1
|
Mansfield LN, Kahn BZ, Kokitkar S, Kritikos KI, Brantz SN, Brewer NT. HPV vaccine standing orders and communication in primary care: A qualitative study. Vaccine 2024; 42:3981-3988. [PMID: 38816304 PMCID: PMC11242613 DOI: 10.1016/j.vaccine.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 04/26/2024] [Accepted: 05/09/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Standing orders may improve HPV vaccination rates, but clinical staff's readiness to use them has not been well-explored. We sought to explore benefits and challenges to using HPV vaccine standing orders for adolescents ages 9 to 12, understand clinical staff roles in communication about HPV vaccine, and how standing orders can reduce barriers contributing to vaccine disparities among racial and ethnic marginalized groups. METHODS Participants were a sample of 16 U.S. nurses, medical assistants, and healthcare providers working in primary care, recruited from June to September 2022. Trained staff conducted virtual, semi-structured qualitative interviews. We analyzed the resulting data using reflexive thematic analysis. RESULTS Themes reflected benefits and challenges to using HPV vaccine standing orders and strategies to address clinic barriers to improve vaccine access and HPV vaccine communication. Benefits included faster and efficient clinic flow; fewer missed vaccine opportunities and promotion of early vaccination; and normalization of HPV vaccination as routine care. Challenges included possible exacerbation of existing HPV vaccine communication and recommendation barriers; and how the complexity of the vaccine administration schedule lessens nurses' and medical assistants' confidence to use standing orders. Strategies to address vaccine access barriers included using nurse-only visits to empower nurse autonomy and catch up on HPV vaccination; engaging clinical staff to follow up with overdue children; and educating parents on HPV vaccine before their child is vaccine eligible. CONCLUSION Using HPV vaccine standing orders can promote autonomy for nurses and medical assistants and address vaccine access barriers. Clinical staff engagement and clinic support to mitigate existing vaccine communication barriers are needed to empower staff to use of HPV vaccine standing orders.
Collapse
Affiliation(s)
- Lisa N Mansfield
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
| | - Benjamin Z Kahn
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Saayli Kokitkar
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Katherine I Kritikos
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Sierra N Brantz
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Noel T Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
2
|
Foley S, Flowers A, Hall T, Jansen MT, Burcin M. "That Was an Eye Opener for Me": Mixed-Methods Outcomes Educating Texas Community Health Workers on HPV Vaccination Using Project ECHO ®. Vaccines (Basel) 2024; 12:806. [PMID: 39066444 PMCID: PMC11281520 DOI: 10.3390/vaccines12070806] [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: 05/24/2024] [Revised: 07/11/2024] [Accepted: 07/14/2024] [Indexed: 07/28/2024] Open
Abstract
Human papillomavirus (HPV) is known to cause six different types of cancer. HPV vaccination can prevent over 90% of these cancers. Community health workers (CHWs) have the potential to drive HPV vaccination demand through education and navigation by addressing vaccine hesitancy and dis/misinformation and by reaching non-English speaking, vulnerable, or rural populations. Despite their possible reach, there is limited research on HPV vaccination education programs for CHWs. In 2020-2021, the American Cancer Society (ACS) HPV Cancer Free Texas (HPVCFT) Project implemented the eight-session Mission: HPVCFT Vaccination ECHO-CHW Program ten times. This manuscript details the program's implementation processes and outcomes. The program used the Project ECHO model and was offered in both English and Spanish. One hundred and forty-six Texan CHWs completed pre- and post-training surveys. The participants demonstrated significant HPV vaccination knowledge increases and desirable shifts in their foundational HPV vaccination beliefs, including the belief that the HPV vaccine is for cancer prevention. The participants also reported increased confidence in communicating about the HPV vaccine in the community. Improving knowledge, beliefs, and confidence in HPV vaccination is the first step in addressing concerns and increasing uptake. Future research and interventions are needed to better understand how CHWs can be more systematically linked to vaccination opportunities or provided with clearer paths for directing patients to providers that vaccinate.
Collapse
Affiliation(s)
- Shaylen Foley
- Interventions and Implementation Department, American Cancer Society, 3380 Chastain Meadows Pkwy NW, Suite 20, Kennesaw, GA 30144, USA; (A.F.); (M.B.)
| | - Ashleigh Flowers
- Interventions and Implementation Department, American Cancer Society, 3380 Chastain Meadows Pkwy NW, Suite 20, Kennesaw, GA 30144, USA; (A.F.); (M.B.)
| | - Tralisa Hall
- Interventions and Implementation Department, American Cancer Society, 3380 Chastain Meadows Pkwy NW, Suite 20, Kennesaw, GA 30144, USA; (A.F.); (M.B.)
| | | | - Michelle Burcin
- Interventions and Implementation Department, American Cancer Society, 3380 Chastain Meadows Pkwy NW, Suite 20, Kennesaw, GA 30144, USA; (A.F.); (M.B.)
| |
Collapse
|
3
|
Holford D, Anderson EC, Biswas A, Garrison A, Fisher H, Brosset E, Gould VC, Verger P, Lewandowsky S. Healthcare professionals' perceptions of challenges in vaccine communication and training needs: a qualitative study. BMC PRIMARY CARE 2024; 25:264. [PMID: 39033114 PMCID: PMC11265004 DOI: 10.1186/s12875-024-02509-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/01/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Healthcare professionals (HCPs) can play an important role in encouraging patients and their caregivers to be vaccinated. The objective of this qualitative study was to investigate HCPs' perspectives on challenges in vaccine communication and unmet training needs in this domain. METHODS Semi-structured interviews were conducted with 41 HCPs (mainly nurses and physicians) with vaccination roles (23 in England; 18 in France), gathering information on: (1) HCPs' approach to vaccine conversations with patients; (2) Challenges of communicating about vaccines; (3) Vaccine-related training and learning resources available to HCPs, and; (4) HCPs' training needs around vaccine communication. RESULTS HCPs described a range of communication experiences that indicated insufficient time, information, and skills to confidently navigate difficult conversations with vaccine-hesitant patients. Communication skills were especially important to avoid conflict that could potentially damage the patient-provider relationship. Some HCPs interviewed had received communication training, but for most, this training was not specific to vaccination. Although general communication skills were transferable to vaccine conversations, most HCPs welcomed specific training and informational resources to support countering patients' misconceptions or misinformation about vaccines. CONCLUSIONS HCPs would benefit from training tailored to address vaccine communication with patients, and this should be part of a systemic approach that also provides time and space to have effective vaccine conversations.
Collapse
Affiliation(s)
- Dawn Holford
- School of Psychological Science, University of Bristol, 12A Priory Road, Bristol, BS8 1TU, United Kingdom.
| | - Emma C Anderson
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Aishmita Biswas
- School of Psychological Science, University of Bristol, 12A Priory Road, Bristol, BS8 1TU, United Kingdom
| | - Amanda Garrison
- Faculté Des Sciences Médicales Et Paramédicales, Southeastern Health Regional Observatory (Observatoire Régional de La Santé, ORS) PACA, Marseille, France
| | - Harriet Fisher
- Bristol Medical School, National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE) University of Bristol, Bristol, United Kingdom
| | - Emeline Brosset
- Faculté Des Sciences Médicales Et Paramédicales, Southeastern Health Regional Observatory (Observatoire Régional de La Santé, ORS) PACA, Marseille, France
| | - Virginia C Gould
- School of Psychological Science, University of Bristol, 12A Priory Road, Bristol, BS8 1TU, United Kingdom
| | - Pierre Verger
- Faculté Des Sciences Médicales Et Paramédicales, Southeastern Health Regional Observatory (Observatoire Régional de La Santé, ORS) PACA, Marseille, France
- Unité des Virus Émergents (UVE: Aix-Marseille Univ, Università di Corsica, IRD 190, Inserm 1207, IRBA), Marseille, France
| | - Stephan Lewandowsky
- School of Psychological Science, University of Bristol, 12A Priory Road, Bristol, BS8 1TU, United Kingdom
- Department of Psychology, University of Potsdam, Potsdam, Germany
- School of Psychological Science, University of Western Australia, Perth, Australia
| |
Collapse
|
4
|
Dionne M, Sauvageau C, Etienne D, Kiely M, Witteman H, Dubé E. Development of Promising Interventions to Improve Human Papillomavirus Vaccination in a School-Based Program in Quebec, Canada: Results From a Formative Evaluation Using a Mixed Methods Design. JMIR Form Res 2024; 8:e57118. [PMID: 38976317 PMCID: PMC11263894 DOI: 10.2196/57118] [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: 02/07/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND Despite the availability of school-based human papillomavirus (HPV) vaccination programs, disparities in vaccine coverage persist. Barriers to HPV vaccine acceptance and uptake include parental attitudes, knowledge, beliefs, and system-level barriers. A total of 3 interventions were developed to address these barriers: an in-person presentation by school nurses, an email reminder with a web-based information and decision aid tool, and a telephone reminder using motivational interviewing (MI) techniques. OBJECTIVE Here we report on the development and formative evaluation of interventions to improve HPV vaccine acceptance and uptake among grade 4 students' parents in Quebec, Canada. METHODS In the summer of 2019, we conducted a formative evaluation of the interventions to assess the interventions' relevance, content, and format and to identify any unmet needs. We conducted 3 focus group discussions with parents of grade 3 students and nurses. Interviews were recorded, transcribed, and analyzed for thematic content using NVivo software (Lumivero). Nurses received training on MI techniques and we evaluated the effect on nurses' knowledge and skills using a pre-post questionnaire. Descriptive quantitative analyses were carried out on data from questionnaires relating to the training. Comparisons were made using the proportions of the results. Finally, we developed a patient decision aid using an iterative, user-centered design process. The iterative refinement process involved feedback from parents, nurses, and experts to ensure the tool's relevance and effectiveness. The evaluation protocol and data collection tools were approved by the CHU (Centre Hospitalier Universitaire) de Québec Research Ethics Committee (MP-20-2019-4655, May 16, 2019). RESULTS The data collection was conducted from April 2019 to March 2021. Following feedback (n=28) from the 3 focus group discussions in June 2019, several changes were made to the in-person presentation intervention. Experts (n=27) and school nurses (n=29) recruited for the project appreciated the visual and simplified information on vaccination in it. The results of the MI training for school nurses conducted in August 2019 demonstrated an increase in the skills and knowledge of nurses (n=29). School nurses who took the web-based course (n=24) filled out a pretest and posttest questionnaire to evaluate their learning. The rating increased by 19% between the pretest and posttest questionnaires. Several changes were made between the first draft of the web-based decision-aid tool and the final version during the summer of 2019 after an expert consultation of experts (n=3), focus group participants (n=28), and parents in the iterative process (n=5). More information about HPV and vaccines was added, and users could click if more detail is desired. CONCLUSIONS We developed and pilot-tested 3 interventions using an iterative process. The interventions were perceived as potentially effective to increase parents' knowledge and positive attitudes toward HPV vaccination, and ultimately, vaccine acceptance. Future research will assess the effectiveness of these interventions on a larger scale.
Collapse
Affiliation(s)
- Maude Dionne
- Institut National de Santé Publique du Québec, Quebec, QC, Canada
| | - Chantal Sauvageau
- Institut National de Santé Publique du Québec, Quebec, QC, Canada
- Infectious and Immune Diseases Axis, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Doriane Etienne
- VITAM-Centre de Recherche en Santé Durable, Québec, QC, Canada
- Population Health and Optimal Health Practices Axis, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Marilou Kiely
- Institut National de Santé Publique du Québec, Quebec, QC, Canada
- Infectious and Immune Diseases Axis, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Holly Witteman
- Faculty of Medicine, Université Laval, Québec, QC, Canada
- VITAM-Centre de Recherche en Santé Durable, Québec, QC, Canada
- Population Health and Optimal Health Practices Axis, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Eve Dubé
- Infectious and Immune Diseases Axis, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Faculty of Social Sciences, Université Laval, Québec City, QC, Canada
| |
Collapse
|
5
|
Murciano-Gamborino C, Diez-Domingo J, Fons-Martinez J. Healthcare Professionals' Perspectives on HPV Recommendations: Themes of Interest to Different Population Groups and Strategies for Approaching Them. Vaccines (Basel) 2024; 12:748. [PMID: 39066386 PMCID: PMC11281591 DOI: 10.3390/vaccines12070748] [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: 05/24/2024] [Revised: 06/26/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024] Open
Abstract
As a flagship of the Europe's Beating Cancer Plan, the European Commission supports EU member states' efforts to strengthen and expand the routine vaccination of girls and boys against human papillomavirus (HPV). Populations across Europe have grown in diversity, and health systems must adapt to meet the specific needs of increasing diversity. Healthcare professionals (HCPs) must strive to communicate HPV vaccine information in a culturally sensitive manner and address specific concerns related to cultural beliefs, trust in health systems and perceived risks. The objectives of this exploratory study are to identify which themes are most frequently raised during the recommendation of vaccination to minors based on the characteristics of the population (religion, region of origin, gender, level of education and language proficiency) and to collect strategies to improve communication with a diverse population. A survey was distributed through various European public health institutions to HCPs in the region and their networks. The survey included multi-response questions (themes addressed during vaccination recommendation based on population characteristics) and open-ended questions (own qualitative comments and strategies). The most common issues that arise during vaccine recommendation are a lack of knowledge, followed by misinformation. Differences were detected according to the population characteristics. Suggested strategies to improve HPV vaccine recommendation focused on the following aspects: affordability; sexuality and gender; communication platforms; multilingualism; quality of care; school collaboration. HCPs report differences according to the characteristics of the population receiving the recommendation. Personalisation of the recommendations would help to optimise the decision-making process for some groups.
Collapse
Affiliation(s)
- Carlos Murciano-Gamborino
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain;
| | - Javier Diez-Domingo
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain;
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Jaime Fons-Martinez
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain;
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, 28029 Madrid, Spain
| |
Collapse
|
6
|
Chido-Amajuoyi OG, Osaghae I, Onyeaka HK, Shete S. Barriers to the assessment and recommendation of HPV vaccination among healthcare providers in Texas. Vaccine X 2024; 18:100471. [PMID: 38523619 PMCID: PMC10958477 DOI: 10.1016/j.jvacx.2024.100471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 03/26/2024] Open
Abstract
Background Healthcare providers (HCPs) recommendations for HPV vaccination plays a critical role in increasing vaccination uptake. This study assesses the prevalence of reported barriers to HPV vaccination assessment and recommendation among HCPs in Texas. Methods Study data were obtained from a population-based survey of HCPs currently practicing in Texas. Participants were asked about their HPV vaccination assessment and recommendation practices and the reasons for not assessing or recommending the vaccine. Barriers were stratified by HCP characteristics including age, sex, race/ethnicity, location of practice, provider type, and type of facility. Results Among the 826 HCPs included in this study, 47.3 % never, 49.6 % sometimes, and 3.0 % often/always assessed a patient's HPV vaccination status. Similarly, 36.0 % never, 36.2 % sometimes, and 27.9 % often/always recommended HPV vaccination. The most frequently reported barriers to assessment and recommendation of HPV vaccination were time constraints (22.9 %), delegating the task to others (15.0 %), lack of effective tools and information to give patients (12.0 %), and requiring additional training (9.2 %). HCPs who were female, less than 35 years old, non-Hispanic black, and nonphysician HCPs (Physician Assistant, Nurse Practitioner) most frequently reported lacking effective tools and information and a need for additional training. Conclusion The assessment and recommendation for HPV vaccination among HCPs in Texas is suboptimal. Barriers reported varied based on the provider's characteristics. Addressing these barriers, such as by providing more effective tools and information and offering additional training to HCPs, could potentially increase HPV vaccination rates in Texas. The findings also suggest that interventions should be tailored to specific demographic groups.
