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Offeddu V, Low MSF, Surendran S, Kembhavi G, Tam CC. Acceptance and feasibility of school-based seasonal influenza vaccination in Singapore: A qualitative study. Vaccine 2020; 38:1834-1841. [PMID: 31862193 DOI: 10.1016/j.vaccine.2019.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 12/06/2019] [Accepted: 12/10/2019] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Influenza is a major cause of disease in children. School-based seasonal influenza vaccination can be a cost-effective tool to improve vaccine uptake among children, and can bring substantial health and economic benefits to the broader community. The acceptance and feasibility of school-based influenza vaccination are likely to be highly context-specific, but limited data exist from tropical settings with year-round influenza transmission. We conducted a qualitative study to assess acceptability and feasibility of a school-based seasonal influenza vaccination programme in Singapore. METHODS We conducted qualitative in-depth interviews with key stakeholders, including healthcare professionals, representatives of relevant ministries, preschool principals and parents to understand their perspectives on a proposed school-based seasonal influenza vaccination programme. Interviews were transcribed verbatim and analysed using thematic analysis. RESULTS We conducted 40 interviews. Although preschool-aged children are currently the recommended age group for vaccination, stakeholders suggested introducing the programme in primary and/or secondary schools, where existing vaccination infrastructure would facilitate delivery. However, more comprehensive evidence on the local influenza burden and transmission patterns among children is required to develop an evidence-based, locally relevant rationale for a school-based vaccination programme and effectively engage policy-makers, school staff, and parents. Extensive, age-appropriate public education and awareness campaigns would increase the acceptability of the programme among stakeholders. Stakeholders indicated that an opt-out programme with free or subsidised vaccination would be the most likely to achieve high vaccine coverage and make access to vaccination more equitable. CONCLUSIONS Overall, participants were supportive of a free or subsidised school-based influenza vaccination programme in primary and/or secondary schools, although children in this age group are not currently a recommended group for vaccination. However, a better informed, evidence-based rationale to estimate the programme's impact in Singapore is currently lacking. Extensive, age-appropriate public education and awareness campaigns will help ensure full support across key stakeholder groups.
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Affiliation(s)
- Vittoria Offeddu
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 117549 Singapore.
| | - Mabel Sheau Fong Low
- Harvard T.H. Chan School of Public Health, Harvard University, MA 02138 Cambridge, USA
| | - Shilpa Surendran
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 117549 Singapore.
| | - Gayatri Kembhavi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 117549 Singapore
| | - Clarence C Tam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 117549 Singapore; London School of Hygiene & Tropical Medicine, WC1E 7HT London, United Kingdom.
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Facilitators and barriers of parental attitudes and beliefs toward school-located influenza vaccination in the United States: Systematic review. Vaccine 2017; 35:1987-1995. [PMID: 28320592 DOI: 10.1016/j.vaccine.2017.03.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/01/2017] [Accepted: 03/07/2017] [Indexed: 11/21/2022]
Abstract
The study objective was to identify facilitators and barriers of parental attitudes and beliefs toward school-located influenza vaccination in the United States. In 2009, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention expanded their recommendations for influenza vaccination to include school-aged children. We conducted a systematic review of studies focused on facilitators and barriers of parental attitudes toward school-located influenza vaccination in the United States from 1990 to 2016. We reviewed 11 articles by use of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework. Facilitators were free/low cost vaccination; having belief in vaccine efficacy, influenza severity, and susceptibility; belief that vaccination is beneficial, important, and a social norm; perception of school setting advantages; trust; and parental presence. Barriers were cost; concerns regarding vaccine safety, efficacy, equipment sterility, and adverse effects; perception of school setting barriers; negative physician advice of contraindications; distrust in vaccines and school-located vaccination programs; and health information privacy concerns. We identified the facilitators and barriers of parental attitudes and beliefs toward school-located influenza vaccination to assist in the evidence-based design and implementation of influenza vaccination programs targeted for children in the United States and to improve influenza vaccination coverage for population-wide health benefits.
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Middleman AB, Won T, Auslander B, Misra S, Short M. HPV vaccine uptake in a school-located vaccination program. Hum Vaccin Immunother 2016; 12:2872-2874. [PMID: 27548752 DOI: 10.1080/21645515.2016.1208326] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Previous research has implied that while parents may be willing to have their adolescents receive some recommended vaccines via school-located vaccination program (SLVP), they were less likely to agree to the HPV vaccine being administered via SLVP. During an SLVP in a large urban area, 86% of those participating in the program received an HPV vaccine.
