triggiani M, Parente R, Phillips EJ. Identifying and Managing Those at Risk for Vaccine-Related Allergy and Anaphylaxis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2008-2022. [PMID: 37182566 DOI: 10.1016/j.jaip.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/13/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023]
Abstract
Immediate hypersensitivity reactions to vaccines, the most severe of which is anaphylaxis, are uncommon events occurring in fewer than 1 in a million doses administered. These reactions are infrequently immunoglobulin E-mediated. Because they are unlikely to recur, a reaction to a single dose of a vaccine is rarely a contraindication to redosing. This narrative review article contextualizes the recent knowledge we have gained from the coronavirus 2019 (COVID-19) pandemic rollout of the new mRNA platform with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines within the much broader context of what is known about immediate reactions to other vaccinations of routine and global importance. We focus on what is known about evidence-based approaches to diagnosis and management and what is new in our understanding of mechanisms of immediate vaccine reactions. Specifically, we review the epidemiology of immediate hypersensitivity vaccine reactions, differential diagnosis for immune-mediated and nonimmune reaction clinical phenotypes, including how to recognize immunization stress-related responses. In addition, we highlight what is known about mechanisms and review the rare but important contribution of excipient allergies and specifically when to consider testing for them as well as other key features that contribute to safe evaluation and management.
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Affiliation(s)
- Cosby A Stone
- Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Lene H Garvey
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Shuaib Nasser
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Charley Lever
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Roberta Parente
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Elizabeth J Phillips
- Department of Dermatology, Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tenn; Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tenn; Institute for Immunology & Infectious Diseases, Murdoch University, Murdoch, Perth, Western Australia.
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Human Papillomavirus Vaccination Uptake in the Rio Grande Valley: Results from a Pilot Community-Based Educational and School-Based Vaccination Program and Its Expansion. Vaccines (Basel) 2023; 11:vaccines11020329. [PMID: 36851207 PMCID: PMC9961922 DOI: 10.3390/vaccines11020329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Human papillomavirus (HPV) vaccine is a safe and effective strategy for reducing HPV morbidity and mortality. Schools have become an increasingly attractive setting for delivering vaccinations and supporting vaccination health literacy and decisional support. This study assesses the effectiveness of a community-based, physician-led HPV education campaign (starting in 2016) and onsite middle school-based HPV vaccination program across six school districts (2017, 2019, 2020) in a rural, medically underserved Texas area (Rio Grande Valley). Pre- and post-intervention HPV vaccination rates were tracked against the 2016 National Immunization Survey-Teen target rates (initiation: 49.3%; completion: 32.9%). Summary statistics were stratified by gender, school district, and grade level. The study reached 19,951 students who received HPV vaccines directly or indirectly through our program (10,289 females; 9662 males) (August 2016-August 2022). Of those, 2145 students (1074 females; 1071 males) were vaccinated directly through our program. The overall HPV up-to-date (UTD) rates were 58.8%. The overall median age at HPV vaccine initiation and HPV-UTD (range) was 11 years (9-21) and 12 years (9-20). The overall median interval between HPV vaccine doses (range) was 291 days (146-2968). Recommending HPV vaccine initiation at younger ages increases HPV vaccine completion and providing access to HPV vaccines encourages on-time vaccination and completion.
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Vaccine Literacy, COVID-19 Vaccine-Related Concerns, and Intention to Recommend COVID-19 Vaccines of Healthcare Workers in a Pediatric and Maternity Hospital: A Cross-Sectional Study. Vaccines (Basel) 2022; 10:vaccines10091482. [PMID: 36146559 PMCID: PMC9506120 DOI: 10.3390/vaccines10091482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022] Open
Abstract
Vaccine literacy of healthcare workers (HCWs) may affect the COVID-19 vaccine uptake of the general population. This study aimed to clarify the vaccine literacy level of HCWs in Japan and its impacts on their concerns about vaccines and intention to recommend that others receive vaccines. This cross-sectional survey was conducted in July 2021 based on the recruitment of HCWs in a pediatric and maternity hospital and research center in Tokyo, Japan. All HCWs in this center had the chance to receive the COVID-19 vaccine before the survey, and their vaccine coverage was relatively high, at 95%. A total of 1519 workers answered the questionnaire. The results showed that HCWs with lower functional vaccine literacy had 1.5 times as many concerns about the efficacy of vaccines and 1.6 times as many concerns about the future side effects compared with those with higher literacy. Further, HCWs with higher vaccine literacy were more likely to recommend that older people, people with comorbidities, and pregnant women receive vaccines. Our findings suggest that high vaccine literacy alleviates concerns about COVID-19 vaccines and raised the intention to recommend vaccines to others. To achieve high vaccine coverage, countermeasures such as personalized education are essential.