Collapse
Affiliation(s)
- Onyema G. Chido-Amajuoyi
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Internal Medicine, Texas A&M School of Medicine/Christus Health, Longview, TX, USA
| | - Ikponmwosa Osaghae
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Henry K. Onyeaka
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
7
|
Hirth J, Ostovar-Kermani T, Gutierrez JA, Thompson EL, Barnett TE, Zoorob R. Effect of age at initiation of the human papillomavirus vaccine on the association between race/ethnicity and completion of the vaccine series. Vaccine 2024; 42:2827-2836. [PMID: 38519345 DOI: 10.1016/j.vaccine.2024.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Up-to-date (UTD) of the human papillomavirus (HPV) vaccine series has been low despite 2016 recommendations for 2 doses among initiators <15 years of age and 3 doses for 15+ year olds. This study examined how age at initiation affected the association between race/ethnicity and UTD among adolescent HPV vaccine initiators. We also examined how administration of other adolescent vaccines affected UTD. METHODS A secondary analysis of The National Immunization Survey - Teen data between 2016 and 2020 was conducted. Characteristics associated with initiation of the vaccine series was examined and used to evaluate UTD among initiators. All data were weighted. Associations between characteristics and HPV vaccine initiation were examined using Rao Scott chi-square tests and univariable logistic regression. Multivariable binary logistic regression models stratified by race/ethnicity calculated the strength of association between independent variables and odds of initiation and UTD among initiators. RESULTS The final sample size was 99,719 with 67,855 (68.1 %) initiating HPV vaccination. Among HPV vaccine initiators, Hispanic and black adolescents had lower odds of UTD. However, 9-10-year-old initiators had increased odds (aOR: 5.71; 95 %CI: 3.78-8.63) of UTD compared to 12-year-old initiators. Increased odds of UTD among initiators younger than 12 years were found across racial/ethnic groups. Flu vaccination was associated with decreased odds of UTD among white (aOR: 0.76; 95 %CI:0.65-0.88) and black adolescents (aOR: 0.67; 95 %CI: 0.46-0.96). CONCLUSION Strong recommendations to ensure patients are UTD on the HPV vaccine series are essential to improving UTD among all adolescents and follow-up should occur when administering other vaccines to reduce missed opportunities.
Collapse
Affiliation(s)
- Jacqueline Hirth
- Department of Family and Community Medicine, Baylor College of Medicine, United States.
| | | | - Judith A Gutierrez
- Department of Family and Community Medicine, Baylor College of Medicine, United States
| | - Erika L Thompson
- Department of Population and Community Health, School of Public Health, University of North Texas Health Science Center at Fort Worth, United States
| | - Tracey E Barnett
- Department of Quantitative & Qualitative Health Sciences, School of Public Health, University of Texas at San Antonio, United States
| | - Roger Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, United States
| |
Collapse
|
8
|
Sojati J, Murali A, Rapsinski G, Williams JV. Do Not Throw Away Your Shot: Pilot Study in Improving Medical School Curricula Through Focused Vaccine Education. AJPM FOCUS 2024; 3:100178. [PMID: 38312525 PMCID: PMC10835123 DOI: 10.1016/j.focus.2023.100178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Introduction With widely prevalent vaccine hesitancy and medical mistrust, future healthcare providers require knowledge of vaccines and comfort in discussing vaccines with patients. However, many U.S. medical schools do not offer formal or elective curricula focused on vaccine education. Methods We sought to identify the need for such a curriculum and student gaps in knowledge through a pilot study surveying first- and second-year medical students at a large Pennsylvania medical school to assess knowledge about vaccine initiatives/policies, comfort in discussing vaccines, attitudes toward curricular changes, and effects of COVID-19 on willingness for vaccine education. Results Many participants (>40%) reported insufficient knowledge of vaccine policy, vaccine development and testing, and community vaccine initiatives. The majority (>50%) indicated discomfort in discussing vaccines in a clinical setting. Importantly, 79% of participants reported insufficient coverage of vaccine topics in the current curriculum. A total of 54% decisively wanted formal/mandatory education versus 72% who decisively wanted elective education. Desiring formal education was associated with less comfort in discussing vaccines overall and with vaccine-hesitant people in clinical settings. Reassuringly, 74% of participants noted that the COVID-19 pandemic made them want to learn more about vaccines. Guided by these findings, we conducted a pilot elective teaching about vaccines through case studies, interactive discussions, and role-playing scenarios. Pre- and postcourse surveys showed improvement in student knowledge in all vaccine-related topics assessed. Conclusions These data can inform the development of formal and elective curricula that effectively prepare medical students for patients' vaccine questions.
Collapse
Affiliation(s)
- Jorna Sojati
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Microbiology and Immunology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anjana Murali
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Glenn Rapsinski
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John V. Williams
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Microbiology & Molecular Genetics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Institute for Infection, Immunity, and Inflammation in Children, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
9
|
Faqeeh H, Alsulayyim R, Assiri K, Alqhatani M, Zanquti A, Hakami W, Amri K, Akaram S. Perceptions, Attitudes, and Barriers to Human Papillomavirus Vaccination Among Residents in Saudi Arabia: A Cross-Sectional Study. Cureus 2024; 16:e57646. [PMID: 38707008 PMCID: PMC11070069 DOI: 10.7759/cureus.57646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infection is a prevalent sexually transmitted infection globally, with significant associations with various cancers. Despite the availability of HPV vaccines, vaccination uptake remains suboptimal in many regions, including Saudi Arabia. METHODS This cross-sectional survey-based study aimed to assess perceptions, attitudes, and barriers related to HPV vaccination among residents in different regions of Saudi Arabia. Participants were recruited using a stratified sampling method, and data were collected through a structured questionnaire administered electronically. RESULTS A total of 600 participants were included in the study, with diverse demographic profiles observed. The largest age group was 26-35 years old, comprising 42.7% (n = 256) of the sample. The distribution of gender was approximately equal, with 54.7% (n = 328) male participants. Notable perception and knowledge about HPV were observed, with 49.7% (n = 298) reporting being very familiar. Furthermore, 85.8% (n = 515) believed that HPV could cause serious health problems, and 63.7% (n = 382) perceived the vaccine to be very effective. Positive attitudes toward HPV vaccination were prevalent, with a significant proportion expressing a willingness to recommend the vaccine to themselves (70.0%, n = 420) and their children (65.0%, n = 390). Healthcare provider recommendation emerged as a key influencing factor, with 73.8% (n = 443) citing it as influential. Despite favorable attitudes, barriers to HPV vaccination were reported, including vaccine cost (22.5%, n = 135) and lack of awareness (13.7%, n = 82). However, a substantial proportion of unvaccinated participants cited not applicable reasons (57.2%, n = 343), indicating prior vaccination. Factors associated with HPV vaccination uptake included higher education levels, with those holding a master's degree or above exhibiting higher odds of vaccination uptake (OR (odds ratio): 1.80, 95% CI (confidence interval): 1.35-2.40, p < 0.001). Age (26-35 vs. 18-25) also showed a borderline significant association (OR: 1.25, 95% CI: 0.98-1.60, p = 0.074). CONCLUSION The study highlights the importance of understanding perceptions and barriers to HPV vaccination to inform public health policies and programs in Saudi Arabia. Addressing identified barriers, such as educational campaigns and improving access to vaccination services, is essential for enhancing HPV vaccination coverage and reducing the burden of HPV-related diseases in the region.
Collapse
Affiliation(s)
- Hind Faqeeh
- Obstetrics and Gynecology, AlKhamis Maternity and Children Hospital, Khamis Mushait, SAU
| | - Rahaf Alsulayyim
- Obstetrics and Gynecology, AlKhamis Maternity and Children Hospital, Khamis Mushait, SAU
| | - Kholoud Assiri
- Obstetrics and Gynecology, AlKhamis Maternity and Children Hospital, Khamis Mushait, SAU
| | - Mada Alqhatani
- Obstetrics and Gynecology, AlKhamis Maternity and Children Hospital, Khamis Mushait, SAU
| | - Asmaa Zanquti
- Obstetrics and Gynecology, King Abdulaziz Hospital, Jeddah, SAU
| | - Walaa Hakami
- Obstetrics and Gynecology, Maternity and Children Hospital, Najran, SAU
| | - Khadijah Amri
- Obstetrics and Gynecology, Maternity and Children Hospital, Najran, SAU
| | - Salva Akaram
- Obstetrics and Gynecology, AlKhamis Maternity and Children Hospital, Khamis Mushait, SAU
| |
Collapse
|
10
|
Meadows RJ, Gehr AW, Lu Y, Maynard G, Akpan IN, Taskin T, Fulda KG, Patel D, Matches S, Ojha RP, Thompson EL. Effectiveness of provider communication training for increasing human papillomavirus vaccine initiation at a safety-net health system. Prev Med Rep 2024; 39:102660. [PMID: 38426039 PMCID: PMC10901897 DOI: 10.1016/j.pmedr.2024.102660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 03/02/2024] Open
Abstract
Background Strong provider recommendation can increase uptake of human papillomavirus (HPV) vaccination. Therefore, we developed and implemented a provider education intervention on communication strategies for recommending HPV vaccination with clinic-level audit and feedback (HPV: Communicating about HPV to Adults and Teens [HPV CHAT]). We aimed to evaluate the effect of HPV CHAT on HPV vaccine uptake in seven family medicine and pediatric clinics in a large urban health system (USA). Methods We used a quasi-experimental design, where the eligible population included people aged 9-26 years with at least one encounter in June 2020-February 2023 at one of the participating community health clinics. We used interrupted time-series analysis to assess changes in the prevalence of HPV vaccine uptake. We used segmented Poisson regression with a log link function to estimate prevalence ratios (PR) and 95% confidence limits (CL) for level (immediate) and slope (over time) changes with adjustment for seasonality using Fourier transformation. Results Our study population comprised 60,328 observations in which the median age was 17 years (interquartile range: 13-21). A majority (58%) were female and 87% were racial/ethnic minorities. Overall, we observed no sizeable effect of the intervention on HPV vaccination uptake. Nonetheless, heterogeneity was observed by age group with modest increases in individuals aged 9-12 and 13-17 years. Conclusion Our provider feedback intervention had minimal effect on increasing prevalence of HPV vaccination in seven family medicine and pediatric clinics. Novel strategies are needed to address provider barriers related to HPV vaccination.
Collapse
Affiliation(s)
- Rachel J. Meadows
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, Fort Worth, TX, USA
| | - Aaron W. Gehr
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, Fort Worth, TX, USA
| | - Yan Lu
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, Fort Worth, TX, USA
| | - Grace Maynard
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Idara N. Akpan
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Tanjila Taskin
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Kimberly G. Fulda
- North Texas Primary Care Practice-Based Research Network (NorTex), Department of Family Medicine and Osteopathic Manipulative Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Divya Patel
- Department of Epidemiology, Human Genetics and Environmental Science, UTHealth Houston School of Public Health in Austin, Austin, TX, USA
| | - Sarah Matches
- Department of Pediatrics & Women’s Health, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Rohit P. Ojha
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, Fort Worth, TX, USA
| | - Erika L. Thompson
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| |
Collapse
|
11
|
Ponticelli D, Antonazzo IC, Losa L, Zampella A, Di Marino F, Mottola G, Fede MN, Gallucci F, Magliuolo R, Rainone A, Del Giudice C, Arcari A, Ferrara P. Knowledge, Attitudes and Practices Survey of Recombinant Zoster Vaccine among Cardiologists and Cardiac Nurses in Italy. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:93. [PMID: 38256354 PMCID: PMC10820166 DOI: 10.3390/medicina60010093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/20/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Cardiac patients are particularly at risk of herpes zoster (HZ), which is associated with a higher risk of major cardiovascular events. This research aimed to analyze the knowledge, attitudes and practices towards recombinant zoster vaccine (RZV) among cardiac healthcare professionals (HPs). Materials and Methods: A cross-sectional survey was conducted in a cardiological hospital in Italy. Multivariate regression models were built to identify factors associated with the outcomes of interest. Results: The response rate was 78.2% (154/197). Overall, age > 50 years and immunosuppression were recognized as risk factors for HZ by 38.3% and 75.3% of respondents, respectively. Regarding RZV, 29.1% of the HPs correctly responded about its schedule and 57.6% about the possibility of administration in immunocompromised individuals. This knowledge was significantly higher in HPs with a higher educational level (odds ratio (OR) = 4.42; 95%CI 1.70-11.47), in those who knew that HZ could cause postherpetic neuralgia (OR = 2.56; 95%CI 1.05-6.25) or major cardiovascular events (OR = 4.23; 95%CI 1.50-11.91), in those who had participated in professional updates on vaccinations (OR = 3.86; 95%CI 1.51-9.87) and in those who stated the need for further information about the RZV (OR = 6.43; 95%CI 1.42-29.98). Younger HPs (coefficient (β) = -0.02; 95%CI -0.04--0.01), those with a positive attitude toward RZV safety (β = 2.92; 95%CI 2.49-3.36) and those who had previously cared for patients with HZ (β = 0.45; 95%CI 0.03-0.88) reported a more positive attitude toward RZV effectiveness. The practice of recommending vaccination was more prevalent in younger HPs (OR = 0.94; 95%CI 0.89-0.99), in those who had a master's degree or higher education (OR = 7.21; 95%CI 1.44-36.08), in those with more positive attitudes toward RZV effectiveness (OR = 7.17; 95%CI 1.71-30.03) and in HPs who had already recommended the vaccine to patients in the past (OR = 4.03; 95%CI 1.08-14.96). Conclusions: Despite being a single-center study, our research brings attention to factors that currently impact cardiac HPs' approaches to RZV. The findings indicate potential measures to enhance HPs' awareness and practices, ultimately aiming to improve vaccination adherence and reduce the burden associated with HZ.
