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Adebola A, Charis E, Tristan N, Melinda I. Content validation of a Facebook HPV vaccination promotion intervention (#HPVvaxtalks) created for young Black adults (18-26 years old). Public Health Nurs 2024. [PMID: 38923608 DOI: 10.1111/phn.13356] [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: 08/23/2023] [Revised: 04/12/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Despite the expansion in human papillomavirus (HPV) vaccination recommendations, vaccine uptake and completion remain low among Black individuals. An 8-week Facebook intervention (#HPVvaxtalks) was developed to increase knowledge and awareness of HPV risk factors, risk perceptions, and vaccination intention and uptake. This article details the formative phase of experts' feedback and participants' satisfaction on the components of the #HPVvaxtalks for content useability, acceptability, relevance, and visual appeal to inform further refinements. METHOD A convenience sample of 5 experts and 13 young Black adults were invited to provide feedback on #HPVvaxtalks intervention content. The experts reviewed and provided feedback via a survey and open-ended questions. After incorporating suggestions from experts' feedback, 13 participants viewed #HPVvaxtalks posts, took part in a virtual focus group, and completed a survey. Qualitative data were thematically analyzed and integrated with survey results. RESULTS Experts and participants mean age were 41.9 ± 2.3 and 21.2 ± 1.9 years, respectively. Experts and participants reported positive ratings for intervention posts, including useability, acceptability, relevance, and visual appeal. Data provided areas for improvements of #HPVvaxtalks. CONCLUSION: Experts indicated strong content validity and participants showed satisfaction with #HPVvaxtalks content. Ensuring acceptability, relevance, and appeal of the intervention for the target population is an integral part of intervention development.
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Affiliation(s)
- Adegboyega Adebola
- Department of Nursing, University of Kentucky College of Nursing, Lexington, Kentucky, USA
| | - Ebikwo Charis
- Department of Nursing, University of Kentucky College of Nursing, Lexington, Kentucky, USA
| | - Ntego Tristan
- Department of Nursing, University of Kentucky College of Nursing, Lexington, Kentucky, USA
| | - Ickes Melinda
- Department of Kinesiology and Health Promotion, College of Education, University of Kentucky, Lexington, Kentucky, USA
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Tsegaye AT, Lin J, Cole AM, Szpiro A, Rao DW, Walson J, Winer RL. Adherence and Correlates of Cervical Cancer Screening Among East African Immigrant Women in Washington State. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02038-5. [PMID: 38849693 DOI: 10.1007/s40615-024-02038-5] [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: 12/14/2023] [Revised: 05/17/2024] [Accepted: 05/20/2024] [Indexed: 06/09/2024]
Abstract
INTRODUCTION Cervical cancer screening (CCS) among East African immigrants (EAI) in the USA is under explored. This study aimed to investigate adherence to CCS and its correlates among EAI. METHODS We identified 1664 EAI women (25-65 years) with ≥ 1 primary care clinic visit(s) between 2017 and 2018, using University of Washington (UW) Medicine electronic health record data. CCS adherence was defined as Pap testing within 3 years or human papillomavirus/Pap co-testing within 5 years. We used Poisson regression with robust standard errors to cross-sectionally estimate associations with correlates of adherence. Twelve-month screening uptake was also evaluated among overdue women. RESULTS CCS adherence was 63%. Factors associated with higher adherence included older age (adjusted prevalence ratios [APRs]:1.47:95%CI:1.14-1.90, 1.38:95%CI:1.05-1.80, respectively, for ages 30-39 and 40-49 vs 25-29 years), longer duration of care at UW Medicine (APR:1.22:95%CI:1.03-1.45, comparing > 10 vs < 5 years), higher visit frequency (APR:1.23:95%CI:1.04-1.44, 1.46:95%CI:1.24-1.72, respectively, for 3-5 and ≥ 6 vs 1-2 visits), index visit in an obstetrics-gynecology clinic (APR:1.26:95%CI:1.03-1.55, vs family practice), having an assigned primary care provider (APR:1.35: 95%CI:1.02-1.79), breast cancer screening adherence (APR:1.66: 95%CI:1.27-2.17), and colorectal cancer screening adherence (APR:1.59:95%CI:1.24-2.03). Low BMI was associated with lower adherence (APR:0.50:95%CI:0.26-0.96, comparing < 18.5 kg/m2 vs 18.5-24.9 kg/m2). Among 608 (37%) overdue women, 9% were screened in the subsequent 12 months. Having commercial health insurance vs Medicare/Medicaid was associated with higher uptake (adjusted risk ratio:2.44:95%CI:1.15-5.18). CONCLUSION CCS adherence among EAI was lower than the national average of 80%. Interventions focused on increasing healthcare access/utilization or leveraging healthcare encounters to address barriers could increase CCS in EAIs.
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Affiliation(s)
- Adino Tesfahun Tsegaye
- Department of Epidemiology, University of Washington School of Public Health, 3980 15Th Ave NE UW Box # 351619, Seattle, WA, 98195, USA.
| | - John Lin
- Department of Epidemiology, University of Washington School of Public Health, 3980 15Th Ave NE UW Box # 351619, Seattle, WA, 98195, USA
| | - Allison M Cole
- Department of Family Medicine, University of Washington School of Medicine, Seattle, USA
| | - Adam Szpiro
- Department of Biostatistics, University of Washington School of Public Health, Seattle, USA
| | - Darcy W Rao
- Gender Equality Division, Bill & Melinda Gates Foundation, Seattle, USA
| | - Judd Walson
- Departments of Global Health, Medicine (Infectious Diseases), Pediatrics and Epidemiology University of Washington, Seattle, USA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington School of Public Health, 3980 15Th Ave NE UW Box # 351619, Seattle, WA, 98195, USA
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Ghebrendrias S, Mody S, Washington S, Hussein B, Jama F, Jacobs M. A Cervical Cancer Screening Toolkit for Somali Women: A Pilot Randomized Controlled Trial. J Immigr Minor Health 2023; 25:1307-1314. [PMID: 37071376 PMCID: PMC10111298 DOI: 10.1007/s10903-023-01455-8] [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] [Accepted: 01/25/2023] [Indexed: 04/19/2023]
Abstract
This study aims to determine whether a novel cervical cancer screening toolkit will increase rates of pap test completion and HPV vaccination among Somali women living in the United States. We conducted a randomized controlled, pilot trial from June 2021 to February 2022. Somali women aged 21 to 70 were randomized to either receive a toolkit (infographic, video and an in-person health seminar) or not. Health passports confirming a completed pap test and/or HPV vaccination by clinician signature were used to measure outcomes. The primary outcome was pap test completion and the secondary outcome was HPV vaccination. We enrolled 57 participants. Patients randomized to the treatment arm were significantly more likely to have had a pap test (53.7% vs. 3.7%, p < 0.0001) and were also more likely to have received the HPV vaccine (10.7% vs. 3.7%, p = 0.6110). This toolkit increased rates of pap test completion and more participants in the intervention arm received HPV vaccination, though numbers were low. The study design may serve as a reproducible model to determine the effectiveness of patient education materials.