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Affiliation(s)
- Amy B Middleman
- a Department of Pediatrics , University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
| | - Tiana Won
- b Department of Pediatrics , University of Washington , Seattle , WA , USA
| | - Beth Auslander
- c Department of Pediatrics , University of Texas Medical Branch at Galveston , Galveston , TX , USA
| | - Sanghamitra Misra
- d Department of Pediatrics , Baylor College of Medicine , Houston , TX , USA
| | - Mary Short
- e Department of Psychology , University of Houston-Clear Lake , Clear Lake , TX , USA
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Gargano LM, Weiss P, Underwood NL, Seib K, Sales JM, Vogt TM, Rask K, Morfaw C, Murray DL, DiClemente RJ, Hughes JM. School-Located Vaccination Clinics for Adolescents: Correlates of Acceptance Among Parents. J Community Health 2016; 40:660-9. [PMID: 25528325 DOI: 10.1007/s10900-014-9982-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Four vaccines are recommended by The Advisory Committee for Immunization Practices for adolescents: tetanus, diphtheria, acellular pertussis vaccine (Tdap), meningococcal conjugate vaccine (MCV4), human papillomavirus vaccine (HPV), and annual seasonal influenza vaccine. However, coverage among adolescents is suboptimal. School-located vaccination clinics (SLVCs) offer vaccines to students at school, increasing access. This study seeks to determine the relationship between attitudes of parents of middle- and high-school students and acceptance of SLVCs for all four adolescent recommended vaccines. We conducted a telephone and web-based survey among parents of students enrolled in six middle and five high schools in Georgia. Analyses were conducted to examine associations between parental attitudes and willingness to allow their child to be vaccinated at school. Tdap and influenza vaccine had the highest rates of parental SLVC acceptance while HPV vaccine had the lowest. Parents who accepted SLVCs had higher perceived severity of influenza, meningococcal, and HPV illnesses compared to parents who did not accept SLVC. Intention to vaccinate was associated with SLVC acceptance for Tdap [Adjusted OR (AOR) 7.38; 95% confidence interval (CI) 2.44-22.31], MCV4 (AOR 2.97; 95% CI 1.67-5.28), and HPV vaccines (AOR 7.61; 95% CI 3.43-16.89). Social norms were associated with acceptance of SLVCs for influenza vaccine (AOR 1.44; 95% CI 1.12-1.84). These findings suggest parents of adolescents are generally supportive of SLVCs for recommended adolescent vaccines. Perceived severity of illness and intention to get their adolescent vaccinated were the most consistent correlates of parental SLVC acceptance for all vaccines. Future SLVC planning should focus on perceptions of disease severity and benefits of vaccination.
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Affiliation(s)
- Lisa M Gargano
- Emory University, 1462 Clifton Road Room 446, Atlanta, GA, 30329, USA,
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Vercruysse J, Chigurupati NL, Fung L, Apte G, Pierre-Joseph N, Perkins RB. Parents' and providers' attitudes toward school-located provision and school-entry requirements for HPV vaccines. Hum Vaccin Immunother 2016; 12:1606-14. [PMID: 26934421 DOI: 10.1080/21645515.2016.1140289] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To determine parents' and providers' attitudes toward school-located provision and school-entry requirements for HPV vaccination. METHODS Parents/guardians of 11-17 y old girls and pediatric healthcare providers at one inner-city public clinic and three private practices completed semi-structured interviews in 2012-2013. Participants were asked open-ended questions regarding their attitudes toward school-located provision and school-entry requirements for HPV vaccination. Parents' answers were analyzed with relationship to whether their daughters had not initiated, initiated but not completed, or completed the HPV vaccine series. Qualitative analysis was used to identify themes related to shared views. RESULTS 129 parents/guardians and 34 providers participated. 61% of parents supported providing HPV vaccinations in schools, citing reasons of convenience, improved access, and positive peer pressure. Those who opposed school-located provision raised concerns related to privacy and the capacity of school nurses to manage vaccine-related reactions. Parents whose daughters had not completed the series were more likely to intend to vaccinate their daughters in schools (70%) and support requirements (64%) than parents who had not initiated vaccination (42% would vaccinate at school, 46% support requirements) or completed the series (42% would vaccinate at school, 32% support requirements; p < 0 .05 for all comparisons). 81% of providers supported offering vaccination in schools, wanting to take advantage of the captive audience, improve vaccine completion rates, and decrease the administrative burden on medical office staff, but were concerned about adequate information transfer between schools and medical offices. Only 32% of providers supported school-entry requirements, largely because they felt that a requirement might provoke a public backlash that could further hinder vaccination efforts. CONCLUSIONS School-located provision of HPV vaccination was widely accepted by healthcare providers and parents whose children have not completed the series, indicating that this venue might be a valuable addition to improve completion rates. Support for school-entry requirements was limited among both parents and healthcare providers.
