1
|
Pang Y, Li B, Li T, Yang T, Deng J, Deng W. Factors Influencing the Intention of Chinese Adults to Recommend COVID-19 Vaccination for Specific or Non-Specific Groups. Healthcare (Basel) 2024; 12:1377. [PMID: 39057520 PMCID: PMC11276595 DOI: 10.3390/healthcare12141377] [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: 05/22/2024] [Revised: 07/05/2024] [Accepted: 07/07/2024] [Indexed: 07/28/2024] Open
Abstract
The widespread availability of vaccines has profound implications for sustainable public health. Positive recommendation on vaccination is one of the most effective ways to increase the willingness to vaccinate against COVID-19. This study aims to investigate the factors influencing the intentions to recommend COVID-19 vaccination for specific groups (IRCVSG) and the intentions to recommend COVID-19 vaccination for non-specific groups (IRCVNSG) in China and explore the mediating role of vaccine hesitancy and perception of vaccination information. This study conducted a cross-sectional anonymous online survey of adults (N = 903) in 28 provincial-level administrative regions in China in May 2022. The prevalence of IRCVSG and IRCVNSG was 60.5% and 93.0%, respectively. Health information literacy has a significant direct and indirect impact on IRCVSG through safety hesitancy and the perceived adequacy and usefulness of vaccination information. The relationship between health information literacy and IRCVNSG is entirely mediated via hesitation about the effectiveness and perceived usefulness of vaccination information. Special attention should be paid to the safety hesitation of COVID-19 vaccination for specific groups. This study tests these effects from both theoretical and practical perspectives, helping to address barriers to promoting the vaccination of specific groups for COVID-19 in clinical practice, improving health and sustainability.
Collapse
Affiliation(s)
- Yuxin Pang
- School of Management, Beijing Institute of Technology, Beijing 100081, China; (Y.P.); (B.L.); (T.Y.); (J.D.)
- Sustainable Development Research Institute for Economy and Society of Beijing, Beijing 100081, China
- Yangtze River Delta Research Institute, Beijing Institute of Technology, Jiaxing 314003, China
| | - Bowen Li
- School of Management, Beijing Institute of Technology, Beijing 100081, China; (Y.P.); (B.L.); (T.Y.); (J.D.)
- Sustainable Development Research Institute for Economy and Society of Beijing, Beijing 100081, China
- Yangtze River Delta Research Institute, Beijing Institute of Technology, Jiaxing 314003, China
| | - Tongyao Li
- Macquarie Business School, Macquarie University, Sydney, NSW 2109, Australia;
| | - Tianan Yang
- School of Management, Beijing Institute of Technology, Beijing 100081, China; (Y.P.); (B.L.); (T.Y.); (J.D.)
- Sustainable Development Research Institute for Economy and Society of Beijing, Beijing 100081, China
- Yangtze River Delta Research Institute, Beijing Institute of Technology, Jiaxing 314003, China
| | - Jianwei Deng
- School of Management, Beijing Institute of Technology, Beijing 100081, China; (Y.P.); (B.L.); (T.Y.); (J.D.)
- Sustainable Development Research Institute for Economy and Society of Beijing, Beijing 100081, China
- Yangtze River Delta Research Institute, Beijing Institute of Technology, Jiaxing 314003, China
| | - Wenhao Deng
- School of Management, Beijing Institute of Technology, Beijing 100081, China; (Y.P.); (B.L.); (T.Y.); (J.D.)
- Sustainable Development Research Institute for Economy and Society of Beijing, Beijing 100081, China
- Yangtze River Delta Research Institute, Beijing Institute of Technology, Jiaxing 314003, China
| |
Collapse
|
2
|
Perkins RB, Humiston S, Oliver K. Evidence supporting the initiation of HPV vaccination starting at age 9: Collection overview. Hum Vaccin Immunother 2023; 19:2269026. [PMID: 37824444 PMCID: PMC10572037 DOI: 10.1080/21645515.2023.2269026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Affiliation(s)
- Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
| | | | - Kristin Oliver
- Departments of Environmental Medicine and Public Health, Pediatrics, Icahn School of Medicine, New York, NY, USA
| |
Collapse
|
3
|
Ahmad M, Akande A, Majid U. Health care provider trust in vaccination: a systematic review and qualitative meta-synthesis. Eur J Public Health 2022; 32:207-213. [PMID: 35021201 PMCID: PMC9090277 DOI: 10.1093/eurpub/ckab209] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Vaccine hesitancy is a growing issue globally amongst various populations, including health care providers. This study explores the factors that influence vaccine hesitancy amongst nurses and physicians. METHODS We performed a qualitative meta-synthesis of 22 qualitative and mixed-method studies exploring the factors that may contribute to vaccine hesitancy amongst nurses and physicians. We included all articles that mentioned any aspect of trust concerning vaccination, including how trust may influence or contribute to vaccine hesitancy in nurses and physicians. RESULTS Our findings revealed that vaccine hesitancy amongst nurses stemmed predominantly from two factors: distrust in health authorities and their employers, and distrust in vaccine efficacy and safety. Both nurses and physicians had a precarious relationship with health authorities. Nurses felt that their employers and health authorities did not prioritize their health over patients' health, provided inaccurate and inconsistent vaccine information, and were mistrustful of pharmaceutical company motives. Like nurses, physicians were also skeptical of pharmaceutical company motives when it came to vaccination. Additionally, physicians also held doubts regarding vaccine efficacy and safety. CONCLUSIONS The relationship health care providers or their patients have with health authorities and other providers regarding vaccination serves as unsystematic clinical experiences that may bolster vaccine hesitancy. Providing accurate and tangible information to emphasize the safety and efficacy of vaccines to health care providers may help address their specific concerns that may ultimately increase vaccine uptake.
Collapse
Affiliation(s)
- Mobeen Ahmad
- Department of Internal Medicine, Abington Memorial Hospital/Abington-Jefferson Health, Abington, PA, USA
| | - Adebisi Akande
- Department of Biological Sciences, University of Toronto, Toronto, ON, Canada
| | - Umair Majid
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
4
|
Woodall WG, Zimet G, Kong A, Buller D, Reither J, Chilton L, Myers V, Starling R. Vacteens.org: A Mobile Web app to Improve HPV Vaccine Uptake. Front Digit Health 2021; 3:693688. [PMID: 34713171 PMCID: PMC8521965 DOI: 10.3389/fdgth.2021.693688] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
U.S. HPV vaccine uptake remains below the Healthy People 2030 goal of 80% series completion. Parental concerns and misinformation about the efficacy and safety of the Human Papillomavirus (HPV) vaccine remain, and may be addressed by digital interventions tailored to their concerns. Reported here are results from a small scale randomized trial testing a mobile web app for parents and their adolescent daughters (ages 11–14 years) encouraging HPV vaccination in New Mexico, an ethnically-diverse U.S. state. Methods: A clinic-cluster randomized trial where pediatric clinics (n = 9) were recruited and randomized, and parent-adolescent pairs (n = 82) within clinics received either the Vacteens.org/Vacunadolescente.org mobile web app or Usual and Customary (UC) HPV Vaccination information. Parents completed online surveys at baseline and 3-months. Daughters' HPV vaccine data were collected from the New Mexico State Immunization Information System 1 year post baseline. Results: Three month survey results found Vacteens.org/Vacunadolescente.org parents to have higher positive HPV vaccine beliefs, informed decision making, intent to vaccinate and vaccine confidence outcomes than UC parents. HPV vaccine data found higher first dose HPV vaccination (Pearson χ2 = 6.13, p = 0.013, Vacteens.org/Vacunadolescente.org group 59.4%, UC group 40.6%), and higher HPV vaccination series completion (Pearson χ2 = 6.49, p = 0.011, Vacteens.org/Vacunadolescente.org group 68.4%, UC group 31.6%). Conclusions: The small trial results showed the Vacteens.org/Vacunadolescente.org web app prompted positive vaccine-related attitudes and beliefs, and more HPV vaccination initiation and series completion. Mobile web apps can make decision-making tools for HPV vaccination widely available on digital platforms, reducing vaccine hesitancy, and confusion and increase HPV vaccine uptake.
Collapse
Affiliation(s)
| | - Gregory Zimet
- Division of Adolescent Medicine, Department of Pediatrics, Indiana University-Purdue University Indianapolis (IUPUI) Center for HPV Research, Indiana University, Indianapolis, IN, United States
| | - Alberta Kong
- Department of Pediatrics, The University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | | | | | - Lance Chilton
- Department of Pediatrics, The University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | | | - Randall Starling
- Center on Alcohol, Substance Use and Addictions (CASAA), The University of New Mexico, Albuquerque, NM, United States
| |
Collapse
|
5
|
Ashing KT, Ragin C, Ariyo O, Amini A. Thoughts and Consideration Regarding Immigrant Clinicians: Is Cultural Preservation Influencing Providers' Practice in HPV Vaccination? Cancer Invest 2021; 40:111-114. [PMID: 34663155 DOI: 10.1080/07357907.2021.1993879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Immigrant clinicians are vital to population healthcare delivery and therefore population health. One in four physicians in the United States are foreign-born and notably represented in family and pediatric medicine - specialties charged with administering childhood/adolescent vaccines, such as Human Papillomavirus vaccine (HPVV). Our examination suggests there may be unique cultural and socialization factors that influence clinician HPVV recommendation practice; however, immigrant clinicians have not been adequately engaged within the national HPVV agenda. Given the volume and significance of immigrant clinicians, engagement of these clinicians, in both community and nation-wide efforts to increase HPVV, is a necessary step for improving and achieving the national health goal of optimizing HPVV for cancer prevention.
Collapse
Affiliation(s)
- Kimlin T Ashing
- Division of Health Equities, City of Hope National Medical Center, Duarte, CA, USA
| | | | - Oluwatosin Ariyo
- Health Services Management and Policy, East Tennessee State University, Johnson City, TN, USA
| | - Arya Amini
- Department of Radiology, City of Hope National Medical Center, Duarte, CA, USA
| |
Collapse
|
6
|
Xin M, Luo S, She R, Chen X, Li L, Li L, Chen X, Lau JTF. The Impact of Social Media Exposure and Interpersonal Discussion on Intention of COVID-19 Vaccination among Nurses. Vaccines (Basel) 2021; 9:vaccines9101204. [PMID: 34696312 PMCID: PMC8537317 DOI: 10.3390/vaccines9101204] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/04/2021] [Accepted: 10/13/2021] [Indexed: 02/05/2023] Open
Abstract
COVID-19 vaccine hesitancy among nurses is a global public health concern and it is imperative to understand associated factors. Information environment plays a critical role in shaping health behaviors, while few studies explored such effects in the context of COVID-19 vaccination. A cross-sectional survey was conducted among 1902 nurses in China. The study investigated the effects of social media exposure/interpersonal discussion on intention of COVID-19 vaccination and tested whether perceived effectiveness of COVID-19 vaccines (perceived vaccine efficacy, perceived duration of protection, and perceived effectiveness in preventing resurgences) mediated such associations. Results showed that about 68.0% and 56.5% of the participants had an intention of free and self-paid COVID-19 vaccinations, respectively. Frequent social media exposure and interpersonal discussion were positively associated with vaccination intentions. Perceived vaccine efficacy significantly mediated the effects of frequent social media exposure and interpersonal discussion, whereas perceived effectiveness in preventing resurgences suppressed the effects of frequent social media exposure. In conclusion, the prevalence of intention of COVID-19 vaccination was relatively low among Chinese nurses and health promotion is needed. Frequent social media exposure and interpersonal discussion potentially enhanced vaccination intentions via increased perceived vaccine efficacy. The findings can help inform the development of relevant health communication interventions.