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Affiliation(s)
- Selemawit Ghebrendrias
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, M:9300 Campus Point Drive, MC 7433, La Jolla, San Diego, CA 92037 USA
| | - Sheila Mody
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, M:9300 Campus Point Drive, MC 7433, La Jolla, San Diego, CA 92037 USA
| | - Sierra Washington
- Department of Obstetrics and Gynecology, Stony Brook University School of Medicine, 101 Nicolls Road, HSC T9 Room 090, Stony Brook, NY 11794-8091 USA
| | - Balquiso Hussein
- Somali Family Service, Community Health Worker, 5348 University Ave Unit 203, San Diego, CA 92105 USA
| | - Fadumo Jama
- Somali Family Service, Community Health Worker, 5348 University Ave Unit 203, San Diego, CA 92105 USA
| | - Marni Jacobs
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, M:9300 Campus Point Drive, MC 7433, La Jolla, San Diego, CA 92037 USA
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Abdi N, Ebengho S, Mohamed N, Scallon A, Mohamed A, Ahmed A, Abdi A, Ahmed R, Mohamed F, Ibrahim A, Ali A, West KM, Ronen K. Early Pandemic Access to COVID-19 Testing in the Somali Community in King County, Washington, USA: a Mixed-Methods Evaluation. J Racial Ethn Health Disparities 2023; 10:2930-2943. [PMID: 36478269 PMCID: PMC9734463 DOI: 10.1007/s40615-022-01470-9] [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: 07/24/2022] [Revised: 11/11/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Racial and ethnic disparities in COVID-19 infection and outcomes have been documented, but few studies have examined disparities in access to testing. METHODS We conducted a mixed methods study of access to COVID-19 testing in the Somali immigrant community in King County, Washington, USA, early during the COVID-19 pandemic. In September 2020-February 2021, we conducted quantitative surveys in a convenience sample (n = 528) of individuals who had accessed PCR testing, recruited at King County testing sites near Somali population centers and through social media outreach in the Somali community. We compared self-identified Somali and non-Somali responses using Chi-square and Wilcoxon rank sum tests. We also conducted three Somali-language focus groups (n = 26) by video conference to explore Somali experiences with COVID-19 testing, and in-depth interviews with King County-based policymakers and healthcare workers (n = 13) recruited through the research team's professional network to represent key demographics and roles. Data were analyzed using qualitative rapid analysis to explore the county's COVID-19 testing landscape. RESULTS Among 420 survey respondents who had received COVID-19 testing in the prior 90 days, 29% of 140 Somali vs. 11% of 280 non-Somali respondents tested because of symptoms (p = 0.001), with a trend for longer time from symptom onset to testing (a measure of testing access) among Somali respondents (median 3.0 vs. 2.0 days, p = 0.06). Focus groups revealed barriers to testing, including distrust, misinformation, stigma, language, lack of awareness, and transportation. Stakeholders responding from all sectors highlighted the importance of community partnership to improve access. CONCLUSION Somali communities experience barriers to COVID-19 testing, as evidenced by the longer time from symptom onset to testing and corroborated by our qualitative findings. These barriers, both structural and community-derived, may be overcome through partnerships between government and community to support community-led, multilingual service delivery and racial representation among medical staff.
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Affiliation(s)
- Najma Abdi
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Sabrina Ebengho
- School of Public Health, University of Washington, Seattle, WA, USA
- Somali Health Board, Tukwila, WA, USA
| | | | - Andrea Scallon
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Ayan Mohamed
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Asiya Ahmed
- School of Public Health, University of Washington, Seattle, WA, USA
- Somali Health Board, Tukwila, WA, USA
| | | | - Ruweida Ahmed
- School of Medicine, University of Washington, Seattle, WA, USA
| | | | - Anisa Ibrahim
- Somali Health Board, Tukwila, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Ahmed Ali
- Somali Health Board, Tukwila, WA, USA
| | - Kathleen McGlone West
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Keshet Ronen
- Department of Global Health, University of Washington, Seattle, WA, USA.
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Ailloud J, Branchereau M, Fall E, Juneau C, Partouche H, Bonnay S, Oudin-Doglioni D, Michel M, Gagneux-Brunon A, Bruel S, Thilly N, Gauchet A. How can we improve the acceptability of vaccination against Human Papillomavirus (HPV) in France? An original qualitative study with focus groups comprising parents and school staff, interviewed separately. Vaccine 2023:S0264-410X(23)00656-4. [PMID: 37344259 DOI: 10.1016/j.vaccine.2023.05.072] [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: 10/21/2022] [Revised: 05/16/2023] [Accepted: 05/31/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND It has been proven that vaccination is effective against Human Papillomavirus (HPV) infections, genital warts, and pre-cancerous and cancerous cervical lesions. Nevertheless, the HPV vaccine coverage of 37.4 % in 2021 in France is one of the lowest in Europe. To explore and understand the reason why French population is so late compared to its neighbours, we carried out focus groups with mothers and with National Education school staff. We aimed to identify knowledge and perceptions of HPV in both study populations, as well as factors influencing HPV vaccination. METHODS Between January 2020 and March 2021, we performed a qualitative study using an inductive approach with a thematic content analysis (TCA). We conducted semi-structured focus groups with 29 people including 15 mothers of adolescents in middle schools and 14 school staff from the national education system. RESULTS Different factors influenced the decision-making process of parents and school staff: knowledge and perceptions of HPV and its vaccine, sources of information about HPV and vaccination. Mothers' discourses differed from those of school staff. They mentioned the importance of gynaecological monitoring and the negative image of pharmaceutical companies, and questioned internet as a reliable source of information. For their part, school staff mentioned cultural and/or religious affiliation, municipalities' role to inform the population, and ethical dilemma or logistical challenges regarding HPV vaccination in schools. CONCLUSION The results of these focus groups provided information on which elements may harm or help HPV vaccination. Identified perceptions, beliefs, knowledge, barriers, and facilitators will help us to build an intervention program focus on general practitioners (GP), school staff, parents, and adolescents.