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Affiliation(s)
| | | | - Leslie Fung
- b Sargent College of Health and Rehabilitation Services, Boston University , Boston , MA , USA
| | - Gauri Apte
- a Boston University School of Medicine , Boston , MA , USA
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Lee A, Wong MCS, Chan TT, Chan PKS. A home-school-doctor model to break the barriers for uptake of human papillomavirus vaccine. BMC Public Health 2015; 15:935. [PMID: 26392084 PMCID: PMC4578840 DOI: 10.1186/s12889-015-2269-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 09/14/2015] [Indexed: 11/17/2022] Open
Abstract
Background A high coverage of human papillomavirus (HPV) vaccination is required to achieve a clinically significant reduction in disease burden. Countries implementing free-of-charge national vaccination program for adolescent girls are still challenged by the sub-optimal uptake rate. Voluntary on-site school-based mass vaccination programs have demonstrated high coverage. Here, we tested whether this could be an option for countries without a government-supported vaccination program as in Hong Kong. Method A Home-School-Doctor model was evolved based on extensive literature review of various health promotion models together with studies on HPV vaccination among adolescent girls. The outcome measure was uptake of vaccination. Factors associated with the outcome were measured by validated surveys in which 4,631 students from 24 school territory wide participated. Chi-square test was used to analyze association between the categorical variables and the outcome. Multivariate analysis was performed to identify independent variables associated with the outcome with vaccine group as case and non-vaccine group as control. Results In multivariate analysis, parental perception of usefulness of the Home-School-Doctor model had a very high odds ratio for uptake of HPV vaccination (OR 26.6, 95 % CI 16.4, 41.9). Paying a reasonable price was another independent factor associated with increased uptake (OR 1.71, 95 % CI 1.39, 2.1 for those with parents willing to pay US$125-250 for vaccination). For parents and adolescents who were not sure where to get vaccination, this model was significantly associated with improved uptake rate (OR 1.66, 95 % CI 1.23, 2.23). Concerns with side effects of vaccine (OR 0.70, 95 % CI 0.55, 0.88), allowing daughters to make their own decisions (OR 0.49, 95 % CI 0.38, 0.64) and not caring much about daughters’ social life (95 % CI 0.45, 0.92) were factors associated with a lower uptake. Discussion The findings of this study have added knowledge on how a school-based vaccination program would improve vaccine uptake rate even when the users need to pay. Our findings are consistent with other study that the most acceptable way to achieve high uptake of HPV vaccine is to offer voluntary school-based vaccination. Conclusion A model of care incorporating the efforts and expertise of academics and health professionals working closely with school can be applied to improve the uptake of vaccine among adolescent girls. Subsidized voluntary school-based vaccination scheme can be an option.
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Affiliation(s)
- Albert Lee
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4th Floor, School of Public Heath, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. .,Centre for Health Education and Health Promotion, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4th Floor, Lek Yuen Health Centre, Shatin, New Territories, Hong Kong.
| | - Martin C S Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4th Floor, School of Public Heath, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
| | - Tracy T Chan
- Centre for Health Education and Health Promotion, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4th Floor, Lek Yuen Health Centre, Shatin, New Territories, Hong Kong.
| | - Paul K S Chan
- Department of Microbiology, The Chinese University of Hong Kong, 1st Floor, Clinical Sciences Building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
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Shlay JC, Rodgers S, Lyons J, Romero S, Vogt TM, McCormick EV. Implementing a School-Located Vaccination Program in Denver Public Schools. THE JOURNAL OF SCHOOL HEALTH 2015; 85:536-543. [PMID: 26149309 DOI: 10.1111/josh.12281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 01/09/2015] [Accepted: 02/03/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND School-located vaccination (SLV) offers an opportunity to deliver vaccines to students, particularly those without a primary care provider. METHODS This SLV program offered 2 clinics at each of 20 elementary schools (influenza vaccine) and 3 clinics at each of 7 middle/preschool-eighth-grade schools (adolescent platform plus catch-up vaccines) during the 2009-2010 and 2010-2011 school years. Established programmatic processes for immunization delivery in an outreach setting were used. Billing and vaccine inventory management processes were developed. Vaccines from the federal Vaccines for Children program were used for eligible students. Third-party payers were billed for insured students; parents were not billed for services. RESULTS The proportion of enrolled students who received at least 1 dose of vaccine increased from year 1 to year 2 (elementary: 28% to 31%; middle: 12% to 19%). Issues identified and addressed included program planning with partners, development and implementation of billing processes, development of a solution to adhere to the Family Educational Rights and Privacy Act requirements, development and utilization of an easy-to-comprehend consent form, and implementation of standard work procedures. CONCLUSIONS This SLV program offered an alternative approach for providing vaccinations to students outside of the primary care setting. To be successful, ongoing partnerships are needed.