Collapse
Affiliation(s)
- Meiqi Xin
- Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (M.X.); (R.S.)
| | - Sitong Luo
- Vanke School of Public Health, Tsinghua University, Beijing 100083, China;
| | - Rui She
- Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (M.X.); (R.S.)
| | - Xi Chen
- Hunan Provincial Center for Disease Control and Prevention, Changsha 410007, China;
| | - Liping Li
- School of Public Health, Shantou University Medical College, Shantou 515041, China;
| | - Lijuan Li
- School of Public Health, Dali University, Dali 671003, China;
| | - Xiaojun Chen
- The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, China;
| | - Joseph T. F. Lau
- Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (M.X.); (R.S.)
- Correspondence:
| |
Collapse
|
7
|
Daniel CL, Atkins A. HPV vaccination disparities and strategies to prevent oropharyngeal cancer in males. Prev Med Rep 2021; 24:101521. [PMID: 34466373 PMCID: PMC8383099 DOI: 10.1016/j.pmedr.2021.101521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 08/05/2021] [Accepted: 08/08/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Casey L Daniel
- University of South Alabama College of Medicine, Mobile, AL, USA
| | - Amanda Atkins
- University of South Alabama College of Medicine, Mobile, AL, USA
| |
Collapse
|
8
|
Thoughts and consideration regarding immigrant clinicians: is cultural preservation influencing providers' practice in HPV vaccination. Cancer Causes Control 2021; 32:1043-1045. [PMID: 34448991 DOI: 10.1007/s10552-021-01488-0] [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: 05/01/2020] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
Immigrant clinicians are vital to population healthcare delivery and therefore population health. One in four physicians in the USA is foreign-born and notably represented in family and pediatric medicine-specialties charged with administering childhood/adolescent vaccines, such as human papillomavirus vaccine (HPVV). Our examination suggests there may be unique cultural and socialization factors that influence clinician HPVV recommendation practice; however, immigrant clinicians have not been adequately engaged within the national HPVV agenda. Given the volume and significance of immigrant clinicians, engagement of these clinicians, in both community and nation-wide efforts to increase HPVV, is a necessary step for improving and achieving the national health goal of optimizing HPVV for cancer prevention.
Collapse
|
9
|
Akande A, Ahmad M, Majid U. A qualitative meta-synthesis on how autonomy promotes vaccine rejection or delay among health care providers. Health Promot Int 2021; 37:6309734. [PMID: 34171926 DOI: 10.1093/heapro/daab099] [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] [Indexed: 11/13/2022] Open
Abstract
In spite of the overwhelming evidence that highlights the effectiveness of routine vaccination, an increasing number of people are refusing to follow recommended vaccination schedules. While the majority of research in this area has focussed on vaccine hesitancy in parents, there is little research on the factors that promote vaccine hesitancy in health care providers (HCPs). Identifying factors that promote vaccine hesitancy in HCPs is essential because it may help broaden our understanding of vaccine hesitancy in patients. Therefore, the goal of this investigation was to review 21 studies and examine how professional autonomy and risk perception may promote vaccine acceptance, rejection and delay in physicians and nurses. We found that vaccine hesitant nurses and physicians shared similar views towards vaccines; both groups believed that their decision to vaccinate was separate from their role as an HCP. This belief comprised of three themes: decisional autonomy, personal risk perception and alternatives to vaccination. Both groups believed that mandatory vaccine policies reduced their ability to decide whether vaccination was in their best interests. We argue that decisional autonomy may weaken risk perception of disease, which in turn may encourage beliefs and behaviours that reinforce a 'hero persona' that reduces appropriate preventive and hygiene measures. We employ the Health Belief Model to discuss the crucial role that risk perceptions may play in reinforcing autonomy in vaccine hesitant physician and nurses. We conclude this paper by providing a set of recommendations that aim to improve the decision-making process surrounding mandatory vaccinations for HCPs.
Collapse
Affiliation(s)
- Adebisi Akande
- Department of Biological Sciences, University of Toronto, Toronto, Canada
| | - Mobeen Ahmad
- Department of Internal Medicine, Abington Memorial Hospital/Abington-Jefferson Health, Abington, PA, USA
| | - Umair Majid
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| |
Collapse
|
10
|
Kazemi S, Tavousi M, Zarei F. A mobile-based educational intervention on STI-related preventive behavior among Iranian women. HEALTH EDUCATION RESEARCH 2021; 36:212-223. [PMID: 33515025 DOI: 10.1093/her/cyaa054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
While rates of sexually transmitted infections (STIs) in Iran are alarming, little is known about preventive sexual behaviors. The purpose of this article was to assess the effect of a mobile-based educational program to promote preventive behaviors regarding STIs in Iranian women. Using Roger's protection motivation theory, the following measures were developed as the study's conceptual framework: STI knowledge, STI vulnerability, STI prevention self-efficacy and STI prevention intentions. These variables were measured by the Persian version of a valid Korean four-scale tool. Data from 76 women were analyzed: 37 women in the smartphone application (Experimental) group and 39 in the control group. Health Education Sexually Transmitted Infections Application was developed as a smartphone application training program. Participants were tested at three-time points: pre-test (baseline), post-test 1 (immediately after the program's completion) and post-test 2 (16 weeks after the program's completion). Significant group differences were found at different times in STI knowledge, vulnerability, prevention self-efficacy and prevention intentions. The smartphone application was effective in sustaining the effects of the educational program in the experimental group. The development of appropriate teaching materials on sensitive public health issues, such as STIs to promote individual self-learning skills is suggested.
Collapse
Affiliation(s)
- Sara Kazemi
- Faculty of Medical Sciences, Department of Health Education, Tarbiat Modares University, Tehran, Iran
| | - Mahmoud Tavousi
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Fatemeh Zarei
- Department of Health Education & Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| |
Collapse
|
11
|
Xu H, Song K, Qin L, Qu Y, Niu Q, Li B, Han Z. Knowledge of Chinese dentists on HPV, their willingness and barriers to recommend HPV vaccination to patients. Hum Vaccin Immunother 2021; 17:2728-2735. [PMID: 33687314 DOI: 10.1080/21645515.2021.1885967] [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: 12/31/2022] Open
Abstract
Objective: This study aimed to assess the knowledge of Chinese dentists on human papilloma virus (HPV), their willingness and factors prevention them from recommending patients for HPV vaccination, and to identify ways through which dentists can acquire HPV-related knowledge.Methods: This was a cross-sectional study based on Chinese dentists. The anonymous self-filled questionnaire method was used to collect demographic information of participants, their knowledge of HPV, willingness and barriers to recommending HPV vaccines to patients, and the strategies they can adopt to obtain HPV-related knowledge.Results: A total of 517 dentists completed the questionnaire, and 89.94% of dentists were willing to recommend HPV vaccination to patients. Participants aged 30-39 years, male dentists and dentist-in-charge had relatively lower knowledge scores than other groups. Besides, participants aged 30-39 years, working in private hospitals, and practicing in Southern China had a lower willingness to recommend HPV vaccination to patients. Recommending HPV vaccination to patients is not within the scope of practicing dentists, and concerns about the safety of the HPV vaccine were found to be the main barriers preventing its recommendation. Notably, 97.87% of dentists were eager to acquire HPV-related knowledge, and agreed for the first time to enroll in relevant educational courses.Conclusion: Chinese dentists had expressed a strong desire to recommend HPV vaccines to patients, even though their knowledge of HPV was scanty. Therefore, measures to improve their understanding of HPV vaccines and eliminate barriers suppressing their willingness to recommend HPV vaccines are urgently needed.
Collapse
Affiliation(s)
- Haoyue Xu
- Department of Oral and Maxillofacial & Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, P.R. China
| | - Kai Song
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Lizheng Qin
- Department of Oral and Maxillofacial & Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, P.R. China
| | - Yi Qu
- Department of Oral and Maxillofacial & Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, P.R. China
| | - Qifang Niu
- Department of Oral and Maxillofacial & Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, P.R. China
| | - Bo Li
- Department of Oral and Maxillofacial & Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, P.R. China
| | - Zhengxue Han
- Department of Oral and Maxillofacial & Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, P.R. China
| |
Collapse
|
12
|
Stefanoff P, Sobierajski T, Bulinska-Stangrecka H, Augustynowicz E. Exploring factors improving support for vaccinations among Polish primary care physicians. PLoS One 2020; 15:e0232722. [PMID: 32357190 PMCID: PMC7194393 DOI: 10.1371/journal.pone.0232722] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/20/2020] [Indexed: 11/19/2022] Open
Abstract
In Poland, primary care physicians are the most used and most trusted source of information on immunisation. We aimed to explore factors influencing support for vaccinations among physicians employed in the childhood immunisation programme, in order to inform education of healthcare workers and programme organization. In June-July 2017, we carried out a national cross-sectional survey of physicians working in randomly selected primary healthcare practices, and interviewed them by telephone. We assessed support for vaccinations using an ordinal scale (0–6) comprised of three equally weighted questions on the respondent support of the programme and vaccination of self and family. We also created a scale (0–3) based on correct answers to vaccination myths. We used ordered logistic regression to investigate factors independently influencing support for vaccinations, reporting the proportional odds ratios and 95% confidence intervals for one unit increase in the support score. Of 2,609 respondents contacted, we interviewed 500 (19%). The median vaccination support score (0–6) was 5 (IQR 2). After adjusting for other variables, we did not find significant effects of sex, medical specialty, adhering to recommendations, attending a conference in previous year, using non-scientific sources of information and self-assessed knowledge on vaccination support score. Age over 60 years, correctly addressing vaccination myths and use of one or more than one scientific sources of knowledge, significantly improved support for vaccinations (aOR = 1.97, 1.57, 3.09 and 2.68, respectively). We recommend to increase the amount, quality and accessibility of evidence-based educational materials for primary care physicians working with childhood immunisations.
Collapse
Affiliation(s)
- Pawel Stefanoff
- Department of Epidemiology of Infectious Diseases and Surveillance, National Institute of Public Health – National Institute of Hygiene, Warsaw, Poland
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
- * E-mail:
| | - Tomasz Sobierajski
- Institute of Applied Social Sciences, University of Warsaw, Warsaw, Poland
| | | | - Ewa Augustynowicz
- Department of Epidemiology of Infectious Diseases and Surveillance, National Institute of Public Health – National Institute of Hygiene, Warsaw, Poland
| |
Collapse
|
13
|
Berenson AB, Hirth JM, Southerland JH. Knowledge of human papillomavirus among dental providers: A mixed methods study. Vaccine 2020; 38:423-426. [PMID: 31690468 DOI: 10.1016/j.vaccine.2019.10.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 10/14/2019] [Accepted: 10/25/2019] [Indexed: 01/29/2023]
Abstract
Dental professionals are encouraged by the American Dental Association (ADA) to recommend the HPV vaccine to eligible patients. To better understand their comfort level in following this recommendation, we conducted a mixed methods study of dentists and dental hygienists. A total of 173 providers were surveyed and 8 interviewed. The majority felt they had an important role in preventing HPV-related OPC and that they should educate their patients and encourage HPV vaccination. However, most providers had low knowledge about HPV and expressed a need to obtain more information on the topic. In particular, they desired information about the HPV vaccine, its connection to cancer and where to refer patients for vaccination. They also wanted access to visual aids to help them bring up the topic. This study demonstrates the need to develop and disseminate educational programs for dental providers so they can assist with efforts to raise HPV vaccination rates.