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Affiliation(s)
- Julien Ailloud
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, 38000 Grenoble, France
| | - Marion Branchereau
- Centre Régional de Coordination des Dépistages des cancers-Pays de la Loire, Angers, France
| | - Estelle Fall
- Université de Lorraine, APEMAC, F-57000 Metz, France
| | - Catherine Juneau
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, 38000 Grenoble, France; Health Psychology Lab, McGill University, Montreal, Canada
| | - Henri Partouche
- Département de Médecine générale, Université Paris Cité, France
| | | | - Damien Oudin-Doglioni
- Institut Pasteur, Université Paris Cité, Global Health Department, Epidemiology of Emerging Diseases Unit, France
| | - Morgane Michel
- Université Paris Cité, ECEVE, UMR 1123, Inserm, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'épidémiologie clinique, Paris, France
| | - Amandine Gagneux-Brunon
- Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, CIC INSERM 1408 Vaccinologie, CHU de Saint-Etienne, Saint-Etienne, France
| | - Sébastien Bruel
- Health, Systemic, Process UR 4129 Research Unit, University Claude Bernard, University of Lyon, Lyon, France; Department of General Practice, Jacques Lisfranc Faculty of Medicine, Saint-Etienne-Lyon University, Saint-Etienne, France
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, F-54000 Nancy, France; Université de Lorraine, CHRU-Nancy, Département Méthodologie, Promotion, Investigation, F-54000 Nancy, France
| | - Aurélie Gauchet
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, 38000 Grenoble, France.
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Shin MB, Ko LK, Ibrahim A, Mohamed FB, Lin J, Celentano I, Shankar M, Amsalu F, Ali AA, Richardson BA, Taylor VM, Winer RL. The Impact of a Comic Book Intervention on East African-American Adolescents' HPV Vaccine-Related Knowledge, Beliefs and Intentions. J Immigr Minor Health 2022; 24:1489-1500. [PMID: 35357620 PMCID: PMC10129048 DOI: 10.1007/s10903-022-01359-z] [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] [Accepted: 03/16/2022] [Indexed: 11/27/2022]
Abstract
HPV vaccine uptake is low among East African-American (EAA) adolescents. We developed a comic book and evaluated the impact on HPV/HPV-vaccine knowledge, beliefs and vaccine intentions. The intervention was delivered to HPV-unvaccinated EAA adolescents attending educational dinners with their mothers. Adolescents aged 14-17 were sequentially assigned alternately to a pre- or post-test. Results were compared with chi-squared tests and generalized estimating equation models adjusted for age, gender, and mother's language. Among 136 (pre-test = 64, post-test = 72) participants (90% Somali), pre/post differences were observed for proportions of correct responses to questions on HPV (44.0% vs. 82.9%, RR:1.87[95%CI 1.54-2.27]), HPV-vaccine knowledge (42.8% vs. 75.4%, RR:1.74[95%CI 1.46-2.07]), comfort discussing HPV/HPV vaccine with parents (57.8% vs. 90.3% somewhat/very comfortable, RR:1.55[95%CI 1.24-1.94]), and willingness (37.5% vs. 83.3% probably/definitely willing, RR:2.16[95%CI 1.55-3.01]) and intention (34.4% vs. 86.1% somewhat/very likely, RR:2.38[95%CI:1.69-3.37]) to get vaccinated. The intervention improved participants' HPV/HPV-vaccine knowledge, beliefs and vaccine intentions. Similar interventions could be adapted for other racial/ethnic minorities.
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Affiliation(s)
- Michelle B Shin
- School of Nursing, University of Washington, Seattle, WA, USA
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Linda K Ko
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Anisa Ibrahim
- Harborview Medical Center, Department of Pediatrics, University of Washington, Seattle, WA, USA
- Somali Health Board, Seattle, WA, USA
| | | | - John Lin
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Isabelle Celentano
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
| | - Megha Shankar
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Medicine, University of California, San Diego, CA, USA
| | - Fanaye Amsalu
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | | | - Barbra A Richardson
- Department of Biostatistics, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Victoria M Taylor
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
- Department of Epidemiology, University of Washington School of Public Health, 3980 15th Ave NE, Box 351619, Seattle, WA, 98195, USA.
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Tankwanchi ABS, Jaca A, Ndlambe AM, Zantsi ZP, Bowman B, Garrison MM, Larson HJ, Vermund SH, Wiysonge CS. Non-COVID-19 vaccine hesitancy among migrant populations worldwide: a scoping review of the literature, 2000-2020. Expert Rev Vaccines 2022; 21:1269-1287. [DOI: 10.1080/14760584.2022.2084075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Anelisa Jaca
- Cochrane South Africa, South African Medical Research Council, Cape Town, SA
| | - Asiphe M Ndlambe
- Cochrane South Africa, South African Medical Research Council, Cape Town, SA
| | - Zukiswa P Zantsi
- Cochrane South Africa, South African Medical Research Council, Cape Town, SA
| | - Brett Bowman
- Department of Psychology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, SA
| | - Michelle M Garrison
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Heidi J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Sten H Vermund
- Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, SA
- Department of Global Health, Stellenbosch University, Cape Town, SA
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, SA
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8
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Oh A, Gaysynsky A, Winer RL, Lee HY, Brewer NT, White A. Considerations and opportunities for multilevel HPV vaccine communication interventions. Transl Behav Med 2022; 12:343-349. [PMID: 35171276 PMCID: PMC9012999 DOI: 10.1093/tbm/ibab129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
From 2016 to 2019, the National Cancer Institute and the Centers for Disease Control and Prevention funded three Special Interest Projects focused on developing and testing multilevel HPV vaccination communication interventions. In this commentary, we highlight lessons learned from the funded projects, including the importance of engaging community members in the early stages of the research process, the challenges of evaluating multilevel interventions, and the need to consider stakeholder implementation preferences.
