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Rubinstein EB, Heinemann LL. A crisis of confidence? Intervening in vaccine hesitancy in North Dakota. Med Anthropol Q 2024; 38:298-312. [PMID: 38847386 DOI: 10.1111/maq.12873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/03/2024] [Indexed: 08/31/2024]
Abstract
In November 2020, North Dakota reported a higher number of cases and deaths per capita from COVID-19 than any other state in the United States. Several months later, it reported one of the country's highest rates of vaccine hesitancy, leading to the development and implementation of the state-funded and physician-led "Vaccine Champion" ("VaxChamp") program. Glossing the primary problem as one of "provider confidence," the VaxChamp program emphasized a standardized, scalable intervention that targeted healthcare providers directly, and patients only indirectly. Although the program hit its quantitative benchmarks, a qualitative inquiry into the program's history and context reveals multiple crises of confidence, many beyond the bioscientific domain of the program's focus. Drawing from work in medical and linguistic anthropology, we describe and analyze the "multiple levers of vaccine confidence" at play in the intervention and its surrounding context, as well as how these crises of confidence emerged.
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Affiliation(s)
- Ellen B Rubinstein
- Department of Sociology and Anthropology, North Dakota State University, Fargo, North Dakota, USA
| | - Laura L Heinemann
- Department of Cultural and Social Studies, Creighton University, Omaha, Nebraska, USA
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Chido-Amajuoyi OG, Osaghae I, Onyeaka HK, Shete S. Barriers to the assessment and recommendation of HPV vaccination among healthcare providers in Texas. Vaccine X 2024; 18:100471. [PMID: 38523619 PMCID: PMC10958477 DOI: 10.1016/j.jvacx.2024.100471] [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: 06/01/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 03/26/2024] Open
Abstract
Background Healthcare providers (HCPs) recommendations for HPV vaccination plays a critical role in increasing vaccination uptake. This study assesses the prevalence of reported barriers to HPV vaccination assessment and recommendation among HCPs in Texas. Methods Study data were obtained from a population-based survey of HCPs currently practicing in Texas. Participants were asked about their HPV vaccination assessment and recommendation practices and the reasons for not assessing or recommending the vaccine. Barriers were stratified by HCP characteristics including age, sex, race/ethnicity, location of practice, provider type, and type of facility. Results Among the 826 HCPs included in this study, 47.3 % never, 49.6 % sometimes, and 3.0 % often/always assessed a patient's HPV vaccination status. Similarly, 36.0 % never, 36.2 % sometimes, and 27.9 % often/always recommended HPV vaccination. The most frequently reported barriers to assessment and recommendation of HPV vaccination were time constraints (22.9 %), delegating the task to others (15.0 %), lack of effective tools and information to give patients (12.0 %), and requiring additional training (9.2 %). HCPs who were female, less than 35 years old, non-Hispanic black, and nonphysician HCPs (Physician Assistant, Nurse Practitioner) most frequently reported lacking effective tools and information and a need for additional training. Conclusion The assessment and recommendation for HPV vaccination among HCPs in Texas is suboptimal. Barriers reported varied based on the provider's characteristics. Addressing these barriers, such as by providing more effective tools and information and offering additional training to HCPs, could potentially increase HPV vaccination rates in Texas. The findings also suggest that interventions should be tailored to specific demographic groups.
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Affiliation(s)
- Onyema G. Chido-Amajuoyi
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Internal Medicine, Texas A&M School of Medicine/Christus Health, Longview, TX, USA
| | - Ikponmwosa Osaghae
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Henry K. Onyeaka
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Kong WY, Oh NL, Kennedy KL, Carlson RB, Liu A, Ozawa S, Brewer NT, Gilkey MB. Identifying Healthcare Professionals With Lower Human Papillomavirus (HPV) Vaccine Recommendation Quality: A Systematic Review. J Adolesc Health 2024; 74:868-877. [PMID: 38231146 PMCID: PMC11031337 DOI: 10.1016/j.jadohealth.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE Strengthening healthcare professionals' (HCPs) communication is an evidence-based approach to increasing human papillomavirus (HPV) vaccine uptake among adolescents. To better target future interventions, we sought to synthesize evidence on HCP subgroups who most need to improve their HPV vaccine recommendation quality. METHODS We searched five databases for quantitative studies published from 2012 to 2022 on HPV vaccine recommendation quality, including recommendation consistency and strength, for United States adolescents. Two coders independently abstracted data from each eligible study, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We summarized variation in recommendation quality by clinical and HCP characteristics. RESULTS The 28 eligible studies indicated that relatively low proportions of HCPs used higher-quality recommendation practices (median: 61% across 30 measures) and that recommendation quality varied across HCP subgroups. The most consistent findings were that more pediatric HCPs used higher-quality recommendations than family medicine HCPs (8 of 11 studies, 2-60 percentage point difference) and that HPV-related knowledge was associated with higher recommendation quality (four of seven studies). Most studies observed no differences in recommendation quality by clinical role (e.g., provider vs. nurse) or HCP demographics (e.g., gender, age, race/ethnicity). DISCUSSION Studies suggest a substantial need to improve HCPs' recommendation quality, with opportunities for targeting future interventions.
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Affiliation(s)
- Wei Yi Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Nul Loren Oh
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathryn L Kennedy
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Rebecca B Carlson
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Amy Liu
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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AlShamlan NA, AlOmar RS, AlAbdulKader AM, Shafey MM, AlGhamdi FA, Aldakheel AA, AlShehri SA, Felemban LA, AlShamlan SA, Al Shammari MA. HPV Vaccine Uptake, Willingness to Receive, and Causes of Vaccine Hesitancy: A National Study Conducted in Saudi Arabia Among Female Healthcare Professionals. Int J Womens Health 2024; 16:463-474. [PMID: 38505127 PMCID: PMC10949268 DOI: 10.2147/ijwh.s449979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/12/2024] [Indexed: 03/21/2024] Open
Abstract
Background Epidemiological evidence has shown that human papillomavirus (HPV) is the most frequent cause of sexually transmitted infection, and vaccination is an essential measure to prevent associated diseases and complications. This study aimed to assess the HPV vaccine uptake and its associated factors as well as HPV vaccine hesitancy by female healthcare workers (HCWs) in Saudi Arabia. Methods This online, questionnaire-based, cross-sectional study involved female HCWs in Saudi Arabia between July and October 2022. The study tool included questions about sociodemographic, occupational, and reproductive characteristics, uptake of HPV vaccination, and reasons of hesitancy. Chi-squared and t-tests were used for bivariate analyses, and multivariable logistic regression was used to adjust for confounders. Results The total number of participants was 1857. Around 20% of HCWs received at least one dose of the HPV vaccine, and around 45% were willing to take it this year. Lower odds of vaccine uptake were reported among older participants and those with a higher level of education. However, nurses, HCWs with a previous HPV infection, those with a family history of cervical cancer, or those with a previous cervical cancer screening test had higher odds of receiving the vaccine. On the other hand, older participants and diploma degree holders were less willing to take the HPV vaccine. Higher odds of willingness were reported in married HCWs, those with a previous HPV infection, those who received a previous HPV vaccine dose, or those who were screened for cervical cancer. Lack of knowledge and some misconceptions were the most reported reasons for hesitancy. Conclusion Certain factors that affect HCWs personal decisions to take the vaccine were identified. By targeting these issues, epidemiologists, public health officials and women's health care providers can work to increase HPV vaccine uptake and reduce the burden of HPV-related diseases in this population.
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Affiliation(s)
- Nouf A AlShamlan
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Reem S AlOmar
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Assim M AlAbdulKader
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Marwa Mahmoud Shafey
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faisal A AlGhamdi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah A Aldakheel
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Saud A AlShehri
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Lyana A Felemban
- College of Medicine, Fakeeh College of Medical Sciences, Jeddah, Saudi Arabia
| | - Shahad A AlShamlan
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Malak A Al Shammari
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Alfhaid F, Alzahrani MK, Aljulifi MZ, Alrohaimi Y, Alawlah MN, AlMutairi FLM, Alkahtani SMH, Almousa MA, Alrashidi SN. Prevalence and Perception of HPV Vaccination Among Health Science Students in Saudi Arabia. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S695-S698. [PMID: 38595505 PMCID: PMC11000862 DOI: 10.4103/jpbs.jpbs_946_23] [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: 09/24/2023] [Revised: 10/01/2023] [Accepted: 10/06/2023] [Indexed: 04/11/2024] Open
Abstract
Objective This study was carried out to assess the prevalence and perception of human papilloma virus (HPV) vaccination in health science students in Majmaah University, Saudi Arabia. Methodology A descriptive cross-sectional study was conducted at different health science colleges of Majmaah University on female students. The knowledge of the participants regarding HPV was assessed using a pre-tested questionnaire. The history of vaccination of these female participants was also enquired. Results More than three-fifth of the participants had heard about HPV. Of these, 83 participants, 59 (71.1%), were aware that it is a disease of women and how to diagnose it. Most participants (86.7%) knew that it can cause cervical cancer, while only 57.8% knew it could be asymptomatic. There were 18% of such participants who thought that HPV and human immunodeficiency virus are the same and that there is no vaccine for the prevention of HPV. Only 14.5% (n = 12) were vaccinated against HPV. Conclusion A clear gap between knowledge and practice of HPV vaccination was observed, and health education should be planned to educate health professionals to avoid misconceptions.
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Affiliation(s)
- Fahad Alfhaid
- Department of Family Medicine, College of Medicine, Majmaah University, Majmaah 11952, Saudi Arabia
| | - Mansour Khater Alzahrani
- Department of Family Medicine, College of Medicine, Majmaah University, Majmaah 11952, Saudi Arabia
| | - Mohammed Zaid Aljulifi
- Department of Family Medicine, College of Medicine, Majmaah University, Majmaah 11952, Saudi Arabia
| | - Yousef Alrohaimi
- Department of Paediatric, College of Medicine, Majmaah University, Majmaah 11952, Saudi Arabia
| | - Maram Nasser Alawlah
- General Physician, Department of Family Medicine, Qassim Cluster, Buraidah, Ministry of Health, Saudi Arabia
| | | | - Sara Mohammad H. Alkahtani
- General Physician, Department of Family Medicine, Ministry of Health, Al-Qassim Cluster, Al-Qassim, Saudi Arabia
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Albayat SS, Mundodan JM, Elmardi K, Hasnain S, Khogali H, Baaboura R, Al-Romaihi HE, AlKubaisi NJ, Bougmiza MI. Knowledge, attitude, and practices regarding human papilloma virus vaccination among physicians in Qatar. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241227360. [PMID: 38282514 PMCID: PMC10826392 DOI: 10.1177/17455057241227360] [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: 04/30/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND The human papilloma virus is a global problem that affects sexually active women and men, with cervical cancer being the most serious associated disease. Most cervical cancer cases can be prevented by vaccination against the human papilloma virus early in life. The objective of this study was to assess the knowledge, attitudes, and practices among physicians working in Qatar, regarding the human papilloma virus, infection, and prevention using vaccines. STUDY-DESIGN This was a cross-sectional study using quantitative data collection. METHODOLOGY An online survey targeting physicians working in Qatar was conducted, using a web-based pretested questionnaire. The questionnaire comprised four sections capturing a few demographic details, 33 questions in the Knowledge Section, 12 questions eliciting the attitude, and 14 practice-related questions. Mean knowledge score was calculated and those with a score more than the mean score were considered to have sufficient knowledge. Association between knowledge and attitude/practices/independent variables were looked for using bivariate and multivariate analysis. Logistic regression was used to identify the predictors for recommending human papilloma virus vaccines. RESULTS Of the 557 physicians who participated, 83.7% had sufficient knowledge, but only 69.1% knew that human papilloma virus vaccines were available in Qatar. The majority (89.4%) knew that human papilloma virus infection could be asymptomatic and 96.1% knew at least one symptom; 77% believed the human papilloma virus vaccine would substantially decrease the chances of human papilloma virus infection and related cancers and 46.5% felt physicians were less motivated to promote the human papilloma virus vaccine. The perceived barriers to community acceptance of the human papilloma virus vaccine were lack of awareness regarding the relationship between human papilloma virus and cervical cancer (61.6%), doubts regarding efficacy (32.5%), fear regarding safety (26.9%), concern that the human papilloma virus vaccination may encourage risky sexual behavior (26.8%), and perceived low-risk (23.3%) and cost (24.6%). Only 21.5% commonly discussed sexual health with their clients. More than one-third were not interested in recommending the human papilloma virus vaccine. Bivariate analysis showed nationality, specialization, discussing with patients, and recommending vaccine to be significantly associated with knowledge. Bivariate and regression analysis identified that female gender and physician's religion were significant predictors to recommend the human papilloma virus vaccine. CONCLUSION Most physicians have good knowledge. Less than one-fourth commonly discussed sexual health with their clients. More than one-third were not interested in recommending the human papilloma virus vaccine. This issue might affect the human papilloma virus vaccination program implementation if not well addressed.
