Parents' Internet use for information about HPV vaccine

The association of caregiver attitudes, information sources, and trust with HPV vaccine initiation among adolescents

This study described caregiver attitudes and the information sources they access about HPV vaccination for adolescents and determined their influence on human papillomavirus (HPV) vaccination initiation. An online survey was administered to 1,016 adults in July 2021. Participants were eligible if they were the caregiver of a child aged 9-17 residing in Mississippi, Arkansas, Tennessee, Missouri, and select counties in Southern Illinois. Multivariate logistic regression was used to estimate the association of caregiver attitudes and information sources with HPV vaccination. Information from doctors or healthcare providers (87.4%) and internet sources other than social media (31.0%) were the most used sources for HPV vaccine information. The highest proportion of caregivers trusted their doctor or healthcare providers (92.4%) and family or friends (68.5%) as sources of information. The HPV vaccine series was more likely to be initiated in children whose caregivers agreed that the vaccine is beneficial (AOR = 4.39, 95% CI = 2.05, 9.39), but less likely with caregivers who were concerned about side effects (AOR = 0.61, 95% CI = 0.42, 0.88) and who received HPV vaccination information from family or friends (AOR = 0.57, 95% CI = 0.35, 0.93). This study found that caregivers' attitudes, information sources, and trust in those sources were associated with their adolescent's HPV vaccination status. These findings highlight the need to address attitudes and information sources and suggest that tailored interventions considering these factors could increase HPV vaccination rates.

Attitudes, healthcare interactions, and communication preferences for HPV vaccines among hesitant Hispanic/Latinx parents: how does this compare with influenza and COVID-19 vaccines?

OBJECTIVE

We explored HPV vaccine concerns and healthcare provider communication among Hispanic/Latinx hesitant parents during the COVID-19 pandemic, and how those concerns and provider communications compared for influenza and COVID-19 vaccines. As a secondary aim, we explored communication needs and strategies for these recommended vaccines.

DESIGN

We applied a concurrent, multi-method study design (survey and interview) with 23 Hispanic/Latinx American parents of adolescents aged 11-18 years. An inductive deductive thematic approach was used to interpret interview data. Descriptives were used to analyze survey data.

RESULTS

Overall, most parents (77%) perceived that their child was receiving too many vaccines. Regarding hesitancy for the HPV vaccine, major parental concerns related to vaccine effectiveness (83%), vaccine necessity (83%), and vaccine safety (80%). For the COVID vaccine, major concerns were the newness of vaccine (83%), vaccine safety (77%), low perceived effectiveness (77%), and low perceived need (77%). For influenza vaccines, major parental concerns were vaccine safety (73%), low perceived need (73%), and preference for natural over vaccine-induced immunity (73%). Parents had overall positive views towards vaccination. Some parents prioritized school-required vaccines, and others ranked the recommended vaccines- HPV, COVID-19, and influenza vaccines- for their children. They saw the benefits of recommended vaccines; however, there were concerns. The majority received a provider's recommendation for HPV vaccination for their child, while over half had not received a recommendation for COVID-19 and influenza vaccines. Recommended communication strategies were diverse with parents highlighting the need for providers to capitalize on waiting and clinic rooms to provide education.

CONCLUSION

Healthcare providers should take advantage of missed opportunities, improve healthcare interactions with a strong recommendation and persistent communication, and offer diverse communication strategies and messaging for vaccines. Future work should further explore multi-vaccine concerns and how addressing these concerns through healthcare-provider communication could improve HPV vaccination along with COVID-19 and influenza vaccination.

Determinants of Human Papillomavirus (HPV) vaccination intentions among young adult college students using the theory of planned behavior

Purpose: To determine college students' intentions to be Human Papillomavirus (HPV) vaccinated. Methods: The study was comprised of college students aged 18-45 years. A survey was developed based on the Theory of Planned Behavior (TPB). The significance of the TPB constructs-attitude, subjective norms, and perceived behavioral control-and an additional construct-knowledge-in predicting intention were assessed. Results: The regression model containing attitude, subjective norms and perceived behavioral control accounted for 40% of the variance in intention. Attitude and subjective norms were significant predictors, while perceived behavioral control was not. Provider recommendation was the only significant covariate. Knowledge did not significantly contribute to the model. Discussion: The TPB was useful in predicting HPV vaccination intentions. A focus on attitude, subjective norms and provider recommendation may be useful in creating new or enhancing existing interventions.

Patterns of digital health access and use among US adults: A latent class analysis

Background Digital technologies allow users to engage in health-related behaviors associated with positive outcomes. We aimed to identify classes of US adults with distinct digital technologies access and health use patterns and characterize class composition. Data came from Health Information National Trends Survey Wave 5 Cycles 1-4, a nationally representative cross-sectional survey of US adults ( N  = 13,993). We used latent class analysis to identify digital technologies access and health use patterns based on 32 behaviors and access to requisite technologies and platforms that include the internet, internet-enabled devices, health monitors, and electronic health records (EHRs). We ran a multinomial logistic regression to identify sociodemographic and health correlates of class membership ( n  = 10,734). Results Ten classes captured patterns of digital technology access and health use among US adults. This included a digitally isolated, a mobile-dependent, and a super user class, which made up 8.9%, 7.8%, and 13.6% of US adults, respectively, and captured access patterns from only basic cellphones and health monitors to near complete access to web-, mobile-, and EHR-based platforms. Half of US adults belonged to classes that lacked access to EHRs and relied on alternative web-based tools typical of patient portals. The proportion of class members who used digital technologies for health purposes varied from small to large. Older and less educated adults had lower odds of belonging to classes characterized by access or engagement in health behaviors. Hispanic and Asian adults had higher odds of belonging to the mobile-dependent class. Individuals without a regular healthcare provider and those who had not visited a provider in the past year were more likely to belong to classes with limited digital technologies access or health use. Discussion Only one third of US adults belonged to classes that had near complete access to digital technologies and whose members engaged in almost all health behaviors examined. Sex, age, and education were associated with membership in classes that lacked access to 1 + digital technologies or exhibited none to limited health uses of such technologies. Results can guide efforts to improve access and health use of digital technologies to maximize associated health benefits and minimize disparities.