Collapse
Affiliation(s)
- Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, TX, United States.
| | - Jacqueline M Hirth
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, TX, United States
| | - Janet H Southerland
- Interprofessional Education, Institutional Effectiveness & Health Education Center, University of Texas Medical Branch, Galveston, TX, United States
| |
Collapse
|
14
|
Amith M, Roberts K, Tao C. Conceiving an application ontology to model patient human papillomavirus vaccine counseling for dialogue management. BMC Bioinformatics 2019; 20:706. [PMID: 31865902 PMCID: PMC6927108 DOI: 10.1186/s12859-019-3193-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background In the United States and parts of the world, the human papillomavirus vaccine uptake is below the prescribed coverage rate for the population. Some research have noted that dialogue that communicates the risks and benefits, as well as patient concerns, can improve the uptake levels. In this paper, we introduce an application ontology for health information dialogue called Patient Health Information Dialogue Ontology for patient-level human papillomavirus vaccine counseling and potentially for any health-related counseling. Results The ontology’s class level hierarchy is segmented into 4 basic levels - Discussion, Goal, Utterance, and Speech Task. The ontology also defines core low-level utterance interaction for communicating human papillomavirus health information. We discuss the design of the ontology and the execution of the utterance interaction. Conclusion With an ontology that represents patient-centric dialogue to communicate health information, we have an application-driven model that formalizes the structure for the communication of health information, and a reusable scaffold that can be integrated for software agents. Our next step will to be develop the software engine that will utilize the ontology and automate the dialogue interaction of a software agent.
Collapse
Affiliation(s)
- Muhammad Amith
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin Road, Suite 600, Houston, TX, 77030, USA
| | - Kirk Roberts
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin Road, Suite 600, Houston, TX, 77030, USA
| | - Cui Tao
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin Road, Suite 600, Houston, TX, 77030, USA.
| |
Collapse
|
15
|
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.
Collapse
|
16
|
Maness SB, Thompson EL. Social Determinants of Human Papillomavirus Vaccine Uptake: An Assessment of Publicly Available Data. Public Health Rep 2019; 134:264-273. [PMID: 30951641 DOI: 10.1177/0033354919838219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Despite cancer prevention benefits associated with the human papillomavirus (HPV) vaccine, uptake in the United States is relatively low among males and females. Our objective was to use the Healthy People 2020 social determinants of health framework to determine the availability and characteristics of data on economic, educational, social, health care, and community factors affecting HPV vaccine uptake in the United States. METHODS We included the most recent data sets from 6 publicly available, US-based, federally funded surveys that contained at least 1 measure of HPV vaccination among adolescents and young adults. We searched each data set for any social determinants of health measures within the 5 domains of the framework: economic stability, education, social and community context, health and health care, and neighborhood and built environment. RESULTS The social determinants of health domains of education, economic stability, and health and health care appeared in all data sets. The domains of social and community context and neighborhood and built environment appeared in only 3 data sets. Even when domains were represented, we discovered gaps in the data sets, in which only limited measures of the social determinants were available. CONCLUSION The addition of questions about the social determinants of health to the surveys that generate these data sets, particularly in the domains of social and community context and neighborhood and built environment, would strengthen the ability of public health researchers, policy makers, and professionals to identify associations between the social determinants of health and HPV vaccine uptake.
Collapse
Affiliation(s)
- Sarah B Maness
- 1 Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA
| | - Erika L Thompson
- 2 Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA
| |
Collapse
|
17
|
Lee YY, Wang Z. Facilitators and barriers for healthcare providers to recommend HPV vaccination to attendees of public sexually transmitted diseases clinics in Hong Kong, China. PLoS One 2019; 14:e0209942. [PMID: 30625211 PMCID: PMC6326499 DOI: 10.1371/journal.pone.0209942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 12/13/2018] [Indexed: 11/29/2022] Open
Abstract
Background Attendees of sexually transmitted diseases (STD) clinics could also benefit from HPV vaccination. Healthcare providers’ recommendation is the most effective published method in motivating HPV vaccination initiation. This study was to investigate practice of recommending HPV vaccination to attendees among healthcare providers (doctors and nurses) working in public STD clinics in Hong Kong, China. Method Participants were medical doctors, registered nurses and enrolled nurses working in all eight public STD clinics in Hong Kong. All of them (29 doctors and 82 nurses) were approached by telephone. A self-administered questionnaire was mailed to them. A total of 98 completed questionnaires were received (28 doctors and 70 nurses). The study was conducted during January to May, 2018. Using recommendation of HPV vaccination to any attendees in the last year as the dependent variable, univariate and multiple logistic regression models were fitted. Results In the last 12 months, 16.3% and 36.7% of the participants had recommended HPV vaccination to any male attendees and to any female attendees of their clinics; 41.8% had recommended it to either male or female attendees. Adjusting for significant background variables (professions and years of working experience in the clinic), three constructs of the Theory of Planned Behavior were significantly associated with the dependent variable in expected directions. They were: 1) the Positive Attitude Scale (adjusted odds ratios, AOR: 1.20, 95%CI: 1.02, 1.41), 2) the Negative Attitude Scale (AOR: 0.85, 95%CI: 0.77, 0.94), and 3) the Perceived Behavioral Control Scale (AOR: 1.37, 95%CI: 1.08, 1.75). Conclusion STD clinics are ideal settings that allow healthcare providers to access individuals who are at high-risk of HPV infection and promote HPV vaccination. Health promotion targeting these healthcare providers is warranted to enhance their perceived importance of recommending HPV vaccination. Such promotion should modify their attitudes and perceived behavioral control related to recommending HPV vaccination to attendees.
Collapse
Affiliation(s)
| | - Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- * E-mail:
| |
Collapse
|
18
|
Improving Human Papilloma Virus Vaccination Rates at an Urban Pediatric Primary Care Center. Pediatr Qual Saf 2018; 3:e098. [PMID: 30584625 PMCID: PMC6221589 DOI: 10.1097/pq9.0000000000000098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 07/11/2018] [Indexed: 12/25/2022] Open
Abstract
Introduction Despite compelling evidence regarding its safety and efficacy, human papilloma virus vaccination rates remain low nationally with high rates of missed vaccination opportunities. Provider recommendation is the most important factor in determining vaccine approval by families; yet, studies show that providers are hesitant to strongly recommend vaccination, especially at younger ages. We hypothesized that educational and quality improvement interventions targeting our clinical team would decrease rates of missed opportunities to vaccinate patients aged 11-13 years and improve vaccination rates among patients aged 9-10 years old. Methods This quality improvement project took place at an urban, academic pediatric primary care center in north Philadelphia, which serves as the medical home for over 22,000 patients. A multidisciplinary team performed a series of planned sequential interventions to improve human papilloma virus vaccination rates. The electronic health records of children aged 9-13 who presented to our center from September 2014 through December 2015 were queried. Statistical process control charts and established rules for detecting special cause variation were applied. Results Rates of missed opportunities to vaccinate 11- to 13-year-old patients decreased from 63% to 18% during the intervention period. Rates of immunization of 9- to 10-year-old patients increased from 56% to 84% during the intervention period. Conclusion This low-cost, multifaceted, interdisciplinary quality improvement project resulted in a decrease in missed opportunities to vaccinate among children aged 11-13 years old and improved the vaccination rates of 9-10 year olds. Ongoing interventions are needed to sustain these efforts and to ensure timely vaccine series completion.
Collapse
|
19
|
Kasting ML, Christy SM, Sutton SK, Lake P, Malo TL, Roetzheim RG, Schechtman T, Zimet GD, Walkosz BJ, Salmon D, Kahn JA, Giuliano AR, Vadaparampil ST. Florida physicians' reported use of AFIX-based strategies for human papillomavirus vaccination. Prev Med 2018; 116:143-149. [PMID: 30219689 PMCID: PMC6260815 DOI: 10.1016/j.ypmed.2018.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/27/2018] [Accepted: 09/11/2018] [Indexed: 11/24/2022]
Abstract
HPV vaccination rates in Florida are low. To increase rates, the CDC recommends clinics adhere to components of their evidence-based quality improvement program, AFIX (Assessment, Feedback, Incentives, and eXchange of information). We explored factors associated with engaging in HPV-specific AFIX-related activities. In 2016, we conducted a cross-sectional survey of a representative sample of 770 pediatric and family medicine physicians in Florida and assessed vaccination practices, clinic characteristics, and HPV-related knowledge. Data were analyzed in 2017. The primary outcome was whether physicians' clinics engaged in ≥1 AFIX activity. We stratified by physician specialty and developed multivariable models using a backward selection approach. Of the participants in the analytic sample (n = 340), 52% were male, 60% were White of any ethnicity, and 55% were non-Hispanic. Pediatricians and family medicine physicians differed on: years practicing medicine (p < 0.001), HPV-related knowledge (p < 0.001), and VFC provider status (p < 0.001), among others. Only 39% of physicians reported engaging in ≥1 AFIX activity. In the stratified multivariable model for pediatricians, AFIX activity was significantly associated with HPV-related knowledge (aOR = 1.33;95%CI = 1.08-1.63) and provider use of vaccine reminder prompts (aOR = 3.61;95%CI = 1.02-12.77). For family medicine physicians, HPV-related knowledge was significant (aOR = 1.57;95%CI = 1.20-2.05) as was majority race of patient population (non-Hispanic White vs. Other: aOR = 3.02;95%CI = 1.08-8.43), daily patient load (<20 vs. 20-24: aOR = 9.05;95%CI = 2.72-30.10), and vaccine administration to male patients (aOR = 2.98;95%CI = 1.11-8.02). Fewer than half of Florida pediatric and family medicine physicians engaged in any AFIX activities. Future interventions to increase AFIX engagement should focus on implementing and evaluating AFIX activities in groups identified as having low engagement in AFIX activities.
Collapse
Affiliation(s)
- Monica L Kasting
- Moffitt Cancer Center & Research Institute, Division of Population Science, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, United States; Moffitt Cancer Center & Research Institute, Center for Immunization and Infection Research in Cancer, 12902 Magnolia Drive, Tampa, FL 33612, United States.
| | - Shannon M Christy
- Moffitt Cancer Center & Research Institute, Division of Population Science, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, United States; University of Tennessee Health Science Center, College of Medicine, 66. N. Pauline St., Suite 322, Memphis, TN 38163, United States; University of South Florida, Morsani College of Medicine, 13330 USF Laurel Drive, Tampa, FL 33612, United States.
| | - Steven K Sutton
- University of South Florida, Morsani College of Medicine, 13330 USF Laurel Drive, Tampa, FL 33612, United States; Moffitt Cancer Center & Research Institute, Division of Quantitative Sciences, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, United States.
| | - Paige Lake
- Moffitt Cancer Center & Research Institute, Division of Population Science, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, United States.
| | - Teri L Malo
- University of North Carolina, Lineberger Comprehensive Cancer Center, 101 East Weaver Street, Ste 203, Campus Box 7293, Carrboro, NC 27510, United States.
| | - Richard G Roetzheim
- Moffitt Cancer Center & Research Institute, Division of Population Science, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, United States; University of South Florida, Morsani College of Medicine, 13330 USF Laurel Drive, Tampa, FL 33612, United States.
| | - Tommy Schechtman
- Pediatric Partners, 3401 PGA Blvd, Suite 300, Palm Beach Gardens, FL 33410, United States.
| | - Gregory D Zimet
- Indiana University School of Medicine, Department of Pediatrics, 410 W. 10th Street, HS 1001, Indianapolis, IN 46202, United States.
| | - Barbara J Walkosz
- Klein Buendel, Inc., 1667 Cole Blvd. Ste. 225, Golden, CO 80401, United States.
| | - Daniel Salmon
- Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe Street Room W5035, Baltimore, MD 21205, United States.
| | - Jessica A Kahn
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4000, Cincinnati, OH 45229, United States; University of Cincinnati, College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, United States.
| | - Anna R Giuliano
- Moffitt Cancer Center & Research Institute, Division of Population Science, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, United States; Moffitt Cancer Center & Research Institute, Center for Immunization and Infection Research in Cancer, 12902 Magnolia Drive, Tampa, FL 33612, United States.
| | - Susan T Vadaparampil
- Moffitt Cancer Center & Research Institute, Division of Population Science, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, United States; Moffitt Cancer Center & Research Institute, Center for Immunization and Infection Research in Cancer, 12902 Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, Morsani College of Medicine, 13330 USF Laurel Drive, Tampa, FL 33612, United States.
