Practices and opinions regarding HPV vaccination among French general practitioners: evaluation through two cross-sectional studies in 2007 and 2010

A transversal cross-sectional study of factors related to HPV vaccination status and cancer screening participation among French women aged 25-40

BACKGROUND

In 2020, uterine cervical cancer (UCC) was the 12th most common cancer among women in France and the 4th worldwide. French health authorities wanted to increase Human Papilloma Virus (HPV) vaccination and screening rates. There were still many barriers to these measures among young women, their families, and health professionals and teachers. Between 2014 and 2019, international studies found inconsistent effects of HPV vaccination on UCC screening. In 2022, a survey was conducted among women aged 25 to 40 in the Nord-Pas-de-Calais region to assess participation 1) in HPV vaccination and its barriers, 2) in UCC screening as a function of HPV vaccination status.

METHODS

Data were collected using an anonymous online questionnaire distributed by QR code in 80 general practices randomly selected in the Nord-Pas-de-Calais region between January and June 2022. Results were analyzed bivariately using the Chi2 test, multivariately when numbers allowed, and in age subgroups (sensitivity analysis).

RESULTS

407 complete questionnaires (for 602 participating women) were analyzed. In our sample, 41% of women aged 25 to 40 in the Nord-Pas-de-Calais region were vaccinated against HPV viruses in 2022. The risk factors for non-vaccination, after multivariable adjustment, were: the periods of eligibility for vaccination in the early days of French vaccination (2007-2012: odds ratio OR = 0.04 [95% CI, 0.02-0.09]; 2012-2017: OR = 0.5 [0.3-0.8]), information received from non-medical sources (OR = 0.3 [0.2-0.6]), and absence of information about vaccination (OR = 0.12 [0.05-0.27]). In our sample, 90% of women were screened for UCC. In bivariate analysis, women at risk of not being screened were those who were youngest, had been vaccinated against HPV, were not heterosexual, lived alone, had gynecological follow-up by their general practitioner, and did not have regular gynecological follow-up. Sensitivity analysis showed that the only risk factor significantly correlated with non-screening regardless of age group was lack of regular gynecological follow-up.

CONCLUSIONS

Participation in HPV vaccination and UCC screening is improved by medical education and gynecological follow-up. This multicenter study, limited by the relative youth of vaccination in France, should be repeated after 2037 to assess the possible effect of vaccination on screening.

Human papillomavirus vaccination coverage and knowledge, perceptions and influencing factors among university students in Guangzhou, China

Introduction: HPV vaccines were administered in mainland China from July 2017 at a gradual rate. We aimed to assess the vaccination rate and vaccination influencing factors among college students in mainland China.Methods: From October to December 2018, we conducted face-to-face questionnaires including 5 sections and 22 questions to collect demographic information, HPV infection and transmission knowledge, HPV vaccine knowledge and attitudes among college students in Guangzhou, China. HPV vaccine vaccination status and cervical screening behaviors were self-reported. Knowledge and attitudes differences between the vaccinate and non-vaccinate groups were analyzed using univariable logistic regression. Vaccination-related influencing factors were estimated using multivariable logistic regression.Results: 5307 of 5414 valid questionnaires were collected. The self-reported cervical screening rate and HPV vaccine coverage were 11.82% (9.03%-14.61%) and 3.09% (2.62%-3.56%). In total, 55.57% of the participants were hesitant about vaccination. Urban residence (OR = 2.1, 95%CI: 1.4-3.3), high monthly consumption (OR = 2.6, 95%CI: 1.9-3.6), awareness of vaccination adaptive population (OR = 3.1, 95%CI: 1.9-5.0), awareness of infection-related risk factors (OR = 2.5, 95%CI: 1.1-5.7), and awareness of HPV vaccine effectiveness (OR = 3.2, 95%CI: 2.0-5.2) were significant in multivariable logistic regression.Conclusion: HPV vaccine coverage is quite low among college students in China Guangzhou. Economic affordability, awareness of HPV infection, and belief in the effectiveness of HPV vaccine are influencing factors for vaccination. In the future, establishing a national financial subsidy and strengthening health education is needed to increase the vaccination rate in China.

