Sense & sensibility: Decision-making and sources of information in mothers who decline HPV vaccination of their adolescent daughters

Parental willingness to vaccinate their daughters against human papilloma virus and its associated factors in Woldia town, Northeast Ethiopia

Background

The cells of the cervical epithelial wall are the source of the malignant tumor caused by the human papilloma virus (HPV) known as cervical cancer. In 2018, Ethiopia implemented the HPV vaccine specifically targeting girls aged 9-14 years. This vaccination initiative serves as an effective preventive measure against cervical cancer, provided that parents express a positive inclination to have their daughters vaccinated as part of the program.

Objective

The aim of the study was to assess parental willingness to vaccinate their daughters against human papillomavirus and its associated factors in Woldia town, Northeast Ethiopia.

Methods

A community-based cross-sectional study was conducted among 414 parents of daughters aged 9-14 years between 10 and 25 January 2023. Respondents were selected by a systematic sampling method and a face-to-face interview was conducted to collect data. Data were entered into Epi Data version 4.6 and exported to SPSS version 25 for analysis. Multivariable analyses were used to examine the association between dependent and independent variables. The adjusted odds ratio (AOR), 95% confidence interval (CI), and p-value <0.05 were used to determine statistical significance.

Results

A total of 410 study participants with a response rate of 99% were included in the study, and approximately 72.9% (95% CI: 68.3-77.2) of them were willing to vaccinate their daughters. This study found that parents with a family history of cervical cancer screening (AOR = 3.27, 95%; CI = 1.38-7.74), secondary and above educational status (AOR = 2.72, 95% CI = 1.29-5.73), good knowledge of the human papilloma virus vaccination (AOR = 3.00, 95% CI = 1.70-5.28), and favorable attitude toward the human papilloma virus vaccine (AOR = 4.40, 95% CI = 2.45-7.88) were significantly associated with parental willingness to vaccinate their daughters against human papilloma virus.

Recommendation

In this study, most parents were willing to vaccinate their daughters against human papilloma virus. The significant determinants of parental willingness to their daughter's human papilloma virus vaccination were family history of cervical cancer screening, level of education, and knowledge and attitude toward the human papilloma virus vaccine. Therefore, health information regarding the human papillomavirus vaccination with an emphasis on raising community awareness should be designed.

Vaccine Hesitancy among European Parents-Psychological and Social Factors Influencing the Decision to Vaccinate against HPV: A Systematic Review and Meta-Analysis

BACKGROUND

Due to low adherence to HPV vaccination programs, the European region struggles with vaccination rates lower than 30% among the targeted population. The present report investigated various socio-demographic and psychological factors influencing European parents' hesitancy towards vaccinating their children.

METHODS

As of September 2023, four databases were searched. After applying inclusion criteria, all articles comparing psychological and socio-demographic factors in parents who vaccinate or do not vaccinate their children were included.

RESULTS

Twenty-five primary publications met the criteria, totaling 385,460 responders, of which 311,803 want to or have already vaccinated their child, and 73,555 do not wish to do so. Immigrant and employment status, religion, age of parents and the child's gender seemed to influence their decision to vaccinate their child. Previous experience with vaccines, perceived safety and efficacy and the mother's previous abnormal CCS results also impacted their decision. The caregivers' education, gender, civil status, number of children, family history of neoplasia or mother's CCS attendance did not influence their hesitancy to vaccine.

CONCLUSION

Multiple demographic, social, economic and psychological barriers involved in the parents' hesitancy to vaccinate their children against the HPV virus were highlighted. Specific at-risk categories that need to be targeted with information, education and vaccination campaigns were identified.