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Affiliation(s)
- Judith C Shlay
- University of Colorado Denver, Anschutz Medical Campus, 12631 East 17th Avenue, Aurora, CO 80045.
- Denver Public Health Department, Denver Health Immunization and Travel Clinic, 605 Bannock Street, Denver, CO 80204.
| | - Sarah Rodgers
- Denver Public Health Department, Denver Public Health Immunization and Travel Clinic, 605 Bannock Street, Denver, CO 80204.
| | - Jean Lyons
- Division of Student Services, Department of Nursing and Student Health Services, Denver Public Schools, 780 Grant Street, Denver, CO 80203.
| | - Scott Romero
- Division of Student Services, Denver Public Schools, 780 Grant Street, Denver, CO 80203.
| | - Tara M Vogt
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE., Atlanta, GA 30333.
| | - Emily V McCormick
- Denver Public Health Department, 605 Bannock Street, Denver, CO 80204.
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Nodulman JA, Starling R, Kong AS, Buller DB, Wheeler CM, Woodall WG. Investigating stakeholder attitudes and opinions on school-based human papillomavirus vaccination programs. THE JOURNAL OF SCHOOL HEALTH 2015; 85:289-98. [PMID: 25846308 PMCID: PMC4576450 DOI: 10.1111/josh.12253] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 08/22/2014] [Accepted: 12/25/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND In several countries worldwide, school-based human papillomavirus (HPV) vaccination programs have been successful; however, little research has explored US stakeholders' acceptance toward school-based HPV vaccination programs. METHODS A total of 13 focus groups and 12 key informant interviews (N = 117; 85% females; 66% racial/ethnic minority) were conducted with 5 groups of stakeholders: parents of adolescent girls, parents of adolescent boys, adolescent girls, middle school nurses, and middle school administrators throughout the 5 public health regions of New Mexico. RESULTS All groups of stakeholders lacked knowledge on HPV and HPV vaccines. Stakeholders were interested in--but apprehensive about--the benefits of HPV vaccination. Despite previous literature showing the benefits of using middle schools as an HPV vaccination site, stakeholders did not deem middle schools as a viable site for vaccination. Nurses reported that using the school as an HPV vaccination site had not occurred to them; parents and adolescents stated they were uncertain about using this type of program. School administrators indicated that they lacked implementation authority. CONCLUSIONS Our study uncovered barriers to using middle schools as a site of HPV vaccination. Resources should be directed toward increased support and education for middle school nurses who function as opinion leaders relevant to the uptake of HPV vaccination.
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Affiliation(s)
- Jessica A. Nodulman
- Assistant Professor, Department of Communication Studies, Augustana College, Old Main Office 212, 639 38th Street, Rock Island, IL 61201
| | - Randall Starling
- Senior Research Scientist II, Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale Blvd., SE MSC11-6280, Albuquerque, NM87106
| | - Alberta S. Kong
- Associate Professor, Department of Pediatrics, University of New Mexico School of Medicine, MSC10 5590 1 UNM, Albuquerque, NM87131
| | - David B. Buller
- Senior Scientist, Klein Buendel, Inc., 1667 Cole Suite 225, Golden, CO 80401
| | - Cosette M. Wheeler
- Professor, Center for HPV Prevention, University of New Mexico, Department of Pathology, MSC08 4640 Albuquerque, NM87131
| | - W. Gill Woodall
- Professor of Communication, Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale Blvd. SE MSC11-6280, Albuquerque, NM87106
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Parent attitudes about adolescent school-located vaccination and billing. J Adolesc Health 2014; 55:665-71. [PMID: 25037893 DOI: 10.1016/j.jadohealth.2014.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/26/2014] [Accepted: 05/28/2014] [Indexed: 11/21/2022]
Abstract
PURPOSE School-located vaccination programs may need to bill health insurance to be sustainable. This mixed methods study assessed parent attitudes about school-located vaccination and billing. METHODS Seven public schools in Denver, Colorado, participated in a school-located adolescent vaccination program that billed students' insurance. From April through June 2010, a survey was administered to parents of 1,000 randomly selected sixth to eighth grade students in these schools. In March and April 2011, focus groups were conducted with a sample of parents of adolescents attending these schools to further explore and help explain patterns emergent in the survey data. RESULTS Survey response rate was 66%. Among survey respondents, 56% strongly supported and 29% somewhat supported school-located vaccination. Forty-two percent reported concern about receiving a bill if their child participated in a school-located vaccination program that billed insurance, and 23% did not want to provide insurance information to the school. Four focus groups were conducted with English-speaking (n = 17) and Spanish-speaking (n = 14) parents. Focus group participants indicated strong support for school-located vaccination, emphasizing the convenience of the program for both parents and adolescents. These parents also appreciated the affordability of the program and reported feeling comfortable with in-school vaccination delivery. Very few participants indicated concerns about providing health insurance information to the school, but some expressed concern about potential record scatter. CONCLUSIONS Although some parents expressed concerns about billing health insurance for school-located vaccination, most parents indicated strong support for school-located vaccination.