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Affiliation(s)
- April Oh
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Anna Gaysynsky
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
- ICF Next Government, ICF, Rockville, MD, USA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
| | - Hee Y Lee
- School of Social Work, University of Alabama, Tuscaloosa, AL, USA
| | - Noel T Brewer
- Department Of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Arica White
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Hassan SA, Mohamed F, Sheikh N, Basualdo G, Daniel NA, Schwartz R, Gebreselassie BT, Beyene YK, Gabreselassie L, Bayru K, Tadesse B, Libneh HA, Shidane M, Benalfew S, Ali A, Rao D, Patel RC, Kerani RP. "They Wait until the Disease Has Taking over You and the Doctors Cannot Do Anything about It": Qualitative Insights from Harambee! 2.0. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12706. [PMID: 34886432 PMCID: PMC8657258 DOI: 10.3390/ijerph182312706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/24/2021] [Accepted: 11/27/2021] [Indexed: 11/19/2022]
Abstract
African immigrants make up a large subgroup of Black/African-Americans in the US. However, because African immigrant groups are typically categorized as "Black," little is known about their preventative healthcare needs. Differences in culture, life and healthcare experiences between African immigrant populations and US-born people may influence preventive health care uptake. Thus, policymakers and healthcare providers lack information needed to make informed decisions around preventive care for African immigrants. This formative study was conducted among the largest East African immigrant communities in King County, WA. We recruited religious leaders, community leaders, health professionals, and lay community members to participate in thirty key informant interviews and five focus group discussions (n = 72 total), to better understand preventative healthcare attitudes in these communities. Through inductive coding and thematic analysis, we identified factors that impact preventative healthcare attitudes of the Somali, Ethiopian and Eritrean immigrant communities and deter them from accessing and utilizing healthcare. Cultural beliefs and attitudes around preventative healthcare, mistrust of westernized healthcare, religious beliefs/views, intersecting identities and shared immigrant experiences all influence how participants view preventative healthcare. Our results suggest that interventions that address these factors are needed to most effectively increase uptake of preventative healthcare in African immigrant communities.
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Affiliation(s)
- Shukri A. Hassan
- Department of Medicine, University of Washington, Seattle, WA 98104, USA; (R.C.P.); (R.P.K.)
| | - Farah Mohamed
- Department of Medicine, University of Washington, Seattle, WA 98104, USA; (R.C.P.); (R.P.K.)
- Somali Health Board, Tukwila, WA 98188, USA; (M.S.); (A.A.)
| | - Najma Sheikh
- Department of Global Health, University of Washington, Seattle, WA 98195, USA; (N.S.); (D.R.)
| | - Guiomar Basualdo
- Department of Anthropology, University of Washington, Seattle, WA 98195, USA;
| | - Nahom A. Daniel
- Department of Biology, University of Washington, Seattle, WA 98195, USA;
| | - Rahel Schwartz
- Ethiopian Community Center in Seattle, Seattle, WA 98118, USA; (R.S.); (B.T.); (H.A.L.); (S.B.)
- Ethiopian Health Board, Seattle, WA 98118, USA
| | | | - Yikealo K. Beyene
- Eritrean Health Board, Seattle, WA 98122, USA; (B.T.G.); (Y.K.B.); (L.G.); (K.B.)
| | - Luwam Gabreselassie
- Eritrean Health Board, Seattle, WA 98122, USA; (B.T.G.); (Y.K.B.); (L.G.); (K.B.)
| | - Kifleyesus Bayru
- Eritrean Health Board, Seattle, WA 98122, USA; (B.T.G.); (Y.K.B.); (L.G.); (K.B.)
| | - Bethel Tadesse
- Ethiopian Community Center in Seattle, Seattle, WA 98118, USA; (R.S.); (B.T.); (H.A.L.); (S.B.)
| | - Hirut Amsalu Libneh
- Ethiopian Community Center in Seattle, Seattle, WA 98118, USA; (R.S.); (B.T.); (H.A.L.); (S.B.)
| | | | - Sophia Benalfew
- Ethiopian Community Center in Seattle, Seattle, WA 98118, USA; (R.S.); (B.T.); (H.A.L.); (S.B.)
| | - Ahmed Ali
- Somali Health Board, Tukwila, WA 98188, USA; (M.S.); (A.A.)
- Department of Global Health, University of Washington, Seattle, WA 98195, USA; (N.S.); (D.R.)
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA 98195, USA; (N.S.); (D.R.)
| | - Rena C. Patel
- Department of Medicine, University of Washington, Seattle, WA 98104, USA; (R.C.P.); (R.P.K.)
- Department of Global Health, University of Washington, Seattle, WA 98195, USA; (N.S.); (D.R.)
| | - Roxanne P. Kerani
- Department of Medicine, University of Washington, Seattle, WA 98104, USA; (R.C.P.); (R.P.K.)
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Jang SH, Brown EVR, Lee EJ, Ko LK. "Blood pressure monitoring should be a habit": adaptation of the Check. Change. Control. program for Asian American older adults, from group-based in-person to one-on-one telephone delivery. Transl Behav Med 2021; 11:1244-1253. [PMID: 33447851 DOI: 10.1093/tbm/ibaa142] [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: 11/12/2022] Open
Abstract
Asian Americans have the lowest rate of awareness about hypertension, including controlled hypertension, among all racial/ethnic groups in the USA. A high proportion of Asian American older adults have limited English proficiency (LEP) and hypertension. This study adapted the Check. Change. Control. (CCC) program, a community-based intervention for hypertension control delivered in a face-to-face group setting, to phone-based delivery and evaluated the acceptability of the program among Asian American older adults with LEP. Thirteen participants received phone-based educational sessions on hypertension control over 4 months. After 4 months of interventions, we interviewed the 13 Asian American older adults and 4 counselors to examine the acceptability of the adapted CCC program. Both Asian American older adults and counselors found the phone-based delivery of the CCC program to be acceptable, and some participants recommended holding an in-person meeting before telephone delivery to review the program content and clarify information. Future study needs to explore the effectiveness of the phone-based delivery of the program on blood pressure management among larger groups of Asian American older adults.