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Affiliation(s)
| | | | - Khalid Elmardi
- HP-CDC, Department of Public Health, Ministry of Public Health, Doha, Qatar
| | - Samina Hasnain
- HP-CDC, Department of Public Health, Ministry of Public Health, Doha, Qatar
| | - Hayat Khogali
- HP-CDC, Department of Public Health, Ministry of Public Health, Doha, Qatar
| | | | | | | | - Mohamed Iheb Bougmiza
- Community Medicine Residency Program Director, Primary Health Care Corporation, Doha, Qatar
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McNeil CJ, Barr B, Munawar I, DeWitt ME, Myers JS, Shetty AK. Assessing Barriers to Human Papillomavirus (HPV) Vaccination in At-Risk Rural Communities of Western North Carolina, United States. Vaccines (Basel) 2023; 11:1785. [PMID: 38140189 PMCID: PMC10747883 DOI: 10.3390/vaccines11121785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/18/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Human papillomavirus (HPV) vaccination among adolescents in rural, western North Carolina (NC) remains suboptimal. Data are needed to understand the barriers to HPV vaccination in these communities. We conducted a cross-sectional pilot study of parental attitudes and provider practices regarding HPV vaccination in rural western NC counties with lower HPV vaccination rates. Eight health department clinics were enrolled in the study. Further, 29 provider and 32 parent surveys were analyzed along with environmental scans. Median provider comfort regarding knowledge of HPV-associated diseases was 85% (IQR = 75-95), on a scale of 0-100% (100% representing complete comfort). Median parental comfort level regarding knowledge of HPV-associated diseases and the HPV vaccine was 75% (IQR = 50-89) and 75% (IQR = 49-96), respectively. Less than 25% of parents rated the HPV vaccine as 'extremely effective' against genital (16.7%) and anal cancers (17.9%). Parents were more likely to rate the vaccine as 'extremely effective' to 'very effective' if their child was female. There was no significant difference between parental- and provider-reported comfort with knowledge about HPV-associated diseases (p = 0.0725) and the HPV vaccine (p = 0.167). This study identified multiple opportunities to increase HPV vaccine coverage among unvaccinated adolescents at parental, provider, and clinic levels. Health education of rural NC residents and providers in public health settings may identify future interventions to increase HPV vaccine uptake.
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Affiliation(s)
- Candice J. McNeil
- Office of Global Health, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (B.B.); (A.K.S.)
- Section on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA; (I.M.); (M.E.D.)
| | - Breona Barr
- Office of Global Health, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (B.B.); (A.K.S.)
- Department of Family Medicine, West Virginia University, Ranson, WV 26506, USA
| | - Iqra Munawar
- Section on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA; (I.M.); (M.E.D.)
| | - Michael E. DeWitt
- Section on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA; (I.M.); (M.E.D.)
- Department of Biology, Wake Forest University, Winston-Salem, NC 27109, USA
| | - Jenny Snow Myers
- Immunization Branch, Division of Public Health, Carolina Department of Health and Human Services, Raleigh, NC 27609, USA;
| | - Avinash K. Shetty
- Office of Global Health, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (B.B.); (A.K.S.)
- Section on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA; (I.M.); (M.E.D.)
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Kassymbekova F, Zhetpisbayeva I, Tcoy E, Dyussenov R, Davletov K, Rommel A, Glushkova N. Exploring HPV vaccine knowledge, attitudes, barriers and information sources among parents, health professionals and teachers in Kazakhstan: a mixed-methods study protocol. BMJ Open 2023; 13:e074097. [PMID: 37739465 PMCID: PMC10533667 DOI: 10.1136/bmjopen-2023-074097] [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] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) is a prevalent sexually transmitted infection linked to certain types of malignant neoplasms, notably cervical cancer (CC). In Kazakhstan, a high prevalence of high oncogenic HPV types (HR-HPV) has been observed, and CC ranks as the second most common malignancy among women with a crude incidence rate of 18.3 cases per 100 000 women. The HPV vaccine, developed as the primary prevention measure against HPV infection, including the most prevalent HR-HPV, received approval from the WHO in 2009. In 2014, Kazakhstan initiated HPV vaccination as a pilot project in four sub-national regions; however, it was later in 2017 discontinued due to widespread parental refusal influenced by negative media reports. This study aims to examine knowledge, attitudes, information sources, barriers to HPV vaccination and factors associated with HPV vaccination hesitancy among different target groups in Kazakhstan prior to the HPV vaccine re-launch announced by the Ministry of Health. METHODS AND ANALYSIS This mixed-method-designed research comprises quantitative and qualitative components. Data on HPV awareness, attitudes towards HPV vaccination and sources of information will be collected through an online survey administered by parents and legal guardians, health professionals, and schoolteachers in the Republic of Kazakhstan between January 2023 and January 2024. Additionally, qualitative data on Kazakhstani parental beliefs and attitudes toward HPV vaccination will be collected through online focus group discussions. ETHICS AND DISSEMINATION OF RESULTS The study has been approved by the local ethics committee at the Kazakhstan Medical University "Higher School of Public Health" (KMU "KSPH") (No. 138 of 31.05.2021). The results will be reported in publications, at conferences among researchers and healthcare and school education professionals in Kazakhstan, and internationally.
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Affiliation(s)
- Fatima Kassymbekova
- Department of Public Health and Social Sciences, Kazakhstan Medical University "KSPH", Almaty, Kazakhstan
| | - Indira Zhetpisbayeva
- Department of Public Health and Social Sciences, Kazakhstan Medical University "KSPH", Almaty, Kazakhstan
| | - Evgeniya Tcoy
- Department of Obstetrics and Gynaecology, Kazakh-Russian Medical University, Almaty, Kazakhstan
| | - Rassul Dyussenov
- Department of Public Health and Social Sciences, Kazakhstan Medical University "KSPH", Almaty, Kazakhstan
| | - Kairat Davletov
- Health Research Center, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Alexander Rommel
- Epidemiology and Health Monotoring, Robert Koch Institute, Berlin, Germany
| | - Natalya Glushkova
- Department of Epidemiology, Biostatistics and Evidence Based Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan
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Jin SW, Lattimore DC, Harlin E, Davis L, Erholtz V, Brandt HM. Medical and public health professionals' perceived facilitators and barriers of human papillomavirus (HPV) vaccination among African American adolescents in Shelby County, Tennessee. BMC Health Serv Res 2023; 23:469. [PMID: 37165427 PMCID: PMC10173571 DOI: 10.1186/s12913-023-09415-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/18/2023] [Indexed: 05/12/2023] Open
Abstract
Human papillomavirus (HPV) infects nearly 85% of sexually active Americans during their lifetime, causing most cervical and five other cancers. Routine HPV vaccination is recommended for adolescents to prevent HPV-attributable cancers, but HPV vaccination coverage remains low, especially in Tennessee. In 2021, 54.6% of the population in Shelby County, Tennessee was Black or African American, reporting higher rates of new cervical cancer cases than other counties in Tennessee. While medical and public health professionals (HPs) play a critical role in promoting vaccination coverage, little is known about the factors HPs perceive to influence HPV vaccination for this population. This study sought to explore HPs' perceived facilitators and barriers of HPV vaccination among African American adolescents. Qualitative individual interviews with 26 HPs in Shelby County were conducted between October 2019 and February 2020. Interpretive content analysis of the interview data guided by the socio-ecological model revealed several important themes regarding the facilitators and barriers across the individual, interpersonal, and community levels. At the individual level, parental vaccine hesitancy emerged as a leading barrier to HPV vaccination, while appropriate education facilitated the vaccination. At the interpersonal level, a lack of strong provider recommendations impeded HPV vaccination, whereas improved communication skills with patients facilitated the vaccination. Finally, the community-level barriers included a lack of education and social/religious norms; the community-level facilitators included community outreach efforts. HPs should consider development of comprehensive community-based approaches that leverage the facilitators and barriers at multiple levels to increase HPV vaccination among African American adolescents in this region.
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Affiliation(s)
- Seok Won Jin
- School of Social Work, The University of Memphis, 119 McCord Hall, Memphis, TN, 38152, USA.
- Department of Medical Humanities and Social Science, College of Medicine, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
- Institute of Media Arts , Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| | | | - Eric Harlin
- School of Social Work, The University of Memphis, 119 McCord Hall, Memphis, TN, 38152, USA
| | - Levonna Davis
- School of Social Work, The University of Memphis, 119 McCord Hall, Memphis, TN, 38152, USA
| | - Virginia Erholtz
- The University of Memphis, 226 McCord Hall, Memphis, TN, 38152, USA
| | - Heather M Brandt
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
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Habermacher C, Lalloué B, Lamouille V, Thilly N, Agrinier N. Family physicians' practices and attitudes towards HPV vaccination since extension of HPV vaccination to males. Infect Dis Now 2023; 53:104669. [PMID: 36736826 DOI: 10.1016/j.idnow.2023.104669] [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: 09/01/2022] [Revised: 01/06/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To describe family physicians' (FP) practices and attitudes towards HPV vaccination guidelines since its extension to males in 2021, and to identify levers to promote HPV vaccination in all adolescents. PATIENTS AND METHODS Cross-sectional study among FPs established in France in 2021. We collected sociodemographic data, practices, opinions, and attitudes towards vaccination, and FPs' demands regarding training and information about HPV. We used logistic regression models to identify the variables associated with HPV vaccination proposal. RESULTS Of 530 FPs included, 469 (88.5%) reported that they systematically proposed HPV vaccines to girls vs 335 (63.2%) to boys. A total of 366 (69.0%) FPs reported an increase in HPV vaccines proposal to all adolescents since the extension of HPV vaccination to males recommended by French guidelines. However, factors associated with HPV vaccination proposal differed by target females and target males. Setting and mode of practice, opinion about the number of recommended vaccines and HPV vaccines, and demands of training on HPV vaccines were associated with HPV vaccination proposal to target females. Whereas academic status, opinion about HPV vaccination guidelines extension to males, using continuing medical education as the main source of information on HPV vaccines, and demands for training on HPV vaccines were associated with HPV vaccination proposal to target males. CONCLUSIONS Extension of HPV vaccination to males in French guidelines might have had a favorable impact on HPV vaccination proposal by FPs to adolescents. However, levers to promote HPV vaccination might differ according to the target population sex.