Collapse
Affiliation(s)
| | - Ippazio Cosimo Antonazzo
- Center for Public Health Research, University of Milan–Bicocca, 20900 Monza, Italy
- Laboratory of Public Health, IRCCS Istituto Auxologico Italiano, 20165 Milan, Italy
| | - Lorenzo Losa
- Center for Public Health Research, University of Milan–Bicocca, 20900 Monza, Italy
| | | | | | | | | | | | | | | | | | | | - Pietro Ferrara
- Center for Public Health Research, University of Milan–Bicocca, 20900 Monza, Italy
- Laboratory of Public Health, IRCCS Istituto Auxologico Italiano, 20165 Milan, Italy
| |
Collapse
|
12
|
Leung SOA, Villa A, Duffey-Lind E, Welch K, Jabaley T, Hammer M, Feldman S. An Interactive Educational Tool to Improve Human Papillomavirus Vaccine Knowledge and Recommendation Among Nurses. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1880-1886. [PMID: 37610520 DOI: 10.1007/s13187-023-02352-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 08/24/2023]
Abstract
In United States, only 57% of women and 53% of men in the recommended age groups have received all recommended doses of the human papillomavirus (HPV) vaccine. Healthcare provider education has been associated with strong vaccine recommendation and vaccination uptake. Our objective was to create a 7-min interactive online educational tool to improve knowledge and willingness to recommend the HPV vaccine among nurses. This is a prospective pre-test/post-test study to evaluate the effectiveness of the educational tool consisting of 10 flashcards in a question-answer format. Oncology nurses at our cancer center were invited to participate by email, which led them to the educational tool (i.e., intervention) along with pre- and post-test questions on HPV-associated cancers, vaccine-eligible age groups, dosing schedules, adverse events, and willingness to recommend. Of the 110 participants (mean age of 41.2 ± 11.4, 98% female, 64% >10 years of practice), there was improvement in knowledge after intervention in HPV-associated cancers (81% to 97%; p = 0.02), percentage of cervical caused by HPV (33% to 64%; p < 0.05), and dosing schedule (47% to 93%; p < 0.05). All participants correctly stated that continued screening is needed after vaccination both pre- and post-intervention. Eighty-five percent strongly agreed that the intervention improved their HPV knowledge, and 77% stated they were more likely to recommend the HPV vaccine after the intervention. While nurses are willing to recommend the vaccine, there remains persistent knowledge gaps. A brief 7-min self-administered online interactive flashcard educational intervention is effective in improving the HPV vaccine knowledge among nurses.
Collapse
Affiliation(s)
- Shuk On Annie Leung
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, McGill University Health Center, Cedars Cancer Centre, D02.7224, 1001 Décarie Blvd., Montreal, QC, H4A 3J1, Canada.
| | - Alessandro Villa
- Oral Medicine, Oral Oncology and Dentistry, Miami Cancer Institute, Miami, FL, USA
| | - Eileen Duffey-Lind
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Theresa Jabaley
- Phyllis F. Cantor Center for Research in nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Marilyn Hammer
- Phyllis F. Cantor Center for Research in nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sarah Feldman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA, USA
| |
Collapse
|
13
|
Moffroid H, Doglioni DO, Chyderiotis S, Sicsic J, Barret AS, Raude J, Bruel S, Gauchet A, Michel M, Gagneux-Brunon A, Thilly N, Mueller JE. Can physicians and schools mitigate social inequalities in human papillomavirus vaccine awareness, uptake and vaccination intention among adolescents? A cross-sectional study, France, 2021 to 2022. Euro Surveill 2023; 28:2300166. [PMID: 37971661 PMCID: PMC10655205 DOI: 10.2807/1560-7917.es.2023.28.46.2300166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/27/2023] [Indexed: 11/19/2023] Open
Abstract
BackgroundIn France, human papillomavirus (HPV) vaccination coverage varies across socioeconomic levels.AimWe aimed at assessing HPV vaccine awareness, uptake and vaccination intention among adolescents in France.MethodsIn a cluster-randomised study, 13-15-year-old students in 61 French middle schools completed a web-based questionnaire. We used multivariable logistic regression to evaluate determinants of HPV vaccine awareness, self-reported uptake and vaccination intention among unvaccinated students and interaction terms to explore effects of visits to family physician and remembering school lessons on vaccination. The French deprivation index of school municipalities served as proxy for socioeconomic levels.ResultsAmong 6,992 participants, awareness was significantly associated with parental education (odds ratio (OR) = 0.82; 95% confidence interval (CI): 0.71-0.95), language spoken at home (OR = 0.59; 95% CI: 0.52-0.66) and deprivation level (OR = 0.57; 95% CI: 0.44-0.71), regardless of physician visit or school lessons. Vaccine uptake was associated with parental education without a recent physician visit (OR = 0.31; 95% CI: 0.16-0.59, vs OR = 0.64; 95% CI: 0.52-0.78 with a visit, interaction p = 0.045). Vaccination intention among unvaccinated was associated with deprivation level (moderate-low vs low) among students not remembering school lessons on vaccination (OR = 0.17; 95% CI: 0.05-0.62, vs OR = 0.93; 95% CI: 0.51-1.67 remembering school lessons, interaction p = 0.022). Parental education was associated with vaccination intention among students reporting a physician visit (OR = 0.41; 95% CI: 0.26-0.64 vs OR = 1.05; 95% CI: 0.50-2.20 without a visit, interaction p = 0.034).ConclusionOur results suggest that healthcare and school could promote vaccination and mitigate social inequalities in HPV vaccination coverage.
Collapse
Affiliation(s)
- Hadrien Moffroid
- Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, 75015 Paris, France
- University of Melbourne, Melbourne, Australia
| | - Damien Oudin Doglioni
- Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, 75015 Paris, France
| | - Sandra Chyderiotis
- Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, 75015 Paris, France
| | | | | | - Jocelyn Raude
- Université Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U1309 - 35000 Rennes, France
| | - Sebastien Bruel
- Department of General Practice, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, Université de Lyon, Saint-Etienne, France
- Health, Systemic, Process UR 4129 Research Unit, University Claude Bernard, University of Lyon, Lyon, France
| | - Aurelie Gauchet
- Université Savoie Mont Blanc, Université Grenoble Alpes LIP/PC2S, Grenoble, France
| | - Morgane Michel
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'épidémiologie clinique, Paris, France
- Université Paris Cité, ECEVE, UMR1123, Inserm, Paris, France
| | - Amandine Gagneux-Brunon
- CHU de Saint-Etienne - Service d'infectiologie
- Centre International de Recherche en Infectiologie, Team GIMAP, Université de Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, Nancy, France
- Université de Lorraine, CHRU-Nancy, Département Méthodologie, Promotion, Investigation, Nancy, France
| | - Judith E Mueller
- Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, 75015 Paris, France
- Université Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U1309 - 35000 Rennes, France
| |
Collapse
|
14
|
Lo Moro G, Ferrara M, Langiano E, Accortanzo D, Cappelletti T, De Angelis A, Esposito M, Prinzivalli A, Sannella A, Sbaragli S, Vuolanto P, Siliquini R, De Vito E. Countering vaccine hesitancy: a systematic review of interventions to strengthen healthcare professionals' action. Eur J Public Health 2023; 33:905-915. [PMID: 37581903 PMCID: PMC10567238 DOI: 10.1093/eurpub/ckad134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Vaccine hesitancy is relevant for healthcare professionals (HCPs) who face challenges in building trusting relationships with patients. Accordingly, the VAX-TRUST project has been developed to improve experiences of HCPs and patients dealing with vaccinations. To support VAX-TRUST, this work aimed to identify latest interventions targeted at HCPs to address hesitancy and increase vaccine uptake. METHODS A systematic review was conducted according to PRISMA by searching PubMed, Scopus and Embase. The protocol was registered on PROSPERO. Articles were eligible if evaluated interventions directly targeted at HCPs/healthcare students. The search was run on 26 January 2022. Articles published in 2016 or after were included. RESULTS A total of 17 492 records were identified; 139 articles were selected. Most articles were set in USA (n = 110). Over half had a pre-post design without a control group (n = 78). A total of 41 articles focused on single-component interventions, 60 on multi-component interventions involving only HCPs and/or students and 38 on multi-component interventions involving also other professionals. Main components were in-person education (n = 76), synchronous (n = 10) and asynchronous (n = 23) online learning, educational materials (n = 26), performance assessment and feedback (n = 33), electronic record changes (n = 30), role play/simulation (n = 21) and online games/apps (n = 5). Educational sessions were mainly about scientific update or communication. Outcomes of interventions were grouped in: vaccination rates (n = 69), knowledge (n = 32), attitudes (n = 26), confidence in counselling (n = 30) and acceptability (n = 16). CONCLUSIONS Apps, gaming, role play/simulations could represent innovative interventions. This review highlighted the need of delving into communication strategies and using more robust evaluations, longer follow-up and standardized measurements.
Collapse
Affiliation(s)
- Giuseppina Lo Moro
- Department of Public Health Sciences and Paediatrics, University of Turin, Turin, Italy
| | - Maria Ferrara
- Department of Human, Social and Health Sciences, University of Cassino and Southern Lazio, Cassino, Italy
| | - Elisa Langiano
- Department of Human, Social and Health Sciences, University of Cassino and Southern Lazio, Cassino, Italy
| | - Davide Accortanzo
- Department of Public Health Sciences and Paediatrics, University of Turin, Turin, Italy
| | - Toni Cappelletti
- Department of Public Health Sciences and Paediatrics, University of Turin, Turin, Italy
| | - Aldo De Angelis
- Department of Public Health Sciences and Paediatrics, University of Turin, Turin, Italy
| | - Maurizio Esposito
- Department of Human, Social and Health Sciences, University of Cassino and Southern Lazio, Cassino, Italy
| | | | - Alessandra Sannella
- Department of Human, Social and Health Sciences, University of Cassino and Southern Lazio, Cassino, Italy
| | - Sara Sbaragli
- Department of Human, Social and Health Sciences, University of Cassino and Southern Lazio, Cassino, Italy
| | - Pia Vuolanto
- Research Centre for Knowledge, Science, Technology and Innovation Studies of Tampere University, Tampere, Finland
| | - Roberta Siliquini
- Department of Public Health Sciences and Paediatrics, University of Turin, Turin, Italy
- AOU City of Health and Science of Turin, Turin, Italy
| | - Elisabetta De Vito
- Department of Human, Social and Health Sciences, University of Cassino and Southern Lazio, Cassino, Italy
| |
Collapse
|
15
|
Moya EM, Garcia A, Joyce Ponder A, Frietze G. Addressing knowledge gaps: the key role of community health workers and healthcare providers in human papillomavirus prevention and vaccine uptake in a border community. Front Public Health 2023; 11:1243539. [PMID: 37829098 PMCID: PMC10565852 DOI: 10.3389/fpubh.2023.1243539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/08/2023] [Indexed: 10/14/2023] Open
Abstract
The Human Papillomavirus (HPV) is the most common sexually transmitted infection and nearly every person who is sexually active will get HPV at some point in their lifetime without having the HPV vaccine. Healthcare Providers (HCPs) and Community Health Workers (CHWs) play an essential role in promoting the HPV vaccine and providing education about HPV in communities. Three focus groups with CHWs (n = 17) and HCPs (n = 7) were conducted and led by trained facilitators. In addition to participating in the focus group, CHWs and HCPs completed a brief questionnaire. Focus groups were voice recorded and transcribed for qualitative analysis. Independent coders conducted content analysis to identify the salient themes of the focus groups. Several important findings emerged from this study highlighting the barriers to HPV knowledge, gaps in the self-perceived role of HPV cancer prevention, and opportunities to action. Financial, knowledge, patriarchy, behaviors, attitudes, and fears were identified as the perceived patient-related barriers to promoting HPV cancer prevention. Both CHWs and HCPs explained that their female patients are often discouraged by their husbands from seeking out sexual health-related healthcare. Finding suggest the need for community tailored education on HPV and "best practice" trainings for HPV prevention that is applicable to both CHWs and HCPs.
Collapse
Affiliation(s)
- Eva M. Moya
- Department of Social Work, College of Health Sciences, The University of Texas at El Paso, El Paso, TX, United States
| | - Araceli Garcia
- Border Biomedical Research Center, The University of Texas at El Paso, El Paso, TX, United States
| | - Amy Joyce Ponder
- Department of Social Work, College of Health Sciences, The University of Texas at El Paso, El Paso, TX, United States
| | - Gabriel Frietze
- Border Biomedical Research Center, The University of Texas at El Paso, El Paso, TX, United States
- School of Pharmacy, College of Health Sciences, The University of Texas at El Paso, El Paso, TX, United States
| |
Collapse
|
16
|
Kassymbekova F, Zhetpisbayeva I, Tcoy E, Dyussenov R, Davletov K, Rommel A, Glushkova N. Exploring HPV vaccine knowledge, attitudes, barriers and information sources among parents, health professionals and teachers in Kazakhstan: a mixed-methods study protocol. BMJ Open 2023; 13:e074097. [PMID: 37739465 PMCID: PMC10533667 DOI: 10.1136/bmjopen-2023-074097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) is a prevalent sexually transmitted infection linked to certain types of malignant neoplasms, notably cervical cancer (CC). In Kazakhstan, a high prevalence of high oncogenic HPV types (HR-HPV) has been observed, and CC ranks as the second most common malignancy among women with a crude incidence rate of 18.3 cases per 100 000 women. The HPV vaccine, developed as the primary prevention measure against HPV infection, including the most prevalent HR-HPV, received approval from the WHO in 2009. In 2014, Kazakhstan initiated HPV vaccination as a pilot project in four sub-national regions; however, it was later in 2017 discontinued due to widespread parental refusal influenced by negative media reports. This study aims to examine knowledge, attitudes, information sources, barriers to HPV vaccination and factors associated with HPV vaccination hesitancy among different target groups in Kazakhstan prior to the HPV vaccine re-launch announced by the Ministry of Health. METHODS AND ANALYSIS This mixed-method-designed research comprises quantitative and qualitative components. Data on HPV awareness, attitudes towards HPV vaccination and sources of information will be collected through an online survey administered by parents and legal guardians, health professionals, and schoolteachers in the Republic of Kazakhstan between January 2023 and January 2024. Additionally, qualitative data on Kazakhstani parental beliefs and attitudes toward HPV vaccination will be collected through online focus group discussions. ETHICS AND DISSEMINATION OF RESULTS The study has been approved by the local ethics committee at the Kazakhstan Medical University "Higher School of Public Health" (KMU "KSPH") (No. 138 of 31.05.2021). The results will be reported in publications, at conferences among researchers and healthcare and school education professionals in Kazakhstan, and internationally.
Collapse
Affiliation(s)
- Fatima Kassymbekova
- Department of Public Health and Social Sciences, Kazakhstan Medical University "KSPH", Almaty, Kazakhstan
| | - Indira Zhetpisbayeva
- Department of Public Health and Social Sciences, Kazakhstan Medical University "KSPH", Almaty, Kazakhstan
| | - Evgeniya Tcoy
- Department of Obstetrics and Gynaecology, Kazakh-Russian Medical University, Almaty, Kazakhstan
| | - Rassul Dyussenov
- Department of Public Health and Social Sciences, Kazakhstan Medical University "KSPH", Almaty, Kazakhstan
| | - Kairat Davletov
- Health Research Center, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Alexander Rommel
- Epidemiology and Health Monotoring, Robert Koch Institute, Berlin, Germany
| | - Natalya Glushkova
- Department of Epidemiology, Biostatistics and Evidence Based Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| |
Collapse
|
17
|
Iova CF, Badau D, Daina MD, Șuteu CL, Daina LG. Evaluation of the Knowledge and Attitude of Adolescents Regarding the HPV Infection, HPV Vaccination and Cervical Cancer in a Region from the Northwest of Romania. Patient Prefer Adherence 2023; 17:2249-2262. [PMID: 37706209 PMCID: PMC10497041 DOI: 10.2147/ppa.s421875] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/22/2023] [Indexed: 09/15/2023] Open
Abstract
Purpose In Romania, after reaching the age of 18, teenage girls can make an informed decision about vaccination. The aim of the study was to evaluate both knowledge and attitudes related to HPV infection, HPV vaccination, cervical cancer, as well as intentions, reservations, reasons that could influence the decision related to vaccination. Patients and Methods We applied an anonymized questionnaire to 690 teenage girls in the 18-19 age group, recruited from 15 high schools in Bihor County. Based on the answers to the question corresponding to item 14 of subscale 3, 2 groups were identified: the group with a hesitant behavior called the non-vaccine group (GNV) and the group with a positive behavior called the pro-vaccine group (GPV). The statistical analysis was processed by using IBM-SPSS 22. Results The analysis revealed significant differences between the groups in terms of the level of knowledge and attitudes related to vaccination, the adolescent girls in the GPV being more aware of the role and importance of HPV vaccination and more open to the idea of vaccination. For the GNV, the behavior can be explained by the fact that even if they have heard about the HPV infection being transmitted through unprotected sex and they think that vaccination in general is necessary to prevent certain diseases, they do not know if HPV vaccination would be effective in protecting them in the future. Adolescents from GPV declare they would accept HPV vaccination if it would be offered to them or they are already vaccinated. Conclusion Alongside interventions targeting parents and health-care professionals, it is necessary to improve the level of knowledge of adolescents about HPV infection, HPV vaccination and cervical cancer, by organizing information campaigns in schools, campaigns in which professionals in the field should be involved, but also by implementing education programs addressed to them.