Cognitions and behaviours of general practitioners in France regarding HPV vaccination: A theory-based systematic review

Human papillomavirus (HPV) vaccination is safe and efficacious to prevent persistent HPV infection, precancerous anogenital lesions and cervical cancer. However, in countries where vaccination programmes are implemented outside of schools, such as France, reaching high HPV vaccination coverage of the target population is challenging. Many studies have been performed in France to assess cognitions of general practitioners (GPs) regarding HPV vaccination. However, the evidence is not consistent about which cognitions are key. To provide a comprehensive overview, we performed a systematic review of studies conducted in France on GPs' cognitions regarding HPV vaccination and used the reasoned action approach to extract and synthesize data. The systematic search was performed up to July 2020 in Medline via PubMed, PsycINFO, PsycARTICLES, Embase, CINAHL Plus, Web of Science, Pascal and Francis databases. Grey literature was searched for in the French Public Health Database, Cairn. Info, yahoo.fr, and Google Scholar. Twenty-five scientific publications were selected based on eligibility criteria and assessed for quality. Our qualitative synthesis highlights that although 73% of GPs report recommending HPV vaccination, up to 50% would not recommend it because of concerns, including changes in patients' health behaviours and doubts about safety and/or efficacy. GPs' injunctive norms, i.e. trust in institutional information, were shown to be associated positively with GPs' willingness to recommend HPV vaccination. Parents' fears, girls' age, and potential connection with sexuality do not seem to affect GPs' recommendations. These results will inform the development of a professional educational intervention targeting GPs in France.

HPV vaccine hesitancy among parents in Italy: a cross-sectional study

This cross-sectional survey determined the vaccine hesitancy related to Human papillomavirus (HPV) and the determinants among parents of adolescents aged 12 and 13 years in Italy. Data was collected through a self-administered questionnaire. Two-thirds of the parents (66.7%) had heard of HPV infection and knew that the vaccination was a preventive measure. Parents who had vaccinated their child against the HPV were more likely to have this knowledge. The vast majority (88%) considered the immunization useful for the prevention of HPV-related cancers with an average value of 8.4. This positive attitude was higher among parents who had heard of HPV infection and knew that vaccination was a preventive measure, who had received information from physicians, who had vaccinated their child against the HPV, who were concerned that their child could contract the HPV infection, and who needed information on HPV vaccination. More than half (57.9%) self-reported that they had vaccinated their child against HPV and only 6.2% had delayed the administration of a dose. One-third (33.3%) were hesitant toward anti-HPV vaccination with a total Parent Attitudes about Childhood Vaccines Survey (PACV) score ≥50. Unmarried respondents, those who had not heard of HPV infection and did not know that the vaccination was a preventive measure, who did not believe that the vaccination was useful for the prevention of HPV-related cancers, and who needed information on HPV vaccination were more likely to be hesitant. Communication and education strategies must be undertaken to ensure that parents are fully informed and health-care professionals should provide materials with details regarding the risk of acquiring a HPV infection and vaccine usefulness.

HPV vaccination in a context of public mistrust and uncertainty: a systematic literature review of determinants of HPV vaccine hesitancy in Europe

Europe is increasingly described as the region in the world with the least confidence in vaccination, and particularly in the safety of vaccines. The aim of this systematic literature review was to gather and summarise all peer-reviewed and grey literature published about determinants of Human Papillomavirus (HPV) vaccine hesitancy in Europe. Ten thematic categories were identified across the 103 articles which were included in the review. Participants from European studies most commonly reported issues with the quantity and quality of information available about HPV vaccination; followed by concerns about potential side effects of the vaccine; and mistrust of health authorities, healthcare workers, and new vaccines. Comparative analyses indicated that confidence determinants differed by country and population groups. This evidence supports the need to develop context-specific interventions to improve confidence in HPV vaccination and design community engagement strategies aiming to build public trust.

Acceptability of multipurpose human papillomavirus vaccines among providers and mothers of adolescent girls: A mixed-methods study in five countries

Introduction

Multipurpose vaccines (MPVs) could be formulated to prevent multiple sexually transmitted infections simultaneously. Little is known about acceptability of MPVs among vaccine health care providers (HCPs) or mothers of adolescent girls.

Methods

151 adolescent vaccine providers and 118 mothers of adolescent girls aged 9–14 were recruited from five geographically-diverse countries: Argentina, Malaysia, South Africa, South Korea, and Spain. We assessed providers’ preferences for single-purpose human papillomavirus (HPV) vaccine versus MPVs (including HPV+herpes simplex virus (HSV)−2, HPV+HIV, or HPV+HSV-2+HIV) via quantitative surveys. Maternal MPV attitudes were assessed in four focus group discussions (FGDs) in each country.

Results

Most providers preferred MPVs over single-purpose HPV vaccination, with preference ranging from 61% in Malaysia to 96% in South Africa. HPV+HSV-2+HIV was the most preferred MPV formulation (56–82%). Overall, 53% of the mothers preferred MPVs over single-purpose HPV vaccines, with strongest support in South Africa (90%) and lowest support in South Korea (29%). Convenience and trust in the health care system were commonly-cited reasons for MPV acceptability. Safety and efficacy concerns were common barriers to accepting MPVs, though specific concerns differed by country. Across FGDs, additional safety and efficacy information on MPVs were requested, particularly from trusted sources like HCPs.