| |
Collapse
|
20
|
A Physician's Recommendation for Human Papillomavirus Vaccination: What Makes African-American Mothers Compliant? Pediatr Infect Dis J 2018; 37:e222-e225. [PMID: 29329167 DOI: 10.1097/inf.0000000000001906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Improving human papillomavirus (HPV) vaccination among African-American (AA) female adolescents to reduce the cervical cancer burden is important and cost-effective. The study objective is to identify factors most influential to AA mothers' likelihood to comply with a physician's recommendation to get their daughters the HPV vaccine. METHODS We conducted a cross-sectional survey. Participants were recruited through online and community sites (ie, schools, community centers, etc.) in Alabama. A total of 280 AA mothers and their adolescent daughters completed the survey. A binary logistic regression was used to determine factors influencing mother's likelihood to adhere with a physician's recommendation to get their daughters the HPV vaccine. RESULTS The most significant factors influencing mother's likelihood to comply with physician's recommendation were culture: future-time orientation (P = 0.001), perceived barriers of HPV vaccination (P = 0.007), perceived susceptibility to HPV (P = 0.047) and perceived benefits of HPV vaccination (P = 0.002). Further exploration of perceived barriers and perceived benefits found mother's perception that the HPV vaccine is a good way to protect my daughter's health as the only significant benefit. No measures of perceived barriers were significant. CONCLUSIONS A physician's recommendation should advise AA mothers on the risk of HPV and the importance of HPV vaccination at an early age to reduce cervical cancer risk. It should further address mothers' perceived disadvantages of HPV vaccination (eg, side effects). Incorporating this information in physician recommendation practices could increase HPV vaccination rates with implications in reducing the cervical cancer burden among this high-risk population.
Collapse
|
21
|
Rhodes D, Visker J, Cox C, Forsyth E, Woolman K. Public Health and School Nurses' Perceptions of Barriers to HPV Vaccination in Missouri. J Community Health Nurs 2018; 34:180-189. [PMID: 29023157 DOI: 10.1080/07370016.2017.1369806] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Human Papilloma Virus (HPV) is associated with various forms of cancer and is preventable with vaccination. Nurses are in a unique position to directly influence a person's decision to receive the HPV vaccine. A statewide sample of both school and public health nurses was used to assess knowledge and attitudes related to the HPV vaccine as well as nurse's behaviors and behavioral intentions toward educating parents and recommending the vaccine. Positive attitudes and adequate knowledge levels were found, however, the majority of school nurses did not provide information and resources to parents. Targeted health promotion programs for school nurses are recommended.
Collapse
Affiliation(s)
- Darson Rhodes
- a Department of Public Health and Health Education , The College at Brockport, State University of New York , Brockport , New York
| | - Joseph Visker
- b Department of Health Science , Minnesota State University - Mankato , Mankato , Minnesota
| | - Carol Cox
- c Department of Health Science, Truman State University , Kirksville , Missouri
| | - Emily Forsyth
- d Department of Applied Health Science, Indiana University-Bloomington , Bloomington , Indiana
| | - Kendra Woolman
- c Department of Health Science, Truman State University , Kirksville , Missouri
| |
Collapse
|
22
|
Lu PJ, Yankey D, Jeyarajah J, O'Halloran A, Fredua B, Elam-Evans LD, Reagan-Steiner S. Association of Health Insurance Status and Vaccination Coverage among Adolescents 13-17 Years of Age. J Pediatr 2018; 195:256-262.e1. [PMID: 29398056 PMCID: PMC6201297 DOI: 10.1016/j.jpeds.2017.12.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/05/2017] [Accepted: 12/11/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess selected vaccination coverage among adolescents by health insurance status and other access-to-care characteristics. STUDY DESIGN The 2015 National Immunization Survey-Teen data were used to assess vaccination coverage disparities among adolescents by health insurance status and other access-to-care variables. Multivariable logistic regression analysis and a predictive marginal modeling were conducted to evaluate associations between health insurance status and vaccination coverage. RESULTS Overall, vaccination coverage was significantly lower among uninsured compared with insured adolescents for all vaccines assessed for except ≥3 doses of human papillomavirus vaccine (HPV) among male adolescents. Among adolescents 13-17 years of age, vaccination of uninsured compared with insured adolescents, respectively, for tetanus toxoid, reduced content diphtheria toxoid, and acellular pertussis vaccine was 77.4% vs 86.8%; for ≥1 dose of meningococcal conjugate vaccine was 72.9% vs 81.7%; for ≥1 dose of HPV was 38.8% vs 50.2% among male and 42.9% vs 63.8% among female adolescents; for 3 doses of HPV was 24.9% vs 42.8% among female adolescents. In addition, vaccination coverage differed by the following: type of insurance among insured adolescents, having a well-child visit at 11-12 years of age, and number of healthcare provider contacts in the past year. Uninsured were less likely than insured adolescents to be vaccinated for HPV (female: ≥1 dose and 3 doses; and male: ≥1 doses) after adjusting for confounding variables. CONCLUSIONS Overall, vaccination coverage was lower among uninsured adolescents. HPV vaccination coverage was lower than tetanus toxoid, reduced content diphtheria toxoid, and acellular pertussis vaccine Tdap and meningococcal conjugate vaccine in both insured and uninsured adolescents. Wider implementation of effective evidence-based strategies is needed to help improve vaccination coverage among adolescents, particularly for those who are uninsured. Limitation of current federally funded vaccination programs or access to healthcare would be expected to erode vaccine coverage of adolescents.
Collapse
Affiliation(s)
- Peng-Jun Lu
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
| | - David Yankey
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jenny Jeyarajah
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Alissa O'Halloran
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Benjamin Fredua
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Laurie D Elam-Evans
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sarah Reagan-Steiner
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
23
|
Tom A, Robinett H, Buenconsejo-Lum L, Soon R, Hamilton M, Francisco-Natanauan P, Cruz MRD, Balajadia R, Hernandez BY. Promoting and Providing HPV Vaccination in Hawaii: Barriers Faced by Health Providers. J Community Health 2018; 41:1069-77. [PMID: 27038960 DOI: 10.1007/s10900-016-0191-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Despite the availability of HPV prophylactic vaccines, uptake has been suboptimal in the US. In the state of Hawaii, HPV vaccine coverage has decreased among females and remains low among males aged 13-17. The reasons for low uptake are unknown and may indicate the existence of critical barriers to HPV vaccination. The purpose of this investigation was to identify policy, system and environmental barriers and promoters of pediatric HPV vaccination in Hawaii. An online 86-item survey addressing knowledge, attitudes, beliefs, practices, and barriers to HPV vaccination was distributed to practicing physicians in Hawaii specializing in Pediatrics, Family Medicine, and Obstetrics-Gynecology. Survey responses were received from a total of 120 physicians. Private practice physicians reported more concerns with vaccine ordering and stocking costs (p < 0.0001), reimbursement levels (p < 0.0001), and insurance coverage (p < 0.0001) compared to physicians in large group practices. Eighty-three percent of providers cited lack of parent knowledge and understanding of HPV infection as a barrier. Over half of physicians (58 %) reported that completion of the 3-dose schedule was a barrier. Most physicians did not use tracking or reminder systems to ensure dose completion. A majority (58 %) of providers cited the lack of school-based vaccination requirements as a barrier. Uptake of HPV vaccination in Hawaii may be impeded by physician perception of parent knowledge and attitudes. Cost-related system barriers are particular barriers among those in private practice. Completion of the 3-dose schedule also remains a challenge.
Collapse
Affiliation(s)
- Ashlyn Tom
- Cancer Epidemiology Program, University of Hawaii Cancer Center, 701 Ilalo St., Honolulu, HI, 96813, USA
| | - Hali Robinett
- Prevention and Control Program, University of Hawaii Cancer Center, Honolulu, HI, 96813, USA
| | - Lee Buenconsejo-Lum
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, 96813, USA
| | - Reni Soon
- Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, 96813, USA
| | - Michael Hamilton
- The American Academy of Pediatrics (Hawaii Chapter), Honolulu, HI, 96813, USA
| | - Pia Francisco-Natanauan
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, 96813, USA
| | | | - Ronald Balajadia
- Immunization Branch, Hawaii State Department of Health, Honolulu, HI, 96813, USA
| | - Brenda Y Hernandez
- Cancer Epidemiology Program, University of Hawaii Cancer Center, 701 Ilalo St., Honolulu, HI, 96813, USA.
| |
Collapse
|
24
|
Hofstetter AM, Lappetito L, Stockwell MS, Rosenthal SL. Human Papillomavirus Vaccination of Adolescents with Chronic Medical Conditions: A National Survey of Pediatric Subspecialists. J Pediatr Adolesc Gynecol 2017; 30:88-95. [PMID: 27542999 PMCID: PMC5279719 DOI: 10.1016/j.jpag.2016.08.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/06/2016] [Indexed: 01/04/2023]
Abstract
STUDY OBJECTIVE Many adolescents with chronic medical conditions (CMCs) are at risk of human papillomavirus (HPV) infection, associated complications, and underimmunization and often identify a pediatric subspecialist as their main provider. This study aimed to assess the HPV-related understanding, beliefs, and practices of pediatric subspecialists, which are largely unknown. DESIGN AND SETTING National cross-sectional study. PARTICIPANTS Pediatric endocrinologists, hematologist/oncologists, pulmonologists, and rheumatologists identified using the American Medical Association Physician Masterfile (n = 418). INTERVENTIONS Subspecialists who care for adolescents with CMCs in the outpatient setting were recruited to complete a Web-based survey on their HPV-related knowledge, attitudes, comfort, and practices. MAIN OUTCOME MEASURES HPV vaccination recommendation. RESULTS Over half of respondents (50.4%; n = 196/389) reported sometimes or always recommending HPV vaccination to adolescent patients with CMCs. Factors positively associated with recommendation included hematology/oncology (adjusted odds ratio [AOR], 4.69; 95% confidence interval [CI], 1.86-11.81) or rheumatology (AOR, 6.55; 95% CI, 1.67-25.74) specialization, seeing more adolescent patients with CMCs (AOR, 1.01; 95% CI, 1.00-1.02), and sometimes or always discussing sexual health (AOR, 2.53; 95% CI, 1.05-6.08) or checking vaccine status (AOR, 3.83; 95% CI, 1.59-9.20) with these patients. Those who thought it was important, but were uncomfortable discussing sexual health when recommending HPV vaccination (AOR, 0.28; 95% CI, 0.12-0.70) or who reported insufficient HPV vaccine information (AOR, 0.45; 95% CI, 0.23-0.88) or lack of primary-subspecialty care provider communication (AOR, 0.38; 95% CI, 0.16-0.93) as barriers to HPV vaccination were less likely to recommend HPV vaccination. CONCLUSION This study revealed that many subspecialists fail to recommend HPV vaccination to adolescents with CMCs and highlights potential targets for future interventions.