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Affiliation(s)
- Sou Hyun Jang
- Department of Sociology and Convergence Program for Social Innovation, Sungkyunkwan University, Seoul, South Korea
| | - Emily V R Brown
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Eun Jeong Lee
- Asian American Resource and Information Network, Inc., Wood Ridge, NJ, USA
| | - Linda K Ko
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center and Department of Health Services, University of Washington, Seattle, WA, USA
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Habila MA, Kimaru LJ, Mantina N, Valencia DY, McClelland DJ, Musa J, Madhivanan P, Sagay A, Jacobs ET. Community-Engaged Approaches to Cervical Cancer Prevention and Control in Sub-Saharan Africa: A Scoping Review. Front Glob Womens Health 2021; 2:697607. [PMID: 34816234 PMCID: PMC8594022 DOI: 10.3389/fgwh.2021.697607] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/25/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Cervical cancer remains one of the top causes of cancer mortality among African women. Cervical cancer screening and early detection and treatment of precancer is one of the evidence-based interventions to reduce incidence and mortality. The application of community-based participatory research (CBPR) has been used in the United States to improve participation in screening and reduce cervical cancer disparities. However, it is unclear whether these engaged approaches have been used in sub-Saharan African to address disparities related to cervical cancer mortality. Objectives: Highlight community engagement in cervical cancer prevention and control in Sub-Saharan Africa (SSA), describe the community engagement efforts that are currently being used, and to describe the best practices for community engagement toward the end-goal of cervical cancer prevention and control. Methods: We searched PubMed, Embase, CINHAL, African Journals Online (AJOL), and African Index Medicus-WHO from inception until June 8, 2020. After screening 620 titles and abstracts, and reviewing 56 full-text articles according to inclusion and exclusion criteria, 9 articles met the selection criteria and were included. Relevant data variables were extracted from the included articles and a narrative synthesis was performed. Results: Between 2005 and 2019, 9 articles describing research in Ghana, Kenya, Zambia, Senegal, South Africa, and Nigeria were included. These articles described work that largely took place in rural settings predominantly among women age 15-65 years. Leveraging community networks such as community health workers, religious organizations, traditional leaders, and educational institutions increased awareness of cervical cancer. Working within existing social structures and training community members through the research effort were promising methods for addressing the disparities in cervical cancer incidence and mortality among communities. Discussion: The findings of this scoping review have contributed to the understanding of which novel approaches to community-based practices can be used to address cervical cancer disparities among SSA communities that carry a disproportionate disease burden. Community engagement in the research process, while effortful, has shown to be beneficial to researchers and to the communities that they serve, and provides valuable next steps in the effort to address cervical cancer disparities in SSA.
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Affiliation(s)
- Magdiel A. Habila
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
- Department of Health and Pharmaceutical Outcomes, University of Arizona, Tucson, AZ, United States
| | - Linda Jepkoech Kimaru
- Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, United States
| | - Namoonga Mantina
- Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, United States
| | - Dora Yesenia Valencia
- Clinical Translational Sciences, College of Medicine, University of Arizona Health Sciences, Tucson, AZ, United States
| | - D. Jean McClelland
- Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, United States
- Health Sciences Library, University of Arizona, Tucson, AZ, United States
| | - Jonah Musa
- Department of Obstetrics and Gynecology, Jos University Teaching Hospital, Jos, Nigeria
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University, Chicago, IL, United States
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, United States
| | - Atiene Sagay
- Department of Obstetrics and Gynecology, Jos University Teaching Hospital, Jos, Nigeria
| | - Elizabeth T. Jacobs
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
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12
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Jang SH, Cole A, Brown EVR, Ko L. Adaptation of a Mailed-FIT Kit and Patient Navigation Intervention to Increase Colorectal Cancer (CRC) Screening Among Spanish-Speaking Hispanic/Latino Patients. HISPANIC HEALTH CARE INTERNATIONAL 2021; 20:80-88. [PMID: 34159831 DOI: 10.1177/15404153211024116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Hispanic/Latino populations experience significant barriers to colorectal cancer (CRC) screening. ProCRCScreen is a multicomponent CRC screening program that can help primary care clinics improve CRC screening rates, but it needs adaptation to better meet the health care needs of Spanish-speaking Hispanic/Latino populations. METHODS We conducted four focus groups with 22 Spanish-speaking Latino patients and used inductive qualitative content analysis to identify potential program adaptations. RESULTS We identified lack of social support for CRC screening and confusion about completing stool-based testing as important barriers to CRC screening. Participants recommended increased specificity of the fecal immunochemical test (FIT) instructions to increase the likelihood of successful test completion, especially for first-time screening. They also endorsed patient navigation for support in completing CRC screening. DISCUSSION We adapted the informational materials and workflows for the ProCRCScreen program. Future research to test the adapted program is needed.
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Affiliation(s)
- Sou Hyun Jang
- Department of Sociology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Allison Cole
- Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Linda Ko
- Fred Hutchison Cancer Research Center, Seattle, WA, USA
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13
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Chu H, Ko LK, Ibrahim A, Mohamed FB, Lin J, Shankar M, Amsalu F, Ali AA, Richardson BA, Taylor VM, Winer RL. The impact of an educational forum intervention on East African mothers' HPV vaccine-related knowledge, attitudes, and intentions to vaccinate their adolescent children. Vaccine 2021; 39:3767-3776. [PMID: 34053792 PMCID: PMC9984200 DOI: 10.1016/j.vaccine.2021.05.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/09/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE HPV vaccine uptake in U.S. East African adolescents is low. We developed and evaluated a culturally-targeted interactive educational intervention for East African immigrant mothers to increase HPV-vaccine-related knowledge, attitudes, and intentions to vaccinate adolescent children. METHODS Eligible mothers had ≥ 1 11-17-year-old child and reported all children's HPV vaccination status as unvaccinated or unknown. The intervention was delivered via 10 dinners in the Seattle metropolitan area (8 with the Somali community, 2 with the Ethiopian community). Educational presentations and pre/post-tests on knowledge, attitudes, and intentions were conducted in the participants' native language by a co-ethnic physician. Pre/post differences in responses were evaluated with McNemar's tests and GEE models. HPV vaccination uptake 6-months post-intervention was evaluated using state immunization registry data. RESULTS Of 115 participating mothers, most (84%) were Somali and < 40 years of age (60%). Median years of formal education was 8 (range 0-16), and 61% reported a household income <$25,000. Knowledge of HPV/HPV-vaccines was low pre-intervention, with correct responses ranging from 4% to 39% (61%-91% of responses were "not sure"); correct post-intervention responses ranged from 29% to 97%. Pre-intervention, only 12% of mothers thought they had enough information to make a decision about vaccination, compared to 90% post-intervention. Pre-intervention, only 16% of mothers reported that they were somewhat or very likely to vaccinate their child, compared to 83% post-intervention. All pre/post comparisons were statistically significantly different (p < 0.0001). Although mothers were more likely to report correct HPV-related knowledge and positive vaccine attitudes and intentions post-intervention, only two mothers' children initiated HPV vaccination within 6 months after the intervention. CONCLUSIONS Results illustrate that a culturally targeted educational intervention effectively increased East African mothers' HPV vaccine-related knowledge, attitudes, and intentions to vaccinate their adolescent children. Future research should identify additional intervention components that can bridge the gap between intention and behavior to facilitate HPV vaccine uptake.