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Affiliation(s)
- C Habermacher
- Université de Lorraine, Faculté de médecine, F-54000 Nancy, France
| | - B Lalloué
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie clinique, F-54000 Nancy, France
| | - V Lamouille
- Université de Lorraine, Faculté de médecine, F-54000 Nancy, France
| | - N Thilly
- Université de Lorraine, APEMAC, F-54000 Nancy, France; Université de Lorraine, CHRU-Nancy, Département Méthodologie, Promotion, Investigation, F-54000 Nancy, France
| | - N Agrinier
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie clinique, F-54000 Nancy, France; Université de Lorraine, APEMAC, F-54000 Nancy, France.
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11
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Knowledge, attitudes and behaviors of family physicians about childhood vaccinations that are not in the routine vaccination schedule: a cross-sectional study. Prim Health Care Res Dev 2023; 24:e2. [PMID: 36617853 PMCID: PMC9884530 DOI: 10.1017/s1463423622000688] [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] [Indexed: 01/10/2023] Open
Abstract
AIM In our country, there are childhood vaccinations that are not included in the routine vaccination schedule and that families have to buy and have for a fee. In addition to income level, family physicians' recommendations also play a major role in getting these vaccines.Our study was planned to determine the level of knowledge, attitudes and behaviors of family physicians about rotavirus, HPV and meningococcal vaccines, which are not included in the routine vaccination scheme of the Ministry of Health. MATERIALS AND METHODS Our cross-sectional and descriptive study was carried out between May and July 2019. The population of our study consists of approximately 30 000 family physicians working as Family Physicians in Turkey. When the sample size is calculated with 5% margin of error and 95% confidence interval, it turns out to be 381. A 15-question questionnaire prepared by scanning the literature and including socio-demographic characteristics was presented to the participants. The Likert scale, which includes 12 questions about rotavirus, meningococcus, HPV and vaccines developed for these microorganisms, was administered to physicians either face-to-face or via the internet. In our study, the statistical significance level was accepted as P < 0.05, and the SPSS statistical package program was used in the calculations. RESULTS 81 Research Assistants, 62 Family Medicine Specialists and 234 Family Physicians participated in our study, and the participants were determined by simple random sampling method. The mean age of the participating physicians was 37.96 ± 9.3 (min: 25 and max: 68). 50.9% of the physicians were women, 79.8% were married, 85.1% were in the city center, and 62.1% were practicing family medicine as general practitioners. 74.82% of the participating physicians recommend rotavirus and 56.2% HPV vaccines to their patients. 10.6% (40 people) of the physicians participating in our study did not recommend any of the rotavirus, HPV, meningococcal, influenza and adult pertussis vaccines to their patients. In the evaluation of the reason for this, 58.7% (27 people) of physicians who did not recommend special vaccines state that they did not recommend vaccines because they are not included in the routine vaccination schedule of the Ministry of Health. Another important reason was that the vaccines are paid (30.4%, 14 people). To the question of having sufficient information about special vaccines that are not included in the routine vaccination schedule, 26% of the participants stated that they have sufficient knowledge, and 56.5% stated that they have partial knowledge. The Likert knowledge questions total score of those who recommended at least one vaccine to their patients was significantly higher than those who did not recommend it at all. Likert knowledge questions total score of those who had at least one vaccination was significantly higher than those who never had it (P = 0.001). CONCLUSION In general, as the level of knowledge about private vaccines decreases, the rates of self-vaccination, recommending it to their patients, and asking it to be included in the national vaccine schedule decrease. For this reason, increasing the knowledge of physicians about vaccines not included in the national vaccination schedule will contribute to the dissemination of vaccines, thus increasing immunity and reducing mortality and morbidity.
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12
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Lubeya MK, Zekire Nyirenda JC, Chanda Kabwe J, Mukosha M. Knowledge, Attitudes and Practices Towards Human Papillomavirus Vaccination Among Medical Doctors at a Tertiary Hospital: A Cross Sectional Study. Cancer Control 2022; 29:10732748221132646. [PMID: 36214063 PMCID: PMC9558859 DOI: 10.1177/10732748221132646] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Human papillomavirus (HPV) infection is a common sexually transmitted
disease, characterised by persistent infection with high-risk strains
leading to malignant conditions such as cervical cancer. The HPV vaccine is
a well-known primary preventive measure for HPV infections. Previous studies
have shown that medical doctors’ vaccine recommendation is one of the key
strategies in improving HPV vaccine uptake. In 2019, Zambia rolled out the
free national HPV vaccination program targeting 14-year-old girls. However,
the annual coverage for HPV vaccination is variable, with rates as low as
33% for 2021. Materials and Methods We conducted a cross-sectional study between September and December 2020 at
the University Teaching Hospitals in Lusaka, Zambia. We used analysis of
variance to assess the mean differences in the overall scores for knowledge,
attitude and practices towards the HPV vaccine. In addition, we used
structural equation modelling (SEM) to test the traditional education theory
as medical doctors’ HPV vaccine knowledge, attitude, and practices cover
several facets, and SEM can model latent variables. Results We enrolled 121 medical doctors, of whom 67 (44.6%) were male. The majority,
76 (62.8%), were registrars and 79 (65.3%) had more than ten years of
clinical experience. The overall mean knowledge, attitude, and practice
score of the HPV vaccine mean (SD) were 70.2 (15.1), 72.1 (18.5) and 77.1
(28.9), respectively. More than half of the medical doctors would advise
anyone eligible to take the HPV vaccine 66 (54.6%). There was a positive
correlation between attitude and practice towards the HPV vaccine (β = .03,
P = .017). Conversely, there was no evidence of a correlation between
overall HPV knowledge and attitude (β = .01, P = .670) and rank of the
medical doctors (β = −7.87, P = .355). Conclusion Knowledge was high with good attitudes and practices among medical doctors,
which are vital in vaccine recommendation and subsequent uptake.
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Affiliation(s)
- Mwansa Ketty Lubeya
- Department of Obstetrics and
Gynaecology, School of Medicine, The University of
Zambia, Lusaka,
Zambia,Women and Newborn Hospital,
University Teaching Hospitals, Lusaka,
Zambia,Young Emerging Scientists
Zambia, Lusaka,
Zambia,Mwansa Ketty Lubeya, Department of
Obstetrics and Gynaecology, School of Medicine-The University of Zambia P/B
50110 Nationalist road, Lusaka, Zambia.
| | | | - Jane Chanda Kabwe
- Young Emerging Scientists
Zambia, Lusaka,
Zambia,Department of Anaesthesia and
Critical Care, The
National Heart Hospital, Chongwe,
Zambia
| | - Moses Mukosha
- Department of Pharmacy, School of
Health Sciences, The
University of Zambia, Lusaka,
Zambia,HIV and Women’s Health Research
Group, University
Teaching Hospital, Lusaka, Zambia
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13
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Lalonde CS, Teng Y, Burtness BA, Ferris RL, Ahmed R, Saba NF. The Quest to Eradicate HPV-Related Oropharyngeal Carcinoma: An Opportunity Not to Miss. J Natl Cancer Inst 2022; 114:1333-1337. [PMID: 35567531 PMCID: PMC9552310 DOI: 10.1093/jnci/djac098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/29/2022] [Accepted: 05/05/2022] [Indexed: 11/15/2022] Open
Abstract
Oropharyngeal squamous cell carcinoma (OPSCC) accounts for more than half of all head and neck cancers. Since the 1970s, OPSCC has shifted from an environmentally triggered to virally mediated disease due to a sharp rise in human papillomavirus (HPV)-related squamous cell carcinoma. Although a highly effective prophylactic vaccine is available, its current implementation is far below national targets, and OPSCC incidence is predicted to further increase by 2045. However, we believe that with prompt action now, we can not only defy these predictions but also effectively eradicate HPV-related OPSCC in these next 20 years. We herein provide an overview of the necessary elements to eliminate this disease: improved primary vaccine uptake, a 1-time universal vaccination effort, and implementation of novel therapeutics that have potential to cure existing disease.
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Affiliation(s)
- Chloe S Lalonde
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Yong Teng
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Barbara A Burtness
- Department of Medical Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rafi Ahmed
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
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14
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Assessing knowledge of human papillomavirus among men who have sex with men (MSM) using targeted dating applications. Vaccine 2022; 40:5376-5383. [DOI: 10.1016/j.vaccine.2022.07.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 06/22/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022]
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15
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Runngren E, Eriksson M, Blomberg K. Balancing Between Being Proactive and Neutral: School Nurses' Experiences of Offering Human Papilloma Virus Vaccination to Girls. J Sch Nurs 2022; 38:270-278. [PMID: 32578487 PMCID: PMC9069651 DOI: 10.1177/1059840520933323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to describe the experiences of Swedish school nurses when they offered the human papilloma virus (HPV) vaccination to girls aged 10-12 years. Four focus groups with a total of 17 school nurses were conducted and analyzed using inductive content analysis. The results showed that the school nurses were balancing between keeping a neutral role and the need to increase the uptake of the HPV vaccination. They described the consent forms and information that they gave the girls and their parents to help them make an informed decision about the vaccination. There were also ethical and moral dilemmas that arose with regard to the HPV vaccinations. Our findings demonstrate the need to provide school nurses with clear guidelines and support, so they can play an active role in interacting with the girls and their parents when they offer the HPV vaccination.
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Affiliation(s)
- Eva Runngren
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Sweden
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16
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Determinants of Human Papillomavirus Vaccine recommendation among Middle Eastern and Lebanese Healthcare Providers. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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17
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Btoush R, Kohler RK, Carmody DP, Hudson SV, Tsui J. Factors that Influence Healthcare Provider Recommendation of HPV Vaccination. Am J Health Promot 2022; 36:1152-1161. [PMID: 35442819 DOI: 10.1177/08901171221091438] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: This study examined factors associated with healthcare providers' (HCPs') recommendation of HPV vaccination for younger and older adolescents. Methods: This is a cross-sectional study, using web-based survey of HCPs in New Jersey in 2018. The study outcome was a dichotomous measure of HCPs' recommendation of the HPV vaccine. The study predictors included practice characteristics (i.e., proportions of race/ethnicity, age groups, insurance type, and VFC recipients) and HCP's characteristics (i.e., specialty and perceived knowledge, effectiveness, concerns, parent- and system-related barriers, and facilitators). Data analysis included logistic regression models using separate blocks for practice and provider characteristics, followed by a backward stepwise approach to determine the surviving predictors. Results: Respondents (N=390) included physicians (75%) and nurse practitioners (25%), specialized in pediatrics (62%), family medicine (20%), and women's health (18%). The HCPs' recommendation rates for HPV vaccination were 56% for younger adolescents (11-13 years old) and 73% for older adolescents (14-17 years old). For younger adolescents, the recommendation rates were significantly higher in practices with higher proportions of younger adolescent, Black and Hispanic patients; among pediatric providers; and with HCPs' higher levels of knowledge and lower levels of concern about the vaccine. For older adolescents, the rates were significantly higher in practices with higher proportions patients who are Hispanic, privately insured, and VFC recipients; among pediatric providers; and with HCPs' higher levels of knowledge and lower levels of concern about the vaccine as well as higher levels of facilitators for recommending the HPV vaccine. Conclusions: Interventions targeting HCPs need to focus on improving their knowledge regarding the vaccine, reduce their concerns around its safety, and utilize facilitators strategies, particularly among non-pediatric providers.