Awareness Levels of the Link Between Oropharyngeal Cancer and HPV Infection Among Spanish Women: a Hospital-Based Cross-sectional Study

Several observational studies have demonstrated the increased awareness of human papillomavirus (HPV) as an etiological factor of oropharyngeal cancers (OPCs). The incidence of OPCs has increased in recent times, particularly among younger women, and the efficacy of the HPV vaccine in preventing these cancers has gained attention among the medical community. The aim of this study was to explore the health literacy of Spanish adult women regarding factors associated with HPV and its link to OPCs, as well as their awareness of the HPV vaccination. A survey was distributed to 508 women, and 409 (70.5%) were considered as valid participants. The majority of the participants were Caucasian (97.8%) with a mean age of 44.1 ± 11.6. Out of all the participants, only 48.9% women identified HPV as a possible etiology of OPC. The most common sources of information regarding this association were the internet (31.3%), video media (28.9%), and healthcare professionals (28.9%), whereas 16.1% of the participants reported that they had obtained information from three or more sources. The average number of correct answers in the 16-item survey which was used to determine the participants' knowledge of HPV-related diseases was 8.7 ± 4.2, and the average number of correct answers in the 6-item survey regarding the usefulness of the HPV vaccination was 3.3 ± 1.6. According to bivariate models, the variables associated with a poorer level of awareness were related mainly to education (p < 0.001), sexual behavior (p < 0.001), and employment status (p < 0.001). This study contributes toward the discovery of the previously unforeseen psychosocial burden of HPV and its related diseases among Spanish women.

The Value(s) of Vaccination: Building the Scientific Evidence According to a Value-Based Healthcare Approach

Objectives

To provide a new value-based immunization approach collating the available scientific evidence on the topic.

Methods

Four value pillars (personal, allocative, technical, and societal) applied to vaccination field were investigated. A systematic literature review was performed querying three database from December 24th, 2010 to May 27th, 2020. It included studies on vaccine-preventable diseases (VPDs) that mentioned the term value in any part and which were conducted in advanced economies. An in-depth analysis was performed on studies addressing value as key element.

Results

Overall, 107 studies were considered. Approximately half of the studies addressed value as a key element but in most of cases (83.3%) only a single pillar was assessed. Furthermore, the majority of papers addressed the technical value by looking only at classical methods for economic assessment of vaccinations whereas very few dealt with societal and allocative pillars.

Conclusions

Estimating the vaccinations value is very complex, even though their usefulness is certain. The assessment of the whole value of vaccines and vaccinations is still limited to some domains and should encompass the wider impact on economic growth and societies.

Human Papillomavirus Vaccination and Social Media: Results in a Trial With Mothers of Daughters Aged 14-17

Introduction: Parents acquire information about human papillomavirus (HPV) vaccines online and encounter vaccine-critical content, especially on social media, which may depress vaccine uptake. Secondary analysis in a randomized trial of a Facebook-delivered adolescent health campaign targeting mothers with posts on HPV vaccination was undertaken with the aims of (a) determining whether the pre–post-change occurred in self-reports of the mothers on HPV vaccination of their adolescent daughters; (b) describing the comments and reactions to vaccine posts; (c) exploring the relationship of campaign engagement of the mothers assessed by their comments and reactions to posts to change in the self-reports of the mothers of HPV vaccination.

Materials and Methods: Mothers of daughters aged 14–17 were recruited from 34 states of the US (n = 869). A social media campaign was delivered in two Facebook private groups that differed in that 16% of posts in one were focused on indoor tanning (IT) and 16% in the other, on prescription drug misuse, assigned by randomization. In both groups, posts promoted HPV vaccination (n = 38 posts; no randomization) and vaccination for other disease (e.g., influenza, n = 49). HPV and other vaccination posts covered the need for a vaccine, the number of adolescents vaccinated, how vaccines are decreasing the infection rates, and stories of positive benefits of being vaccinated or harms from not vaccinating. Guided by social cognitive theory and diffusion of innovations theory, posts were intended to increase knowledge, perceived risk, response efficacy (i.e., a relative advantage over not vaccinated daughters), and norms for vaccination. Some vaccination posts linked to stories to capitalize on identification effects in narratives, as explained in transportation theory. All mothers received the posts on vaccination (i.e., there was no randomization). Mothers completed surveys at baseline and 12- and 18-month follow-up to assess HPV vaccine uptake by self-report measures. Reactions (such as sad, angry) and comments to each HPV-related post were counted and coded.