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Affiliation(s)
- Huong Chu
- Department of Global Health, University of Washington School of Public Health, 3980 15(th) Ave NE, Box 351620, Seattle, WA 98195, USA.
| | - Linda K. Ko
- Department of Health Services, University of Washington School of Public Health, 3980 15th Ave NE Box 357660, Seattle, WA 98195 USA.,Division of Public Health Services, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N. M3-B232, Seattle, WA 98102 USA
| | - Anisa Ibrahim
- Department of Pediatrics, University of Washington, Harborview Medical Center, 325 9(th) Ave, Seattle, WA 98104, USA; Somali Health Board, 7050 32nd AVE S. Seattle, WA 98118, USA.
| | - Farah Bille Mohamed
- Department of Epidemiology, University of Washington School of Public Health, 3980 15th Ave NE, Box 351619, Seattle, WA 981195 USA
| | - John Lin
- Department of Epidemiology, University of Washington School of Public Health, 3980 15th Ave NE, Box 351619, Seattle, WA 98195, USA.
| | - Megha Shankar
- Department of Medicine, University of Washington, 1959 NE Pacific St, Box 356421, 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
| | - Barbra A. Richardson
- Department of Global Health, University of Washington School of Public Health, 3980 15th Ave NE, Box 351620, Seattle, WA 98195, USA.,Department of Biostatistics, University of Washington School of Public Health, 3980 15th Ave NE, Box 351617, Seattle, WA 98195 USA
| | - Victoria M. Taylor
- Division of Public Health Services, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N. M3-B232, Seattle, WA 98102 USA
| | - Rachel L. Winer
- Department of Epidemiology, University of Washington School of Public Health, 3980 15th Ave NE, Box 351619, Seattle, WA 981195 USA
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14
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Celentano I, Winer RL, Jang SH, Ibrahim A, Mohamed FB, Lin J, Amsalu F, Ali AA, Taylor VM, Ko LK. Development of a theory-based HPV vaccine promotion comic book for East African adolescents in the US. BMC Public Health 2021; 21:1137. [PMID: 34126968 PMCID: PMC8201717 DOI: 10.1186/s12889-021-11005-2] [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: 10/01/2020] [Accepted: 05/06/2021] [Indexed: 11/26/2022] Open
Abstract
Background Human Papillomavirus (HPV) vaccine uptake is low among East African adolescents in the US. Adolescents’ preferences influence HPV vaccine decisions, yet few interventions exist that address East African adolescents’ beliefs about HPV vaccines. We describe a multi-step process on how to create a theory-based comic book by integrating empirical findings, theory and focus group data from East African parents in the US. Methods Our multi-methods process included conducting focus groups with Somali, Ethiopian, and Eritrean mothers (n = 30) to understand mothers and adolescents socio-cultural beliefs and information needs about the HPV vaccine, creating comic book messages integrating the focus group findings, and assessing the acceptability of the finalized comic book among Somali, Ethiopian, and Eritrean adolescents (n = 134). Results We identified categories around socio-cultural beliefs (such ethnic representation and concerns about pork gelatin in vaccines), HPV vaccine information needs, and diffusion of information. We then mapped the categories to theoretical constructs and operationalized them into the comic book. Finally, we describe the overall acceptability of the comic book and specifics on comic book structure, appeal of characters, and message relevance. Conclusions A rigorous multi-step process that integrates theory and focus group data can help create culturally appropriate health messages that can educate and appeal to the community. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11005-2.
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Affiliation(s)
- Isabelle Celentano
- Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific Street, Magnuson Health Sciences Bldg., Box 357660, Seattle, WA, 98195, USA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Box 359933, 325 9th Ave, Seattle, WA, 98104, USA
| | - Sou Hyun Jang
- Department of Sociology, Sungkyunkwan University, Seoul, South Korea
| | - Anisa Ibrahim
- Department of Pediatrics, University of Washington, Harborview Medical Center, 325 9th Ave, Seattle, WA, 98104, USA
| | - Farah Bille Mohamed
- Department of Epidemiology, University of Washington, Box 359933, 325 9th Ave, Seattle, WA, 98104, USA
| | - John Lin
- Department of Epidemiology, University of Washington, Box 359933, 325 9th Ave, Seattle, WA, 98104, USA
| | - Fanaye Amsalu
- Department of Epidemiology, University of Washington, Box 359933, 325 9th Ave, Seattle, WA, 98104, USA
| | - Ahmed A Ali
- Somali Health Board, 625 Strander Blvd Building, Tukwila, WA, 98188, USA
| | - Victoria M Taylor
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N, M3-B232, Seattle, WA, 98102, USA
| | - Linda K Ko
- Department of Health Services, University of Washington and Division of Public Health Science, Fred Hutchinson Cancer Research Center, Hans Rosling Center for Public Health, 3980 15th Avenue NE, UW Mailbox 351621, Seattle, WA, 98195, USA.