Collapse
Affiliation(s)
- Camelia Florina Iova
- Faculty of Medicine and Pharmacy, Doctoral School, University of Oradea, Oradea, 410081, Romania
- Department of Epidemiological Surveillance and Disease Control, Directorate of Public Health of Oradea, Oradea, 410042, Romania
| | - Dana Badau
- Petru Maior Faculty of Sciences and Letters, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, 540142, Romania
- Interdisciplinary Doctoral School, Transilvania University, Brasov, 500068, Romania
| | | | - Corina Lacramioara Șuteu
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, 410081, Romania
- Department of Quality Management in Health, Emergency Clinical County Hospital of Oradea, Oradea, Romania
| | - Lucia Georgeta Daina
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, 410081, Romania
- Department of Quality Management in Health, Emergency Clinical County Hospital of Oradea, Oradea, Romania
| |
Collapse
|
18
|
Štrbac M, Vuković V, Pustahija T, Nikolić N, Rajčević S, Ilić S, Dugandžija T, Patić A, Ristić M, Petrović V. Motives and attitudes of parents toward HPV vaccination: Results from the initial period of HPV vaccine rollout in Serbia. PLoS One 2023; 18:e0287295. [PMID: 37410715 PMCID: PMC10325070 DOI: 10.1371/journal.pone.0287295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/03/2023] [Indexed: 07/08/2023] Open
Abstract
Human papillomavirus (HPV) infection is one of the most common viral infections in sexually active population worldwide, and is the main cause of cervical cancer, which is the fourth most common cancer among women. Serbia ranks third in incidence and mortality rate of cervical cancer in Europe. We conducted a cross-sectional study considering parents' motivation for the HPV vaccination of their children. Statistical analysis included descriptive statistics and a logistic regression model. We found that the strongest motive was "Recommendation from paediatrician" (20.2%), followed by the attitude that HPV vaccine protects against cancers in different localization (15.4%), the motive "It is better to vaccinate a child than expose them to potential risk of HPV infection" (13.3%) and "Feeling anxiety due to a possible infection and cancer in the child" (13.1%). For those parents that vaccinated their child for some other strongest motive, reasons like "Vaccine is free of charge", "Recommendation from friends and family" and motive "My child received all obligatory vaccines, so I want to receive this one as well", were significantly more frequently selected. In the group where paediatricians' recommendation was not a motive for accepting the HPV vaccine, the largest percentage of parents (89.6%) selected motive "HPV vaccine protects against cancers in different localization" and the motive "It is better to vaccinate a child than expose them to potential risk of HPV infection" (78.1%). Paediatrician's recommendation is very important for parents' decision to vaccinate, however, other motives also influenced and had significance in making the parents' decision to vaccinate their children against HPV. Encouraging trust in public health authorities in Serbia, highlighting the advantages of the HPV vaccine and further encouraging healthcare workers to give stronger recommendations can increase the HPV vaccine uptake. Finally, we provided the basis to create more targeted messages that will empower parents to vaccinate their children.
Collapse
Affiliation(s)
- Mirjana Štrbac
- Institute of Public Health of Vojvodina, Novi Sad, Serbia
| | - Vladimir Vuković
- Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Tatjana Pustahija
- Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Nataša Nikolić
- Institute of Public Health of Vojvodina, Novi Sad, Serbia
| | - Smiljana Rajčević
- Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Svetlana Ilić
- Institute of Public Health of Vojvodina, Novi Sad, Serbia
| | - Tihomir Dugandžija
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Aleksandra Patić
- Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Mioljub Ristić
- Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Vladimir Petrović
- Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| |
Collapse
|
19
|
Song D, Liu P, Wu D, Zhao F, Wang Y, Zhang Y. Knowledge and Attitudes towards Human Papillomavirus Vaccination (HPV) among Healthcare Providers Involved in the Governmental Free HPV Vaccination Program in Shenzhen, Southern China. Vaccines (Basel) 2023; 11:vaccines11050997. [PMID: 37243101 DOI: 10.3390/vaccines11050997] [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: 04/06/2023] [Revised: 05/13/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
No research has been conducted to explore the variables associated with healthcare providers' (HCPs) knowledge and attitudes toward the human papillomavirus vaccine (HPV) since the vaccine was approved for free use in some Chinese cities. In Shenzhen, southern China, a convenience sample strategy was used to distribute questionnaires to HCPs involved in the government's HPV vaccination program from Shenzhen. There were 828 questionnaires collected in total, with 770 used in the analysis. The mean HPV and HPV vaccine knowledge score was 12.0 among HCPs involved in the government HPV vaccination program (with a total score of 15). the average scores for HPV and HPV vaccine knowledge varied among different types of medical institutions. District hospitals had the highest mean score of 12.4, while private hospitals ranked fourth with a mean score of 10.9. Multivariate logistic regression results revealed significant disparities in the type of license and after-tax annual income across HCPs (p < 0.05). The future education and training for HCPs should focus on private community health centers (CHCs), HCPs whose license type is other than a doctor, and HCPs with low after-tax annual income.
Collapse
Affiliation(s)
- Danhong Song
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| | - Peiyi Liu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen 518000, China
| | - Dadong Wu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen 518000, China
| | - Fanghui Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| | - Yueyun Wang
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen 518000, China
| | - Yong Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| |
Collapse
|
20
|
Ellingson MK, Bednarczyk RA, O’Leary ST, Schwartz JL, Shapiro ED, Niccolai LM. Understanding the Factors Influencing Health Care Provider Recommendations about Adolescent Vaccines: A Proposed Framework. J Behav Med 2023; 46:356-365. [PMID: 35194726 PMCID: PMC8862696 DOI: 10.1007/s10865-022-00296-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 02/03/2022] [Indexed: 11/17/2022]
Abstract
Health care provider recommendations are among the most important factors influencing parents' decisions to vaccinate their adolescents. However, delivery of high-quality health care provider recommendations for vaccination is not universal. There is wide variation in the strength, timeliness and consistency of the delivery of recommendations for all adolescent vaccines. The factors that influence health care providers' recommendations are multi-level and can be conceptualized in much the same way as vaccine acceptance among parents. Health care providers are influenced by their own attitudes and beliefs about a vaccine and also by the patient they are treating and by the community in which they practice as well as state and national level vaccine policy. We propose a multi-level framework for understanding the factors that influence health care providers' recommendations at the individual, interpersonal and community level to both develop and adapt interventions to improve providers' recommendations.
Collapse
Affiliation(s)
- Mallory K. Ellingson
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, 60 College St, New Haven, CT 06520 USA
| | - Robert A. Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA USA
- Cancer Prevention and Control Program, Winship Cancer Institute, Emory University, Atlanta, GA USA
| | - Sean T. O’Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Jason L. Schwartz
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, CT 06520 USA
| | - Eugene D. Shapiro
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, 60 College St, New Haven, CT 06520 USA
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06520 USA
| | - Linda M. Niccolai
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, 60 College St, New Haven, CT 06520 USA
| |
Collapse
|
21
|
Sertkaya D, Şen Bayturan S. Pediatric and Family Physicians' Attitudes Regarding Childhood Optional Vaccines During the COVID-19 Pandemic. Cureus 2023; 15:e37338. [PMID: 37182049 PMCID: PMC10169092 DOI: 10.7759/cureus.37338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 05/16/2023] Open
Abstract
INTRODUCTION To maintain high vaccination rates, vaccination interventions should be targeted according to interests such as parents' knowledge, attitudes, beliefs, and vaccine hesitancy. METHODS This research was conducted between June 2020 and April 2021 using a questionnaire about optional vaccines (OVs) in Turkey. RESULTS A total of 241 physicians participated and 14 physicians were excluded due to insufficient data. Finally, a total of 227 physicians, including 115 pediatricians and 112 family physicians, were included in the study. The mean age of pediatricians and family physicians was 33.42 ± 8.25 years and 35.46 ± 11.09 years, respectively. There was no significant difference between pediatricians and family physicians in terms of age and gender (p > 0.05). Nearly half of all physicians (49%) stated that they do not have sufficient knowledge about OVs. Pediatricians (64%) stated that they have sufficient knowledge at a higher rate than family physicians (37%) (p = 0.000). Physicians who declared having sufficient knowledge informed families about OVs more frequently than those with insufficient knowledge (p = 0.000). Pediatricians provide information about OVs more frequently than family physicians (p = 0.001). Rotavirus and meningococcal vaccines were the most frequently recommended vaccines. CONCLUSIONS Rotavirus and meningococcal B were the most recommended OVs. About half of the physicians participating in the study stated that they did not have sufficient knowledge about OVs. Physicians with sufficient knowledge of OVs recommend OVs more frequently.
Collapse
Affiliation(s)
| | - Semra Şen Bayturan
- Pediatric Infectious Diseases, Faculty of Medicine, Manisa Celal Bayar University, Manisa, TUR
| |
Collapse
|
22
|
Zastawna B, Załuska R, Milewska A, Zdęba-Mozoła A, Ogonowska A, Kozłowski R, Owczarek A, Marczak M. Protective Vaccination Used by Doctors for Prevention of Infections. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4153. [PMID: 36901165 PMCID: PMC10001470 DOI: 10.3390/ijerph20054153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
Doctors, as with all healthcare workers, are a specific risk group due to a high probability of contact with contagious pathogens. An online survey was conducted among Polish doctors to establish their use of protective vaccination to decrease their personal risk of infection. The online survey was conducted using questions about medics' vaccination decisions and approaches. The results revealed that immunization against VPDs for most participants was not adequate based on recommendations or developments in vaccinology. To increase vaccination as a prophylactic method among doctors, especially those not involved in the immunization of patients, an educational campaign is demanded. As non-immunized medics are at risk themselves and are also a threat to the safety of patients, legal changes and the monitoring of vaccine acceptance and perception among medics are required.
Collapse
Affiliation(s)
- Beata Zastawna
- Department of Management and Logistics in Health Care, Medical University of Lodz, 90-131 Lodz, Poland
| | - Roman Załuska
- Department of Management and Logistics in Health Care, Medical University of Lodz, 90-131 Lodz, Poland
| | - Anna Milewska
- Department of Statistics and Medical Informatics, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Agnieszka Zdęba-Mozoła
- Department of Management and Logistics in Health Care, Medical University of Lodz, 90-131 Lodz, Poland
| | - Agnieszka Ogonowska
- Department of Management and Logistics in Health Care, Medical University of Lodz, 90-131 Lodz, Poland
| | - Remigiusz Kozłowski
- Center for Security Technologies in Logistics, Faculty of Management, University of Lodz, 90-237 Lodz, Poland
| | - Anna Owczarek
- Department of Management and Logistics in Health Care, Medical University of Lodz, 90-131 Lodz, Poland
| | - Michał Marczak
- Collegium of Management, WSB University in Warsaw, 03-204 Warszawa, Poland
| |
Collapse
|
23
|
Sutton S, Azar SS, Evans LK, Murtagh A, McCarthy C, John MS. HPV Knowledge Retention and Concurrent Increase in Vaccination Rates 1.5 Years After a Novel HPV Workshop in Medical School. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:240-247. [PMID: 34669178 DOI: 10.1007/s13187-021-02106-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
Comprehensive education regarding human papillomavirus (HPV) pathogenesis, vaccination, and patient counseling are not routinely included in the medical school curriculum; consequently, student and provider knowledge, especially concerning head and neck pathology, remains low. The objective of this study was to demonstrate long-term retention of HPV knowledge and positive attitudes towards HPV vaccination after attending our novel HPV workshop, with a focus on knowledge of oropharyngeal cancer. A follow-up survey was administered to medical students 1.5 years after the initial completion of the workshop. HPV vaccination records from the student-led clinic were collected from the immunization information system. Awareness that HPV causes oropharyngeal cancer was present in 33% of medical students pre-curriculum; immediate and long-term post-curricular awareness of this association remained at 90% or higher (p < 0.0001). Comfort with HPV counseling, having enough information to recommend the vaccine, and knowledge of HPV malignancies, symptoms, transmission, and vaccination schedule remained persistently elevated over pre-curriculum scores (p < 0.05). Long-term knowledge scores were also higher than a control group of medical students at the same stage of training who had never participated in the workshop (p < 0.05). HPV vaccination rates at the medical school's student-run clinic also increased after the curriculum, from an average of 1.89 HPV vaccines given per clinic to 3.55 (p = 0.001). This study demonstrates that knowledge and positive attitudes were maintained 1.5 years after participating in this HPV curriculum during students' preclinical years of medical school. Additionally, an increase in HPV vaccination rates occurred at a student-led clinic, indicating a positive clinical impact on the curriculum.
Collapse
Affiliation(s)
- Sarah Sutton
- University of Nevada, Reno School of Medicine - Reno, 1664 N Virginia St, Reno, NV, 89557, USA.
| | - Shaghauyegh S Azar
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA - Los Angeles, Los Angeles, CA, USA
| | - Lauran K Evans
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA - Los Angeles, Los Angeles, CA, USA
| | - Ariel Murtagh
- Department of Family Medicine, University of California Irvine - Los Angeles, Los Angeles, CA, USA
| | - Catherine McCarthy
- Department of Family Medicine, University of Nevada, Reno School of Medicine - Reno, Reno, NV, USA
| | - Maie St John
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA - Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
24
|
Osaghae I, Darkoh C, Chido-Amajuoyi OG, Chan W, Padgett Wermuth P, Pande M, Cunningham SA, Shete S. Healthcare Provider's Perceived Self-Efficacy in HPV Vaccination Hesitancy Counseling and HPV Vaccination Acceptance. Vaccines (Basel) 2023; 11:300. [PMID: 36851178 PMCID: PMC9965421 DOI: 10.3390/vaccines11020300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND HPV vaccine hesitancy is a key contributor to the sub-optimal HPV vaccination uptake in the United States. We aimed to determine the association between healthcare providers' self-efficacy in HPV vaccination hesitancy counseling and HPV vaccination acceptance after initial and follow-up counseling sessions. METHODS Population-based cross-sectional study of healthcare providers (HCPs) practicing in Texas. Logistic regression analyses were used to determine the odds of HPV vaccination acceptance by vaccine-hesitant patients. Additionally, generalized estimating equations were used to compare HPV vaccination acceptance by hesitant patients after follow-up versus initial counseling sessions. RESULTS 1283 HCPs completed the survey with a mean (SD) age of 47.1 (11.3) years. HCPs who believed that they were very/completely confident in counseling HPV-vaccine-hesitant parents had higher odds of observing HPV vaccination acceptance very often/always after an initial counseling session (adjusted odds ratio (AOR): 3.50; 95% CI: 2.25-5.44) and after follow-up counseling sessions (AOR: 2.58; 95% CI: 1.66-4.00) compared to HCPs that perceived they were not at all/somewhat/moderately confident. The odds of HPV vaccination being accepted very often/always by vaccine-hesitant parents was 61% (AOR: 1.61; 95% CI: 1.32-1.95) higher after follow-up counseling sessions compared to an initial counseling session. The results were similar for the counseling of HPV-vaccine-hesitant adult patients. CONCLUSIONS The confidence level of HCPs in counseling hesitant parents and adult patients impacts HPV vaccination acceptance. Importantly, acceptance was higher after follow-up counseling sessions than initial counseling sessions. HCPs should receive training in HPV vaccination counseling to enhance their confidence in counseling hesitant patients and should utilize every visit to counsel hesitant patients.