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Affiliation(s)
- Rula Btoush
- School of Nursing, 5751Rutgers University, Newark, NJ, USA
| | - Racquel Kelly Kohler
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.,Rutgers School of Public Health, New Brunswick, NJ, USA
| | | | - Shawna V Hudson
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.,Department of Family Medicine and Community Health, 12287Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Jennifer Tsui
- Department of Preventive Medicine, 12223University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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18
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Verger P, Botelho-Nevers E, Garrison A, Gagnon D, Gagneur A, Gagneux-Brunon A, Dubé E. Vaccine hesitancy in health-care providers in Western countries: a narrative review. Expert Rev Vaccines 2022; 21:909-927. [PMID: 35315308 DOI: 10.1080/14760584.2022.2056026] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Vaccine hesitancy (VH) is a leading cause of suboptimal vaccine uptake rates worldwide. The interaction between patients and health-care providers (HCPs) is the keystone in addressing VH. However, significant proportions of HCPs, including those who administer vaccines, are personally and professionally vaccine-hesitant. AREAS COVERED This narrative review sought to characterize the nature, extent, correlates, and consequences of VH among HCPs. We included 39 quantitative and qualitative studies conducted in Western countries, published since 2015, that assessed VH among HCPs in general, for several vaccines. Studies were reviewed using the WHO 3Cs model - (lack of) confidence, complacency, and (lack of) convenience. EXPERT OPINION Despite the lack of validated tools and substantial heterogeneity in the methods used to measure VH among HCPs, this review confirms its presence in this population, at frequencies that vary by country, profession type, setting, and level of medical education. Lack of knowledge and mistrust in health authorities/pharmaceutical industry/experts were among its principal drivers. Improving the content about vaccination in HCPs' training programs, facilitating access to reliable information for use during consultations, and developing and validating instruments to measure HCPs' VH and its determinants are key to addressing VH among HCPs.
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Affiliation(s)
- Pierre Verger
- ORS Paca, Southeastern Health Regional Observatory, Marseille, France.,Faculty of Medicine, Aix-Marseille University, Marseille, France
| | - Elisabeth Botelho-Nevers
- Department of Infectious Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France.,CIRI - Centre International de Recherche en Infectiologie, Lyon, France.,Univ Lyon, Jean Monnet University, Saint-Etienne, France.,Chair PreVacCi, Presage Institut, Jean Monnet University, Saint-Etienne, France
| | - Amanda Garrison
- ORS Paca, Southeastern Health Regional Observatory, Marseille, France.,Faculty of Medicine, Aix-Marseille University, Marseille, France
| | - Dominique Gagnon
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Quebec, Canada
| | - Arnaud Gagneur
- Department of Pediatrics, Centre de Recherche du CHUS, Quebec, Canada.,Faculté de médecine et des sciences de la santé, Département de pédiatrie, Université de Sherbrooke-Campus de la Santé, Quebec, Canada
| | - Amandine Gagneux-Brunon
- Department of Infectious Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France.,CIRI - Centre International de Recherche en Infectiologie, Lyon, France.,Univ Lyon, Jean Monnet University, Saint-Etienne, France.,Chair PreVacCi, Presage Institut, Jean Monnet University, Saint-Etienne, France.,CIC INSERM Vaccinology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Eve Dubé
- Deptartment of Anthropology, Laval University, Quebec, Canada
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19
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Kurani S, MacLaughlin KL, Jacobson RM, St Sauver JL, Jenkins GD, Fan C, Jacobson DJ, Inselman J, Zhu X, Griffin JM, Finney Rutten LJ. Socioeconomic disadvantage and human papillomavirus (HPV) vaccination uptake. Vaccine 2022; 40:471-476. [PMID: 34916103 PMCID: PMC8778948 DOI: 10.1016/j.vaccine.2021.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 01/26/2023]
Abstract
IMPORTANCE Despite availability of safe and effective human papillomavirus (HPV) vaccines, vaccination uptake remains low in the U.S. Research examining the impact of neighborhood socioeconomic status on HPV vaccination may help target interventions. OBJECTIVE To examine the association between area deprivation and HPV vaccine initiation and completion. DESIGN, SETTING, PARTICIPANTS Retrospective cohort study of individuals aged 11-18 years residing in the upper Midwest region. Receipt of HPV vaccination was examined over a three-year follow-up period (01/01/2016-12/31/2018). MAIN OUTCOMES AND MEASURES Outcomes of interest were initiation and completion of HPV vaccination. Demographic data were collected from the Rochester Epidemiology Project (REP). Area-level socioeconomic disadvantage was measured by calculating an Area Deprivation Index (ADI) score for each person, a measure of socioeconomic disadvantage derived from American Community Survey data. Multivariable mixed effect Cox proportional hazards models were used to examine the association of ADI quartiles (Q1-Q4) with HPV vaccine series initiation and completion, given initiation. RESULTS Individuals residing in census block groups with higher deprivation had significantly lower likelihood of HPV vaccine initiation (Q2: HR = 0.91, 0.84-0.99 Q3: HR = 0.83, 0.76-0.90; Q4: HR = 0.84, 0.74-0.96) relative to those in the least-deprived block groups (Q1). Similarly, those living in block groups with higher deprivation had significantly lower likelihood of completion (Q2: HR = 0.91, 0.86-0.97; Q3: HR = 0.87, 0.81-0.94; Q4: HR = 0.82, 0.74-0.92) compared to individuals in the least-deprived block groups (Q1). CONCLUSIONS AND RELEVANCE Lower probability of both HPV vaccine-series initiation and completion were observed in areas with greater deprivation. Our results can inform allocation of resources to increase HPV vaccination rates in our primary care practice and provide an example of leveraging public data to inform similar efforts across diverse health systems.
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Affiliation(s)
- Shaheen Kurani
- Division of Health Care Delivery Research, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
| | - Kathy L MacLaughlin
- Department of Family Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
| | - Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA; Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
| | - Jennifer L St Sauver
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
| | - Gregory D Jenkins
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
| | - Chun Fan
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
| | - Debra J Jacobson
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
| | - Jonathan Inselman
- Division of Health Care Delivery Research, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
| | - Xuan Zhu
- Division of Health Care Delivery Research, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
| | - Joan M Griffin
- Division of Health Care Delivery Research, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
| | - Lila J Finney Rutten
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
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20
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Bishop JM, Real FJ, McDonald SL, Klein M, DeBlasio D, Kahn JA, Kreps GL, Rosen BL. Evaluation of HPV Vaccine: Same Way, Same Day TM: A Pilot Study. JOURNAL OF HEALTH COMMUNICATION 2021; 26:839-845. [PMID: 34985403 DOI: 10.1080/10810730.2021.2021459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Missed clinical opportunities and the lack of strong and consistent vaccine recommendations are key reasons for low HPV vaccination rates. The purpose of this study was to conduct a pilot evaluation of a web-based training's impact on knowledge, attitudes, and self-efficacy related to providing evidence-based HPV vaccine recommendations. Participants completed three online interactive learning modules and the HPV Vaccine: Same Way, Same Day™ smartphone application (app). Participants completed a pre-training survey, immediate post-training survey, and two-month post-survey. Participants demonstrated a statistically significant increase in knowledge scores from T1 to T2 and T1 to T3. Mean attitudes for recommending HPV vaccination for female patients increased from T1 to T2 and T1 to T3. Mean attitudes for recommending HPV vaccination for male patients increased from T1 to T2 and T1 to T3. Mean self-efficacy scores increased from T1 to T2 and T1 to T3. The HPV Vaccine: Same Way, Same Day™ app is a promising strategy for improving HPV vaccine recommendations among physicians. Future research should explore long-term effects and enroll attending and community physicians to examine its efficacy in other physician populations.
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Affiliation(s)
- James M Bishop
- Department of Health Sciences, James Madison University, Harrisonburg, Virginia, USA
| | - Francis J Real
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Skye L McDonald
- School of Human Services, University of Cincinnati, Cincinnati, Ohio, USA
| | - Melissa Klein
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Dominick DeBlasio
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jessica A Kahn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gary L Kreps
- Department of Communication, George Mason University, Fairfax, Virginia, USA
| | - Brittany L Rosen
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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21
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McGee LU, Ressler KS, Boom JA, Bulsara S, Sangi-Haghpeykar H, Jibaja-Weiss ML, Montealegre JR. Incomplete Records as a Leading Cause of Missed Opportunity for Human Papillomavirus Vaccine Initiation in a Safety Net Health System. Acad Pediatr 2021; 21:1118-1125. [PMID: 33359360 DOI: 10.1016/j.acap.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 11/25/2020] [Accepted: 12/15/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The goal of this study was to categorize reasons behind missed opportunities for human papillomavirus (HPV) vaccine initiation in an under-resourced population and to identify associated patient and clinic characteristics. METHODS Manual chart review was performed for patients aged 11 to 18 years who visited a primary care clinic in a health system in Texas, USA between 06/01/18 and 08/31/18 and were due for an initial HPV vaccine dose but did not receive it. Reasons for HPV vaccine noninitiation were categorized as follows: incomplete immunization record, no documentation of discussion (no documentation that the HPV vaccine was offered or ordered), refusal, staff/provider error, and medical. Multinomial logistic regression was used to examine factors associated with each category. RESULTS Of 4467 adolescents seen in the study period, 575 (12.9%) were due for the first dose of HPV vaccine but did not receive it. The most common reason for noninitiation was incomplete immunization record (37%), followed by no documentation of discussion (24%), refusal (20%), staff/provider error (15%), and medical (4%). The highest odds of incomplete immunization were among older adolescents. The highest odds of no documentation of discussion were during sick visits. The highest odds of staff/provider error were among patients with commercial insurance. The lowest odds of refusal were in patients with county/indigent insurance. CONCLUSIONS The most common reason for missed opportunity visits for HPV vaccine initiation was lack of adequate immunization records. Our study highlights the importance of immunization record access and bidirectional reporting as important targets for future interventions.
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Affiliation(s)
- Lindy U McGee
- Department of Pediatrics, Baylor College of Medicine (LU McGee, JA Boom, and JR Montrealegre), Houston, Tex; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine (LU McGee, S Bulsara, ML Jibaja-Weiss, and JR Montealegre), Houston, Tex.
| | - Kelly S Ressler
- Department of Medical Education, Baylor College of Medicine (KS Ressler), Houston, Tex
| | - Julie A Boom
- Department of Pediatrics, Baylor College of Medicine (LU McGee, JA Boom, and JR Montrealegre), Houston, Tex
| | - Shaun Bulsara
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine (LU McGee, S Bulsara, ML Jibaja-Weiss, and JR Montealegre), Houston, Tex
| | - Haleh Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Baylor College of Medicine (H Sangi-Haghpeykar), Houston, Tex
| | - Maria L Jibaja-Weiss
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine (LU McGee, S Bulsara, ML Jibaja-Weiss, and JR Montealegre), Houston, Tex; School of Health Professions, Baylor College of Medicine (ML Jibaja-Weiss), Houston, Tex
| | - Jane R Montealegre
- Department of Pediatrics, Baylor College of Medicine (LU McGee, JA Boom, and JR Montrealegre), Houston, Tex; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine (LU McGee, S Bulsara, ML Jibaja-Weiss, and JR Montealegre), Houston, Tex
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22
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Lin C, Mullen J, Smith D, Kotarba M, Kaplan SJ, Tu P. Healthcare Providers' Vaccine Perceptions, Hesitancy, and Recommendation to Patients: A Systematic Review. Vaccines (Basel) 2021; 9:vaccines9070713. [PMID: 34358132 PMCID: PMC8310254 DOI: 10.3390/vaccines9070713] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 12/13/2022] Open
Abstract
Despite vaccines' effectiveness in reducing the rate of preventable diseases, vaccine hesitancy has threatened public health and economies worldwide. Healthcare providers' (HCP) communications and behavior strongly influence patient receptivity and uptake. The goal of this review was to examine HCP vaccine perceptions, knowledge, and reservations and how these attitudes affect their recommendations and vaccination practices. Primary research studies published by 16 September 2020 were searched in PubMed, Web of Science, Embase, CINAHL, and PsycINFO. A 14-item scale was developed for survey study and risk of bias appraisal (SSRBA). In total, 96 papers from 34 countries were included, covering 17 vaccines (HPV and influenza vaccines the most studied). Recommendation was positively associated with provider knowledge and experience, beliefs about disease risk, and perceptions of vaccine safety, necessity, and efficacy. HCP vaccination attitudes and practices varied across specialties, vaccines, and countries; demographic impact was inconclusive. Barriers included anticipation of patient/parental concerns or refusal, lacking clear guidelines, time constraints, and cost. For HPV, vaccines were more often recommended to older, female adolescents and by physicians who discussed sexual health. HCPs are vital advocates for patients and the public, but studies indicated a prevalence of provider hesitancy pertaining to inadequate knowledge, low vaccine confidence, and suboptimal uptake themselves. Improving HCP knowledge and assuring their access to information they deem trustworthy are essential to supporting HCPs' role as "trusted messengers" to promote vaccine acceptance.