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Davies C, Taba M, Deng L, Karatas C, Bag S, Ross C, Forster A, Booy R, Skinner SR. Usability, acceptability, and feasibility of a High-Density Microarray Patch (HD-MAP) applicator as a delivery method for vaccination in clinical settings. Hum Vaccin Immunother 2022; 18:2018863. [PMID: 35100525 PMCID: PMC9196792 DOI: 10.1080/21645515.2021.2018863] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background High-density microarray patch (HD-MAP) vaccines may increase vaccine acceptance and use. We aimed to ascertain whether professional immunizers (PIs) and other healthcare workers (HCWs) in Australia, a High-Income Country (HIC), found the HD-MAP applicator usable and acceptable for vaccine delivery. Methods This feasibility study recruited PIs and HCWs to administer/receive simulated HD-MAP administration, including via self-administration. We assessed usability against essential and desirable criteria. Participants completed a survey, rating their agreement to statements about HD-MAP administration. A subset also participated in an interview or focus group. Survey data were analyzed using descriptive statistics, and interviews were transcribed and subject to thematic analysis. Results We recruited 61 participants: 23 PIs and 38 HCWs. Findings indicated high usability and acceptability of HD-MAP use across both groups by a healthcare professional or trained user and for self-administration with safety measures in place. Most administrations met essential criteria, but PIs, on average, applied the HD-MAP for slightly less time than the required 10-seconds, which the HCWs achieved. PIs perceived safety concerns about home administration but found layperson self-administration acceptable in an emergency, pandemic, and rural or remote settings. Conclusions Participants found HD-MAP administration usable and acceptable. Usability and acceptability are likely to be improved through end-user education and training. Professional immunizers and healthcare workers found high-density microarray patch devices highly usable and acceptable to administer vaccines. HD-MAPs may have advantages over intramuscular injections in clinical settings and in pandemics.
Vaccination with HD-MAP may improve acceptance for those with needle-related anxiety.
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Affiliation(s)
- Cristyn Davies
- Specialty of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia.,Sydney Institute of Infectious Diseases, University of Sydney, Sydney, Australia
| | - Melody Taba
- Specialty of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia.,Sydney Institute of Infectious Diseases, University of Sydney, Sydney, Australia
| | - Lucy Deng
- Specialty of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia.,National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, Australia
| | - Ceylan Karatas
- Specialty of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia.,Graduate School of Medicine, The University of Wollongong, Keiraville, Australia
| | - Shopna Bag
- Centre for Population Health, Western Sydney Public Health Unit, North Parramatta, Australia.,Faculty of Medicine and Health, Westmead Clinical School, The University of Sydney, Westmead, Australia
| | - Charles Ross
- Vaxxas Pty Ltd, Translational Research Institute, Woolloongabba, Australia
| | - Angus Forster
- Vaxxas Pty Ltd, Translational Research Institute, Woolloongabba, Australia
| | - Robert Booy
- Specialty of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia.,Sydney Institute of Infectious Diseases, University of Sydney, Sydney, Australia
| | - S Rachel Skinner
- Specialty of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia.,Sydney Institute of Infectious Diseases, University of Sydney, Sydney, Australia
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Mitchell H, Lim R, Gill PK, Dhanoa J, Dubé È, Bettinger JA. What do adolescents think about vaccines? Systematic review of qualitative studies. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001109. [PMID: 36962668 PMCID: PMC10022047 DOI: 10.1371/journal.pgph.0001109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/02/2022] [Indexed: 11/19/2022]
Abstract
Adolescence presents a key opportunity to build vaccine-related health literacy and promote vaccine confidence and uptake. Although adolescents are central to vaccination programs, their views around vaccines are frequently underrepresented in qualitative literature. We reviewed qualitative studies to systematically identify and summarize existing evidence on adolescents' own understanding of vaccines and experiences with vaccine decision-making, including self-consent when applicable. CINAHL; Embase; Ovid Medline; and Psych Info database searches were last updated on May 28, 2022. Data pertaining to general study characteristics, participant demographics, and qualitative content were extracted independently by two reviewers and analyzed using textual narrative synthesis. Out of 3559 individual records, 59 studies were included. The majority of the studies were conducted in high-income countries and 75% focused on human papilloma virus vaccines, with the remaining studies looking at COVID-19, meningococcal, hepatitis B and influenza vaccines or adolescent experiences with vaccines in general. Adolescent self-consent was explored in 7 studies. Perspectives from sexual and gender minorities were lacking across studies. Adolescents often had limited understanding of different vaccines and commonly perceived vaccine information to be directed towards their parents rather than themselves. Many adolescents felt school-based vaccine education and information available through healthcare providers were insufficient to make informed decisions about vaccines. While adolescents described obtaining vaccine information from traditional and online media, face-to-face interactions and opinions from trusted adults remained important. Adolescents generally relied on their parents for vaccine-decision making, even when self-consent was an option. A notable exception to this included marginalized adolescents who could not rely on parents for health-related advice. Qualitative literature about adolescent vaccines would be enriched by studies examining vaccines other than the HPV vaccine, studies examining adolescent vaccine programs in low and middle-income countries, and by deliberately eliciting vaccine experiences of adolescent with diverse sexual orientation and gender identities.
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Affiliation(s)
- Hana Mitchell
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Rebecca Lim
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Prubjot K Gill
- University of British Columbia Library, University of British Columbia, Vancouver, BC, Canada
| | - Joban Dhanoa
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Ève Dubé
- Institut National de Santé Publique du Québec, Québec City, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
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