Collapse
Affiliation(s)
- Annika M Hofstetter
- Department of Pediatrics, Columbia University, New York, New York; Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington.
| | - Lauren Lappetito
- Department of Pediatrics, Columbia University, New York, New York
| | - Melissa S Stockwell
- Department of Pediatrics, Columbia University, New York, New York; NewYork-Presbyterian Hospital, New York, New York; Mailman School of Public Health, Columbia University, New York, New York
| | - Susan L Rosenthal
- Department of Pediatrics, Columbia University, New York, New York; NewYork-Presbyterian Hospital, New York, New York; Department of Psychiatry, Columbia University, New York, New York
| |
Collapse
|
25
|
Vadaparampil ST, Malo TL, Sutton SK, Ali KN, Kahn JA, Casler A, Salmon D, Walkosz B, Roetzheim RG, Zimet GD, Giuliano AR. Missing the Target for Routine Human Papillomavirus Vaccination: Consistent and Strong Physician Recommendations Are Lacking for 11- to 12-Year-Old Males. Cancer Epidemiol Biomarkers Prev 2016; 25:1435-1446. [PMID: 27486020 DOI: 10.1158/1055-9965.epi-15-1294] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 07/25/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Rates of routine human papillomavirus (HPV) vaccination of adolescent males in the United States are low. Leading health organizations advocate consistent and strong physician recommendations to improve HPV vaccine dissemination. This study describes the prevalence and correlates of consistent and strong physician recommendations for HPV vaccination of adolescent males. METHODS We surveyed pediatric and family medicine physicians in Florida about their HPV vaccine recommendations for male vaccine-eligible age groups (11-12, 13-17, 18-21 years). Descriptive statistics compared consistency and strength of HPV recommendations across age groups. Multivariable logistic regression examined factors associated with consistent and strong recommendations for 11- to 12-year-olds. RESULTS We received 367 completed surveys (51% response rate). Physicians most often consistently and strongly recommended HPV vaccine to males ages 13 to 17 (39%) compared with ages 11 to 12 (31%) and 18 to 21 (31%). Consistent and strong recommendation for 11- to 12-year-old males was more likely to be delivered by Vaccine for Children providers and less likely among physicians who reported more personal barriers to vaccination, particularly concerns about vaccine safety, concerns about adding vaccines to the vaccine schedule, and difficulty in remembering to discuss HPV vaccination. CONCLUSIONS Physicians' current consistency and strength of HPV vaccine recommendations do not align with national recommendations. Interventions to improve HPV vaccine recommendations must also consider the influence of physicians' personal barriers to HPV vaccine delivery. IMPACT As one of the first studies to examine both consistency and strength of physicians' HPV vaccine recommendations for males, our findings can inform future interventions focused on facilitating physicians' recommendations. Cancer Epidemiol Biomarkers Prev; 25(10); 1435-46. ©2016 AACR.
Collapse
Affiliation(s)
- Susan T Vadaparampil
- Division of Population Science, Moffitt Cancer Center, Tampa, Florida. Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida. Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, Florida.
| | - Teri L Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Steven K Sutton
- Division of Population Science, Moffitt Cancer Center, Tampa, Florida. Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, Florida
| | - Karla N Ali
- Division of Population Science, Moffitt Cancer Center, Tampa, Florida
| | - Jessica A Kahn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohia
| | - Alix Casler
- Department of Pediatrics, Orlando Health Physician Associates, Orlando, Florida
| | - Daniel Salmon
- Department of International Health and Health Behavior Society, John Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Richard G Roetzheim
- Division of Population Science, Moffitt Cancer Center, Tampa, Florida. Department of Family Medicine, College of Medicine, University of South Florida, Tampa, Florida
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Anna R Giuliano
- Division of Population Science, Moffitt Cancer Center, Tampa, Florida. Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida. Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, Florida
| |
Collapse
|
26
|
Teplow-Phipps RL, Papadouka V, Benkel DH, Holleran S, Ramakrishnan R, Rosenthal SL, Soren K, Stockwell MS. Influence of Gender and Gender-Specific Recommendations on Adolescent Human Papillomavirus Vaccination. Am J Prev Med 2016; 51:161-169. [PMID: 27032464 DOI: 10.1016/j.amepre.2016.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 01/12/2016] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The human papillomavirus (HPV) vaccine was introduced for female adolescents prior to male adolescents. Understanding coverage patterns related to gender-specific recommendations and factors associated with early adoption and timely completion may be important for future vaccines. METHODS Retrospective analysis of HPV vaccine initiation (one or more dose) and completion (three or more doses) patterns in adolescents aged 11-18 years using 2009-2013 New York Citywide Immunization Registry data. Log binomial models assessed patient-specific (age, insurance) and practice-specific (facility type, number of adolescents, poverty level) variables on early adoption (within 1 year of recommendation) and timely completion (within 12 months) by gender. RESULTS Of 1,494,767 adolescents, 50.2% were male, 57.5% were vaccinated in private practices, 58.7% in practices with more adolescents, and 48.8% in highest poverty locations. More female (54.0%) than male (33.5%) adolescents initiated vaccination (p<0.001). Of those, 56.1% received three or more doses, 34.1% within 12 months (30.0% male, 36.8% female, p<0.001). In 2009-2012, the proportion of still-eligible male adolescents who newly initiated increased from 0.1% to 17.0%; rates for female adolescents increased from 15.4% to 17.3%. Vaccination initiation within 1 year of gender-specific recommendations was similar (27.4% female, 27.3% male). For both genders, the uninsured were less likely to have early adoption and timely completion. Being publicly insured was associated with early adoption in both genders, but with timely completion in male adolescents only. Being seen in a public facility and in a practice with more adolescents was also associated with early adoption. CONCLUSIONS Changing HPV vaccine recommendations had minimal cross-gender impact. Early adoption and timely completion patterns were mostly similar across genders.
Collapse
Affiliation(s)
- Randi L Teplow-Phipps
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, New York; New York-Presbyterian Hospital, New York, New York
| | - Vikki Papadouka
- Bureau of Immunization, New York City Department of Health and Mental Hygiene, New York, New York
| | - Denise H Benkel
- Bureau of Immunization, New York City Department of Health and Mental Hygiene, New York, New York
| | - Stephen Holleran
- Division of Biomathematics, Department of Pediatrics, Columbia University, New York, New York
| | - Rajasekhar Ramakrishnan
- Division of Biomathematics, Department of Pediatrics, Columbia University, New York, New York
| | - Susan L Rosenthal
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Karen Soren
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, New York; New York-Presbyterian Hospital, New York, New York
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, New York; New York-Presbyterian Hospital, New York, New York; Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York.
| |
Collapse
|
27
|
Scherr CL, Augusto B, Ali K, Malo TL, Vadaparampil ST. Provider-reported acceptance and use of the Centers for Disease Control and Prevention messages and materials to support HPV vaccine recommendation for adolescent males. Vaccine 2016; 34:4229-4234. [PMID: 27340095 DOI: 10.1016/j.vaccine.2016.06.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE We evaluated Florida-based physicians' awareness and use of the Centers for Disease Control and Prevention's (CDC) "You are the Key" campaign website, including messages to support physicians' human papillomavirus (HPV) vaccine recommendations. METHODS Using closed-ended and free-text survey items, physicians' (n=355) practices related to HPV vaccination recommendations for males and use of the CDC's materials were assessed. Descriptive statistics were calculated for closed-ended questions, and thematic analysis was conducted on free-text responses. RESULTS Over half of physicians were aware of the CDC's website (n=186; 57.9%); of those aware, fewer than half reported using the website (n=86; 46.2%). Slightly more than half reported awareness of the CDC's messages (n=178; 55.3%); however, less than one-third of those aware reported using them (n=56; 31.5%). Physicians' comments on the CDC's messages were favorable; 78.6-93.2% said they would use a message in clinic. CONCLUSION Additional research is needed to identify the best mechanisms for resource dissemination and to understand why physicians do not use these messages, despite favorable attitudes.
Collapse
Affiliation(s)
- C L Scherr
- Northwestern University, School of Communication, Department of Communication Studies, Center for Communication and Health, 710 North Lake Shore Drive 15th Floor, Chicago, IL 60611, USA
| | - B Augusto
- Moffitt Cancer Center, Health Outcomes and Behavior, 120902 Magnolia Drive, MRCCANCONT, Tampa, FL 33612, USA
| | - K Ali
- Moffitt Cancer Center, Health Outcomes and Behavior, 120902 Magnolia Drive, MRCCANCONT, Tampa, FL 33612, USA
| | - T L Malo
- University of North Carolina, Lineberger Comprehensive Cancer Center and Department of Health Behavior, 324 Rosenau Hall CB# 7440, Chapel Hill, NC 27599, USA
| | - S T Vadaparampil
- Moffitt Cancer Center, Health Outcomes and Behavior, 120902 Magnolia Drive, MRCCANCONT, Tampa, FL 33612, USA.
| |
Collapse
|
28
|
Gilkey MB, McRee AL. Provider communication about HPV vaccination: A systematic review. Hum Vaccin Immunother 2016; 12:1454-68. [PMID: 26838681 PMCID: PMC4964733 DOI: 10.1080/21645515.2015.1129090] [Citation(s) in RCA: 212] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/19/2015] [Accepted: 12/03/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Improving HPV vaccination coverage in the US will require healthcare providers to recommend the vaccine more effectively. To inform quality improvement efforts, we systematically reviewed studies of provider communication about HPV vaccination. METHODS We searched MEDLINE, CINAHL, EMBASE, and POPLINE in August 2015 to identify studies of provider communication about HPV vaccination. RESULTS We identified 101 qualitative and quantitative studies. Providers less often recommended HPV vaccine if they were uncomfortable discussing sex, perceived parents as hesitant, or believed patients to be low risk. Patients less often received recommendations if they were younger, male, or from racial/ethnic minorities. Despite parents' preference for unambiguous recommendations, providers often sent mixed messages by failing to endorse HPV vaccine strongly, differentiating it from other vaccines, and presenting it as an "optional" vaccine that could be delayed. CONCLUSION Interventions are needed to help providers deliver effective recommendations in the complex communication environment surrounding HPV vaccination.
Collapse
Affiliation(s)
- Melissa B. Gilkey
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, MA
| | | |
Collapse
|
29
|
Lindley MC, Jeyarajah J, Yankey D, Curtis CR, Markowitz LE, Stokley S. Comparing human papillomavirus vaccine knowledge and intentions among parents of boys and girls. Hum Vaccin Immunother 2016; 12:1519-27. [PMID: 27003108 DOI: 10.1080/21645515.2016.1157673] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND/OBJECTIVE Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Previous research suggests some differences between male and female adolescents in correlates of vaccine receipt and reasons for non-vaccination; few studies examine both sexes together. This analysis assessed knowledge and attitudes related to HPV disease and vaccination, intention to vaccinate, and reasons for delayed vaccination or non-vaccination among parents of boys and girls 13-17 y old in 50 states, the District of Columbia, and selected local areas. METHODS National Immunization Survey-Teen 2013 data were analyzed and gender differences examined. RESULTS In this sample, adolescent boys were more likely than girls to be unvaccinated and less likely to have completed the HPV vaccination series (p < 0.005 for both). Parents of girls were more likely than parents of boys to report a provider recommendation for HPV vaccination (65.0% vs. 42.1%). Only 29% of girls' parents reported a provider recommendation to begin vaccination by 11-12 y old. Among unvaccinated teens, parental intention to vaccinate in the next 12 months did not differ by sex, but reasons for vaccination or non-vaccination did. Many parents do not know the recommended number of HPV doses. CONCLUSIONS Gender differences in provider vaccination recommendations and reasons for vaccination might partially explain differential HPV uptake by male and female adolescents. Clinicians should offer strong recommendations for HPV vaccination at 11-12 y old for both girls and boys. To reduce missed opportunities, HPV vaccination should be presented in the context of, and given concurrently with, other routinely administered vaccines.