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15
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Ghebrendrias S, Pfeil S, Crouthamel B, Chalmiers M, Kully G, Mody S. An Examination of Misconceptions and Their Impact on Cervical Cancer Prevention Practices among Sub-Saharan African and Middle Eastern Refugees. Health Equity 2021; 5:382-389. [PMID: 34095709 PMCID: PMC8175255 DOI: 10.1089/heq.2020.0125] [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] [Accepted: 03/29/2021] [Indexed: 11/12/2022] Open
Abstract
Objective: The purpose of the study was to understand cervical cancer screening and prevention practices of refugee women in San Diego, California and identify desired components of a cervical cancer screening toolkit. Methods: We conducted a qualitative study utilizing semi-structured focus groups and identified common themes via grounded theory analysis. Results: There were 53 female refugee participants from Sub-Saharan Africa and the Middle East. Over half of all women surveyed expressed a fear of pelvic exams and loss of modesty as barriers to seeking gynecologic care, with nearly 34% avoiding routine pap tests. Of the 18 participants who were asked if they were aware of the Human Papilloma Virus (HPV) vaccination, only one had heard of the vaccine and none had received it for themselves or their children. Over 60% of participants were interested in educational materials surrounding HPV and pap tests. Conclusion: There is a significant lack of knowledge regarding cervical cancer screening and HPV vaccination among refugee women in San Diego, California. Refugee women in this study were interested in multi-modal educational materials as part of a cervical cancer screening toolkit.
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Affiliation(s)
- Selemawit Ghebrendrias
- Division of Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, San Diego, California, USA
| | - Sarah Pfeil
- Department of Obstetrics and Gynecology, University of California, San Diego, San Diego, California, USA
| | - Bonnie Crouthamel
- Department of Obstetrics and Gynecology, University of California, Davis, Davis, California, USA
| | - Morgen Chalmiers
- Department of Obstetrics and Gynecology, University of California, San Diego, San Diego, California, USA
| | - Gennifer Kully
- Department of Obstetrics and Gynecology, University of California, San Diego, San Diego, California, USA
| | - Sheila Mody
- Department of Obstetrics and Gynecology, University of California, San Diego, San Diego, California, USA
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16
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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.
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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.
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Maternal Vaccination in Uganda: Exploring Pregnant Women, Community Leaders and Healthcare Workers' Perceptions. Vaccines (Basel) 2021; 9:vaccines9060552. [PMID: 34070536 PMCID: PMC8230088 DOI: 10.3390/vaccines9060552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background: We investigated pregnant women, community leaders, healthcare workers (HCWs) and programme managers' perceptions of maternal vaccination in Kampala, Uganda. Methods: We conducted focus group discussions, key informant interviews and in-depth discussions with HCWs (3), community leaders (3), pregnant women (8) and programme managers (10) between November 2019 and October 2020. Data were analysed thematically. Results: Pregnant women, community leaders and some HCWs had limited maternal immunisation knowledge. There was confusion over what constitutes a vaccine. Pregnant women may not receive vaccines because of mistrust of government; use of expired vaccines; reliance on traditional medicine; religious beliefs; fear of side effects; HCWs attitudes; and logistical issues. The key facilitators of maternal vaccination were a desire to prevent diseases, positive influences from HCWs and information about vaccine side effects. Community leaders and some pregnant women highlighted that pregnant women do not make decisions about maternal vaccination independently and are influenced by different individuals, including other pregnant women, older people, partners, relatives (parents), community leaders, HCWs and the government. Conclusions: Our results indicate that public health messaging should target all community members, including partners and parents of pregnant women as well as HCWs, to improve knowledge of and confidence in maternal vaccines.
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Lederle M, Tempes J, Bitzer EM. Application of Andersen's behavioural model of health services use: a scoping review with a focus on qualitative health services research. BMJ Open 2021; 11:e045018. [PMID: 33952550 PMCID: PMC8103375 DOI: 10.1136/bmjopen-2020-045018] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Qualitative methods have become integral in health services research, and Andersen's behavioural model of health services use (BMHSU) is one of the most commonly employed models of health service utilisation. The model focuses on three core factors to explain healthcare utilisation: predisposing, enabling and need factors. A recent overview of the application of the BMHSU is lacking, particularly regarding its application in qualitative research. Therefore, we provide (1) a descriptive overview of the application of the BMHSU in health services research in general and (2) a qualitative synthesis on the (un)suitability of the model in qualitative health services research. METHODS We searched five databases from March to April 2019, and in April 2020. For inclusion, each study had to focus on individuals ≥18 years of age and to cite the BMHSU, a modified version of the model, or the three core factors that constitute the model, regardless of study design, or publication type. We used MS Excel to perform descriptive statistics, and applied MAXQDA 2020 as part of a qualitative content analysis. RESULTS From a total of 6319 results, we identified 1879 publications dealing with the BMSHU. The main methodological approach was quantitative (89%). More than half of the studies are based on the BMHSU from 1995. 77 studies employed a qualitative design, the BMHSU was applied to justify the theoretical background (62%), structure the data collection (40%) and perform data coding (78%). Various publications highlight the usefulness of the BMHSU for qualitative data, while others criticise the model for several reasons (eg, its lack of cultural or psychosocial factors). CONCLUSIONS The application of different and older models of healthcare utilisation hinders comparative health services research. Future research should consider quantitative or qualitative study designs and account for the most current and comprehensive model of the BMHSU.
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Affiliation(s)
- Mareike Lederle
- Public Health and Health Education, Pädagogische Hochschule Freiburg, Freiburg im Breisgau, Germany
| | - Jana Tempes
- Public Health and Health Education, Pädagogische Hochschule Freiburg, Freiburg im Breisgau, Germany
| | - Eva M Bitzer
- Public Health and Health Education, Pädagogische Hochschule Freiburg, Freiburg im Breisgau, Germany
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Obol JH, Harrison R, Lin S, Obwolo MJ, Richmond R. Perceptions of key informants on the provision of cervical cancer prevention and control programme in Uganda: implication for cervical cancer policy. BMC Public Health 2020; 20:1396. [PMID: 32928155 PMCID: PMC7488649 DOI: 10.1186/s12889-020-09482-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023] Open
Abstract
Background Uganda has one of the highest burdens of cervical cancer globally. In 2010 the Ugandan Ministry of Health launched the Strategic Plan for Cervical Cancer Prevention and Control with the hope of developing cervical cancer policy in Uganda. This study explored the beliefs of senior key informants in Uganda about cervical cancer prevention, the control programme, and the relevance of cervical cancer policy. Methods We conducted 15 key informant interviews with participants from six organisations across Northern and Central Uganda. Participants were drawn from district local government health departments, St. Mary’s Hospital Lacor, Uganda Nurses and Midwifery Council, non-governmental organisations (NGOs) and Ministry of Health in Kampala, Uganda. The interview recordings were transcribed and analysed using thematic analysis. Results Seven themes emerged relating to the cervical cancer prevention and control programmes in Uganda: (1) policy frameworks for cervical cancer, (2) operationalising cervical cancer prevention and control, (3) financial allocation and alignment, (4) human resources and capability, (5) essential supplies and vaccines, (6) administrative data and resource distribution, and (7) cervical cancer services. Conclusions The key informants perceive that the lack of a cervical cancer policy in Uganda is hindering cervical cancer prevention and control programmes. Therefore, the Ministry of Health and stakeholders need to work together in coming up with an effective policy framework that will accelerate efforts towards cervical cancer prevention and control in Uganda.