Results: Initiation of HPV vaccination (1 dose) was reported by 63.4% of mothers at baseline, 71.3% at 12-month posttest (pre/post p < 0.001), and 73.3% at 18-month posttest (pre/post p < 0.001). Completion of HPV vaccination (two or three doses) was conveyed by 50.2% of mothers at baseline, 62.5% at 12-month posttest (pre/post p < 0.001), and 65.9% at 18-month posttest (pre/post p < 0.001). For posts on HPV vaccines, 8.1% of mothers reacted (n = 162 total), and 68.4% of posts received a reaction (63.2% like; 13.2% love, 7.9% sad). In addition, 7.6% of mothers commented (n = 122; 51 unfavorable, 68 favorable, 1 neutral), and 50.0% of these posts received a comment. There were no differences in pre–post change in vaccine status by the count of reactions or comments to HPV vaccine posts (Ps > 0.05). Baseline vaccination was associated with the valence of comments to HPV vaccine posts (7.2% of mothers whose daughters had completed the HPV series at baseline made a favorable comment but 7.6% of mothers whose daughters were unvaccinated made an unfavorable comment).

Conclusion: Effective strategies are needed in social media to promote HPV vaccines and counter misinformation about and resistance to them. Mothers whose daughters complete the HPV vaccine course might be recruited as influencers on HPV vaccines, as they may be predisposed to talk favorably about the vaccine. Comments from mothers who have not been vaccinated should be monitored to ensure that they do not spread vaccine-critical misinformation. Study limitations included lack of randomization and control group, relatively small number of messages on HPV vaccines, long measurement intervals, inability to measure views of vaccination posts, reduced generalizability related to ethnicity and social media use, and use of self-reported vaccine status.

Clinical Trial Registration:www.clinicaltrials.gov, identifier NCT02835807.

Environmental factors affecting mothers' decision-making about the HPV vaccination for their daughters

OBJECTIVE

This study aimed to investigate environmental factors influencing mothers' decision-making regarding vaccination of the human papillomavirus (HPV) for their daughters.

METHODS

This was a cross-sectional study, with data collected using online surveys from July to September 2018. Participants were 230 mothers of second-year female middle-school students in South Korea. The proportional stratification sampling method was used to reflect the difference in medical level between regions. Independent variables consisted of individual (demographic characteristics, HPV-related characteristics, knowledge, attitude, and subjective norms) and environmental factors (the influence of healthcare providers, school, and community environments) were examined. The potential factors influencing vaccination uptake were determined using hierarchical logistic regression.

RESULTS

The factors influencing mothers' decision-making about the HPV vaccine for their daughters were their attitude toward HPV vaccination (OR = 0.78 p < .001), whether a healthcare provider provided HPV-vaccine-related information (OR = 2.42, p = .030), and presenting positive-framed information (OR = 4.21, p = .020).

CONCLUSIONS

To increase HPV vaccination among the target population, it is necessary to consider environmental factors identified in this study. Healthcare providers should provide accurate information regarding the vaccination. Information emphasizing the vaccination's benefits is particularly important.

Perceptions of cervical cancer prevention among a group of ethnic minority women in Denmark-A qualitative study

BACKGROUND

Cervical cancer screening (CCS) and human papillomavirus vaccination (HPVV) are effective measures against cervical cancer (CC). Attendance in HPVV and CCS provides the greatest protection, while combined non-attendance in HPVV and CCS provides little to no protection. It is hence concerning that some large ethnic minority groups show considerably lower HPVV and CCS attendance than other women-especially women from Middle-Eastern and North African (MENA) countries and Pakistan. Little is, however, known about the reasons for this low combined attendance pattern n.

AIM

To explore perceptions of and barriers to HPVV and CCS, among MENA and Pakistani women in Denmark.

METHOD

Focus group interviews were conducted. Data was transcribed verbatim, and analysed using systematic text condensation.