Conclusions

Though maternal acceptability of MPVs varied by country, MPV acceptability would be enhanced by having HCPs provide parents with additional MPV vaccine safety and efficacy information. While most providers preferred MPVs, future health behavior research should identify acceptability barriers, and targeted provider interventions should equip providers to improve vaccination discussions with parents.

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We gauged acceptance of a multipurpose vaccine (MPV) concept to prevent HPV and STIs.

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Most vaccine providers were willing to administer an MPV for HPV, HSV-2, and HIV.

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Mothers of teen girls desired safety and efficacy evidence before accepting MPVs.

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In mothers, MPV acceptability differed by region and daughter's vaccination history.

Scoring and psychometric validation of the 'Determinants of Intentions to Vaccinate' (DIVA©) questionnaire

Background

Primary care physicians (PCPs) play a key role regarding vaccination in France. The aims of the present study were to define the scoring rules and to assess the measurement properties of the ‘Determinants of Intentions to Vaccinate’ (DIVA^©) questionnaire that aims to assess PCPs’ attitudes and beliefs toward vaccination.

Methods

The DIVA questionnaire was derived from a literature review and PCPs focus groups. Scoring and early validation of the DIVA questionnaire were determined during a cross-sectional study conducted in France. During the study, PCPs had to complete the DIVA questionnaire for any of the six vaccine-preventable diseases (VPDs) to which they were randomly assigned (measles, pertussis, pneumococcus infection, seasonal influenza, human papillomavirus -HPV- infection and tetanus). Descriptive analyses of items and the analysis of the grouping of items into domains were conducted. Internal consistency reliability and construct validity was assessed according to each VPD.

Results

The DIVA questionnaire was completed by 1,069 PCPs and was well accepted. The ‘Commitment of the PCP to the vaccination approach’ score showed very good internal consistency reliability (Cronbach’s alpha >0.70 overall and for each VPD). The construct validity of the DIVA questionnaire was confirmed.

Conclusions

The DIVA questionnaire is a valid and reliable measure of PCPs’ attitudes and beliefs toward vaccination.

Electronic supplementary material

The online version of this article (doi:10.1186/s12875-016-0539-3) contains supplementary material, which is available to authorized users.

Factors influencing the recommendation of the Human Papillomavirus vaccine by South African doctors working in a tertiary hospital

BACKGROUND

In South Africa, HPV vaccination programme has been incorporated recently in the school health system. Since doctors are the most trusted people regarding health issues in general, their knowledge and attitudes regarding HPV infections and vaccination are very important for HPV vaccine program nationally.

OBJECTIVE

The objective of this study was to investigate factors contributing to recommendation of HPV vaccines to the patients.

METHODS

This was a quantitative cross-sectional study conducted among 320 doctors, using a self-administered anonymous questionnaire.

RESULTS

All the doctors were aware of HPV and knew that HPV is transmitted sexually. Their overall level of knowledge regarding HPV infections and HPV vaccine was poor. But the majority intended to prescribe the vaccine to their patients. It was found that doctors who knew that HPV 6 and 11 are responsible for >90% of anogenital warts, their patients would comply with the counselling regarding HPV vaccination, and received sufficient information about HPV vaccination were 5.68, 4.91 and 4.46 times respectively more likely to recommend HPV vaccination to their patients, compared to their counterparts (p<0.05).

CONCLUSION

There was a knowledge gap regarding HPV infection and HPV vaccine among the doctors.

Human papillomavirus infection and vaccination: Knowledge and attitudes among young males in Italy

This study assessed knowledge and attitudes about Human papillomavirus (HPV) and the relative vaccination and their determinants in a sample of young males. The survey was conducted between January and April 2015 among a sample of 1000 males aged between 14-24 y in the geographic area of Naples and Caserta, Italy. The 54.9% of the participants reported of having heard about the HPV infection. Those who were aware about the availability of the vaccine, who reported the first vaginal sexual encounter before the 18 y and at least at 18 y compared to those who had not had a complete sexual intercourse, who had undergone a health checkup in the last year, and who had received information about the HPV vaccine by physicians had a significant higher knowledge about the HPV infection. The 58.2% reported that they would be willing to receive the HPV vaccine. Those younger, who reported the first vaginal sexual encounter at least at 18 y, who agreed that male should receive the vaccine, who knew that both males and females can acquire the infection, and who agreed that the vaccine is an important preventive intervention, expressed more positive attitude toward willingness to receive the vaccine. More information about the HPV vaccine were required by those who agreed that the vaccine is an important preventive intervention, who reported the first vaginal sexual encounter at least at 18 y, who have had only one partner in the last year compared to students who had no partner, and who had received information about the vaccine by physicians. This study highlights a need for improved education of young males of the HPV infection and the associated diseases and about the benefit of the vaccination.