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Affiliation(s)
- Cheryl Lin
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (D.S.); (M.K.)
| | - Jewel Mullen
- Dell Medical School, The University of Texas at Austin, Austin, TX 78712, USA;
| | - Danielle Smith
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (D.S.); (M.K.)
| | - Michaela Kotarba
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (D.S.); (M.K.)
| | - Samantha J. Kaplan
- Medical Center Library and Archives, Duke University, Durham, NC 27710, USA;
| | - Pikuei Tu
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (D.S.); (M.K.)
- Correspondence:
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Dang JHT, Stewart SL, Blumberg DA, Rodriguez HP, Chen MS. Patient and clinician factors associated with uptake of the human papillomavirus (HPV) vaccine among adolescent patients of a primary care network. Vaccine 2021; 39:3528-3535. [PMID: 34023133 DOI: 10.1016/j.vaccine.2021.04.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination rates for adolescents remain relatively low. The purpose of this study is to examine patient and clinician factors associated with HPV vaccination among patients, ages 11-17, of a large community-based primary care network. METHODS Electronic health records and administrative data from a large primary care network from January 2017 - June 2018 for patients ages 11-17 (n = 10,682) and the 198 primary care clinicians that saw them were analyzed. Mixed effects logistic regression models examined the association of patient and clinician factors with HPV vaccine uptake. RESULTS Most patients (63.0%) had at least one dose of the HPV vaccine, and 37.7% were up to date. In adjusted analyses, patients who received the tetanus, diphtheria, and pertussis (Tdap) vaccine (OR = 2.8, 95% CI: 2.1-3.9) compared to those who did not receive the vaccine and patients with five or more medical visits (OR = 1.9, 95% CI: 1.6-2.2) had the greatest odds of being up to date with the HPV vaccine series. Compared to White patients, African American/Black (OR = 0.8, 95% CI: 0.6 - 1.0) and Alaskan Native/American Indian (OR = 0.5, 95% CI: 0.3-0.9) patients were less likely to be up to date. Boys were also less likely to be up to date with the HPV vaccine series compared to girls (OR = 0.7, 95% CI: 0.7-0.8). Additionally, patients with family/general practice primary care clinicians were less likely to have their patients up to date than those with pediatricians (OR = 0.8, 95% CI: 0.6 - 1.0). CONCLUSION HPV vaccine uptake varied by patient characteristics, heath care utilization and primary care clinician specialty. These findings may inform future evidence-based interventions aimed at increasing HPV vaccine uptake among adolescents by targeting patient sub-groups and reducing missed opportunities for vaccination.
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Affiliation(s)
- Julie H T Dang
- University of California, Davis School of Medicine, Division of Health Policy and Management, Department of Public Health Sciences, 4501 X Street, Suite 3003, Sacramento, CA 95817, USA.
| | - Susan L Stewart
- University of California, Davis School of Medicine, Division of Biostatistics, Department of Public Health Sciences, 2450 48th Street, Suite 1600, Sacramento, CA 95817, USA
| | - Dean A Blumberg
- University of California, Davis Health, Department of Pediatrics, 2561 Stockton Blvd, Sacramento, CA 95817, USA
| | - Hector P Rodriguez
- University of California, Berkeley, School of Public Health, Division of Health Policy and Management, 2121 Berkeley Way #5427, Berkeley, CA 94704, USA
| | - Moon S Chen
- University of California, Davis School of Medicine, Division of Hematology and Oncology, 2540 48th Street, Suite 1600, Sacramento, CA 95817, USA
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Mansfield LN, Vance A, Nikpour JA, Gonzalez-Guarda RM. A systematic review of human papillomavirus vaccination among US adolescents. Res Nurs Health 2021; 44:473-489. [PMID: 33860541 DOI: 10.1002/nur.22135] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 11/07/2022]
Abstract
The human papillomavirus (HPV) causes many anogenital and oral cancers affecting young adults in the United States. Vaccination during adolescence can prevent HPV-associated cancers, but vaccine uptake among adolescents is low and influenced by factors serving as barriers and facilitators to HPV vaccination. In this systematic review, we synthesized research using the socioecological framework model to examine individual-level, relationship-level, community-level, and societal-level factors that influence HPV vaccine initiation and completion among US adolescents. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to guide the methodology for this review. An electronic search was conducted in January 2020 using PubMed, Cumulative Index of Nursing and Allied Health Literature, ProQuest Central, Scopus, and American Psychological Association PsycInfo databases. The Joanna Briggs Institute tools were used to assess the quality for the 57 studies included in this review. The most consistent influences of HPV vaccination included age at vaccination, awareness, and knowledge about HPV vaccination, socioeconomic status, insurance status, race/ethnicity, and preventative care behaviors at the individual level. Provider recommendation, familial/peer support of vaccination, and parental health behaviors were influences at the relationship level. Although fewer findings elucidated community-level and societal-level influences, high-poverty areas, high-risk communities with large proportions of racial/ethnic minority groups, healthcare facilities servicing children, and combined health policies appear to serve as facilitators of HPV initiation and completion. Findings from this review can inform culturally relevant and age-specific interventions and multi-level policies aiming to improve HPV vaccination coverage in the United States.
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Affiliation(s)
- Lisa N Mansfield
- School of Nursing, Duke University, Durham, North Carolina, USA.,Division of General Internal Medicine and Health Services Research, National Clinician Scholars Program, University of California, Los Angeles, Los Angeles, California, USA
| | - Ashlee Vance
- Institute for Healthcare Policy and Innovation, National Clinical Scholars Program, University of Michigan, Ann Arbor, Michigan, USA
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Jäger L, Senn O, Rosemann T, Plate A. Awareness, Attitudes and Clinical Practices Regarding Human Papillomavirus Vaccination among General Practitioners and Pediatricians in Switzerland. Vaccines (Basel) 2021; 9:vaccines9040332. [PMID: 33915931 PMCID: PMC8065954 DOI: 10.3390/vaccines9040332] [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: 03/02/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 11/16/2022] Open
Abstract
In Switzerland, the human papillomavirus vaccination (HPVv) coverage rate lies below a desirable threshold. General practitioners (GPs) and pediatricians have been recognized as important providers of the HPVv, but there is little known about their self-attributed role and its relationship with their actual HPVv behavior. Therefore, the objective of this study was to explore the awareness, attitudes, and clinical practices of Swiss GPs and pediatricians concerning HPVv by means of a web-based questionnaire. We analyzed the responses of 422 physicians (72% GPs, 28% pediatricians). A substantial proportion of respondents considered the HPVv “absolutely essential” (54.2% of pediatricians, 30.6% of GPs). GPs indicated spending more time and effort on HPVv counseling for female rather than male patients more often compared to pediatricians (44.0% versus 13.9%, p < 0.001). The weekly number of patients aged 18–26 years seen in practice (p = 0.002) and whether the HPVv was deemed “absolutely essential” (adjusted odds ratio 2.39, 95% confidence interval 1.12–5.08) were factors associated with GPs administering HPVv in their practice. Shortcomings in terms of awareness, effort in the identification of potential vaccination candidates, and the role of male patients were revealed. By addressing these gaps, Swiss primary care providers could contribute to an increase in the national HPVv coverage rate.
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Affiliation(s)
- Levy Jäger
- Correspondence: ; Tel.: +41-44-255-75-06
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Escriva-Boulley G, Mandrik O, Préau M, Herrero R, Villain P. Cognitions and behaviours of general practitioners in France regarding HPV vaccination: A theory-based systematic review. Prev Med 2021; 143:106323. [PMID: 33171178 PMCID: PMC7840585 DOI: 10.1016/j.ypmed.2020.106323] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 01/11/2023]
Abstract
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.
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Affiliation(s)
| | - Olena Mandrik
- The University of Sheffield, School of Health and Related Research (ScHARR), Health Economic and Decision Science (HEDS), Sheffield S1 4DA, United Kingdom
| | - Marie Préau
- Laboratoire GRePS (EA 4163), Université Lyon 2, 69676 Bron, France
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones, Biomédicas, San Jose, Costa Rica
| | - Patricia Villain
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, World Health Organization (IARC - WHO), 69372 Lyon, France.
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Bouchez M, Ward JK, Bocquier A, Benamouzig D, Peretti-Watel P, Seror V, Verger P. Physicians’ decision processes about the HPV vaccine: A qualitative study. Vaccine 2021; 39:521-528. [DOI: 10.1016/j.vaccine.2020.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
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Petrusek J, Thorpe E, Britt CJ. HPV vaccination practices and attitudes among primary care physicians since FDA approval to age 45. Am J Otolaryngol 2020; 41:102685. [PMID: 32866846 DOI: 10.1016/j.amjoto.2020.102685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/12/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to examine HPV vaccine administration practices since FDA approval to age 45 and assess knowledge regarding HPV and its association with oropharyngeal cancer. METHODS A survey was distributed to 86 primary care physicians at Loyola University Medical Center. The survey contained 11 questions designed to capture HPV vaccination practices, knowledge of FDA approval, and barriers to vaccination. RESULTS 46 (53%) physicians completed the survey and 45 responses were included. Among respondents who treat males ages 9-21 and females ages 9-26, the vaccination is widely recommended with >95% always or almost always recommending the vaccination. Among those treating males >21, and females >26, 52% and 35% of physicians recommend vaccination to these cohorts, respectively. Only 17% and 26% of respondents would recommend the vaccine to men and women respectively up to age 45. 100% of respondents recognize an association between HPV and cervical cancer, and 90% of respondents recognize HPV's association with oropharyngeal cancer. However, respondents also associate HPV with oral cavity and laryngeal cancer. 28% of respondents said parents are barriers to vaccination, while 7% said that insurance is a barrier. CONCLUSIONS HPV vaccination is widely recommended by physicians at our institution; however, for men older than 21 and women older than 26, vaccination recommendation rates decrease, and relatively few physicians would offer the vaccination up to age 45. Primary care physicians at our institution recognize HPV's close association to oropharyngeal cancer. Barriers to vaccination are primarily negative perception of the vaccine by patients and parents.