FINDINGS

Seventeen long-term resident women originating from six major MENA countries and Pakistan were included. Mean age was 36 years. We found that these women, across different age groups and descent, had sparse knowledge and understanding about CC, and their perceived relevance of disease prevention was low. Compared to HPVV, their barriers to CCS were more fixed and often linked to socio-cultural factors such as taboos related to female genitals and sexuality. Moreover, they presented unmet expectations and signs of mistrust in the healthcare system. However, at the end of the interviews, participants became more attentive toward CC prevention, particularly toward HPVV.

CONCLUSION

Elements of insufficient knowledge and understanding of CC and its prevention were found among a group of MENA and Pakistani women. Their socio-cultural background further represents a barrier particularly towards CCS. Additionally, negative experiences and unmet expectations lessen their trust in the healthcare system. All of which underlines the need for new tailored CC preventive strategies for this group. Based on our findings we suggest that future studies develop and evaluate interventions aiming to improve HPVV and CCS, including user-involvement.

The Danish Diabetes Musculoskeletal Cohort: Non-Responder Analysis of an Electronic Survey Using Registry Data

Purpose

To conduct a non-responder analysis on a musculoskeletal (MSK) electronic questionnaire.

Methods

Individuals aged 18 years and older, diagnosed with diabetes mellitus (DM), and attended an ambulatory DM clinic formed the sample frame. They were invited to complete an electronic musculoskeletal (MSK) conditions and symptoms questionnaire booklet using a secured electronic email system. Individuals whose secured email box was not active at the time were discarded. Using the Central Person Registry number, a unique number assigned to all Danish residents, we linked the sample frame to different registries to learn more about non-responders. Non-responders were either individuals who did not respond to a single question and those who responded “No” to the first question about willing to participate. We calculated descriptive statistics for each characteristic. Univariate logistic regression models were conducted to determine the relationship between each characteristic and non-responder status.

Results

The response rate was 36% (n = 3812). Individuals with type 2 DM (OR 2.0 (95% CI 1.8–2.2)), secondary DM (1.9 (1.3–2.8)) or unspecified DM (2.1 (1.8–2.4)) were more likely to be non-responders than individuals with Type 1 DM. Also, individuals aged 70–79 (1.3 (1.1–1.6)) and 80 years and older (5.9 (4.5–7.7)) were more likely to be non-responders than 18–29 years old individuals. However, individuals aged 40–49 (1.5 (1.2–1.8)), 50–59 (1.5 (1.3–1.8)) or 60–69 (1.4 (1.1–1.6)) were more likely to be responders than 18–29 years old individuals. Individuals with Charlson Comorbidity Index (CCI) of 1 (2.0 (1.3.2.9) or CCI of 2 (1.7 (1.1–2.5) were more likely to be responders than individuals with a CCI of 0. Lastly, individuals who were currently outside of the workforce (1.6 (2.4–2.9) or had unknown/missing socioeconomic status (3.9 (2.8–5.3) were more likely to be non-responders than individuals who were working.

Conclusion

Although we did find a non-response bias, this cohort will be an important source to determine the prevalence and consequences of MSK conditions in a secondary care DM population.

Ethics check-up of public health immunization programs in Canada

The World Health Organization (WHO) recognizes immunization as one of the most successful and effective public health interventions for saving lives. In developing a roadmap for prioritizing use of the coronavirus disease 2019 (COVID-19) vaccines in the context of limited supply, WHO highlighted the importance of a values (ethical principles) framework. Immunization does need to be subject to independent ethical scrutiny of vaccine research data, manufacturing practices, the legal and ethical assurance of informed consent, and also social justice issues with respect to program equity, including right to access. An ethics review of Australia's immunization program was reported in 2012. This CANVax (Canadian Vaccination Evidence Resource and Exchange Centre) Brief offers an ethics review of immunization in Canada using the criteria utilized for Australia.