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Affiliation(s)
- James Henry Obol
- University of New South Wales School of Public Health and Community Medicine, Kensington, NSW, 2033, Australia. .,Gulu University, Faculty of Medicine, P. O Box 166, Gulu, Uganda.
| | - Reema Harrison
- University of New South Wales School of Public Health and Community Medicine, Kensington, NSW, 2033, Australia
| | - Sophia Lin
- University of New South Wales School of Public Health and Community Medicine, Kensington, NSW, 2033, Australia
| | | | - Robyn Richmond
- University of New South Wales School of Public Health and Community Medicine, Kensington, NSW, 2033, Australia
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Immunization Campaigns and Strategies against Human Papillomavirus in Italy: The Results of a Survey to Regional and Local Health Units Representatives. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6764154. [PMID: 31355274 PMCID: PMC6637711 DOI: 10.1155/2019/6764154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 06/04/2019] [Indexed: 12/11/2022]
Abstract
Objective. The study aimed to assess the impact of HPV immunization campaigns organizational aspects, the characteristics of immunization program (vaccination targets and type of offer), and communicative strategies adopted by four Italian administrative regions on vaccination coverage observed. Methods. From November 2017 to March 2018, regional and Local Health Units (LHUs) representatives were invited to complete an online survey including 54 questions evaluating vaccination invite systems, access systems to vaccination centres, reminder and recall systems, and adverse events surveillance. An overall descriptive analysis was conducted. Since observed vaccine coverage (VC) obtained in females (2002-2004 birth cohorts) was lower than objectives fixed by the Italian Ministry of Health, variables were assessed using the national VC mean obtained in the 2003 girls birth cohort as outcome. Results. Twenty-six LHUs belonging to 4 Northern and Southern Italian regions participated in the study. Organizational aspects significantly related to VC lower than the national mean were access to vaccine centres without appointment and parents' reservation as appointment planning system. Recall systems for both the first and the second dose, including the appointment in the invitation letter, the availability of regional immunization registry, and education of healthcare workers on universal HPV immunization strategies, instead, were related to higher VC. As regards preadolescent immunization strategies, both VC obtained in girls and boys were far from the Ministerial goals. Only 20% of LHUs introduced multicohort female strategies while all LHUs adopted copayment targeting both men and women. Immunizations strategies targeting subjects at risk were implemented only in half of participating LHUs. Conclusions. VC observed in participating LHUs are largely lower than the national objectives in all anti-HPV vaccine targets. Both organizational and educational strategies have to be implemented to improve the VC goals.
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Kelly-Hanku A, Newland J, Aggleton P, Ase S, Aeno H, Fiya V, Vallely LM, Toliman PJ, Mola GD, Kaldor JM, Vallely AJ. HPV vaccination in Papua New Guinea to prevent cervical cancer in women: Gender, sexual morality, outsiders and the de-feminization of the HPV vaccine. PAPILLOMAVIRUS RESEARCH 2019; 8:100171. [PMID: 31212024 PMCID: PMC6595234 DOI: 10.1016/j.pvr.2019.100171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/02/2019] [Accepted: 06/07/2019] [Indexed: 01/25/2023]
Abstract
Papua New Guinea has among the highest estimated burden of cervical cancer globally, but currently lacks national cervical screening or human papillomavirus (HPV) vaccination programmes. The Papua New Guinean government is committed to introducing the HPV vaccine for primary prevention, but locally-relevant research evidence is not available to guide implementation. Experience from earlier Papua New Guinean health programmes suggests that appropriate engagement with local health cosmologies and cultures for health/wellbeing, illness/disease, and recognition of the role of ‘outsiders’ in preventing, promoting or contributing to sickness, are essential to the successful introduction of biomedical interventions in this setting. We describe findings from a multi-site qualitative study undertaken in three provinces in Papua New Guinea (2012-14). Twenty-one gender specific focus group discussions and 82 semi-structured interviews, with a total of 208 participants, were conducted. There was strong community support for the introduction of the HPV vaccine for cervical cancer prevention in Papua New Guinea. Significantly, and despite being officially discussed in the context of a planned future intervention focusing on vaccinating young girls to prevent cervical cancer, the intervention was de-feminised, where both girls and boys were supported to be vaccinated in any HPV programme in Papua New Guinea. First study of HPV vaccine acceptability in Papua New Guinea and the Pacific. Evidence of strong support for the vaccination of both girls and boys against HPV in Papua New Guinea. Local beliefs and concerns about HPV immunisation may impact acceptability in Papua New Guinea. Suspicion of Western medicine and health care workers reported in rural areas.
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Affiliation(s)
- Angela Kelly-Hanku
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Papua New Guinea; Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Australia.
| | - Jamee Newland
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Australia
| | - Peter Aggleton
- Centre for Social Research in Health, UNSW Sydney, Australia; Sociology Department, Australian National University, Australia
| | - Sophie Ase
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Papua New Guinea
| | - Herick Aeno
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Papua New Guinea
| | - Voletta Fiya
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Papua New Guinea
| | - Lisa M Vallely
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Australia
| | - Pamela J Toliman
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Papua New Guinea; Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Australia
| | - Glen Dl Mola
- Department of Obstetrics and Gynaecology, University of Papua New Guinea, Papua New Guinea
| | - John M Kaldor
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Australia
| | - Andrew J Vallely
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Papua New Guinea; Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Australia
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