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Affiliation(s)
- Jeffrey Petrusek
- Department of Otolaryngology, Loyola University Medical Center, Maywood, IL 60153, United States of America.
| | - Eric Thorpe
- Department of Otolaryngology, Loyola University Medical Center, Maywood, IL 60153, United States of America
| | - Christopher J Britt
- Department of Otolaryngology, Loyola University Medical Center, Maywood, IL 60153, United States of America
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Agyei-Baffour P, Asare M, Lanning B, Koranteng A, Millan C, Commeh ME, Montealegre JR, Mamudu HM. Human papillomavirus vaccination practices and perceptions among Ghanaian Healthcare Providers: A qualitative study based on multi-theory model. PLoS One 2020; 15:e0240657. [PMID: 33064718 PMCID: PMC7567370 DOI: 10.1371/journal.pone.0240657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/30/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Healthcare providers' (HCPs) recommendations for the Human Papillomavirus (HPV) vaccine are likely to increase the vaccination uptake. However, little is known about Ghanaian HCPs' general practices regarding HPV vaccination. We used Multi-Theory Model (MTM) constructs (i.e. participatory dialogue, behavioral confidence, environment, social and emotional transformation) to examine Ghanaian HCPs' attitudes towards HPV vaccination and their vaccination recommendation practices. METHODS We conducted three, 60-minute focus group discussions (FGDs) with HCP in the second-largest government hospital in Ghana. Sixteen semi-structured open-ended questions based on MTM constructs were used to guide the FGDs. We explored HCPs' general knowledge about HPV, vaccination recommendation behavior, physical environment, and socio-cultural factors associated with the HPV vaccination. Data from the FGDs were transcribed and thematically coded using NVivo software. RESULTS The sample of (n = 29) HCPs consisting of males (n = 15) and females (n = 14) between the ages of 29 and 42 years participated in the FGDs. Our analyses showed that HCPs (a) rarely offered HPV vaccination recommendations, (b) showed varied understanding about who should be vaccinated regarding age eligibility, gender, and infection status. Perceived barriers to HPV vaccination include (a) low urgency for vaccination education due to competing priorities such as malaria and HIV/AIDS; (b) lack of data on HPV vaccination; (c) lack of awareness about the vaccine safety and efficacy; (c) lack of HPV vaccine accessibility and (d) stigma, misconceptions and religious objections. HCPs expressed that their motivation for counseling their clients about HPV vaccination would be increased by having more knowledge about the vaccine's efficacy and safety, and the involvement of the parents, chiefs, churches, and opinion leaders in the vaccination programs. CONCLUSION The study's findings underscore the need for a comprehensive HPV vaccination education for HCPs in Ghana. Future HPV vaccination education programs should include information about the efficacy of the vaccine and effective vaccination messages to help mitigate HPV vaccine-related stigma.
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Affiliation(s)
- Peter Agyei-Baffour
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Matthew Asare
- Department of Public Health, Baylor University, Waco, Texas, United States of America
- * E-mail:
| | - Beth Lanning
- Department of Public Health, Baylor University, Waco, Texas, United States of America
| | - Adofo Koranteng
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Cassandra Millan
- Department of Public Health, Baylor University, Waco, Texas, United States of America
| | - Mary E. Commeh
- Non-Communicable Disease Control, Ghana Health Services, Accra, Ghana
| | - Jane R. Montealegre
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine Houston, Houston, Texas, United States of America
| | - Hadii M. Mamudu
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, United States of America
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Hennebery RB, Dang DN, Sisson C, Naresh A. Factors Associated with Initiation of HPV Vaccination Among Young Women and Girls in Urban and Suburban New Orleans. J Community Health 2020; 45:775-784. [PMID: 32124163 DOI: 10.1007/s10900-020-00793-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Vaccination coverage against human papilloma virus (HPV) in the United States remains low. This study aimed to identify factors associated with initiation of HPV vaccination among young women and girls in New Orleans, Louisiana. The study was conducted in Pediatrics and Obstetrics & Gynecology clinics in New Orleans between 2014 and 2017. Surveys were administered to women ages 18 through 26, and guardians of girls ages 12 through 17. Demographics, health history, sources of medical information, knowledge of HPV and HPV vaccination, opinions on vaccination, expected support for vaccination, and systems-level barriers were assessed. Participants self-reported discussion of the vaccine with a healthcare provider, and whether they or their child had been vaccinated. Participants were predominantly black and low-income. Among young adults, 61/121 (50%) had received any doses of the HPV vaccine; 71/94 (75%) of girls had received it (p < 0.01). In both groups, knowledge of the HPV vaccine, believing the vaccine was available from their usual healthcare provider, and having discussed the vaccine with their provider were associated with increased odds of vaccination. Among young adults, additional factors associated with vaccination were younger age, distance from a healthcare center, knowledge of HPV, and expectation of support from parents. Among guardians, holding negative views on vaccination was associated with decreased odds of vaccination. Discussion of the vaccine with a healthcare provider was the factor most strongly associated with initiation of HPV vaccination in both groups. The results provided actionable items to increase HPV vaccination uptake in these populations.
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Affiliation(s)
- Ruth B Hennebery
- Tulane University School of Medicine, 1430 Tulane Ave., New Orleans, LA, 70112, USA
| | - Dung N Dang
- Tulane University School of Medicine, 1430 Tulane Ave., New Orleans, LA, 70112, USA
| | - Caitlin Sisson
- Tulane University School of Medicine, 1430 Tulane Ave., New Orleans, LA, 70112, USA
| | - Amber Naresh
- Department of Obstetrics & Gynecology, Tulane University School of Medicine, 1430 Tulane Ave., SL #8611, New Orleans, LA, 70112, USA.
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Amponsah-Dacosta E, Kagina BM, Olivier J. Health systems constraints and facilitators of human papillomavirus immunization programmes in sub-Saharan Africa: a systematic review. Health Policy Plan 2020; 35:701-717. [PMID: 32538437 PMCID: PMC7294244 DOI: 10.1093/heapol/czaa017] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2020] [Indexed: 12/03/2022] Open
Abstract
Given the vast investments made in national immunization programmes (NIPs) and the significance of NIPs to public health, it is important to understand what influences the optimal performance of NIPs. It has been established that well-performing NIPs require enabling health systems. However, systematic evidence on how the performance of health systems impacts on NIPs is lacking, especially from sub-Saharan Africa. We conducted a qualitative systematic review to synthesize the available evidence on health systems constraints and facilitators of NIPs in sub-Saharan Africa, using human papillomavirus immunization programmes as a proxy. Fifty-four articles published between 2008 and 2018 were found to be eligible. Data extraction was guided by an analytical model on the interface between NIPs and health systems. A cross-cutting thematic analysis of the extracted data was performed. This systematic review provides evidence necessary for informing ongoing health systems strengthening initiatives in sub-Saharan Africa. There is evidence to suggest that NIPs in sub-Saharan Africa have surmounted significant health systems constraints and have achieved notable public health success. This success can be attributed to strong political endorsement for vaccines, clear governance structures and effective collaboration with global partners. Despite this, significant health systems constraints persist in service delivery, vaccine communication, community engagement, the capacity of the health workforce and sustainable financing. These constraints could derail further progress if not addressed through health systems strengthening efforts. There is a need to expand the research agenda to include the comprehensive evaluation of health systems constraints and facilitators of NIPs within sub-Saharan Africa.
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Affiliation(s)
- Edina Amponsah-Dacosta
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
- Health Policy and Systems Division, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Benjamin M Kagina
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Jill Olivier
- Health Policy and Systems Division, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
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McCauley LM, Lake LM, Madison NR, Huntsman RE, Baker CM. Pharmacist and pharmacy intern perceptions of adolescent vaccination administration. J Am Pharm Assoc (2003) 2020; 60:S7-S12.e1. [PMID: 32359813 DOI: 10.1016/j.japh.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 02/28/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To characterize pharmacists' and pharmacy interns' perceptions of administering adolescent vaccinations. Secondary objectives were to model the association between 1) perceptions and respondent demographic information and 2) pre- and post-training survey responses. DESIGN A 12-item survey, on the basis of the Theory of Self-Perception, was used to collect respondents' perceptions of adolescent vaccination administration retrospectively before and after pharmacist and pharmacy intern completion of Online training. The training reviewed Center for Disease Control and Advisory Committee on Immunization Practice recommendations for vaccination schedules, vaccine administration, managing adverse reactions, finding vaccine-related information, the importance of vaccinating, and dispelling common misconceptions. SETTING AND PARTICIPANTS Pharmacists and pharmacy interns representing 114 Indiana community pharmacy locations within a national supermarket chain were eligible to complete an Online survey between March and April 2019. OUTCOME MEASURES Descriptive statistics were used to characterize pharmacists' and pharmacy interns' perceptions of adolescent vaccination administration. A multivariable regression analysis was used to determine the association between perceptions and respondent demographic information. Differences in perceptions before and after the training module were evaluated using paired t tests. RESULTS Of the 293 eligible pharmacists and pharmacy interns, 138 (47.1%) completed the survey and 124 (42.3%) responses were included for analysis. Pharmacists and pharmacy interns had positive perceptions of adolescent vaccination administration. There was a negative relationship between the number of years that a pharmacist had been in practice and their baseline perceptions of adolescent vaccination administration (P = 0.02). There was a statistically significant increase in perceptions following completion of the training module (P < 0.001). CONCLUSION Pharmacists and pharmacy interns, specifically those who have been in practice for few years, had positive perceptions about adolescent vaccination administration but their perceptions were strengthened with additional training. Further research is needed to determine the relationship between additional training and vaccination rates.
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Kara Elitok G, Bulbul L, Altuntas SB, Altuntas B, Günindi G, Haltaş M, Yuvarlan A, Toprak D, Bulbul A. Recommending immunizations to adolescents in Turkey: a study of the knowledge, attitude, and practices of physicians. Hum Vaccin Immunother 2020; 16:1132-1138. [PMID: 32040380 DOI: 10.1080/21645515.2020.1715146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: The aim of this study was to determine the knowledge, attitudes, and practices of family physicians and pediatricians in regard to adolescent immunization.Methods: The study was conducted from March to May 2017. A total of 665 physicians participated. Participants were asked 31 questions about their personal sociodemographic characteristics and their knowledge, attitudes, and practices around adolescent immunization.Results: The study sample consisted of 348 family physicians (52.3% of the sample) and 317 pediatricians (47.7%). The results showed that 5.4% of family physicians and 10.4% of pediatricians thought that they had enough knowledge about adolescent immunization (p < .01). Overall, 15.8% of family physicians and 12.7% of pediatricians provided adolescents with information about vaccines 'always/most of the time'. A variety of reasons for not providing information about adolescent vaccines was provided, including 'inability to allocate time' (50.2% of family physicians, 69.3% of pediatricians); 'forgetfulness' (34.8% of family physicians, 28.5% of pediatricians); 'lack of knowledge about vaccines' (34.1% of family physicians, 27.4% of pediatricians); and 'no need to immunize adolescents' (15.7% of family physicians, 6.5% of pediatricians) (p < .01). HPV immunization was recommended only to girls by 30.5% of family physicians and 38.8% of pediatricians (p < .01). The percentages of family physicians and pediatricians not recommending that adolescents be immunized with the Tdap vaccine were 53.4% and 42.6%, respectively (p = .016). Meningococcal immunization was not recommended by 20.7% of family physicians and 11.4% of pediatricians (p < .01), and influenza immunization was not recommended by 10.3% of family physicians and 8.2% of pediatricians (p < .01).Conclusion: Family physicians and pediatricians in Turkey have low rates of recommendation of immunization to adolescents. Reasons for not recommending immunization include an inability to allocate time, forgetfulness, and lack of knowledge about vaccines. We conclude that educational programs should be used to improve knowledge of adolescent immunization among family physicians and pediatricians.