Balancing risks: Qualitative study of attitudes, motivations and intentions about attending for mammography during the COVID-19 pandemic

AIMS

To explore attitudes, motivations and intentions about attending for mammography among women who cancelled or postponed breast cancer screening, which had remained open in Denmark during the COVID-19 pandemic.

METHODS

A telephone interview study was conducted at the end of April 2020. A qualitative, phenomenological approach was chosen to identify themes and concepts and a semi-structured interview guide was developed. The analysis was structured according to constructs from the theory of planned behaviour, including attitudes to breast cancer screening, norms and motivations to comply with breast cancer screening, perceived control and anticipated regret.

RESULTS

Interviews were carried out with 33 women aged 50-69 (mean 62) years. The women felt that screening was of secondary importance during the height of the pandemic and they felt low perceived control over transportation to the screening clinic and over the screening situation itself, where social distancing was impossible. They perceived messages from the authorities as conflicting regarding the request for social distancing and a lack of recommendations about using face masks at the screening clinic.

CONCLUSIONS

Women who postponed or cancelled breast cancer screening during the COVID-19 pandemic felt that public recommendations appeared contradictory. Uncertainty about the 'new norm(al)' of COVID-19 made them stay at home, although the screening clinics remained open. The findings point to the importance of addressing perceived inconsistency between recommendations from the World Health Organization and the national management of these recommendations, and to secure univocal information from the authorities about the recommended use of healthcare services in a time of crisis.

Vaccination against HPV: boosting coverage and tackling misinformation

The availability of human papillomavirus (HPV) vaccines and screening tests has raised the possibility of globally eliminating cervical cancer, which is caused by HPV. Cervical cancer is a very common malignancy worldwide, especially among deprived women. High vaccination coverage is key to the containment and eventual elimination of the infection. Public HPV vaccination programmes in Italy and Denmark were swiftly established and are among the most successful worldwide. Still, in both countries, it has been challenging to achieve and maintain the recommended coverage of > 80% in girls. In a well-studied Italian region, vaccination coverage in girls at age 15 years (World Health Organization's gold standard) reached 76% in 2015 but decreased to 69% in 2018, likely due to work overload in public immunization centres. In Denmark, doubts about safety and efficacy of the HPV vaccine generated a decline in coverage among girls age 12-17, from 80% in 2013 down to 37% in 2015, when remedial actions made it rise again. Insights from these two countries are shared to illustrate the importance of monitoring coverage in a digital vaccine registry and promptly reacting to misinformation about vaccination.

Chinese mothers' intention to vaccinate daughters against human papillomavirus (HPV), and their vaccine preferences: a study in Fujian Province

Little is known regarding Chinese mothers' intention to vaccinate their daughters against human papillomavirus (HPV) since the HPV vaccine was approved for use in China in 2016. The aim was to explore maternal HPV vaccination acceptance, preference for 2-, 4- or 9-valent HPV vaccine and acceptance of domestically manufactured HPV vaccines. Study participants were mothers of primary school children in Southeastern region of Fujian. An online cross-sectional survey was undertaken between June and August 2019. Among the total of 3,586 completed responses (response rate 28.5%), the intention to vaccinate daughter against HPV was high (83.3%). Higher maternal education and perceived benefit and barriers were associated with greater intention to vaccinate. Among mothers who did not intend to vaccinate their daughters, the three most common reasons were daughter being too young to receive HPV vaccination (40.6%), fear of side effects (31.9%) and vaccine price is too high (16.0%). The largest proportion (41.4%) preferred their daughter to be vaccinated with the 9-valent HPV vaccine (9vHPV). Greater preference for 9vHPVwas strongly associated with higher maternal education level and annual household income. The majority of mothers expressed a preference for imported HPV vaccine (56.3%). Our result indicates that lower intentions to vaccinate daughters against HPV among less educated and lower-income mothers may lead to significant social inequalities in HPV vaccine uptake in the country.