Collapse
Affiliation(s)
- Megan C Lindley
- a Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , Georgia
| | - Jenny Jeyarajah
- a Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , Georgia
| | - David Yankey
- a Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , Georgia
| | - C Robinette Curtis
- a Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , Georgia
| | - Lauri E Markowitz
- b Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , Georgia
| | - Shannon Stokley
- a Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , Georgia
| |
Collapse
|
30
|
Fiks AG, Luan X, Mayne SL. Improving HPV Vaccination Rates Using Maintenance-of-Certification Requirements. Pediatrics 2016; 137:e20150675. [PMID: 26908681 DOI: 10.1542/peds.2015-0675] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Many pediatricians are now required to participate in American Board of Pediatrics Maintenance of Certification (MOC) Part IV programs focused on improving health care quality, but the benefits of participation are unproven. METHODS Twenty-seven primary care pediatricians from 11 primary care practices participated in a 1-year MOC program for human papillomavirus (HPV) vaccine. Participants received education and electronic health record (EHR)-generated performance feedback reports with their rates of captured HPV immunization opportunities (dose given at eligible visit) and those of peers. In each of 3 cycles, clinicians collectively identified a goal for improvement. Rates of captured opportunities among adolescents 11 to <18 years old were tabulated, and statistical process control charts were created to evaluate changes over time among participants compared with 200 nonparticipants. Provider perceptions of the program and time invested were recorded via survey. RESULTS Participating clinicians missed fewer opportunities for HPV vaccination than nonparticipants. MOC participants significantly increased their captured opportunities relative to nonparticipating clinicians by 5.7 percentage points for HPV dose 1 at preventive visits and by 0.7 and 5.6 percentage points for doses 1 and 2, respectively, at acute visits. There were no significant differences for other doses. The estimated program cost was $662/participant. Of the participating pediatricians, 96% felt the effort to participate was warranted, and half would not have joined the project without the MOC requirement. CONCLUSIONS Participation in MOC Part IV improved vaccination at modest cost and with high pediatrician satisfaction, demonstrating benefits of the program that may help to inform future initiatives.
Collapse
Affiliation(s)
- Alexander G Fiks
- The Pediatric Research Consortium (PeRC), Department of Biomedical and Health Informatics, Center for Pediatric Clinical Effectiveness (CPCE), PolicyLab, and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Xianqun Luan
- Office of Clinical Quality Improvement, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | | |
Collapse
|
31
|
Suryadevara M, Handel A, Bonville CA, Cibula DA, Domachowske JB. Pediatric provider vaccine hesitancy: An under-recognized obstacle to immunizing children. Vaccine 2015; 33:6629-34. [DOI: 10.1016/j.vaccine.2015.10.096] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/18/2015] [Accepted: 10/23/2015] [Indexed: 01/05/2023]
|
32
|
Gilkey MB, Malo TL, Shah PD, Hall ME, Brewer NT. Quality of physician communication about human papillomavirus vaccine: findings from a national survey. Cancer Epidemiol Biomarkers Prev 2015; 24:1673-9. [PMID: 26494764 DOI: 10.1158/1055-9965.epi-15-0326] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/23/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Improving the quality of physicians' recommendations for human papillomavirus (HPV) vaccination is critical to addressing low coverage. Thus, we sought to describe HPV vaccine communication practices among primary care physicians. METHODS Pediatricians and family physicians (n = 776) completed our national online survey in 2014. We assessed the quality of their HPV vaccine recommendations on strength of endorsement (i.e., saying the vaccine is important), timeliness (recommending it by ages 11-12), consistency (recommending it routinely vs. using a risk-based approach), and urgency (recommending same-day vaccination). RESULTS A sizeable minority of physicians reported that they do not strongly endorse HPV vaccine (27%) or deliver timely recommendations for girls (26%) or boys (39%). Many physicians (59%) used a risk-based approach to recommending HPV vaccine, and only half (51%) usually recommended same-day vaccination. Overall recommendation quality was lower among physicians who were uncomfortable talking about HPV vaccine or who believed parents did not value it. Quality was higher among physicians who began discussions by saying the child was due for HPV vaccine versus giving information or eliciting questions. CONCLUSION Many physicians in our national sample reported recommending HPV vaccine inconsistently, behind schedule, or without urgency. These practices likely contribute to under-immunization among adolescents, and may convey ambivalence to parents. IMPACT As one of the first studies to assess multiple aspects of recommendation quality, these findings can inform the many state and national initiatives that aim to improve communication about HPV vaccine so as to address the persistent underuse of a powerful tool for cancer prevention.
Collapse
Affiliation(s)
- Melissa B Gilkey
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
| | - Teri L Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina. Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Parth D Shah
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Megan E Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Noel T Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina. Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| |
Collapse
|
33
|
Physician communication about adolescent vaccination: How is human papillomavirus vaccine different? Prev Med 2015; 77:181-5. [PMID: 26051197 PMCID: PMC4490050 DOI: 10.1016/j.ypmed.2015.05.024] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/26/2015] [Accepted: 05/30/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Low human papillomavirus (HPV) vaccination coverage stands in stark contrast to our success in delivering other adolescent vaccines. To identify opportunities for improving physicians' recommendations for HPV vaccination, we sought to understand how the communication context surrounding adolescent vaccination varies by vaccine type. METHODS A national sample of 776 U.S. physicians (53% pediatricians, 47% family medicine physicians) completed our online survey in 2014. We assessed physicians' perceptions and communication practices related to recommending adolescent vaccines for 11- and 12-year-old patients. RESULTS About three-quarters of physicians (73%) reported recommending HPV vaccine as highly important for patients, ages 11-12. More physicians recommended tetanus, diphtheria, and acellular pertussis (Tdap) (95%) and meningococcal vaccines (87%, both p<0.001) as highly important for this age group. Only 13% of physicians perceived HPV vaccine as being highly important to parents, which was far fewer than perceived parental support for Tdap (74%) and meningococcal vaccines (62%, both p<0.001). Physicians reported that discussing HPV vaccine took almost twice as long as discussing Tdap. Among physicians with a preferred order for discussing adolescent vaccines, most (70%) discussed HPV vaccine last. CONCLUSIONS Our findings suggest that primary care physicians perceived HPV vaccine discussions to be burdensome, requiring more time and engendering less parental support than other adolescent vaccines. Perhaps for this reason, physicians in our national study recommended HPV vaccine less strongly than other adolescent vaccines, and often chose to discuss it last. Communication strategies are needed to support physicians in recommending HPV vaccine with greater confidence and efficiency.
Collapse
|
34
|
Asiedu GB, Breitkopf CR, Kremers WK, Ngo QV, Nguyen NV, Barenberg BJ, Tran VD, Dinh TA. Vietnamese Health Care Providers' Preferences Regarding Recommendation of HPV Vaccines. Asian Pac J Cancer Prev 2015; 16:4895-900. [DOI: 10.7314/apjcp.2015.16.12.4895] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
35
|
Dodd RH, Marlow LAV, Waller J. Discussing a diagnosis of human papillomavirus oropharyngeal cancer with patients: An exploratory qualitative study of health professionals. Head Neck 2015; 38:394-401. [PMID: 25351993 PMCID: PMC5032980 DOI: 10.1002/hed.23916] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 12/17/2022] Open
Abstract
Background The role of human papillomavirus (HPV) in oropharyngeal squamous cell cancer (SCC) has now been well established. Clinicians' experiences and challenges of talking to patients about HPV have yet to be explored. Methods Fifteen health professionals caring for patients with oropharyngeal SCC were interviewed. Interviews were analyzed thematically. Results Participants expressed mixed views about explaining the causal role of HPV to their patients. Normalizing HPV and emphasizing the positive prognosis associated with it were regarded as key messages to be communicated. Challenging experiences included managing couples in a consultation and patients' concerns about transmitting HPV to their partners. Some participants described limitations to their HPV knowledge and identified the need for further information and training. Conclusion This study identified challenges experienced by health professionals working with patients with oropharyngeal SCC and highlights some key messages to convey to patients. Clinical guidance for health professionals and further information for patients about HPV‐positive oropharyngeal SCC are needed. © 2015 The Authors Head & Neck Published by Wiley Periodicals, Inc. Head Neck 38: 394–401, 2016
Collapse
Affiliation(s)
- Rachael H Dodd
- Department of Epidemiology and Public Health, Cancer Research United Kingdom Health Behaviour Research Centre, London, United Kingdom
| | - Laura A V Marlow
- Department of Epidemiology and Public Health, Cancer Research United Kingdom Health Behaviour Research Centre, London, United Kingdom
| | - Jo Waller
- Department of Epidemiology and Public Health, Cancer Research United Kingdom Health Behaviour Research Centre, London, United Kingdom
| |
Collapse
|
36
|
Starzyk EJ, Kelley MA, Caskey RN, Schwartz A, Kennelly JF, Bailey RC. Infant male circumcision: healthcare provider knowledge and associated factors. PLoS One 2015; 10:e0115891. [PMID: 25635664 PMCID: PMC4312077 DOI: 10.1371/journal.pone.0115891] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 11/26/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The emerging science demonstrates various health benefits associated with infant male circumcision and adult male circumcision; yet rates are declining in the United States. The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend that healthcare providers present evidence-based risk and benefit information for infant male circumcision to parent(s) and guardian(s). The purpose of this study was to assess providers' level of infant male circumcision knowledge and to identify the associated characteristics. METHODS An online survey was administered to healthcare providers in the family medicine, obstetrics, and pediatrics medical specialties at an urban academic health center. To assess infant male circumcision knowledge, a 17 point summary score was constructed to identify level of provider knowledge within the survey. RESULTS Ninety-two providers completed the survey. Providers scored high for the following knowledge items: adverse event rates, protects against phimosis and urinary tract infections, and does not prevent hypospadias. Providers scored lower for items related to more recent research: protection against cervical cancer, genital ulcer disease, bacterial vaginosis, and reduction in HIV acquisition. Two models were constructed looking at (1) overall knowledge about male circumcision, and (2) knowledge about male circumcision reduction in HIV acquisition. Pediatricians demonstrated greater overall infant male circumcision knowledge, while obstetricians exhibited significantly greater knowledge for the HIV acquisition item. CONCLUSION Providers' knowledge levels regarding the risks and benefits of infant male circumcision are highly variable, indicating the need for system-based educational interventions.
Collapse
Affiliation(s)
- Erin J. Starzyk
- University of Illinois at Chicago, School of Public Health, Division of Community Health Sciences, Chicago, Illinois, United States of America
| | - Michele A. Kelley
- University of Illinois at Chicago, School of Public Health, Division of Community Health Sciences, Chicago, Illinois, United States of America
| | - Rachel N. Caskey
- University of Illinois at Chicago, College of Medicine, Department of Internal Medicine and Pediatrics, Chicago, Illinois, United States of America
| | - Alan Schwartz
- University of Illinois at Chicago, College of Medicine, Department of Medical Education, Chicago, Illinois, United States of America
| | - Joan F. Kennelly
- University of Illinois at Chicago, School of Public Health, Division of Community Health Sciences, Chicago, Illinois, United States of America
| | - Robert C. Bailey
- University of Illinois at Chicago, School of Public Health, Division of Epidemiology and Biostatistics, Chicago, Illinois, United States of America
| |
Collapse
|
37
|
Ozsurekci Y, Karadag Oncel E, Bayhan C, Celik M, Ozkaya-Parlakay A, Arvas M, Ceyhan M. Knowledge and attitudes about human papillomaviruses and immunization among Turkish pediatricians. Asian Pac J Cancer Prev 2015; 14:7325-9. [PMID: 24460296 DOI: 10.7314/apjcp.2013.14.12.7325] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is one of the most common sexually transmitted infectious agents, and the effectiveness of vaccine delivery programs will depend largely upon whether providers recommend vaccines. The objectives of this study were to examine pediatrician characteristics, knowledge, and attitudes associated with HPV and HPV immunization. MATERIALS AND METHODS Attendees of the national pediatric meeting in 2011, were asked to complete a questionnaire that, aside from demographic information, elicited level of agreement with statements regarding HPV, its related diseases, and HPV vaccination. It also documented attitudes and beliefs about HPV vaccination. RESULTS Of the 480 attendees, 226 (47%) filled in the questionnaire. The level of pediatrician HPV-related knowledge varied. The majority (78%) were aware that HPV infection is the most common sexually transmitted infection, while 51% were unaware that a condom is ineffective protection against HPV infection. Between 60-80% of respondents were aware of the effectiveness of HPV vaccination for women. On the other hand, only 10% were aware of reasons why men should be vaccinated against HPV. The majority (75%) of Turkish pediatricians were likely to recommend HPV vaccination to their daughter, if they had one. Seventy percent of pediatricians agreed that the HPV vaccination should be added to the National Immunization Program (NIP) in Turkey. However, the respondents documented concerns about the cost of the vaccination. CONCLUSIONS Increasing pediatricians' knowledge and awareness of HPV and HPV vaccination may assist with the implementation of an effective NIP.