[Practices and attitudes regarding HPV vaccination among general practitioners from Besançon]

OBJECTIVES

To assess opinions, practices and difficulties of general practitioners (GP) of Besançon concerning human papillomavirus (HPV) vaccination.

MATERIALS AND METHODS

A survey among the 140 GP of Besançon, France, was conducted in 2015.

RESULTS

A percentage of 77.1 reported being favourable to HPV vaccination and 72.9% practices HPV vaccination. The 2 main concerns about HPV vaccination for GP are the fear of side effects (for 40.6% of GP) and the doubt on efficacy. According to GP, the hepatitis B vaccination controversy, the fear of side effects, the limited clinical efficacy experience and the lack of confidence in health authorities are concerns about HPV vaccination for 77.1%, 76%, 74% and 49% of patients, respectively.

CONCLUSION

Courses for GP on HPV vaccination must be pursued and reinforced. A school-based program could be developed to facilitate communication between GP and patients to improve HPV vaccination coverage.

General practitioners' attitudes and behaviors toward HPV vaccination: A French national survey

OBJECTIVE

General practitioners (GPs) play a crucial role in human papillomavirus (HPV) vaccine acceptance in France. We sought to study: (1) GPs' perceptions of its risks and efficacy and their recommendation behavior; (2) the relative importance of factors associated with the frequency of their recommendations.

METHODS

Cross-sectional observational study in 2014 nested in a national panel of 1712 randomly selected GPs in private practice in France (response rate: 92.4%). We used model averaging to analyze the associations of self-reported frequency of GPs' HPV vaccine recommendations with their perception of its risk-benefit balance and their opinions about the utility of vaccines in general.

RESULTS

Overall, 72% of participants reported frequently recommending HPV vaccination; 60% considered that not enough is known about its risks. The model averaging showed that the factors most associated with infrequent recommendation of this vaccine by GPs were: unfavorable perceptions of its risk-benefit balance (OR=0.13; 95%CI=0.09-0.21; partial R(2)=0.10), a decision not to vaccinate one's own daughter(s) with this vaccine (OR=0.13; 95%CI=0.07-0.24; partial R(2)=0.05), and doubts about vaccine utility in general (OR=0.78; 95%CI=0.71-0.86; partial R(2)=0.03).

CONCLUSION

Although nearly three-quarters of French GPs frequently recommended the HPV vaccine, our findings indicate that a substantial percentage of them are hesitant about it. Doubts about its risks and efficacy strongly influence their recommendation behavior. More research is warranted to help design and evaluate tailored tools and multicomponent intervention strategies to address physician's hesitancy about this vaccine.

Human papillomavirus-associated cancers: a survey on otorhinolaryngologists' knowledge and attitudes on prevention

Human papillomavirus (HPV) infection is a recognised causal factor associated with oropharyngeal cancers. The global burden of HPVrelated oropharyngeal cancers is on the increase and is predicted to surpass the burden of cervical cancer in the near future. As evidence is accumulating on the potential effectiveness of an HPV vaccine in controlling the oropharyngeal cancer epidemic; otorhinolaryngologists assume a key role - not only in the diagnosis and treatment of HPV-related cancers - but also in educating and advocating on HPV prevention. We conducted a survey to assess Italian otorhinolaryngologists' knowledge and attitudes regarding HPV infection, HPV-related oropharyngeal diseases and cancers and available prevention measures, including vaccines. This is the first study conducted in Italy and Europe on this topic. A total of 262 Italian otorhinolaryngologists were recruited during the National Conference of the Italian Association of Otorhinolaryngologists. Our results show that Italian otorhinolaryngologists are knowledgeable regarding HPV infection and have a positive attitude towards HPV vaccine. Our findings provide a useful basis to plan, implement and evaluate targeted educational programmes and training. As we show herein, educational programmes and training specifically focusing on HPV are effective in increasing physicians' knowledge and positive attitudes towards prevention; this ultimately contributes to enhance vaccine uptake among patients and the general population. With the overall aim of controlling the burden of HPV-related cancers, resources and efforts should be devoted to promote continuing education among otorhinolaryngologists and the general medical community and to increase awareness on the role of vaccines in prevention of HPV-related cancers. In this context, there is tremendous opportunity for healthcare providers across fields to cooperate and for public health and otorhinolaryngologist communities to join forces and engage in fruitful collaboration.