Collapse
Affiliation(s)
- Ikponmwosa Osaghae
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Charles Darkoh
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
| | | | - Wenyaw Chan
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, TX 77030, USA
| | - Paige Padgett Wermuth
- Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX 77030, USA
| | - Mala Pande
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sonia A. Cunningham
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sanjay Shete
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| |
Collapse
|
25
|
Barriers in the School-Based Pan-Gender HPV Vaccination Program in Sweden: Healthcare Providers' Perspective. Vaccines (Basel) 2023; 11:vaccines11020310. [PMID: 36851188 PMCID: PMC9962905 DOI: 10.3390/vaccines11020310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) vaccines effectively prevent, and can even eliminate, HPV-related cancers. Currently, vaccination rates are suboptimal in the national Swedish school-based vaccination program. School nurses play a key role in all aspects of the vaccination process. Therefore, this study aims to explore school nurses' perceived HPV vaccination challenges. METHODS Seven focus group interviews were conducted with school nurses (n = 35) working in nine socio-demographically diverse municipalities in mid-Sweden. Data were analyzed using qualitative content analysis. RESULTS Participants described difficulties in encountering and handling the diversity of reasons for vaccine hesitancy. Parents known to be skeptical of vaccines in general were seen as most difficult to reach. Uncertainty was expressed concerning the extent of professional responsibility for vaccine promotion. The informants expressed a lack of guidelines for vaccine promotion and described challenges in supporting the child's own wishes. Creating a safe space for the individual child was seen as crucial. Other problems described were the challenges of overcoming children's fear of needles, supporting unvaccinated children, and being confronted with the remaining gender inequities of the pan-gender vaccination program. CONCLUSIONS Our results suggest that school nurses, especially those new to their profession, may benefit from training and guidance22 material on how to address vaccine hesitancy.
Collapse
|
26
|
Stöcker A, Hoffmann J, Mause L, Neufeind J, Ohnhäuser T, Scholten N. What impact does the attitude toward COVID-19 vaccination have on physicians as vaccine providers? A cross sectional study from the German outpatient sector. Vaccine 2023; 41:263-273. [PMID: 36456389 PMCID: PMC9691451 DOI: 10.1016/j.vaccine.2022.11.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND COVID-19 vaccination is recognized as a key component in addressing the COVID-19 pandemic. Physicians' attitudes toward vaccination are known to play a defining role in the management and dissemination of medical advice to patients. In Germany, outpatient practitioners are predominantly responsible for the dissemination of vaccines. METHOD Using a cross-sectional online survey, 932 outpatient general practitioners, gynecologists, and pediatricians in Germany were asked in fall, 2021, about their attitude toward COVID-19 vaccination and - among others - their communication in vaccine discussions, their assessment of vaccine safety, and reporting of suspected adverse events. Physicians were divided into two groups along their attitudes toward COVID-19 vaccination. In addition, multivariate linear regression models were constructed to assess differences in communication strategies. RESULTS 92 % of physicians had a positive or very positive attitude toward COVID-19 vaccination. Own vaccination status, practice-based vaccination delivery, and estimated vaccination coverage among patients were significantly associated with the attitude toward vaccination. Confidence in vaccine safety was significantly lower among physicians with negative attitudes. There were no differences between the two groups in self-assessment of the ability to detect suspected adverse events, but there were differences in the observing and reporting of adverse events. For the linear regression models, we found that a more negative attitude toward COVID-19 vaccination was significantly associated with increased acceptance of patient refusal of COVID-19 vaccination and empathic behavior for patient concerns. In contrast, willingness to engage in a detailed persuasion consultation was significantly lower. Pediatricians showed significantly higher empathy for patient-side concerns compared to general practitioners, whereas gynecologists showed less empathy than general practitioners. DISCUSSION The physician's attitude toward COVID-19 vaccination influences the physician's practices as a vaccine provider. However, when providing medical advice and healthcare, the physician should focus on the actual needs of the patient.
Collapse
Affiliation(s)
- Arno Stöcker
- University of Cologne, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Germany,Corresponding author
| | - Jan Hoffmann
- University of Cologne, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Germany
| | - Laura Mause
- University of Cologne, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Germany
| | - Julia Neufeind
- Immunization Unit, Robert Koch-Institute, Berlin, Germany
| | - Tim Ohnhäuser
- University of Cologne, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Germany
| | - Nadine Scholten
- University of Cologne, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Germany
| |
Collapse
|
27
|
Ampofo AG, Mackenzie L, Boyes AW. HPV vaccination: Intention to participate among female senior high school students in Ghana. Vaccine 2023; 41:159-169. [PMID: 36411133 DOI: 10.1016/j.vaccine.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cervical cancer is the second most common cancer and the second leading cause of cancer death among women in Ghana. HPV vaccination is expected to be added to the national vaccination schedule in 2023. This study aimed to: i) describe intentions to participate in HPV vaccination and ii) explore factors associated with vaccination intentions among female senior high school students in Ghana. METHODS Female students (aged 16-24) were recruited from 17 senior high schools in Ashanti Region. A cross-sectional anonymous self-report paper-and-pen survey assessed students' HPV vaccination intentions using three items, and a range of correlates (individual, parent/family, social networks, service provision). Descriptive statistics were calculated for vaccination intentions, and correlates of intention scores (where higher scores indicate stronger intentions) were explored with a linear mixed-effect model. RESULTS Of 2400 participants, 64% (95%CI: 62%, 67%) agreed with at least one vaccination intention item. Uncertainty and disagreement with at least one item were endorsed by 51% (95%CI: 49%, 53%) and 44% (95%CI: 42%, 46%) of students, respectively. One-quarter of the students (25%, 95%CI: 23%, 26%) agreed, 12% (95% 11%, 13%) disagreed, and 11% (95%CI: 10%,13%) indicated uncertainty, on all three vaccination intention items. Vaccination uptake was 4.5%. Students were likely to have higher vaccination intention scores if: they had stronger beliefs about vaccine effectiveness; vaccination was recommended by parents, religious leaders and service providers, and vaccinated peers; and it was free. Students were likely to have lower vaccination intention scores if they perceived barriers to vaccination (e.g., side effects). CONCLUSIONS While two-thirds of students had some intention to participate in HPV vaccination, vaccine hesitancy (i.e., uncertainty or disagreement) was apparent. Alongside the rollout of a free national vaccination programme, messaging about vaccination benefits and effectiveness targeting students, as well as parents, religious leaders, service providers and peers would be beneficial given their influential role in students' vaccination intentions.
Collapse
Affiliation(s)
- Ama Gyamfua Ampofo
- Health Behavior Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia; Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Lisa Mackenzie
- Health Behavior Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia; Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Allison W Boyes
- Health Behavior Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia; Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| |
Collapse
|
28
|
Mello VMDS, Santos VCGD, Baptista AD, Fonseca SC, Faria CA, Vitral CL, Cavalcanti S. Knowledge about human papillomavirus transmission and prevention among physicians in Rio de Janeiro state, Brazil. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20220291. [PMID: 37098929 PMCID: PMC10176655 DOI: 10.1590/1806-9282.20220291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/14/2022] [Indexed: 04/27/2023]
Abstract
OBJECTIVE This study aimed to assess physicians' knowledge about human papillomavirus infection and its prevention. METHODS Descriptive web-based survey with 15 objective questions targeted to physicians affiliated with the Regional Council of Medicine from Rio de Janeiro state, Brazil. Participants were invited by e-mail and the Council social networks, between January and December 2019. RESULTS The study sample had 623 participants, with a median age of 45 years, predominantly women (63%). The most frequent specialties were Obstetrics and Gynecology (21.1%), Pediatrics (11.2%), and Internists (10.5%). Concerning human papillomavirus knowledge, 27.9% of the participants were able to identify accurately all possible forms of transmission, and none of them could recognize all the risk factors of infection. Nevertheless, 95% recognized that asymptomatic infection could occur in both sexes. Regarding knowledge about clinical manifestations, diagnosis, and screening, only 46.5% were able to identify all human papillomavirus-related cancers, 42.6% were aware of the periodicity of Pap smears, and 39.4% indicated that serological test was not adequate for diagnosis. The recommended age group for human papillomavirus vaccination was recognized by 94% of the participants, as well as the need for a Pap smear and the use of condoms, even after vaccination. CONCLUSIONS There is good knowledge about prevention and screening for human papillomavirus infections; many gaps were identified regarding transmission, risk factors, and associated diseases among physicians in Rio de Janeiro state.
Collapse
Affiliation(s)
| | | | | | - Sandra Costa Fonseca
- Universidade Federal Fluminense, Instituto de Saúde Coletiva, Departamento de Epidemiologia e Bioestatística - Niterói (RJ), Brazil
| | - Carlos Augusto Faria
- Universidade Federal Fluminense, Faculdade de Medicina, Departamento Materno Infantil - Niterói (RJ), Brazil
| | - Claudia Lamarca Vitral
- Universidade Federal Fluminense, Instituto Biomédico, Departamento de Microbiologia e Parasitologia - Niterói (RJ), Brazil
| | - Silvia Cavalcanti
- Universidade Federal Fluminense, Instituto Biomédico, Departamento de Microbiologia e Parasitologia - Niterói (RJ), Brazil
| |
Collapse
|
29
|
Osaghae I, Darkoh C, Chido-Amajuoyi OG, Chan W, Wermuth PP, Pande M, Cunningham SA, Shete S. Association of provider HPV vaccination training with provider assessment of HPV vaccination status and recommendation of HPV vaccination. Hum Vaccin Immunother 2022; 18:2132755. [PMID: 36265005 PMCID: PMC9746413 DOI: 10.1080/21645515.2022.2132755] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The delivery of strong HPV vaccine recommendations hinges on the expertise of healthcare providers (HCPs) in assessing patients' status and recommending HPV vaccination. We conducted a population-based cross-sectional study of HCPs practicing in Texas to examine the relationship between HPV vaccination training of HCPs and HPV vaccination status assessment and recommendation. Logistic regression analyses were used to assess the association between HCPs' formal training and recency of training in HPV vaccination promotion or counseling with HPV vaccination status assessment and recommendation. Of the 1,283 HCPs who completed the online survey, 43% had received training in HPV vaccination promotion or counseling, 47% often/always assess HPV vaccination status, and 59% often/always recommend HPV vaccination. Compared with HCPs who received no training, those who received training had over four times higher odds (adjusted odds ratio [AOR]: 4.32; 95% CI: 3.06-6.10) of often/always assessing HPV vaccination status and over three and half times higher odds (AOR: 3.66; 95% CI: 2.73-4.90) of often/always recommending HPV vaccination. Furthermore, HCPs who recently received HPV vaccination training had higher odds of HPV vaccination status assessment and recommendations than those without training. Hispanic HCPs had higher odds of often/always assessing HPV vaccination status and recommending vaccination than did non-Hispanic White HCPs. Also, nurses and physician assistants had lower odds of often/always assessing HPV vaccination status and recommending HPV vaccination than did physicians. Targeted and continuous training of HCPs in HPV vaccination promotion or counseling is needed to increase HPV vaccination status assessment, recommendation, and uptake rates.
Collapse
Affiliation(s)
- Ikponmwosa Osaghae
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA,Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA,Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles Darkoh
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA
| | | | - Wenyaw Chan
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, TX, USA
| | - Paige Padgett Wermuth
- Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX, USA
| | - Mala Pande
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sonia a Cunningham
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sanjay Shete
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA,Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA,Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA,CONTACT Sanjay Shete Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center1400 Pressler Dr. FCT4.6002, Houston, TX77030, USA
| |
Collapse
|
30
|
Osaghae I, Darkoh C, Chido-Amajuoyi OG, Chan W, Padgett Wermuth P, Pande M, Cunningham SA, Shete S. HPV Vaccination Training of Healthcare Providers and Perceived Self-Efficacy in HPV Vaccine-Hesitancy Counseling. Vaccines (Basel) 2022; 10:vaccines10122025. [PMID: 36560435 PMCID: PMC9781563 DOI: 10.3390/vaccines10122025] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
HPV vaccine hesitancy is a key barrier to HPV vaccination. Using a population-based survey of HCPs practicing in Texas we determined the association between formal training of HCPs and perceived self-efficacy in counseling HPV vaccine-hesitant parents and adult patients. A total of 1283 HCPs completed the survey, with 879 providing vaccination services to pediatric patients and 1018 providing vaccination services to adult patients. Among HCPs included in this study, 405 of 577 (70%) and 315 of 505 (62%) perceived they were very/completely confident in counseling HPV vaccine-hesitant parents and adult patients, respectively. Compared to HCPs who received no training, those who received formal training in HPV vaccination promotion or counseling had 2.56 (AOR: 2.56; 95% CI:1.69-3.86) and 2.84 times higher odds (AOR: 2.84; 95% CI:1.87-4.33) of perceiving that they were very/completely confident in counseling HPV vaccine-hesitant parents and adult patients, respectively. Additionally, increasing years of practice and volume of patients seen were positively associated with being very/completely confident in counseling HPV vaccine-hesitant parents and adult patients. On the other hand, nurses were less likely than physicians to be very/completely confident in counseling HPV vaccine-hesitant parents. To increase HPV vaccination uptake, HCPs should receive tailored training to improve their self-efficacy in addressing HPV vaccine-hesitancy.