Collapse
Affiliation(s)
- Yasemin Ozsurekci
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey E-mail : , yas.
| | | | | | | | | | | | | |
Collapse
|
38
|
Jeudin P, Liveright E, Del Carmen MG, Perkins RB. Race, ethnicity, and income factors impacting human papillomavirus vaccination rates. Clin Ther 2014; 36:24-37. [PMID: 24417783 DOI: 10.1016/j.clinthera.2013.11.001] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/05/2013] [Accepted: 11/06/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) infection and cervical cancer disproportionately affect low-income and minority women. HPV vaccines have the potential to either reduce or exacerbate racial disparities in HPV-related diseases and cervical cancers, depending on the equitability of vaccine uptake. OBJECTIVES This review aims to identify barriers and facilitators of equitable uptake of HPV vaccination among low-income and minority girls. This review discusses factors related to race, ethnicity, and income that are associated with initiation and completion rates of the 3-dose HPV vaccine series and presents targets for intervention. METHODS We reviewed relevant English-language literature to identify current vaccination rates and factors associated with vaccine uptake. Study findings related to race (black, Latino, Asian), and incomes were summarized. RESULTS Current trends in the United States indicate low uptake among all adolescents, and that rates stagnated between 2011 and 2012. Low-income and minority adolescents are equally or more likely to start the HPV vaccination series than are white and higher-income adolescents, but are less likely to complete all 3 shots. Provider recommendation is a key factor in HPV vaccination, and minorities are less likely to report receiving recommendations for HPV vaccination. CONCLUSIONS As black, Hispanic, and Asian populations continue to grow in the United States over the next several decades, it is imperative that we not only improve HPV vaccination rates overall, but also focus on high-risk populations to prevent an increase in cervical cancer disparities.
Collapse
Affiliation(s)
- Patricia Jeudin
- Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
| | - Elizabeth Liveright
- Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
| | - Marcela G Del Carmen
- Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rebecca B Perkins
- Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts.
| |
Collapse
|
39
|
Hill M, Okugo G. Emergency medicine physician attitudes toward HPV vaccine uptake in an emergency department setting. Hum Vaccin Immunother 2014; 10:2551-6. [PMID: 25483493 PMCID: PMC4977447 DOI: 10.4161/21645515.2014.970933] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/02/2014] [Accepted: 06/18/2014] [Indexed: 11/19/2022] Open
Abstract
A physician's recommendation is the most effective published method of motivating HPV vaccination initiation. The emergency department (ED) is the 'public health safety net', and often the only access to care for underserved populations. Recommendation of the HPV vaccine in the ED is a potential avenue to improve vaccination rates among sub-populations who do not have access to routine medical care. We assessed willingness of EM physicians to recommend the vaccine, target high-risk women, and disclose perceived barriers to vaccination in the ED. A cross sectional study using an 11-item survey, was used to assess physician attitudes toward recommending the HPV vaccine in an ED setting to age eligible patients. 67.4% stated they would recommend the vaccine, 23.9% were neutral, and 8.7% would not recommend the vaccine to age eligible patients in the ED. 41% noted lack of adequate reimbursement for vaccination as a barrier to vaccination in the ED (P<0.05). Physicians were comfortable targeting women at high risk for cervical cancer for vaccination (P<0.05). EM physicians are comfortable targeting high-risk women for HPV vaccination in an ED setting. Support of EM physicians in the national effort to improve HPV vaccine uptake is an important step in eradicating a largely preventable yet lethal cancer.
Collapse
Affiliation(s)
- Mandy Hill
- The University of Texas Health Science Center at Houston; Department of Emergency Medicine; School of Medicine; Houston, TX USA
| | - Glory Okugo
- The University of Texas Health Science Center at Houston; Department of Emergency Medicine; School of Medicine; Houston, TX USA
| |
Collapse
|
40
|
Feemster KA, Middleton M, Fiks AG, Winters S, Kinsman SB, Kahn JA. Does intention to recommend HPV vaccines impact HPV vaccination rates? Hum Vaccin Immunother 2014; 10:2519-26. [PMID: 25483470 DOI: 10.4161/21645515.2014.969613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Despite recommendations for routine vaccination, HPV vaccination rates among adolescent females have remained low. The objective of this prospective cohort study was to determine whether clinician intention to recommend HPV vaccines predicts HPV vaccine series initiation among previously unvaccinated 11 to 18 year-old girls (N=18,083) who were seen by a pediatric clinician (N=105) from a large primary care network within 3 years of vaccine introduction. We used multivariable logistic regression with generalized estimating equations, Cox Regression and standardized survival curves to measure the association between clinician intention and time to and rate of first HPV vaccine receipt among eligible females. All models adjusted for patient age, race/ethnicity, payor category, visit type, and practice location. Eighty-5 percent of eligible 11 to 12 year-old and 95% of 13 to 18 year-old girls were seen by a provider reporting high intention to recommend HPV vaccines. However, only 30% of the cohort initiated the HPV vaccine series and the mean number of days from first eligible visit to series initiation was 190 (95% C.I. 184.2, 195.4). After adjusting for covariates, high clinician intention was modestly associated with girls' likelihood of HPV vaccine series initiation (OR 1.36; 95 % C.I. 1.07, 1.71) and time to first HPV vaccination (HR 1.22; 95% 1.06, 1.40). Despite high intention to vaccinate among this cohort of pediatric clinicians, overall vaccination rates for adolescent girls remained low. These findings support ongoing efforts to develop effective strategies to translate clinician intention into timely HPV vaccine receipt.
Collapse
Affiliation(s)
- Kristen A Feemster
- a Division of Infectious Diseases ; The Children's Hospital of Philadelphia ; Philadelphia , PA USA
| | | | | | | | | | | |
Collapse
|
41
|
Rosberger Z, Krawczyk A, Stephenson E, Lau S. HPV vaccine education: enhancing knowledge and attitudes of community counselors and educators. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:473-477. [PMID: 24146258 DOI: 10.1007/s13187-013-0572-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Educational efforts targeting parents of preadolescents may help them make informed decisions about having their children vaccinated against the human papillomavirus (HPV). We conducted a pilot study examining knowledge, attitudes, and beliefs of community-based health educators and counselors who routinely disseminate sexual health and prevention information through counseling and supporting these parents. We evaluated the impact of a single, brief workshop by administering questionnaires before and after the session. The workshop consisted of an educational intervention that was presented orally by an expert in gynecological oncology and was followed by an open discussion period. Following the information and discussion session, improvements were seen in knowledge accuracy, confidence in being able to discuss HPV vaccine issues with parents, greater willingness to recommend the vaccine, and a better understanding of potential barriers to vaccine uptake. These results suggest that health educators and counselors may be better prepared to encourage their clients to make well-informed decisions regarding HPV vaccination.
Collapse
Affiliation(s)
- Z Rosberger
- Department of Psychology, McGill University, Montreal, QC, Canada,
| | | | | | | |
Collapse
|
42
|
Hill M, Okugo G. Emergency Medicine Physician Attitudes toward HPV vaccine uptake in an Emergency Department Setting. Hum Vaccin Immunother 2014. [DOI: 10.4161/hv.29634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
43
|
Mazza D, Petrovic K, Grech C, Harris N. HPV vaccination in women aged 27 to 45 years: what do general practitioners think? BMC WOMENS HEALTH 2014; 14:91. [PMID: 25074404 PMCID: PMC4149036 DOI: 10.1186/1472-6874-14-91] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/18/2014] [Indexed: 11/10/2022]
Abstract
Background Although the Human Papillomavirus (HPV) vaccine is registered in Australia for females aged 9 to 45 years, females aged 27 to 45 years have shown limited vaccine uptake. Our study explored general practitioners’ (GPs) views concerning HPV vaccination of females in this age group, with particular focus on the barriers and the facilitators to the delivery of the HPV vaccine. Methods Semi-structured telephone interviews were conducted with 24 randomly selected general practitioners from metropolitan Melbourne. Questions were based on a theoretical framework that explained the barriers and facilitators to professional behaviour change. Results According to the GPs, the major barriers to the uptake of the HPV vaccine included the cost of the vaccine, time constraints, and the three-dose schedule. Other barriers that were identified included GPs’ and patients’ beliefs that females in this age group were at low risk of contracting HPV, lack of awareness about the vaccine, and uncertainty about the benefits of this vaccine for females in this age group. In contrast, the facilitators that were identified included the availability of the vaccine on site, the availability of vaccine clinics or nurses for administering the vaccine, the availability of information related to the vaccine either on site or online, and positive opinions from experts in the field. Conclusions Our study has identified some of the barriers and facilitators to the delivery and uptake of the HPV vaccine in females aged 27 to 45 years, as perceived by GPs. Further studies should be conducted to determine which of these should be targeted or prioritised for intervention. The views of women in this age group should also be considered as these would also be influential in designing effective intervention strategies for improving the delivery and uptake of the HPV vaccine.
Collapse
Affiliation(s)
- Danielle Mazza
- Department of General Practice, School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia.
| | | | | | | |
Collapse
|
44
|
Malo TL, Giuliano AR, Kahn JA, Zimet GD, Lee JH, Zhao X, Vadaparampil ST. Physicians' human papillomavirus vaccine recommendations in the context of permissive guidelines for male patients: a national study. Cancer Epidemiol Biomarkers Prev 2014; 23:2126-35. [PMID: 25028456 DOI: 10.1158/1055-9965.epi-14-0344] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Little is known about physicians' human papillomavirus (HPV) vaccine recommendations for males while the Advisory Committee on Immunization Practices' (ACIP) permissive guidelines for male vaccination were in effect. The purpose of this study was to examine and explore factors associated with U.S. physicians' HPV vaccine recommendations to early (ages 11-12), middle (13-17), and late adolescent/young adult (18-26) males. METHODS Nationally representative samples of family physicians and pediatricians were selected in 2011 (n = 1,219). Physicians reported the frequency with which they recommended HPV vaccine to male patients ["always" (>75% of the time) vs. other] for each age group. Statistically significant predictors of vaccine recommendation were identified using multivariable logistic regression. RESULTS The prevalence of physicians reporting they "always" recommended HPV vaccination for males was 10.8% for ages 11 to 12, 12.9% for ages 13 to 17, and 13.2% for ages 18 to 26. Pediatrician specialty and self-reported early adoption of new vaccines were significantly associated with recommendation for all patient age groups. In addition, physician race and patient payment method were associated with physician recommendations to patients ages 11 to 12, and patient race was associated with recommendations to ages 13 to 17 and 18 to 26. CONCLUSIONS Less than 15% of physicians surveyed reported "always" recommending HPV vaccine to male patients following national guidelines for permissive vaccination. Vaccine financing may have affected physicians' vaccine recommendations. IMPACT If these recommendation practices continue following the ACIP's routine recommendation for males in October 2011, then interventions designed to increase recommendations should target family physicians and possibly use early adopters to encourage support of HPV vaccination guidelines.