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Affiliation(s)
- Gizem Kara Elitok
- Department of Family Medicine, Sisli Hamidiye Etfal Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Lida Bulbul
- Department of Pediatrics, University of Health Sciences Bakırköy Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | | | - Bülent Altuntas
- Department of Family Medicine, University of Health Sciences Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Gözde Günindi
- Department of Family Medicine, University of Health Sciences Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Mustafa Haltaş
- Department of Family Medicine, University of Health Sciences Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Ahmet Yuvarlan
- Department of Family Medicine, University of Health Sciences Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Dilek Toprak
- Deparment of Family Medicine, University of Namık Kemal, Tekirdağ, Turkey
| | - Ali Bulbul
- Department of Pediatrics, University of Health Sciences Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
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Rodriguez SA, Mullen PD, Lopez DM, Savas LS, Fernández ME. Factors associated with adolescent HPV vaccination in the U.S.: A systematic review of reviews and multilevel framework to inform intervention development. Prev Med 2020; 131:105968. [PMID: 31881235 PMCID: PMC7064154 DOI: 10.1016/j.ypmed.2019.105968] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 12/17/2019] [Accepted: 12/21/2019] [Indexed: 11/25/2022]
Abstract
Multilevel factors impact HPV vaccine series initiation and completion among adolescents in the U.S. Synthesis of these factors is needed to inform intervention development and to direct future research. Current frameworks synthesizing factors focus on females only and do not include both series initiation and completion outcomes. We conducted a systematic review of reviews to identify modifiable individual-, provider-, and clinic-level factors associated with HPV vaccination outcomes among U.S. adolescents and developed a multilevel framework illustrating relations between factors to inform intervention development. We searched Medline, PsychInfo, Pubmed, CINAHL, and ERIC databases and included reviews published 2006 to July 2, 2018 describing individual-, provider-, or clinic-level factors quantitatively associated with HPV vaccination among U.S. adolescents. Two coders independently screened reviews, extracted data, and determined quality ratings. Sixteen reviews containing 481 unique primary studies met criteria. Factors synthesized into the multilevel framework included parent psychosocial factors (knowledge, beliefs, outcome expectations, intentions) and behaviors, provider recommendation, and patient-targeted and provider-targeted clinic systems. The scope of our framework and review advances research in two key ways. First, the framework illustrates salient modifiable factors at multiple levels on which to intervene to increase HPV vaccination. Second, the review identified critical gaps in the literature at each level. Future research should link the body of literature on parental intentions to vaccination outcomes, identify provider psychosocial factors associated with recommendation behaviors and subsequent vaccine uptake in their patient population, and understand clinic factors associated with successful implementation of patient- and provider-targeted system-level interventions.
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Affiliation(s)
- Serena A Rodriguez
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States.
| | - Patricia Dolan Mullen
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Diana M Lopez
- MD Anderson Cancer Center, Houston, TX, United States
| | - Lara S Savas
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Maria E Fernández
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
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35
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Pfaff N, Garnett C, Mihalek AJ, Mamey MR, Wu S. Pediatric Resident Attitudes Toward Inpatient Immunization of Children and Adolescents: Highlighting Differences in Human Papillomavirus Vaccination. Glob Pediatr Health 2019; 6:2333794X19894123. [PMID: 31840039 PMCID: PMC6900615 DOI: 10.1177/2333794x19894123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/31/2019] [Accepted: 11/19/2019] [Indexed: 11/26/2022] Open
Abstract
Over a decade after its debut, human papillomavirus (HPV) vaccine coverage
remains suboptimal. The inpatient setting presents a largely unexplored
opportunity to increase vaccination rates. This study aims to describe pediatric
resident attitudes toward inpatient immunization and compare differences by
vaccine, in particular HPV. An anonymous survey of beliefs and practices
regarding inpatient vaccines was distributed to pediatric resident physicians at
a single freestanding urban children’s hospital in September 2017. A total of 58
surveys were collected (64% response rate). We found that pediatric residents
were more likely to report that they never or rarely discuss the HPV vaccine
during hospitalization compared with the primary childhood series
(P = .001), Tdap (P = .02), and the
influenza vaccine (P < .001), and rarely offer the HPV
vaccine during hospitalization compared with childhood vaccines
(P = .003) and influenza (P = .001). This
suggests that provider hesitancy still exists for the HPV vaccine, presenting
opportunities for further education and inpatient interventions.
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Affiliation(s)
- Nora Pfaff
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | | | - Mary Rose Mamey
- Children's Hospital Los Angeles, Los Angeles, CA, USA.,University of Southern California, Los Angeles, CA, USA
| | - Susan Wu
- Children's Hospital Los Angeles, Los Angeles, CA, USA
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36
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Abi Jaoude J, Saad H, Farha L, Dagher H, Khair D, Kaafarani MA, Jamaluddine Z, Cherfan P. Barriers, Attitudes and Clinical Approach of Lebanese Physicians Towards HPV Vaccination; A Cross- Sectional Study. Asian Pac J Cancer Prev 2019; 20:3181-3187. [PMID: 31653171 PMCID: PMC6982667 DOI: 10.31557/apjcp.2019.20.10.3181] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES HPV infection is associated with the development of cervical and oropharyngeal cancer. HPV vaccination prevents cervical cancer, but is still not part of Lebanon's routine vaccination schedule. As such, understanding physicians' practice towards HPV vaccination is essential. MATERIAL AND METHODS We conducted a cross-sectional study in Greater Beirut, Lebanon to assess the barriers, attitudes and clinical approach of Lebanese physicians towards HPV vaccination. We also aimed to analyze the factors associated with physicians' barriers to HPV vaccination. RESULTS In total, 228 physicians completed the survey. Our results show that physicians and parents consider the cost of HPV vaccination to be a main barrier (58.9% and 80.7% respectively). Also, parents tend to have concerns about vaccine safety (78.1%), efficacy (68.6%), and lack education concerning HPV infection (81.8%). Furthermore, female physicians tend to have fewer barriers when compared to male physicians (aOR = 0.39; p-value = 0.007). Additionally, physicians who completed residency programs in the USA also showed fewer barriers when compared to physicians who completed Lebanese residency programs (aOR = 0.24; p-value = 0.040). Finally, physicians with higher knowledge score have fewer barriers when compared to those with lower knowledge scores (aOR = 0.42; p-value = 0.018). CONCLUSIONS Physician gender, residency program and level of knowledge play a role in HPV vaccine barriers and recommendation in Lebanon. Future improvements in cost and awareness about HPV might improve vaccination rates. Creating uniform practices towards HPV vaccine is warranted to improve patient care.
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Affiliation(s)
| | - Halim Saad
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Loulwa Farha
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Hiba Dagher
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Diana Khair
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Zeina Jamaluddine
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Patrick Cherfan
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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37
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Educating healthcare providers to increase Human Papillomavirus (HPV) vaccination rates: A Qualitative Systematic Review. Vaccine X 2019; 3:100037. [PMID: 31463471 PMCID: PMC6708991 DOI: 10.1016/j.jvacx.2019.100037] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/25/2019] [Accepted: 07/25/2019] [Indexed: 11/22/2022] Open
Abstract
Objectives HPV vaccination rates in the United States lag behind other developed countries. Educational interventions are primarily directed at patients and parents rather than healthcare providers (HCPs), despite evidence that provider recommendation is a key determinant of vaccine uptake. The objectives for this review are to synthesize the available evidence related to the knowledge, attitudes, and beliefs of HCPs surrounding HPV vaccination, to summarize provider-specific educational interventions which have been evaluated, and to review existing provider-specific educational resources from national organizations and whether they align with the gaps identified. Methods A systematic search was performed using PubMed, Web of Science, CINAHL, and ERIC with MeSH terms human papillomavirus, vaccine, education, workshop, training, knowledge, attitude, belief, intention, and healthcare provider. Full text articles were obtained for studies that described the knowledge and attitudes of providers and/or impact of educational interventions. Data extraction was performed by four independent reviewers. Websites of American organizations with an interest in HPV vaccination were manually searched for provider resources. Results 1066 publications were identified, and 98 articles were fully reviewed with 40 ultimately included. Providers’ knowledge on HPV was generally low with a correspondingly low vaccine recommendation rate. Provider-specific education (e.g., didactic session and communication training) with complimentary interventions demonstrated increased knowledge and vaccine series initiation and completion. Themes identified in descriptive studies highlighted providers’ lack of general HPV and vaccine knowledge, low self-confidence in counselling and addressing parental concerns, and discomfort in discussing sexual issues related to vaccination. Many American organizations have provider-specific resources; however, the effectiveness of these materials has not been established. Conclusions HPV knowledge among providers remains low. Educational interventions to improve knowledge and communication appear to be effective. A breadth of resources from national organizations are available but their efficacy and level of utilization is largely unknown. Coordinated efforts are needed to evaluate provider-specific educational resources to improve vaccine uptake in the US.
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38
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Foss HS, Oldervoll A, Fretheim A, Glenton C, Lewin S. Communication around HPV vaccination for adolescents in low- and middle-income countries: a systematic scoping overview of systematic reviews. Syst Rev 2019; 8:190. [PMID: 31370886 PMCID: PMC6670236 DOI: 10.1186/s13643-019-1100-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/05/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infection causes cervical cancer. More than 80% of those diagnosed with cervical cancer live in low- and middle-income countries (LMICs). The World Health Organization recommends vaccination as a public health measure against cervical cancer. Communication interventions are able to change how people think about vaccination and are thus instrumental in addressing vaccine hesitancy. Our aim was to provide a broad scoping overview of the available evidence on communication with adolescents, parents, and other stakeholders around HPV vaccination for adolescents, with a specific focus on LMICs. METHODS We conducted a systematic scoping overview of systematic reviews addressing a range of questions regarding communication around HPV vaccination. We considered reviews published between 2007 and 2018 focusing on communication around HPV vaccination and that searched for qualitative or quantitative studies for inclusion. We searched the Epistemonikos database which includes reviews from multiple electronic databases. Two overview authors screened titles and abstracts and examined potentially eligible reviews in full text. Data extraction was performed by one overview author and verified by a second. We assessed the reliability of the included reviews using an adapted version of AMSTAR 2. RESULTS We included twelve reviews in our overview. Four reviews assessed the effectiveness of communication interventions. These interventions intended to inform or educate about HPV and HPV vaccination, such as videos and fact sheets, or to remind or recall, such as text message reminders. Eight reviews assessed factors associated with HPV vaccination uptake, including communication-related factors such as whether the vaccine was recommended by a physician and people's knowledge regarding the vaccine. Nine reviews searched for studies from LMICs, but most found only a small number of studies from these countries. CONCLUSIONS The small number of studies identified from LMICs is of concern as these countries face the largest burden of disease related to HPV. This scoping overview also found and excluded a number of reviews because of important methodological limitations, highlighting the need for future reviews to use appropriate methods. The overview indicates areas in which further primary studies are needed on HPV vaccination communication in LMICs. SYSTEMATIC REVIEW REGISTRATION Open Science Framework https://osf.io/agzb4/.
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Affiliation(s)
| | - Ann Oldervoll
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Atle Fretheim
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Claire Glenton
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Simon Lewin
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway.
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
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39
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Eun TJ, Hanchate A, Fenton AT, Clark JA, Aurora MN, Drainoni ML, Perkins RB. Relative contributions of parental intention and provider recommendation style to HPV and meningococcal vaccine receipt. Hum Vaccin Immunother 2019; 15:2460-2465. [PMID: 30862301 DOI: 10.1080/21645515.2019.1591138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
We described the relative contributions of parental intention and provider recommendation style to HPV and meningococcal vaccine receipt. Parent-child dyads that were eligible for both meningococcal and HPV vaccines participated in pre-visit surveys and consented to audio recording of their clinical interactions with healthcare providers related to vaccination. Surveys were analyzed for parent and child demographics and parental intention to vaccinate children with HPV and/or meningococcal vaccines. Audio recordings were analyzed for provider recommendation style, defined as indicated (provider stated vaccine was due at that visit) or not, and for child receipt of vaccines. Linear and logistic regression models were used to determine the relative contributions of parental intention and provider recommendation style to vaccine receipt. 56 parents/child dyads participated. 79% of children received HPV vaccines, and 93% received meningococcal vaccines. After controlling for demographic variables, parental intention did not differ by vaccine type. However, providers were less likely to use an indicated recommendation for HPV than for meningococcal vaccine. After controlling for demographic factors, parental intention, and provider recommendation style, vaccine type (HPV or meningococcal) was no longer associated with vaccine receipt Differences that were previously attributed to vaccine-specific factors may be explained by parents' and providers' roles in vaccine receipt. These findings suggest that interventions and policy recommendations regarding adolescent vaccination should focus on increasing parental demand for vaccines and ensuring that providers present all vaccines as the medical standard of care.