Collapse
Affiliation(s)
- Ikponmwosa Osaghae
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Charles Darkoh
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
| | | | - Wenyaw Chan
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, TX 75207, USA
| | - Paige Padgett Wermuth
- Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX 77030, USA
| | - Mala Pande
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sonia A. Cunningham
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sanjay Shete
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-(713)-745-2483; Fax: +1-(713)-563-4243
| |
Collapse
|
31
|
Ma Y, Han X, Li W, Yang Y, Xu Y, Liu D, Yang W, Feng L, Ma L. Self-reported vaccination-related behavior patterns among healthcare workers and the association with self-directed learning frequency: A nationwide cross-sectional survey. Front Public Health 2022; 10:951818. [PMID: 36339203 PMCID: PMC9634157 DOI: 10.3389/fpubh.2022.951818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/06/2022] [Indexed: 01/24/2023] Open
Abstract
Background Healthcare workers play an essential role in improving the public's vaccination uptake, but the full picture of such workers' engagement in vaccination-related behaviors has not been appropriately identified. According to the Integrated Theory of Health Behavior Change, self-directed learning may be a promising intervention for fostering engagement in vaccination-related behaviors, but the association between self-directed learning and such behaviors remains unclear. This study aimed to determine Chinese healthcare workers' level of engagement in behaviors for combatting vaccine-preventable diseases and assess the association between frequency of performing vaccine-focused SDL and engagement in vaccination-related behaviors. Materials and methods An online cross-sectional survey was conducted from January 27 to February 21, 2022, using the survey platform "wjx." Respondents were restricted to healthcare workers aged 18-65 years. A Sankey diagram and bar plots were constructed to determine patterns of engagement in a vaccination-related-behavior chain. Unconditional binary logistic regression models were fitted to determine the association between frequency of performing vaccine-focused self-directed learning and engagement in vaccination-related behaviors. Results Of the 2,248 survey respondents, data for 2,065 were analyzed. Participants who had received influenza or pneumococcal vaccination, routinely recommended vaccination to patients, tracked patients' vaccination status, and recommended efficiently accounted for 43.2%, 50.8%, 40.3%, and 36.4% of the total participants, respectively. When only considering those who routinely made such recommendations, the proportion of those who performed tracking and efficient recommendation was 28.8% and 26.2%, respectively. When compared to performing self-directed learning "never to less than once/six months," performing self-directed learning "more than once/week" was positively associated with being vaccinated (OR, 95% CI: 2.30, 1.74-3.03), routinely recommending vaccination (OR, 95% CI: 4.46, 3.30-6.04), and tracking the status of patients so recommended (OR, 95% CI: 6.18, 4.35-8.76). Conclusions Chinese healthcare workers' pattern of engagement in vaccination-related behaviors must be improved. Higher frequencies of engagement in self-directed learning are associated with more active engagement in vaccination-related behaviors, meaning raising such frequencies could be a promising intervention for fostering behavior changes in this regard and ultimately increasing vaccination coverage.
Collapse
Affiliation(s)
- Yuan Ma
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuan Han
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Li
- Center for Applied Statistics and School of Statistics, Renmin University of China, Beijing, China
| | - Yuan Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yunshao Xu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Di Liu
- “Breath Circles” Network Platform, Beijing, China
| | - Weizhong Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Luzhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Luzhao Feng
| | - Libing Ma
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Guilin Medical University, Guilin, China,Libing Ma
| |
Collapse
|
32
|
Kataria I, Siddiqui M, Treiman K, Foley S, Anand M, Biswas S, Shastri D, Bhatla N, Radhakrishnan D, Mamidi P, Sankaranarayanan R. Awareness, perceptions, and choices of physicians pertaining to human papillomavirus (HPV) vaccination in India: A formative research study. Vaccine X 2022; 12:100228. [PMID: 36317080 PMCID: PMC9617192 DOI: 10.1016/j.jvacx.2022.100228] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 08/26/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction India accounts for one-fifth of the global burden of cervical cancer cases and mortality. A safe and effective vaccine to prevent human papillomavirus (HPV) infections, the primary cause of cervical malignancies, is available in India but multiple barriers lead to its low uptake in the country. Physicians are a key stakeholder and communicator in the Indian health system and have the potential to increase HPV vaccine uptake. Objective We undertook formative research to understand awareness, perceptions and choices of physicians when recommending the HPV vaccine to parents of adolescent girls. Methods We conducted in-depth interviews with 32 physicians in two districts of West Bengal. Data collection was carried out between July and August 2019. The data was transcribed, coded, and analyzed using NVivo software using the thematic analysis technique. Results Our findings suggest that while physicians are generally aware about the burden of cervical cancer and its prevention by HPV vaccination, they face several barriers to recommending the HPV vaccine routinely and strongly. These include the lack of national-level guidance on the age eligibility and dosage, lack of practice-level opportunities such as well or non-sick visits and other routine adolescent vaccines, practice-level barriers like out-of-pocket cost and vaccine availability, and perceived parental hesitancy arising from reluctance to discuss cervical cancer, its prevention, and HPV vaccination. Conclusions Physicians in our study exhibited hesitancy when recommending the HPV vaccine. They also faced logistical barriers. It is important that the barriers pertaining to when and how physicians recommend the vaccine be tackled through further education, policy change, and development and implementation of interventions that are evidenced-based.
Collapse
Affiliation(s)
- Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, New Delhi, India
| | | | | | - Shaylen Foley
- American Cancer Society, Atlanta, GA, United States,Corresponding author.
| | - Meenu Anand
- American Cancer Society, Atlanta, GA, United States
| | | | | | - Neerja Bhatla
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Pavan Mamidi
- Centre for Social & Behaviour Change, Ashoka University, New Delhi, India
| | | |
Collapse
|
33
|
Akalin A. Knowledge and attitude towards human papillomavirus and its vaccination and affecting factors among nursing and medical students: a questionnaire study. J OBSTET GYNAECOL 2022; 42:3315-3321. [PMID: 36129449 DOI: 10.1080/01443615.2022.2124851] [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: 01/06/2023]
Abstract
The aim of this study was to investigate the knowledge about the Human Papillomavirus (HPV), HPV testing and HPV vaccinations and affecting factors among nursing and medical students and explore their attitudes regarding HPV vaccination. A cross-sectional study was conducted with 635 undergraduate nursing and medical students from March to June 2020 at a state university in Turkey. The data were collected using the Questionnaire Form and HPV Knowledge Scale (HPV-KS). The HPV-KS mean scores of the students were 17.07 ± 6.95. The students were aged 26 and over, females, had good economic status, registered at the faculty of medicine, at higher year of studies, had sexual experience and recommended HPV vaccination got higher knowledge scores regarding HPV, HPV testing and HPV vaccination (p ˂ .05). Despite low vaccination rate (2.0%), almost all the students recommended the HPV vaccine (95.9%). Sex, place of residence, faculty (departments), and year of study are among the significant predictor of knowledge about HPV, HPV testing and HPV vaccinations level up to 39% (p ˂ .05). This study highlights the need for further education and training are required to increase the knowledge about HPV, HPV testing and HPV vaccination, which may help increase awareness and improve the ratio of vaccination.IMPACT STATEMENTWhat is already known on this subject? Human papillomavirus (HPV) is one of the most common sexually transmitted diseases and most likely to cause cervical cancer. Prophylactic vaccine administrations is critical in primary protection from HPV.What the results of this study add? The study revealed the needs for education among nursing and medical students about HPV, HPV testing and HPV vaccines. Knowledge regarding HPV, HPV testing and HPV vaccines is statistically significantly associated with age, sex, economic status, place of residence, faculty, year of study, sexual experience and recommending HPV vaccines. Sex, place of residence, faculty, and year of study are among the statistically significant positive predictors for HPV knowledge.What the implications are of these findings for clinical practice and/or further research? Educators should increase education and/or training opportunities related to HPV among nursing and medical students who are the future healthcare providers and in the risky group for HPV during undergraduate education.
Collapse
Affiliation(s)
- Ayse Akalin
- Department of Nursing, Faculty of Health Sciences, Düzce University, Düzce, Turkey
| |
Collapse
|
34
|
Thompson EL, Preston SM, Francis JKR, Rodriguez SA, Pruitt SL, Blackwell JM, Tiro JA. Social Media Perceptions and Internet Verification Skills Associated With Human Papillomavirus Vaccine Decision-Making Among Parents of Children and Adolescents: Cross-sectional Survey. JMIR Pediatr Parent 2022; 5:e38297. [PMID: 36103216 PMCID: PMC9520398 DOI: 10.2196/38297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Human Papillomavirus (HPV) vaccination is recommended for children aged 11-12 years in the United States. One factor that may contribute to low national HPV vaccine uptake is parental exposure to misinformation on social media. OBJECTIVE This study aimed to examine the association between parents' perceptions of the HPV vaccine information on social media and internet verification strategies used with the HPV vaccine decision-making stage for their child. METHODS Parents of children and adolescents aged 9-17 years were recruited for a cross-sectional survey in North Texas (n=1192) and classified into 3 groups: children and adolescents who (1) were vaccinated, (2) unvaccinated and did not want the vaccine, and (3) unvaccinated and wanted the vaccine. Multinomial logistic regression models were estimated to identify factors associated with the HPV vaccine decision-making stage with children and adolescents who were vaccinated as the referent group. RESULTS Of the 1192 respondents, 44.7% (n=533) had an HPV-vaccinated child, 38.8% (n=463) had an unvaccinated child and did not want the vaccine, and 16.4% (n=196) had an unvaccinated child and wanted the vaccine. Respondents were less likely to be "undecided/not wanting the vaccine" if they agreed that HPV information on social media is credible (adjusted odds ratio [aOR] 0.40, 95% CI 0.26-0.60; P=.001), disagreed that social media makes them question the HPV vaccine (aOR 0.22, 95% CI 0.15-0.33; P<.001), or had a higher internet verification score (aOR 0.74, 95% CI 0.62-0.88; P<.001). CONCLUSIONS Interventions that promote web-based health literacy skills are needed so parents can protect their families from misinformation and make informed health care decisions.
Collapse
Affiliation(s)
- Erika L Thompson
- Department of Biostatistics & Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Sharice M Preston
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston School of Public Health, Dallas, TX, United States.,Department of Health Promotion & Behavioral Science, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Jenny K R Francis
- Department of Pediatrics, University of Texas Southwestern Medical Center; Children's Health, Dallas, TX, United States
| | - Serena A Rodriguez
- Department of Health Promotion & Behavioral Science, University of Texas Health Science Center at Houston School of Public Health, Dallas, TX, United States
| | - Sandi L Pruitt
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - James-Michael Blackwell
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Jasmin A Tiro
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| |
Collapse
|
35
|
Levy MS, Finch L, Lindsay KA, Jeudin P, Huang M. Leveraging teachable moments in cancer prevention by improving HPV vaccination in health professional students (HPS): A systematic review. Front Oncol 2022; 12:978843. [PMID: 36106117 PMCID: PMC9467466 DOI: 10.3389/fonc.2022.978843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionVaccination against HPV is safe and effective in cancer prevention, yet vaccination uptake remains low. Strong recommendation of HPV vaccination by healthcare providers increases immunization rates, but gaps in knowledge persist surrounding HPV and HPV vaccination amongst health professional students (HPS). It is critical to educate HPS in all professions to maximize vaccination opportunities and increase vaccine uptake. The objective of this study is to evaluate evidence on HPV knowledge, vaccine uptake, and educational interventions in HPS to identify specific deficits to improve education.MethodsA systematic literature search for articles on HPV vaccine uptake, knowledge, and educational interventions in HPS was performed in PubMed, Embase, Web of Science, CINAHL, and Scopus from January 1, 2006 – July 21, 2021. Included studies assessed HPS for HPV vaccine uptake, knowledge, counseling comfort, or educational interventions to increase HPV vaccine knowledge. Studies were screened for inclusion by 2 independent reviewers and evaluated for risk of bias. PRISMA guidelines for reporting were followed.ResultsTwenty-one unique articles met inclusion criteria and were included in the analysis. Of the studies included, 20 included knowledge, 11 included vaccine uptake, 8 included interventions, and 12 included counseling comfort. The students in the studies included medical (n=14), dental (n=7), dental hygiene (n=6), nursing (n=3), physician assistant (n=2), public health (n=1), and pharmacy (n=1). Across studies, HPV vaccine series initiation ranged from 34.6-70.3%, with 28.3-58.3% up to date on vaccination. Most students knew that HPV causes cervical cancer (99%), but fewer knew that HPV causes head and neck cancer (40-47%) and oropharyngeal cancer (45%). Educational interventions included team-based approaches and lectures, and improved outcomes including vaccine knowledge, vaccination schedule, and cancer knowledge. Medical students with lower knowledge of HPV were more hesitant to recommend vaccination at baseline but were more likely to recommend vaccination after an education session.DiscussionAcross HPS, inadequacies persist in HPV vaccine uptake, knowledge, and counseling comfort. It is critical to target vaccine uptake in this population and improve existing educational efforts to reduce preventable cancers. Institutions must prioritize HPV vaccine education to impact HPV related death.
Collapse
Affiliation(s)
- Morgan S. Levy
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Lindsey Finch
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Jackson Memorial Hospital, Miami, FL, United States
| | - Kara A. Lindsay
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Patricia Jeudin
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center/University of Miami Miller School of Medicine, Miami, FL, United States
| | - Marilyn Huang
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center/University of Miami Miller School of Medicine, Miami, FL, United States
- *Correspondence: Marilyn Huang,
| |
Collapse
|
36
|
Johnson RR, Cox DA, Deupree J. Assessment of Health Literacy in College-Age Females to Reduce Barriers to Human Papilloma Virus Vaccination. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
37
|
Wong LP, Alias H, Seheli FN, Zimet GD, Hu Z, Lin Y. Human papillomavirus (HPV) vaccination intent and its associated factors: a study of ethnically diverse married women aged 27 to 45 in Malaysia, a Southeast Asian country. Hum Vaccin Immunother 2022; 18:2076525. [PMID: 35714272 PMCID: PMC9481129 DOI: 10.1080/21645515.2022.2076525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction This study aimed to investigate HPV vaccination intention among adult married women aged 27 to 45 years and its associated factors, and their spouse/partner’s influence on HPV vaccination decision-making. Methods This is a cross-sectional, questionnaire-based study. Study participants were recruited through simple random sampling of patients attending obstetrics and gynecology outpatient clinics in a university teaching hospital. Participants were selected based on a computer-generated list of a random list of patients attending the clinic. Results A total of 794 complete responses were received (response rate 88.2%). The mean age of the respondents was 32.2 years with a standard deviation (SD) of ±3.9 years.The vast majority (85.3%) would communicate with their spouse/partner with regard to HPV vaccination decision-making. Nearly 30% (over half were of the Malay ethnic group) perceived their spouse/partner would not consent to their HPV vaccination. Over half (54.9%) reported joint decision-making, and 9.1% (the majority of whom were Malay) reported that HPV vaccination was dependent on their spouse/partner’s decision. Intention to vaccinate against HPV was high (74.5%). Factors influencing HPV vaccination intention were spouse/partner’s consent to HPV vaccination (odds ratio [OR] = 4.51; 95% confidence interval [CI], 3.08–6.62), being a postgraduate student (OR = 4.55; 95% CI, 2.13–9.72 vs. unemployed/housewife), average household income MYR2000–4000 (OR = 2.09; 95%CI, 1.16–3.78 vs. below MYR2000), and an HPV-related knowledge score of 9–20 (OR = 1.60; 95% CI, 1.10–2.32 vs. score 0–8). Conclusion Findings highlight the importance of culture-centered interventions to enhance male partner’s awareness and support for the HPV vaccination of married women.