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Brown DS, Arnold SE, Asay G, Lorick SA, Cho BH, Basurto-Davila R, Messonnier ML. Parent attitudes about school-located influenza vaccination clinics. Vaccine 2014; 32:1043-8. [PMID: 24440111 DOI: 10.1016/j.vaccine.2014.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 11/04/2013] [Accepted: 01/02/2014] [Indexed: 10/25/2022]
Abstract
The use of alternative venues beyond physician offices may help to increase rates of population influenza vaccination. Schools provide a logical setting for reaching children, but most school-located vaccination (SLV) efforts to date have been limited to local areas. The potential reach and acceptability of SLV at the national level is unknown in the United States. To address this gap, we conducted a nationally representative online survey of 1088 parents of school-aged children. We estimate rates of, and factors associated with, future hypothetical parental consent for children to participate in SLV for influenza. Based on logistic regression analysis, we estimate that 51% of parents would be willing to consent to SLV for influenza. Among those who would consent, SLV was reported as more convenient than the regular location (42.1% vs. 19.9%, P<0.001). However the regular location was preferred over SLV for the child's well-being in case of side effects (46.4% vs. 20.9%, P<0.001) and proper administration of the vaccine (31.0% vs. 21.0%, P<0.001). Parents with college degrees and whose child received the 2009-2010 seasonal or 2009 H1N1 influenza vaccination were more likely to consent, as were parents of uninsured children. Several measures of concern about vaccine safety were negatively associated with consent for SLV. Of those not against SLV, schools were preferred as more convenient to the regular location by college graduates, those whose child received the 2009-2010 seasonal or 2009 H1N1 influenza vaccination, and those with greater travel and clinic time. With an estimated one-half of U.S. parents willing to consent to SLV, this study shows the potential to use schools for large-scale influenza vaccination programs in the U.S.
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Affiliation(s)
- Derek S Brown
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - Sarah E Arnold
- Public Health Economics Program, RTI International, Research Triangle Park, NC, USA
| | - Garrett Asay
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Suchita A Lorick
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Bo-Hyun Cho
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Mark L Messonnier
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Short MB, Middleman AB. Focusing on flu: adolescents' perspectives on school-located immunization programs for influenza vaccine. Hum Vaccin Immunother 2013; 10:216-23. [PMID: 24018398 DOI: 10.4161/hv.26332] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION To describe adolescents' perspectives regarding the use of school-located immunization programs (SLIP) for influenza vaccination. More importantly, adolescents were asked what factors would make them more or less likely to use a SLIP offering influenza vaccine. RESULTS Participants were generally found to be knowledgeable about influenza and to have positive attitudes toward receiving the vaccine via SLIP. Students were more willing to participate in a SLIP if it were low cost or free, less time-consuming than going to a doctor, and if they felt they could trust vaccinators. Overall, high school and middle school students ranked the benefits of SLIP similarly to each other. METHODS Focus groups using nominal group method were conducted with middle and high school students in a large, urban school district. Responses were recorded by each school, and then, responses were ranked across all participating schools for each question. CONCLUSIONS A wide range of issues are important to middle and high school students when considering participation in SLIPs including convenience, public health benefits, trust in the program, program safety, and sanitary issues. Further research will be needed regarding the generalizability of these findings to larger populations of students.