Collapse
Affiliation(s)
- Teri L Malo
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, Florida
| | - Anna R Giuliano
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida. Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida. Department of Oncologic Science, College of Medicine, University of South Florida, Tampa, Florida
| | - Jessica A Kahn
- Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ji-Hyun Lee
- Department of Oncologic Science, College of Medicine, University of South Florida, Tampa, Florida. Biostatistics Department, Moffitt Cancer Center, Tampa, Florida
| | - Xiuhua Zhao
- Biostatistics Department, Moffitt Cancer Center, Tampa, Florida
| | - Susan T Vadaparampil
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, Florida. Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida. Department of Oncologic Science, College of Medicine, University of South Florida, Tampa, Florida.
| |
Collapse
|
45
|
Ferrer HB, Trotter C, Hickman M, Audrey S. Barriers and facilitators to HPV vaccination of young women in high-income countries: a qualitative systematic review and evidence synthesis. BMC Public Health 2014; 14:700. [PMID: 25004868 PMCID: PMC4100058 DOI: 10.1186/1471-2458-14-700] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 06/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaccination against Human Papillomavirus (HPV) is recommended for adolescent young women prior to sexual debut to reduce cervical cancer related mortality and morbidity. Understanding factors affecting decision-making of HPV vaccination of young women is important so that effective interventions can be developed which address barriers to uptake in population groups less likely to receive the HPV vaccine. METHODS We undertook a qualitative systematic review and evidence synthesis to examine decision-making relating to the HPV vaccination of young women in high-income countries. A comprehensive search of databases from inception to March 2012 was undertaken to identify eligible studies reporting the perspectives of key stakeholders including policy makers, professionals involved in programme, parents, and young women. Factors affecting uptake of the vaccine were examined at different levels of the socio-ecological model (policy, community, organisational, interpersonal and intrapersonal). RESULTS Forty-one studies were included. Whether young women receive the HPV vaccine is strongly governed by the decisions of policy makers, healthcare professionals, and parents. These decisions are shaped by: financial considerations; social norms and values relating to sexual activity, and; trust in vaccination programmes and healthcare providers. Financial constraints may be overcome through universal healthcare systems offering the HPV vaccine free at the point of delivery. In the healthcare setting, judgements by healthcare professionals about whether to recommend the vaccine may restrict a young woman's access to the vaccine irrespective of her own beliefs and preferences. Parents may decide not to allow their daughters to be vaccinated, based on cultural or religious perceptions about sexual activity. CONCLUSIONS Barriers to the uptake of the HPV vaccine have implications for young women's future sexual, physical and reproductive health. Interventions to address barriers to uptake of the vaccine should target appropriate, and multiple, levels of the socio-ecological model. Issues of trust require clear, accessible, and sometimes culturally appropriate, information about the HPV vaccination programme. Although young women are central to the HPV vaccination programme, their views are underrepresented in the qualitative literature. Future research should consider young women's perceptions of, and involvement in, consent and decision-making.
Collapse
Affiliation(s)
| | - Caroline Trotter
- Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES, UK
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Suzanne Audrey
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| |
Collapse
|
46
|
Rysavy MB, Kresowik JDK, Liu D, Mains L, Lessard M, Ryan GL. Human papillomavirus vaccination and sexual behavior in young women. J Pediatr Adolesc Gynecol 2014; 27:67-71. [PMID: 24405635 DOI: 10.1016/j.jpag.2013.08.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 08/15/2013] [Accepted: 08/20/2013] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To compare sexual attitudes and behaviors of young women who have received or declined the HPV vaccine. DESIGN Cross-sectional survey. SETTING Obstetrics and gynecology and pediatrics clinics at a large, Midwestern, academic health center. PARTICIPANTS 223 young women (ages 13-24): 153 who had received HPV vaccination and 70 with no prior HPV vaccination. MAIN OUTCOME MEASURES Sexual behaviors; attitudes toward sexual activity. RESULTS Vaccinated young women were slightly but significantly younger than unvaccinated (mean age 19.2 vs 20.0). Both groups showed a large percentage of participants engaging in high-risk sexual behavior (75% vs 77%). The mean age at sexual debut was not significantly different between the groups (16.8 vs 17.0) nor was the average number of sexual partners (6.6 for both). Unvaccinated participants were more likely to have been pregnant (20% vs 8.6%, P = .016), although this difference was not significant in multivariate analysis CI [0.902-5.177]. Specific questions regarding high-risk sexual behaviors and attitudes revealed no significant differences between the groups. CONCLUSION We found that sexual behaviors, including high-risk behaviors, were similar between young women who had and had not received HPV vaccination. Our findings provide no support for suggestions that the vaccine is associated with increased sexual activity. Importantly, we found that young women in our population are sexually active at a young age and are engaged in high-risk behaviors, affirming the importance of early vaccination.
Collapse
Affiliation(s)
- Mary B Rysavy
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Jessica D K Kresowik
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Dawei Liu
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA
| | - Lindsay Mains
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Megan Lessard
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA
| | - Ginny L Ryan
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, IA.
| |
Collapse
|
47
|
Cullen KA, Stokley S, Markowitz LE. Uptake of human papillomavirus vaccine among adolescent males and females: Immunization Information System sentinel sites, 2009-2012. Acad Pediatr 2014; 14:497-504. [PMID: 24954170 PMCID: PMC4593413 DOI: 10.1016/j.acap.2014.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 03/04/2014] [Accepted: 03/11/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The Advisory Committee on Immunization Practices (ACIP) has recommended routine human papillomavirus (HPV) vaccination at age 11 or 12 years for girls since 2006 and for boys since 2011. We sought to describe adolescent HPV vaccination coverage, doses administered from 2009 to 2012, and age at first vaccination by sex. METHODS Aggregate data were analyzed from 8 Immunization Information System sentinel sites on HPV vaccinations in children and adolescents aged 11 to 12 years, 13 to 15 years, and 16 to 18 years. Vaccination coverage by age group was reported for 2009 to 2012, and weekly doses administered were determined. Age at first HPV vaccination was calculated for girls in 2007 and 2011 and for boys in 2011. RESULTS This analysis included data on 2.9 million adolescents aged 11 to 18 years. There were small increases in coverage for girls, with receipt of ≥1 dose of HPV vaccine reaching 27.1% of ages 11 to 12, 47.9% of ages 13 to 15, and 57.1% of ages 16 to 18 by December 31, 2012. Uptake of ≥1 dose in boys reached ∼18% for all age groups. Doses administered showed seasonal variation, with highest uptake before back to school among girls and steady increases in boys after the 2009 ACIP recommendation for permissive use. Doses administered to boys surpassed those administered to girls by September 2012. Among vaccinated girls, more received vaccine at the recommended age of 11 to 12 years in 2011 (74.2%) compared to 2007 (9.9%). In 2011, 27.3% of vaccinated boys received their first dose at age 11 to 12 years. CONCLUSIONS HPV vaccination coverage increased among adolescents between 2009 and 2012. However, increases among girls were small, and coverage for boys and girls remained below target levels.
Collapse
Affiliation(s)
- Karen A Cullen
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga.
| | - Shannon Stokley
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Lauri E Markowitz
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga
| |
Collapse
|
48
|
Do Florida Medicaid providers' barriers to HPV vaccination vary based on VFC program participation? Matern Child Health J 2013; 17:609-15. [PMID: 22569945 DOI: 10.1007/s10995-012-1036-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study aimed to determine if physicians' perceived barriers to human papillomavirus (HPV) vaccination were associated with participation in the federal Vaccines for Children (VFC) program. A sample of 800 Florida Medicaid providers was randomly selected from the Florida Medicaid Master Provider File. A cross-sectional study was conducted using a 27-item survey that included 13 potential barriers to immunizing Medicaid patients against HPV, including concerns about vaccine safety and efficacy, discussing sexuality, vaccinated teens practicing riskier sexual behaviors, cost and reimbursement, ensuring 3-dose series completion, and school attendance requirements associated with HPV vaccination. Pearson χ(2) tests were conducted to investigate differences between each barrier and VFC program participation. Data were analyzed for 449 physicians. Compared to non-VFC providers, VFC providers were significantly less likely to somewhat or strongly agree that the following were barriers to vaccination: the cost of stocking the HPV vaccine (p = 0.0011), lack of adequate reimbursement for HPV vaccination (p < 0.0001), and lack of timely reimbursement for HPV vaccination (p < 0.0001). After adjusting for provider specialty and number of years since completion of residency training, VFC status remained significantly associated with the barrier regarding lack of adequate reimbursement for vaccination such that non-VFC providers had a 2.6-fold (95% confidence interval, 1.1-5.8) greater odds of somewhat or strongly agreeing that this barrier applied to them. Increasing participation in the VFC program may decrease physicians' cost-related barriers, which may increase the number of children vaccinated on time according to the recommended schedule.
Collapse
|
49
|
Casciotti DM, Smith KC, Tsui A, Klassen AC. Discussions of adolescent sexuality in news media coverage of the HPV vaccine. J Adolesc 2013; 37:133-43. [PMID: 24439619 DOI: 10.1016/j.adolescence.2013.11.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 11/13/2013] [Accepted: 11/15/2013] [Indexed: 10/25/2022]
Abstract
Given the sexually transmitted nature of human papillomavirus (HPV), some worry the HPV vaccine will create a false sense of security and promote adolescent sexual activity. Media coverage of vaccines can influence social norms, parental attitudes, and vaccine acceptance; in this paper we examine U.S. news media messages related to sexuality and HPV vaccination. Drawing on a structured analysis of 447 articles published during 2005-2009, we qualitatively analyzed a purposive sample of 49 articles discussing adolescent health behaviors related to HPV vaccination. Commonly, articles discussed vaccination in the context of abstinence-only versus comprehensive sexual health education; cited research findings to support vaccination or sex education; argued against connecting vaccination to promiscuous behavior; but included fear-inducing messages. Media messages concerning health behaviors related to HPV vaccination tended to support government and parental involvement in sex education, and dismiss concerns linking vaccination to sexual activity, while also presenting the vaccine as lifesaving.
Collapse
Affiliation(s)
- Dana M Casciotti
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA.
| | - Katherine C Smith
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Room 726, Baltimore, MD 21205, USA.
| | - Amy Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, N. Wolfe Street, Room W4041, Baltimore, MD 21205, USA.
| | - Ann C Klassen
- Department of Community Health and Prevention, Drexel University School of Public Health, 3215 Market Street, Room 435, Philadelphia, PA 19104, USA.
| |
Collapse
|
50
|
"HPV? Never heard of it!": a systematic review of girls' and parents' information needs, views and preferences about human papillomavirus vaccination. Vaccine 2013; 31:5152-67. [PMID: 24029117 DOI: 10.1016/j.vaccine.2013.08.091] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 08/22/2013] [Accepted: 08/28/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Two human papillomavirus vaccines were licenced in 2006/2007 for cervical cancer prevention. National vaccination programmes for schoolgirls were subsequently introduced in some European countries, North America and Australia. To understand factors influencing vaccine uptake and to inform the development of appropriate UK educational materials, we aimed to synthesise evidence of girls' and parents' information needs, views and preferences regarding HPV vaccination. DESIGN Systematic review and mixed method synthesis of qualitative and survey data. DATA SOURCES Twelve electronic databases; bibliographies of included studies 1980 to August 2011. REVIEW METHODS Two reviewers independently screened papers and appraised study quality. Studies were synthesised collaboratively using framework methods for qualitative data, and survey results integrated where they supported, contrasted or added to the themes identified. RESULTS Twenty-eight qualitative studies and 44 surveys were included. Where vaccination was offered, uptake was high. Intention to decline was related to a preference for vaccinating later to avoid appearing to condone early sexual activity, concerns about vaccine safety and low perception of risk of HPV infection. Knowledge was poor and there were many misconceptions; participants tried to assess the potential benefits and harms of vaccination but struggled to interpret limited information about HPV in the context of existing knowledge about sexually transmitted infections and cancer. Conclusion Many girls and their parents have limited understanding to an extent that impinges on their ability to make informed choices about HPV vaccination and could impact on future uptake of cervical screening. This is a considerable challenge to those who design and provide information, but getting the messages right for this programme could help in developing patient information about other HPV related cancers.
Collapse
|