Collapse
Affiliation(s)
- Li Ping Wong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.,Department of Epidemiology and Health Statistics, The School of Public Health, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Haridah Alias
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Farhana Nishat Seheli
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Gregory D Zimet
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, The School of Public Health, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Yulan Lin
- Department of Epidemiology and Health Statistics, The School of Public Health, Fujian Medical University, Fuzhou, Fujian Province, China
| |
Collapse
|
38
|
González-Cano-Caballero M, García-Gámez M, Fernández-Fernández E, Fernández-Ordoñez E, Cano-Caballero MD, Guerra-Marmolejo C. Continuing education programme on vaccines for primary healthcare professionals: mixed-method protocol. BMJ Open 2022; 12:e060094. [PMID: 35697454 PMCID: PMC9196173 DOI: 10.1136/bmjopen-2021-060094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Vaccination is a fundamental intervention in disease prevention; therefore, the advice and recommendations of health professionals have a major influence on the population's decision to be vaccinated or not. Professionals must have sufficient competencies to carry out their work and recommend vaccination with evidence-based knowledge. The aim is to design and validate a strategy to improve professional competencies in vaccination to positively influence adherence and increase vaccination rates in the population. METHODS AND ANALYSIS Training will be designed based on evidence and previous studies and piloted with healthcare providers. To test changes in knowledge, a pretest and post-test will be conducted. To test feasibility, a think-aloud method will be used with participants and triangulated with focus groups using SWOT (strengths, weaknesses, opportunities and threats) analysis. Transfer will be measured using the questionnaire 'factors for the indirect evaluation of transfer' and an efficacy questionnaire 1½ months later; for satisfaction, an ad hoc questionnaire will be used. A summative approach will be used for the analysis of the focus groups and descriptive and bivariate statistics for the questionnaires. ETHICS AND DISSEMINATION This study was approved by the Andalusian Research Ethics Committee, Spain (approval number: 0524-N-20). The results will be made available to the public at journal publications and scientific conferences.
Collapse
Affiliation(s)
| | - Marina García-Gámez
- Department of Nursing, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | | | | | | | | |
Collapse
|
39
|
Siddiqui FA, Padhani ZA, Salam RA, Aliani R, Lassi ZS, Das JK, Bhutta ZA. Interventions to Improve Immunization Coverage Among Children and Adolescents: A Meta-analysis. Pediatrics 2022; 149:186948. [PMID: 35503337 DOI: 10.1542/peds.2021-053852d] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Vaccinations are recognized as a feasible, cost-effective public health intervention for reducing the burden and associated mortality of many infectious diseases. The purpose of this study was to evaluate the effectiveness of potential interventions to improve the uptake of vaccines among children and adolescents. METHODS We performed a literature search until December 2020. Eligible studies were identified using Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, and other sources. We included studies conducted on children and adolescents aged 5 to 19 years. Studies comprised of hospitalized children and those with comorbid conditions were excluded. Two authors independently performed the meta-analysis. RESULTS Findings from 120 studies (123 articles), of which 95 were meta-analyzed, reveal that vaccination education may increase overall vaccination coverage by 19% (risk ratio [RR], 1.19; 95% confidence interval [CI], 1.12-1.26), reminders by 15% (RR, 1.15; 95% CI, 1.11-1.18), interventions for providers by 13% (RR, 1.13; 95% CI, 1.07-1.19), financial incentives by 67% (RR, 1.67; 95% CI, 1.40-1.99), and multilevel interventions by 25% (RR, 1.25; 95% CI, 1.10-1.41). The impact of school-based clinics and policy and legislation on overall vaccination coverage is still uncertain, and no impact of a multicomponent intervention on overall vaccination coverage was found. CONCLUSIONS Educational interventions, reminders, provider-directed interventions, financial incentives, and multilevel interventions may improve vaccination coverage among school-aged children and adolescents.
Collapse
Affiliation(s)
- Faareha A Siddiqui
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Zahra A Padhani
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Razia Aliani
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Zohra S Lassi
- Robinson Research Institute, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan.,Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada
| |
Collapse
|
40
|
Lindsay AC, Delgado D, Valdez MJ, Restrepo E, Granberry P. "Everyone in our community should be informed about the HPV vaccine": Latinx mothers' suggested strategies to promote the human papillomavirus vaccine. Am J Health Promot 2022; 36:853-863. [PMID: 35081770 DOI: 10.1177/08901171211073960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Parents play a critical decision-making role in vaccinating their children against HPV, and mothers, in particular, are key stakeholders as they are often the parent taking their children to healthcare visits. Given the importance of the HPV vaccination as a cancer prevention strategy, this study was designed to explore Latinx mothers' suggested strategies to promote vaccine uptake among Latinx parents. SETTING AND PARTICIPANTS Community-based in Massachusetts, United States, and Latinx mothers. DESIGN AND METHODS Descriptive qualitative research employing individual semi-structured interviews. Data were analyzed using a hybrid method of thematic analysis incorporating deductive and inductive approaches. RESULTS Twenty-two, majority foreign-born (91%) Latinx mothers of adolescent girls (∼60%) and boys (∼40%) aged 11-19 years participated. Mothers suggested several strategies to promote uptake of the HPV vaccine among Latinx families including healthcare providers' increased communication and anticipatory guidance addressing factors influencing parents' HPV vaccination hesitancy, and improved community-wide dissemination of culturally and linguistically relevant information targeting not only parents of age-eligible participants but the broader community. Finally, mothers suggested the use of social media using personal narratives and an enhanced active role of schools in providing accurate information to raise awareness and educate adolescents and parents about the importance of HPV vaccination. CONCLUSION Findings are relevant to the development of tailored interventions to meet the needs of Latinx populations, and ultimately increase Latinx children's HPV vaccination rates.
Collapse
Affiliation(s)
| | | | | | - Emily Restrepo
- Exercise and Health Sciences14708University of Massachusetts Boston
| | | |
Collapse
|
41
|
Grewal R, Deeks SL, Hart TA, Cox J, De Pokomandy A, Grennan T, Lambert G, Moore D, Coutlée F, Gaspar M, George C, Grace D, Jollimore J, Lachowsky NJ, Nisenbaum R, Ogilvie G, Sauvageau C, Tan DHS, Yeung A, Burchell AN. Human papillomavirus (HPV) vaccination across a cascade of knowledge, willingness, and uptake among gay, bisexual, and other men who have sex with men in Canada's three largest cities. Hum Vaccin Immunother 2021; 17:5413-5425. [PMID: 34856869 DOI: 10.1080/21645515.2021.1979379] [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: 10/19/2022] Open
Abstract
BACKGROUND Some Canadian jurisdictions offer publicly funded HPV vaccine to gay, bisexual, and other men who have sex with men (GBM) aged ≤26 years. We characterized factors associated with being in different stages of HPV vaccination. METHODS Engage is a sexual health study of GBM in the three largest Canadian cities recruited via respondent driven sampling (RDS). We categorized participants as: (1) unaware of HPV vaccine, (2) undecided/unwilling to get vaccinated, (3) willing to get vaccinated, (4) vaccinated with one or more doses. Our RDS-II weighted analyses used multinomial logistic regression to identify factors associated with being in earlier stages of the cascade compared to Stage 4. RESULTS Across the cities, 26-40%, 7-14%, 33-39%, and 13-28% were in Stages 1 to 4, respectively. Compared to Stage 4, being in earlier stages of the cascade was associated with bisexual-identification (Stage 1: adjusted odds ratio[aOR] = 2.84, 95% confidence interval[CI] = 1.06-7.62; Stage 2: aOR = 3.09, 95%CI = 1.19-8.05), having immigrated to Canada (Stage 1: aOR = 1.79, 95%CI 1.07-2.99), preference to keep same-sex romantic relationships private (Stage 1: aOR = 1.25, 95% CI = 1.05-1.48; Stage 2: aOR = 1.24, 95%CI = 1.05-1.46), not receiving sexual health information (Stage 1: aOR = 0.31, 95% CI = 0.13-0.71; Stage 2: aOR = 0.27, 95%CI = 0.12-0.64), not accessing a health-care provider (Stage 2: aOR = 0.36, 95%CI = 0.15-0.83), and no past hepatitis A/B vaccination (Stage 1: aOR = 0.16, 95% CI = 0.09-0.30; Stage 2: aOR = 0.18, 95%CI = 0.09-0.35; Stage 3: aOR = 0.38, 95%CI = 0.21-0.61). DISCUSSION Interventions are needed to reduce social and financial barriers, increase sexual health knowledge, and improve GBM-competent health-care access to increase vaccine uptake among GBM.
Collapse
Affiliation(s)
- R Grewal
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - S L Deeks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Nova Scotia Department of Health and Wellness, Halifax, Canada
| | - T A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Psychology, Ryerson University, Toronto, Canada
| | - J Cox
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Montréal, McGill University.,Direction régionale de santé publique, CIUSSS-Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
| | - A De Pokomandy
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - T Grennan
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - G Lambert
- Direction régionale de santé publique, CIUSSS-Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
| | - D Moore
- Department of Medicine, University of British Columbia, Vancouver, Canada.,BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - F Coutlée
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Canada.,Department of Microbiology and Immunology, Université de Montréal, Montréal, Canada
| | - M Gaspar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - C George
- Department of Exercise, Health, and Sport Sciences, University of Maine, Portland, USA
| | - D Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - J Jollimore
- Community-Based Research Centre, Vancouver, Canada
| | - N J Lachowsky
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Community-Based Research Centre, Vancouver, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - R Nisenbaum
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Applied Health Research Centre, Unity Health Toronto, Toronto, Canada
| | - G Ogilvie
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - C Sauvageau
- Faculty of Medicine, Université Laval, Québec City, Canada.,Institut National de santé publique du Québec, Québec, Canada
| | - D H S Tan
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - A Yeung
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - A N Burchell
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
42
|
Francis JK, Rodriguez SA, Dorsey O, Blackwell JM, Balasubramanian BA, Kale N, Day P, Preston SM, Thompson EL, Pruitt SL, Tiro JA. Provider perspectives on communication and dismissal policies with HPV vaccine hesitant parents. Prev Med Rep 2021; 24:101562. [PMID: 34976628 PMCID: PMC8683895 DOI: 10.1016/j.pmedr.2021.101562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 11/16/2022] Open
Abstract
Parental vaccine hesitancy is a growing concern. Less is known about provider or practice characteristics that encounter HPV-specific vaccine-hesitant parents, the providers' confidence in responding to HPV vaccine concerns, and the attitudes and use of vaccine dismissal policies (i.e., removing patients from the practice). North Texas providers completed an online survey. Dependent variables assessed: (1) percentage of HPV vaccine-hesitant parents encountered in practice defined as substantive, or high (≥11%, or among more than one out of ten adolescent patient encounters) versus low (≤10%) levels; (2) confidence in responding to 11 HPV vaccine concerns; (3) attitudes and use of vaccine dismissal policies. Chi-square and Fisher's exact tests were conducted. Among 156 providers, 29% reported high HPV vaccine hesitancy (≥11% of patient population). Overall, providers reported being "very confident" in addressing vaccine concerns (mean: 3.37 out of 4, SD: 0.57). Mean confidence scores were significantly higher for white (vs. non-white) providers and for pediatricians (vs. family practitioners). Providers were least confident in responding to parents' religious/personal beliefs (69%). Some providers (25%) agreed with policies that dismissed vaccine-hesitant parents after repeated counseling attempts. More providers used dismissal policies for childhood (19%) than adolescent (10%) immunizations. Provider communication training should include parental religious/personal beliefs to effectively address HPV vaccine hesitancy. Other regions should examine their HPV-specific vaccine hesitancy levels to understand how the use of dismissal policies might vary between adolescent and childhood immunizations.
Collapse
Affiliation(s)
- Jenny K.R. Francis
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
- Children’s Health, Dallas, TX
| | - Serena A. Rodriguez
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Olivia Dorsey
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - James-Michael Blackwell
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Bijal A. Balasubramanian
- Department of Epidemiology, Human Genetics, and Environmental Science, UTHealth School of Public Health, Houston, TX
| | - Neelima Kale
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, KY
| | - Philip Day
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA
| | - Sharice M. Preston
- Department of Health Promotion and Behavioral Science, UTHealth School of Public Health, Dallas, TX
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, TX
| | - Erika L. Thompson
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX
| | - Sandi L. Pruitt
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jasmin A. Tiro
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
43
|
Vu M, Bednarczyk RA, Escoffery C, Ta D, Huynh VN, Berg CJ. U.S. Vietnamese parents' HPV vaccine decision-making for their adolescents: an exploration of practice-, provider-, and patient-level influences. J Behav Med 2021; 45:197-210. [PMID: 34792723 PMCID: PMC8600911 DOI: 10.1007/s10865-021-00265-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 11/04/2021] [Indexed: 12/15/2022]
Abstract
U.S. Vietnamese have high cervical cancer incidence and low human papillomavirus (HPV) vaccine initiation. Using the P3 model, we explored practice-, provider-, and patient-level determinants of U.S. Vietnamese parents’ HPV vaccine decision-making for their adolescents. We conducted a cross-sectional, online survey (04/2020–12/2020) with U.S. Vietnamese parents who had ≥ 1 adolescent ages 9–18. We assessed HPV vaccination outcomes (initiation, willingness to initiate, completion) and provider recommendation. Modified Poisson regressions were used to identify practice-, provider- and patient-level correlates of outcomes. The sample (n = 408) was 44 years old on average; 83% were female and 85% had a Bachelor’s degree. Around half of adolescents were female (51%) and 13–18 year old (54%). Only 41 and 23% of parents had initiated and completed the HPV vaccine series for their child, respectively. Initiation was associated with receiving provider recommendation (either low- or high-quality), while willingness to initiate was associated with receiving high-quality recommendation. Both initiation and willingness to initiate was negatively associated with parental perception that their child was too young for a “sexually transmitted infection (STI)-preventing vaccine.” Provider recommendation was associated with higher parental U.S. acculturation and the child being older and female. Provider-facing interventions should promote high-quality, age-based, gender-neutral HPV vaccine recommendation. These and population- and individual-facing interventions should recognize the need for additional parental education, particularly related to misconceptions regarding STI prevention.
Collapse
Affiliation(s)
- Milkie Vu
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Danny Ta
- Neil Hodgson Woodruff School of Nursing, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Victoria N Huynh
- Emory College of Arts and Sciences, Emory University, Atlanta, GA, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute of Public Health, George Washington University, Washington, DC, USA.,George Washington Cancer Center, George Washington University, Washington, DC, USA
| |
Collapse
|
44
|
Tucker J, Sarsfield E, Choi KY, Goyal N. Educating School Nurses about Human Papillomavirus (HPV) Associated Cancers and the Importance of HPV Vaccination. J Community Health Nurs 2021; 38:201-208. [PMID: 34787044 DOI: 10.1080/07370016.2021.1972244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To assess and improve school nurse knowledge of HPV-associated cancers. DESIGN An experimental quality improvement study. METHODS At a continuing education regional conference, an interactive HPV education session was provided. Pre- and post-education surveys were completed by attendees. FINDINGS After the educational intervention, 89.9% of nurses indicated a change in knowledge and 83.2% indicated a planned change in practice. CONCLUSIONS An education intervention aimed at school nurses can be impactful in broadening the understanding of HPV oncogenesis. CLINICAL EVIDENCE Educational interventions can be a strategy to increase school nurse knowledge and subsequently patient knowledge about HPV associated cancers.