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Affiliation(s)
- Mary B Short
- Psychology; University of Houston Clear Lake; Houston, TX USA
| | - Amy B Middleman
- Pediatrics; Oklahoma Health Sciences Center; Oklahoma City, OK USA
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Marshall HS, Collins J, Sullivan T, Tooher R, O’Keefe M, Skinner SR, Watson M, Burgess T, Ashmeade H, Braunack-Mayer A. Parental and societal support for adolescent immunization through school based immunization programs. Vaccine 2013; 31:3059-64. [DOI: 10.1016/j.vaccine.2013.04.064] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 03/26/2013] [Accepted: 04/24/2013] [Indexed: 11/24/2022]
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Venkatesh SR, Acosta AB, Middleman AB. Private middle school parents' perspectives regarding school-located immunization programs (SLIPs). J Sch Nurs 2013; 29:315-9. [PMID: 23598568 DOI: 10.1177/1059840513486010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The perspectives of parents of private middle school students regarding the use of school-located immunization programs (SLIPs) are unknown. Parents of private middle school students in a large, urban setting were surveyed (N = 1,210) regarding their willingness to use SLIPs. Analyses included frequencies and chi-square analyses. Data from prior work with public school parents were included for comparison. Of the 1,210 questionnaires, 219 were returned; only 19% of respondents reported they were willing to use a SLIP, compared to 41% of public middle school parents. However, 54% of private school parents were willing to consider using SLIPs for influenza vaccine, and 6% would use SLIPs for human papillomavirus vaccine. Hispanic (Mexican) ethnicity (p = .014) was associated with greater willingness to utilize SLIPs. Private middle school parents, in this sample, are relatively unwilling to utilize SLIPs compared to public school parents. These data should be considered when implementing SLIPs in the future.
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McRee AL, Reiter PL, Pepper JK, Brewer NT. Correlates of comfort with alternative settings for HPV vaccine delivery. Hum Vaccin Immunother 2013; 9:306-13. [PMID: 23291948 DOI: 10.4161/hv.22614] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Low uptake of human papillomavirus (HPV) vaccine calls for innovative approaches. Offering the vaccine in settings outside the traditional medical home, such as schools and pharmacies, could increase use. We sought to characterize the acceptability of HPV vaccine delivery in these alternative settings using a national (US) sample of parents of adolescent males ages 11-17 y (n = 506) and their sons (n = 391) who completed our online surveys in Fall 2010. We used multivariable regression to identify correlates of parents' and sons' comfort with (i.e., acceptability of) alternative settings. Half of parents (50%) and over one-third of sons (37%) reported that they were comfortable with schools or pharmacies as locations for the sons to receive HPV vaccine. Parents and sons were more comfortable with HPV vaccination in alternative settings if the sons had not recently visited their health care providers or had previously received vaccines at school, or if parents and sons were comfortable talking with each other about new vaccines. Parents who perceived greater barriers to HPV vaccination were more comfortable with alternative settings, as were sons who perceived that their peers were more accepting of HPV vaccine (all p < 0.05). Offering HPV vaccine in alternative settings may increase vaccination, especially among hard-to-reach adolescents. For example, our results suggest that offering the vaccine in alternative settings to boys who had not had recent health care visits could increase uptake by more than 10%. Study findings also highlight factors that should be addressed to maximize the potential success of HPV vaccination programs.
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Middleman AB, Short MB, Doak JS. Focusing on flu: Parent perspectives on school-located immunization programs for influenza vaccine. Hum Vaccin Immunother 2012; 8:1395-400. [PMID: 23095868 PMCID: PMC3660758 DOI: 10.4161/hv.21575] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 07/13/2012] [Accepted: 07/22/2012] [Indexed: 11/19/2022] Open
Abstract
School-located immunization programs (SLIP) will only be successful if parents consent to their children's participation. It is critical to understand parent perspectives regarding the factors that make them more or less likely to provide that consent. Organizations creating SLIPs will be able to capitalize on the aspects of SLIPs that parents appreciate, and address and correct issues that may give rise to parent concerns. This study involved five focus groups among the parents of school students in a large, urban school district. Findings highlight the broad range of concepts important to parents when considering participation in a SLIP. The safety and trust issues regarding vaccines in general that are so important to parents are also important to parents when considering participation in a SLIP. Effective communication strategies that include assurances regarding tracking of information and the competence and experience of immunizers will be helpful when addressing parents regarding SLIPs. In addition, parents were very cognizant of and positive regarding the public health benefits associated with SLIPs. Further study among larger populations of parents will further refine these ideas and aid in the development of successful influenza vaccine SLIPs that directly address and communicate with parents about the issues most important to them.
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Affiliation(s)
- Amy B Middleman
- Texas Children's Hospital Center for Vaccine Awareness and Research; Houston, TX, USA.