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Affiliation(s)
- Terresa J Eun
- Department of Sociology, Stanford University , Palo Alto, CA , California , USA
| | - Amresh Hanchate
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA
| | - Anny T Fenton
- Department ofSociology, Harvard University , Cambridge, MA , USA.,Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute , Scarborough, ME , USA
| | - Jack A Clark
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA
| | - Marisa N Aurora
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA.,Department of Health Policy and Management, Boston University School of Public Health , Boston, MA , USA
| | - Mari-Lynn Drainoni
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA.,Department of Health Policy and Management, Boston University School of Public Health , Boston, MA , USA.,Center for Healthcare Organization and Implementation Research, ENRM VA Hospital , Bedford , MA , USA
| | - Rebecca B Perkins
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA.,Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center , Boston, MA , USA
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40
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Abstract
Human papillomavirus (HPV), the most common sexually transmitted viral infection worldwide, is the causative agent for cervical cancer and attributed to anogenital cancers as well as oropharyngeal cancer. Three effective, safe, prophylactic HPV vaccines have been licensed, and studies have demonstrated decreases in HPV prevalence and HPV-related disease endpoints without evidence of waning protection to date. In the United States, only the 9-valent vaccine, which covers 90% of the cancers attributed to HPV in US registries, is available. Because higher titers are found at younger ages, two rather than three doses are needed if the first dose is given prior to age 15 years. HPV vaccination rates in the US lag compared to tetanus-diptheria-acellular pertussis and meningococcal conjugate vaccines. Current efforts are aimed at improving vaccination rates through delivering strong and consistent clinician recommendations at the same time as discussing other adolescent vaccines and preventing missed opportunities for vaccination. [Pediatr Ann. 2019;48(2):e71-e77.].
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41
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Hopfer S, Wright ME, Pellman H, Wasserman R, Fiks AG. HPV vaccine recommendation profiles among a national network of pediatric practitioners: understanding contributors to parental vaccine hesitancy and acceptance. Hum Vaccin Immunother 2019; 15:1776-1783. [PMID: 30570419 PMCID: PMC6746469 DOI: 10.1080/21645515.2018.1560771] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/28/2018] [Accepted: 12/11/2018] [Indexed: 12/15/2022] Open
Abstract
Background: Practitioner communication is one of the most important influences and predictors of HPV vaccination uptake. The objective of this study was to conduct a latent class analysis characterizing pediatric practitioner HPV recommendation patterns. Methods: Pediatric practitioners of the American Academy of Pediatrics' (AAP) Pediatric Research in Office Settings (PROS) national network completed an online survey where they were presented with 5 hypothetical vignettes of well child visits and responded to questions. Questions asked about their use of communication strategies, assessments about the adolescent patient becoming sexually active in the next 2 years for decision-making about HPV vaccine recommendation, and peer norms. Latent class analysis characterized practitioner subgroups based on their response patterns to 10 survey questions. Multinomial logistic regression examined practitioner characteristics associated with each profile. Results: Among 470 respondents, we identified three distinct practitioner HPV vaccine recommendation profiles: (1) Engagers (52%) followed national age-based guidelines, strongly recommended HPV vaccination, and perceived peers as strongly recommending; (2) Protocol Followers (20%) also strongly recommended HPV vaccination, but were less likely to engage families in a discussion about benefits; and (3) Ambivalent HPV Vaccine Recommenders (28%) delayed or did not recommend HPV vaccination and were more likely to use judgment about whether adolescents will become sexually active in the next two years. Practicing in a suburban setting was associated with twice the odds of being an Ambivalent Recommender relative to being an Engager (OR = 2.2; 95% CI:1.1-4.1). Conclusions: Findings underscore the importance of continued efforts to bolster practitioner adoption of evidence-based approaches to HPV vaccine recommendation especially among Ambivalent Recommenders.
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Affiliation(s)
- Suellen Hopfer
- Department of Population Health and Disease Prevention, Irvine, CA, USA
- Institute for Clinical & Translational Science, USA
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
| | - Margaret E. Wright
- Pediatric Research in Office Settings (PROS), Itasca, IL, USA
- American Academy of Pediatrics (AAP), Itasca, IL, USA
| | - Harry Pellman
- University of California, Irvine, CA, USA
- Edinger Medical Group, University of California, Fountain Valley, CA, USA
| | - Richard Wasserman
- Department of Pediatrics, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Alexander G. Fiks
- Pediatric Research in Office Settings (PROS), Itasca, IL, USA
- The Center for Clinical Effectiveness, USA
- Policy Lab, USA
- Pediatric Research Consortium, USA
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, USA
- Department of Pediatrics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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42
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Rippinger N, Heinzler J, Bruckner T, Brucker J, Dinkic C, Hoffmann J, Dornhöfer N, Seitz S, Rom J, Sohn C, Schott TC, Schott S. The impact of a cervical dysplasia diagnosis on individual cancer prevention habits over time: a bicentric case-control study. Arch Gynecol Obstet 2019; 299:847-855. [PMID: 30607592 DOI: 10.1007/s00404-018-5029-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/14/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Annual cervical cancer screening is recommended in Germany as a part of the statutory preventive care. Abnormal results can provoke psychological distress and anxiety, compromising women's adherence. Little is known about how a cervical dysplasia impacts adherence follow-up visits and prevention habits over time. To optimize care strategies, this study aims to identify women at risk for nonadherence to follow-up visits after a screening event. METHODS Between November 2015 and May 2017, participants with an abnormal Pap smear at the Heidelberg and Leipzig University Hospitals received a four-part questionnaire (sociodemographic data, PHQ-D, self-designed fear and prevention habit questions) at the first consultation (T1) and subsequently after 3 (T2) and 6 (T3) months; healthy controls completed the questionnaire at T1. RESULTS 132 women with an abnormal Pap smear [with conization: S1 (n = 68, 51.5%), without intervention: S2 (n = 64, 48.5%)] and healthy controls (K, n = 101) generally adhered to gynecological checkups, except S1 6 months after the first diagnosis (S1/T3 - 0.47, signed rank p < 0.0005). Knowledge of primary prevention information, i.e., HPV vaccination, was significantly higher among K (K 58%, S1 29%, S2 44%, Chi-squared p = 0.01) as was vaccine uptake (K 39% versus S1/S2 7% and 17%, respectively, Chi-squared p = 0.0004). Fear of upcoming Pap smears rose significantly over time (S1/T1-S1/T2-S1/T3, Wilcoxon signed-rank test p < 0.001) and was higher among those with conization at T2 (Chi-square test, p = 0.01) and partially accompanied by panic disorders at T1 (Chi-square test p = 0.035). Realization of general preventive habits rose significantly among women without an operative procedure (S2) over the study. CONCLUSION This study advances the understanding of non-participation in follow-up visits after a dysplasia diagnosis, identifying post-conization women as a special risk group for decreased adherence.
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Affiliation(s)
- N Rippinger
- Department of Gynaecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - J Heinzler
- Department of Gynaecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - T Bruckner
- Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, Heidelberg, Germany
| | - J Brucker
- Department of Gynaecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - C Dinkic
- Department of Gynaecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - J Hoffmann
- Department of Gynaecology and Obstetrics, Leipzig University Hospital, Leipzig, Germany
| | - N Dornhöfer
- Department of Gynaecology and Obstetrics, Leipzig University Hospital, Leipzig, Germany
| | - S Seitz
- Department of Gynaecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany
| | - J Rom
- Department of Gynaecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - C Sohn
- Department of Gynaecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - T C Schott
- Department of Orthodontics and Orofacial Orthopedics, University Hospital Tubingen, Tubingen, Germany
| | - Sarah Schott
- Department of Gynaecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany. .,German Cancer Consortium (DKTK), Heidelberg and German Cancer Research Centre (DKFZ), Heidelberg, Germany.
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43
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Lin X, Shrader L, Rodgers L, Stokley S, Markowitz LE. Increasing human papillomavirus vaccination at the recommended age. Vaccine 2018; 37:686-689. [PMID: 30591254 DOI: 10.1016/j.vaccine.2018.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 11/24/2022]
Abstract
In the United States, human papillomavirus (HPV) vaccine has been recommended for females since 2006 and for males since 2011. However, national HPV vaccination coverage among adolescents is lower than national targets, and many adolescents initiate HPV vaccination later than the recommended age. We analyzed records for >2 million persons born during 1996-2000 who initiated HPV vaccination at age 9 through 16 years from six Immunization Information Systems Sentinel Sites, displayed the distribution of HPV vaccination initiation age, and calculated HPV vaccination coverage. More adolescents in recent cohorts initiated HPV vaccination at the recommended age of 11-12 years, the majority of whom received another recommended vaccine on the same day. However, >40% of all vaccinated adolescents did not initiate the HPV vaccination until age 13 years or later. Continued efforts are needed to increase HPV vaccination initiation at the recommended age.
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Affiliation(s)
- Xia Lin
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | - Loren Rodgers
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shannon Stokley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lauri E Markowitz
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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44
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Hirth J. Disparities in HPV vaccination rates and HPV prevalence in the United States: a review of the literature. Hum Vaccin Immunother 2018; 15:146-155. [PMID: 30148974 DOI: 10.1080/21645515.2018.1512453] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Human papillomavirus (HPV) is a common sexually transmitted infection which is the cause of several cancers, including cervical cancer, and genital warts. Although cervical cancer can be prevented through screening, this cancer persists in the US. More recently, HPV vaccination has the potential to decrease the burden of HPV-related disease among young HPV-unexposed adolescents. Several initiatives aimed to encourage HPV vaccination have been adopted. Unfortunately, uptake of the HPV vaccine remains modest, despite evidence that vaccine-type HPV prevalence is decreasing as a result of HPV vaccination. Further, geographic disparities in vaccination uptake across different US regions and by race/ethnicity may contribute to continuing disparities in HPV-related cancers. More data are needed to evaluate impact of HPV vaccination on HPV prevalence in smaller geographic areas. Further, more information is needed on the impact of individual vaccination programs and policy on population level vaccination and HPV prevalence.
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Affiliation(s)
- Jacqueline Hirth
- a Center for Interdisciplinary Research in Women's Health, Department of Obstetrics & Gynecology , University of Texas Medical Branch , Galveston, TX , USA
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45
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Strengthening the Effectiveness of National, State, and Local Efforts to Improve HPV Vaccination Coverage in the United States: Recommendations From the National Vaccine Advisory Committee. Public Health Rep 2018; 133:543-550. [PMID: 30091942 DOI: 10.1177/0033354918793629] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In February 2018, recognizing the suboptimal rates of human papillomavirus (HPV) vaccination in the United States, the assistant secretary for health of the US Department of Health and Human Services charged the National Vaccine Advisory Committee (NVAC) with providing recommendations on how to strengthen the effectiveness of national, state, and local efforts to improve HPV vaccination coverage rates. In the same month, the NVAC established the HPV Vaccination Implementation Working Group and assigned it to develop these recommendations. The working group sought advice from federal and nonfederal partners. This NVAC report recommends ways to improve HPV vaccination coverage rates by focusing on 4 areas of activity: (1) identifying additional national partners, (2) guiding coalition building for states, (3) engaging integrated health care delivery networks, and (4) addressing provider needs in rural areas.
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46
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Stokley S, Szilagyi PG. Improving Human Papillomavirus Vaccination in the United States: Executive Summary. Acad Pediatr 2018; 18:S1-S2. [PMID: 29502626 PMCID: PMC5848091 DOI: 10.1016/j.acap.2018.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 01/15/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Shannon Stokley
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Atlanta, Ga.
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