Using Facebook to increase coverage of HPV vaccination among Danish girls: An assessment of a Danish social media campaign

OBJECTIVES

In this study we assess how different Facebook (FB) posts resonate with parents hesitant about HPV vaccination and how to engage parents in positive dialogues on FB.

BACKGROUND

Vaccination against human papillomavirus (HPV) was successfully introduced in the Danish childhood vaccination program in 2009 for 12 year-old girls, with coverage reaching approximately 90%. However, negative public debate questioning the safety of the vaccine coincided with a rapid decline in vaccination coverage from 2015. In May 2017, we launched the national campaign Stop HPV - stop cervical cancer with the aim to rebuild trust in the HPV vaccine and increase vaccination coverage. We used a FB page and a social media strategy to engage the campaign's primary target group: mothers hesitant about HPV vaccination of their daughters.

METHODS

We analyzed a variety of posts on the FB page Stop HPV - stop cervical cancer posted from May 2017 to December 2017. We performed analysis documenting post reach, engagement in the posts and sentiment (positive, neutral or negative) of the comments. Focus groups were recruited to provide data about attitudes to the posts and the responses from the FB management team.

RESULTS

84 unique posts were published on the FB page from May 2017 to December 2017 reaching 3,476,023 individual FB profiles. In focus groups, parents requested more in-depth information. However, analyses of FB posts and sentiment of comments showed that personal stories generated higher engagement rates and more positive dialogues compared to factual posts.

CONCLUSION

The FB page Stop HPV - stop cervical cancer has successfully reached and engaged FB users in dialogue about HPV vaccination. Personal stories are effective in creating positive dialogues on FB. However, it remains important to provide factual information to parents to enable informed decision making about HPV vaccination.

Disparities in parental awareness of children's seasonal influenza vaccination recommendations and influencers of vaccination

Objective

To determine parental awareness of influenza vaccination recommendations for children and explore associations with awareness.

Design

Cross-sectional survey.

Setting/participants

South Australian parents with a telephone listing in the Electronic White Pages were randomly selected.

Methods

Participants were interviewed using Computer Assisted Telephone Interviewing (CATI) during May–July 2016. Univariable and multivariable analyses explored characteristics associated with awareness; with the survey data weighted to reflect the population of SA and the probability of selection within a household.

Results

Of 539 parents, 33% were aware of the recommendation that all children (<5 years) should receive the influenza vaccine annually with 51.9% aware that children with special risk medical conditions (SRMC) should also receive the vaccine annually. Characteristics strongly associated with parental awareness of the recommendation for children aged < 5 years were knowledge of recommendation for children with a SRMC (adjusted Odds Ratio [aOR] 10.46, CI 4.44–24.63) or living in a metropolitan area (aOR 2.91, CI 1.19–7.09). There was lack of awareness in those not working (aOR 0.13, CI 0.04–0.47), with trade level education (compared with high school) (aOR 0.25 CI, 0.09–0.71) and in those born in the UK or Ireland (aOR 0.19, CI 0.04–0.85). Awareness of the recommendation for children with SRMC to receive the vaccine was strongly associated with knowledge of the influenza recommendation for children <5 years (aOR 10.22, CI 4.39–23.77) or not being born in Australia [UK/ Ireland (aOR 7.63, CI 1.86–31.31); other (aOR 3.93, CI 0.94–16.42)]. The most influential cues to future receipt were a general practitioner (GP) recommendation (63.8%) and providing influenza vaccine free for all children (37.6%). More parents who delayed or excluded vaccines believed that their children’s vaccinations (in general) were unnecessary, as other children were vaccinated (42.8%) compared to those with no or minor concerns (11.1%) (p<0.0001).

Conclusions

Parental awareness of children’s influenza vaccine recommendations is low. Targeted communication strategies and resources are required to establish broader community awareness of recommendations. Healthcare provider endorsement of the vaccine remains key and health care professionals, particularly GPs and paediatric specialists should be encouraged to discuss influenza vaccine with parents at every opportunity. Many parents have vaccine concerns and addressing concerns across the spectrum of hesitancy is crucial.