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Kelminson K, Saville A, Seewald L, Stokley S, Dickinson LM, Daley MF, Suh C, Kempe A. Parental views of school-located delivery of adolescent vaccines. J Adolesc Health 2012; 51:190-6. [PMID: 22824451 DOI: 10.1016/j.jadohealth.2011.11.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 11/18/2011] [Accepted: 11/20/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE School-located immunization has the potential to increase adolescent vaccination rates. This study assessed parents' attitudes toward administration of adolescent vaccines (tetanus, diphtheria, acellular pertussis [Tdap], meningococcal conjugate [MenACWY], human papillomavirus [HPV], and influenza) at school. METHODS We conducted a mailed survey of parents of sixth graders from July 2009 to September 2009 in three urban/suburban (Aurora, CO) middle schools assessing barriers and facilitators to school vaccination and willingness to consent for vaccines at school. Unadjusted and adjusted analyses examined the association of parent and student characteristics with parent willingness to consent to school-located vaccination. RESULTS The response rate was 62% (500/806). Parents reported 82% of teens had a regular site of health care, and 17% were uninsured. Overall, 71% of parents would consent for vaccines at school; 72% for Tdap, 71% for MenACWY, 53% for HPV (parents of girls), and 67% for seasonal influenza. Among parents who answered it was important their child receives recommended vaccines, (88%) would consent for influenza vaccine at school, compared with Tdap (76%), MenACWY (74%), and HPV (72%). Multivariable logistic regression analysis demonstrated parents of uninsured teens (odds ratio [OR] 3.77, 95% confidence interval [CI]: 1.40, 12.23), who were unmarried (OR 1.90, 95% CI: 1.14, 3.25), or had a child attending the school with the highest percent eligibility for free/reduced lunch (OR 2.75, 95% CI: 1.36, 5.80) were significantly more willing to consent for vaccines at school. CONCLUSIONS These data suggest parents are generally supportive of school-located vaccine delivery, particularly for annual influenza vaccination and for uninsured and low-income adolescents.
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Affiliation(s)
- Karen Kelminson
- Departments of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado 80045, USA.
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Reiter PL, McRee AL, Pepper JK, Chantala K, Brewer NT. Improving human papillomavirus vaccine delivery: a national study of parents and their adolescent sons. J Adolesc Health 2012; 51:32-7. [PMID: 22727074 PMCID: PMC3383639 DOI: 10.1016/j.jadohealth.2012.01.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 12/06/2011] [Accepted: 01/08/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE We examined parents' and adolescents' preferences regarding potential strategies to increase human papillomavirus (HPV) vaccination rates, including offering the vaccine in alternative settings, concomitant administration of vaccines, and optimizing the structure of vaccination medical visits. METHODS A national sample of U.S. parents of adolescent boys aged 11-17 years (n = 506) and their sons (n = 391) completed online surveys in August and September 2010. We used analysis of variance for mixed designs to examine preferences for vaccination settings. RESULTS Parents and sons were most comfortable with sons receiving HPV vaccine in a doctor's office. Parents of sons who had not visited their regular health care providers in the past year were more comfortable with sons receiving HPV vaccine at a public clinic (p < .001) or school (p < .05) compared with parents whose sons had recent visits. Results from the son survey showed a similar pattern. Parents and sons reported moderate levels of acceptability of concomitant administration. They most preferred to have the three HPV vaccine shots administered during brief nurse visits. CONCLUSIONS Offering HPV vaccine in alternative settings and administering it with other recommended adolescent vaccines may increase uptake among adolescent boys. Parents and sons may prefer HPV vaccines be administered during brief nurse visits.
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Affiliation(s)
- Paul L. Reiter
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus, OH,Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | | | | | - Kim Chantala
- UNC Gillings School of Global Public Health, Chapel Hill, NC
| | - Noel T. Brewer
- UNC Gillings School of Global Public Health, Chapel Hill, NC,Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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School-based vaccination: a systematic review of process evaluations. Vaccine 2011; 29:9588-99. [PMID: 22033031 DOI: 10.1016/j.vaccine.2011.10.033] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 09/24/2011] [Accepted: 10/13/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE School-based vaccination is becoming a more widely used method of vaccine delivery. However, evaluations of school-based vaccination program implementation have not been systematically reviewed. This paper describes the results of a systematic review of the literature on process (or implementation) evaluations of school-based vaccination delivery. METHODS Search terms: "school based vaccination" OR (("schools" OR "school") AND ("immunisation" OR "immunization" OR "vaccination")). LIMITS Humans; English language; Age: 6-18 (school-age children and adolescents); No editorials; No letters. Databases: PUBMED; Embase.com; Cochrane Database of Systematic Reviews; Cinahl; Web of Science; PsycINFO. Inclusions: Articles must have originated from an advanced economic 'developed' country, be peer-reviewed, available in English, randomised or non-randomised controlled design, published from 1970 to August 2010 and focused on vaccinations provided in the school setting and during school time which reported one or more outcomes. EXCLUSIONS qualitative or descriptive papers without any evaluation component; papers that only reported on impact evaluation (i.e. number of students vaccinated); and those published before 1970. RESULTS A total of 14 articles were identified as including some element of a process evaluation of a school-based vaccination program. Nurses, parents, teachers, and adolescents were involved in measures of procedural factors related to school-based vaccination implementation. Outcomes included return rates of consent forms; knowledge about the specific vaccine offered; attitudes toward vaccination and school-based vaccination; reasons for non-vaccination; resources, support, and procedures related to implementation; and environmental factors within the school that may impact vaccination success. Vaccination coverage was also reported in the majority of papers. CONCLUSIONS Many studies reported on the importance of ensuring all stakeholders (school nurses, parents, teachers, and adolescents) receive appropriate information and are involved in the vaccination program and implementation processes. Specific consent form dissemination procedures have demonstrated higher return rates. Further controlled studies are needed to determine the best practice approach to implementing these programs is a variety of contexts.