Collapse
Affiliation(s)
- Jacqueline Tucker
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Erin Sarsfield
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA.,Penn State Health, Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Karen Y Choi
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA.,Department of Otolaryngology, Head and Neck Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA.,Penn State Health, Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Neerav Goyal
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA.,Department of Otolaryngology, Head and Neck Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA.,Penn State Health, Penn State Cancer Institute, Hershey, Pennsylvania, USA
| |
Collapse
|
45
|
Torabi SJ, Su-Velez BM, Kasle DA, Yarbrough WG, St John M, Judson BL. Assessing Human Papillomavirus Awareness and the Role of Oropharyngeal Squamous Cell Carcinoma Education on Improving Intention to Vaccinate. Laryngoscope 2021; 132:528-537. [PMID: 34383306 DOI: 10.1002/lary.29805] [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] [Received: 07/15/2021] [Accepted: 07/27/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES/HYPOTHESIS The current state of the U.S. public's knowledge of the relationship between human papillomavirus (HPV) and HPV vaccinations to oropharyngeal squamous cell carcinoma (OPSCC) is unknown. Our objective was to 1) assess the general population's knowledge of human papillomavirus (HPV) and willingness to vaccinate, and 2) assess whether targeted education on HPV-related OPSCC can change intentions to vaccinate. STUDY DESIGN Online cross-sectional survey. METHODS An online, cross-sectional survey utilizing U.S. census-derived quotas to represent the U.S. population was distributed and analyzed to 517 adults in 2020. RESULTS Exactly 72.7% of participants stated that they had or would vaccinate their child against HPV and were designated as "vaccinators." In multivariate regression, Black individuals were less likely to be vaccinators (OR 0.51 [95% CI 0.27-0.94]), but those who were aware of HPV's role in OPSCC were more likely to vaccinate (OR 2.56 [95% CI 1.47-4.46]). Knowledge about vaccination side-effects, eligibility, and mechanisms of HPV spread was low. Only 30.6% of the sample reported understanding the role of HPV in OPSCC. Of these, 43.0% gained this knowledge exclusively from nonhealthcare professional sources, like television. When presented with four short HPV-OPSCC-centered facts (HPV's role in OPSCC etiology, prevalence of infection, clinically silent course, and vaccine preventative effects), 54.0% of "nonvaccinators" indicated a willingness to change their minds. CONCLUSIONS General knowledge about HPV, HPV's role in OPSCC, and the vaccine remains low in the general population. There are racial disparities in willingness to vaccinate within this sample, but these may be overcome by effective education on HPV-related OPSCC. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
Collapse
Affiliation(s)
- Sina J Torabi
- Department of Surgery (Section of Otolaryngology), Yale University School of Medicine, New Haven, Connecticut, U.S.A.,Depart of Otolaryngology - Head and Neck Surgery, University of California, Irvine, Orange, California, U.S.A
| | - Brooke M Su-Velez
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, California, U.S.A
| | - David A Kasle
- Department of Surgery (Section of Otolaryngology), Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Wendell G Yarbrough
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, U.S.A.,Department of Pathology, UNC School of Medicine, Chapel Hill, North Carolina, U.S.A.,Lineberger Comprehensive Cancer Center, UNC School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Maie St John
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, California, U.S.A.,UCLA Head and Neck Cancer Program, David Geffen School of Medicine at University of California, Los Angeles, California, U.S.A
| | - Benjamin L Judson
- Department of Surgery (Section of Otolaryngology), Yale University School of Medicine, New Haven, Connecticut, U.S.A.,Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, U.S.A
| |
Collapse
|
46
|
Regular Healthcare Provider Status Does Not Moderate Racial/Ethnic Differences in Human Papillomavirus (HPV) and HPV Vaccine Knowledge. Vaccines (Basel) 2021; 9:vaccines9070802. [PMID: 34358219 PMCID: PMC8310170 DOI: 10.3390/vaccines9070802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/11/2021] [Accepted: 07/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Racial/ethnic minorities generally have a lower knowledge of human papillomavirus (HPV) and the HPV vaccine than non-Hispanic Whites. They are also less likely to have a regular healthcare provider (HCP). Given the role of HCPs in disseminating health information, we evaluated whether racial/ethnic disparities in HPV knowledge are moderated by regular HCP status. Methods: Data from the Health Information National Trends Survey Five (HINTS 5) Cycles One and Two (2017–2018) were analyzed. HPV and HPV vaccine knowledge were compared by regular HCP status across race/ethnicities. Independent partially-adjusted multivariable logistic regression models were used to assess the association between race/ethnicity and knowledge after controlling for sociodemographic characteristics. The resulting adjusted odds ratios were compared to those from fully-adjusted models that included HCP status. Results: After adjusting for regular HCP status, differences in knowledge persisted between racial/ethnic groups. Compared to Whites, Hispanics and Other race/ethnicities had significantly lower odds of having heard of HPV. Blacks, Hispanics, and Other race/ethnicities had significantly lower odds of having heard of the HPV vaccine. Conclusion: Racial/ethnic minorities had significantly lower levels of knowledge despite HCP status. These data suggest the need to address disparities in health information and strengthen provider–patient communication regarding HPV and the HPV vaccine.
Collapse
|
47
|
Kang BS, Lee SH, Kim WJ, Wie JH, Park IY, Ko HS. Influenza vaccination during pregnancy and influencing factors in Korea: A multicenter questionnaire study of pregnant women and obstetrics and gynecology doctors. BMC Pregnancy Childbirth 2021; 21:511. [PMID: 34271867 PMCID: PMC8285826 DOI: 10.1186/s12884-021-03984-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 07/07/2021] [Indexed: 01/13/2023] Open
Abstract
Background Although the World Health Organization and health authorities in most countries recommend that pregnant women receive inactivated influenza virus vaccines, coverage remains low. This study aimed to investigate (1) the proportion of pregnant women who received an influenza vaccination and influencing factors and (2) the proportion of obstetrics and gynecology (OBGYN) doctors who routinely recommend influenza vaccination to pregnant women and influencing factors. Methods Two separate, anonymized questionnaires were developed for physicians and pregnant and postpartum women and were distributed to multicenters and clinics in South Korea. The proportions of women who received influenza vaccination during pregnancy and OBGYN doctors who routinely recommend the influenza vaccine to pregnant women were analyzed. Independent influencing factors for both maternal influenza vaccination and OBGYN doctors’ routine recommendations to pregnant women were analyzed using log-binomial regression analysis. Results The proportion of self-reported influenza vaccination during pregnancy among 522 women was 63.2%. Pregnancy-related independent factors influencing maternal influenza vaccination were “(ever) received information about influenza vaccination during pregnancy” (OR 8.9, 95% CI 4.17–19.01), “received vaccine information about from OBGYN doctors” (OR 11.44, 95% CI 5.46–24.00), “information obtained from other sources” (OR 4.38, 95% CI 2.01–9.55), and “second/third trimester” (OR 2.41, 95% CI 1.21–4.82).. Among 372 OBGYN doctors, 76.9% routinely recommended vaccination for pregnant women. Independent factors effecting routine recommendation were “working at a private clinic or hospital” (OR 5.33, 95% CI 2.44–11.65), “awareness of KCDC guidelines” (OR 3.11, 95% CI 1.11–8.73), and “awareness of the 2019 national free influenza vaccination program for pregnant women” (OR 4.88, 95% CI 2.34–10.17). OBGYN doctors most commonly chose ‘guidelines proposed by the government or public health (108, 46%) and academic committees (59, 25%), as a factor which expect to affect the future recommendation Conclusion This study showed that providing information about maternal influenza vaccination, especially by OBGYN doctors, is crucial for increasing vaccination coverage in pregnant women. Closer cooperation between the government and OBGYN academic societies to educate OBGYN doctors might enhance routine recommendations. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03984-2.
Collapse
Affiliation(s)
- Byung Soo Kang
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - San Ha Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Woo Jeng Kim
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Ha Wie
- Department of Obstetrics and Gynecology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Yang Park
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Sun Ko
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| |
Collapse
|
48
|
Lin C, Mullen J, Smith D, Kotarba M, Kaplan SJ, Tu P. Healthcare Providers' Vaccine Perceptions, Hesitancy, and Recommendation to Patients: A Systematic Review. Vaccines (Basel) 2021; 9:vaccines9070713. [PMID: 34358132 PMCID: PMC8310254 DOI: 10.3390/vaccines9070713] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 12/13/2022] Open
Abstract
Despite vaccines' effectiveness in reducing the rate of preventable diseases, vaccine hesitancy has threatened public health and economies worldwide. Healthcare providers' (HCP) communications and behavior strongly influence patient receptivity and uptake. The goal of this review was to examine HCP vaccine perceptions, knowledge, and reservations and how these attitudes affect their recommendations and vaccination practices. Primary research studies published by 16 September 2020 were searched in PubMed, Web of Science, Embase, CINAHL, and PsycINFO. A 14-item scale was developed for survey study and risk of bias appraisal (SSRBA). In total, 96 papers from 34 countries were included, covering 17 vaccines (HPV and influenza vaccines the most studied). Recommendation was positively associated with provider knowledge and experience, beliefs about disease risk, and perceptions of vaccine safety, necessity, and efficacy. HCP vaccination attitudes and practices varied across specialties, vaccines, and countries; demographic impact was inconclusive. Barriers included anticipation of patient/parental concerns or refusal, lacking clear guidelines, time constraints, and cost. For HPV, vaccines were more often recommended to older, female adolescents and by physicians who discussed sexual health. HCPs are vital advocates for patients and the public, but studies indicated a prevalence of provider hesitancy pertaining to inadequate knowledge, low vaccine confidence, and suboptimal uptake themselves. Improving HCP knowledge and assuring their access to information they deem trustworthy are essential to supporting HCPs' role as "trusted messengers" to promote vaccine acceptance.
Collapse
Affiliation(s)
- Cheryl Lin
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (D.S.); (M.K.)
| | - Jewel Mullen
- Dell Medical School, The University of Texas at Austin, Austin, TX 78712, USA;
| | - Danielle Smith
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (D.S.); (M.K.)
| | - Michaela Kotarba
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (D.S.); (M.K.)
| | - Samantha J. Kaplan
- Medical Center Library and Archives, Duke University, Durham, NC 27710, USA;
| | - Pikuei Tu
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (D.S.); (M.K.)
- Correspondence:
| |
Collapse
|
49
|
Alsous MM, Ali A, Al-Azzam S, Karasneh R, Amawi H. Knowledge about cervical cancer and awareness about human papillomavirus vaccination among medical students in Jordan. PeerJ 2021; 9:e11611. [PMID: 34178471 PMCID: PMC8214844 DOI: 10.7717/peerj.11611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/24/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives To assess the knowledge about cervical cancer and HPV infection and the awareness towards and perceived barriers of HPV vaccination amid medical students in Jordan. Methods The present study is a cross-sectional survey that was conducted for a period of three months in the College of Medicine at six different universities in Jordan. Third-year to sixth-year students from these medical colleges in Jordan were invited to participate in the study. Results There were 504 students that took part in the study with 42.3% being males and 57.7% females. The mean knowledge score of students in our survey was 21.4 ± 4.4 out of 34, which was categorized as a moderate level of knowledge regarding cervical cancer and HPV. Only 40.5% knew about the availability of the HPV vaccine in Jordan, and 65.9% accepted the idea that it is necessary to introduce the HPV vaccine for school girls in Jordan. Conclusions This study highlights that there is inadequate knowledge about cervical cancer and its screening among medical students in Jordan. Despite the limited awareness about the HPV vaccine among the study’s participants, there is a favorable opinion towards the introduction of the vaccine for school girls in Jordan. The data provide a benchmark on the level of knowledge about cervical cancer and awareness about HPV, which can be used to formulate an effective awareness program.
Collapse
Affiliation(s)
- Mervat M Alsous
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, Irbid Governorate, Jordan
| | - Ahlam Ali
- Medical Biology Centre, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Sayer Al-Azzam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Irbid Governorate, Jordan
| | - Reema Karasneh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Irbid Governorate, Jordan
| | - Haneen Amawi
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, Irbid Governorate, Jordan
| |
Collapse
|
50
|
McFadden SM, Ko LK, Shankar M, Ibrahim A, Berliner D, Lin J, Mohamed FB, Amsalu F, Ali AA, Jang SH, Winer RL. Development and evaluation of an online continuing education course to increase healthcare provider self-efficacy to make strong HPV vaccine recommendations to East African immigrant families. Tumour Virus Res 2021; 11:200214. [PMID: 33647533 PMCID: PMC7944093 DOI: 10.1016/j.tvr.2021.200214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/03/2021] [Accepted: 02/17/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To develop and evaluate an online continuing education (CE) course designed to improve healthcare provider self-efficacy to make strong adolescent HPV vaccine recommendations to East African immigrant families. METHODS Focus groups with providers and East African immigrant mothers informed course development. Providers serving East African immigrant families were recruited to view the course and complete pre-/post-test and two-month follow-up surveys. Pre-/post differences were compared with paired t-tests. RESULTS 202 providers completed the course and pre-/post-test; 158 (78%) completed two-month follow-up. Confidence to make strong HPV vaccine recommendations to East African families increased from 68% pre-test to 98% post-test. Confidence to address common parental concerns also increased: safety, 54% pre-test, 92% post-test; fertility, 55% pre-test, 90% post-test; child too young, 68% pre-test, 92% post-test; and pork gelatin in vaccine manufacturing, 38% pre-test, 90% post-test. Two-month follow-up scores remained high (97% for overall confidence, 94%-97% for addressing parental concerns). All pre-/post-test and pre-test/two-month follow-up comparisons were statistically significant (p < 0.05). CONCLUSIONS The online CE course focused on culturally appropriate strategies for making strong recommendations and addressing specific parental concerns was effective for increasing provider self-efficacy to recommend HPV vaccination to East African families. Similar courses could be tailored to other priority populations.
Collapse
Affiliation(s)
- SarahAnn M McFadden
- University of Washington School of Nursing, 1959 NE Pacific St, Box 357260, Seattle, WA, 98195, USA.
| | - Linda K Ko
- Division of Public Health Services, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M3-B232, Seattle, WA, 98102, USA; Department of Health Services, University of Washington School of Public Health, 3980 15th, Ave NE, Box 351621, Seattle, WA, 98195, USA.
| | - Megha Shankar
- Department of Medicine, University of Washington, 1959 NE Pacific St, Box 356421, Seattle, WA, 98195, USA.
| | - Anisa Ibrahim
- Department of Pediatrics, University of Washington, 1959 NE Pacific St, Box 356320, Seattle, WA, 98104, USA; Somali Health Board, 7050 32nd, AVE S, Seattle, WA, 98118, USA.
| | - Debra Berliner
- Public Health - Seattle & King County, Communicable Disease, Epidemiology, and Immunization Program, 401 5th(,) Ave., Seattle, WA, 98104, USA.
| | - John Lin
- Department of Epidemiology, University of Washington School of Public Health, 3980 15th, Ave NE, Box 351619, Seattle, WA, 98195, USA.
| | - Farah B Mohamed
- Somali Health Board, 7050 32nd, AVE S, Seattle, WA, 98118, USA; Department of Epidemiology, University of Washington School of Public Health, 3980 15th, Ave NE, Box 351619, Seattle, WA, 98195, USA.
| | - Fanaye Amsalu
- Department of Epidemiology, University of Washington School of Public Health, 3980 15th, Ave NE, Box 351619, Seattle, WA, 98195, USA.
| | - Ahmed A Ali
- Somali Health Board, 7050 32nd, AVE S, Seattle, WA, 98118, USA.
| | - Sou Hyun Jang
- Department of Sociology, Sungkyunkwan University, 25-2 Sungkyunkwan-ro, Jongno-gu, Seoul, 03063, South Korea.
| | - Rachel L Winer
- Department of Epidemiology, University of Washington School of Public Health, 3980 15th, Ave NE, Box 351619, Seattle, WA, 98195, USA.
| |
Collapse
|