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20
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School-located immunization programs: Do parental preferences predict behavior? Vaccine 2011; 29:3513-6. [DOI: 10.1016/j.vaccine.2011.02.101] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 02/12/2011] [Accepted: 02/28/2011] [Indexed: 11/23/2022]
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Stockwell MS, Martinez RA, Hofstetter A, Natarajan K, Vawdrey DK. Timeliness of 2009 H1N1 vaccine coverage in a low-income pediatric and adolescent population. Vaccine 2011; 31:2103-7. [PMID: 21458606 DOI: 10.1016/j.vaccine.2011.03.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 03/15/2011] [Accepted: 03/17/2011] [Indexed: 10/18/2022]
Abstract
Despite being at highest risk for 2009 H1N1 virus morbidity and mortality, many children were not immunized with the vaccine. Identification of factors that put certain children at higher risk for under-immunization could reveal populations who may need to be specifically targeted for vaccination interventions in future pandemics. Little is known about the prevalence of, or factors associated with, 2009 H1N1 vaccine coverage in low-income, urban pediatric populations. This study evaluated 2009 H1N1 vaccination coverage in 19,643 children aged 6months to 18years receiving care at one of five community clinics associated with an academic medical center in a low-income community. Any (≥1 dose) and full coverage (1 dose for children ≥10years old, 2 doses for those <10years) was determined as of December 1, 2009 and the end of vaccination period (June 30, 2010). Multivariable analyses were used to assess the impact of race/ethnicity, age, insurance, gender, and language on vaccine coverage and timeliness. By December 1, only 16.6% of children had received one dose, and 5.3% had full coverage. By the end of the vaccination period, 36.2% had received at least one H1N1 dose and 23.6% had full coverage. On multivariable analysis, older age, minority race/ethnicity, and private insurance were negatively associated with vaccination by December 1 and end of vaccination period, even after accounting for attendance at a clinic visit. In future pandemics, when timely receipt of a new vaccine in large populations may be imperative, general vaccination programs as well as special targeted education and vaccine reminders for these at risk groups may be warranted.
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Affiliation(s)
- Melissa S Stockwell
- Division of General Pediatrics, Columbia University, New York, NY, United States.
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Bernard DM, Cooper Robbins SC, McCaffery KJ, Scott CM, Skinner SR. The domino effect: adolescent girls’ response to human papillomavirus vaccination. Med J Aust 2011; 194:297-300. [PMID: 21426284 DOI: 10.5694/j.1326-5377.2011.tb02978.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 12/19/2010] [Indexed: 11/17/2022]
Affiliation(s)
- Diana M Bernard
- Discipline of Paediatrics and Child Health, University of Sydney at the Children's Hospital Westmead, Sydney, NSW
| | - Spring C Cooper Robbins
- Discipline of Paediatrics and Child Health, University of Sydney at the Children's Hospital Westmead, Sydney, NSW
| | - Kirsten J McCaffery
- Screening and Test Evaluation Program, School of Public Health, University of Sydney, Sydney, NSW
| | - Caroline M Scott
- Centre for Population Health, Sydney West Area Health Service, Sydney, NSW
| | - S Rachel Skinner
- Discipline of Paediatrics and Child Health, University of Sydney at the Children's Hospital Westmead, Sydney, NSW
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Voluntary school-based human papillomavirus vaccination: an efficient and acceptable model for achieving high vaccine coverage in adolescents. J Adolesc Health 2010; 47:215-8. [PMID: 20708557 DOI: 10.1016/j.jadohealth.2010.07.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 07/02/2010] [Indexed: 11/20/2022]
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