Evaluating Human Papillomavirus eHealth in Hmong Adolescents to Promote Vaccinations: Pilot Feasibility Study

BACKGROUND

Human papillomavirus (HPV) is a common sexually transmitted infection, causing multiple cancers, including cervical, penile, and anal. Infection and subsequent health risks caused by HPV can be diminished by HPV vaccination. Unfortunately, vaccination rates among Hmong Americans are substantially lower than those among other racial and ethnic groups, despite having higher cervical cancer rates than non-Hispanic White women. Such disparities and sparse literature highlight the need for innovative and culturally appropriate educational interventions to improve HPV vaccine rates in Hmong Americans.

OBJECTIVE

We aimed to develop and evaluate the effectiveness and usability of an innovative web-based eHealth educational website, the Hmong Promoting Vaccines website (HmongHPV website), for Hmong-American parents and adolescents to improve their knowledge, self-efficacy, and decision-making capacities to obtain HPV vaccinations.

METHODS

Through social cognitive theory and community-based participatory action research process, we created a theory-driven and culturally and linguistically appropriate website for Hmong parents and adolescents. We conducted a pre-post intervention pilot study to assess the website's effectiveness and usability. Overall, 30 Hmong-American parent and adolescent dyads responded to questions about HPV and HPV vaccine knowledge, self-efficacy, and decision-making at preintervention, 1 week after intervention, and at the 5-week follow-up. Participants responded to survey questions about website content and processes at 1 and 5 weeks, and a subset of 20 dyad participants participated in telephone interviews 6 weeks later. We used paired t tests (2-tailed) to measure the change in knowledge, self-efficacy, and decision-making processes, and used template analysis to identify a priori themes for website usability.

RESULTS

Participants' HPV and HPV vaccine knowledge improved significantly from pre- to postintervention stage and follow-up. Knowledge scores increased from preintervention to 1 week after intervention for both parents (HPV knowledge, P=.01; vaccine knowledge, P=.01) and children (HPV knowledge, P=.01; vaccine knowledge, P<.001), which were sustained at the 5-week follow-up. Parents' average self-efficacy score increased from 21.6 at baseline to 23.9 (P=.007) at post intervention and 23.5 (P=.054) at follow-up. Similar improvements were observed in the teenagers' self-efficacy scores (from 30.3 at baseline to 35.6, P=.009, at post intervention and 35.9, P=.006, at follow-up). Collaborative decision-making between parents and adolescents improved immediately after using the website (P=.002) and at follow-up (P=.02). The interview data also revealed that the website's content was informative and engaging; in particular, participants enjoyed the web-based quizzes and vaccine reminders.

CONCLUSIONS

This theory-driven, community-based participatory action research-designed and culturally and linguistically appropriate educational website was well received. It improved Hmong parents' and adolescents' knowledge, self-efficacy, and decision-making processes regarding HPV vaccination. Future studies should examine the website's impact on HPV vaccine uptake and its potential for broader use across various settings (eg, clinics and schools).

Using Technology to Overcome Vaccine Hesitancy

Technology holds great potential to address many vaccine hesitancy determinants and support vaccine uptake given its ability to amplify positive messages, support knowledge, and enhance providers' recommendations. Modalities previously implemented with variable success have included automated reminder systems, decision support for clinicians, online education programs, social media campaigns, and virtual reality curricula. Further research is needed to identify the optimal uses of technology at the patient/parent and provider levels to overcome vaccine hesitancy. The most effective interventions will likely be multipronged providing patients, parents, and providers with information related to vaccine status.

The Relationship between Information Dissemination Channels, Health Belief, and COVID-19 Vaccination Intention: Evidence from China

In the context of the ongoing global epidemic of COVID-19 and frequent virus mutations, the implementation of vaccine is the key to the prevention and control of the epidemic at this stage. In order to provide recommendations and evidence to support global epidemic prevention and control and vaccination efforts from the perspectives of health communication and individual psychological perceptions and to improve the vaccination rate of COVID-19 vaccine among appropriate populations, this study conducted a questionnaire survey in eight districts of Beijing and collected a total of 525 valid data points. A health belief model was used to examine the predictors of COVID-19 vaccination behavior, and the relationship between different COVID-19 vaccine information dissemination channels, residents' health beliefs, and propensity to vaccinate was analyzed. This study found the following: (1) among new media, interpersonal communication and traditional media communication channels, the new media channel had the largest number of audiences; (2) the personal health beliefs of audiences in the three information channels differed significantly, with the highest perceived benefits and lowest perceived barriers in the interpersonal communication channel and the highest perceived barriers in the new media communication channel; (3) the health belief model was a significant predictor, with perceived benefits and barriers being the most effective attitudinal variables for predicting vaccination intention. This study is valuable for advancing and improving vaccine communication diffusion research and promoting wider application of the health belief model and communication media in health communication topics.

The impact of exposure to HPV related information and injunctive norms on young women's intentions to receive the HPV vaccine in China: A structural equation model based on KAP theory

Background

The HPV vaccination is a crucial line of defensing against cervical cancer. As a result of government support and positive publicity from the majority of media, a craze for HPV vaccination has occurred in China. Besides, the intentions to get the HPV vaccine among women of appropriate age is also influenced by families' and friends' attitudes and perceptions toward HPV vaccine. Therefore, the purpose of this study was to investigate how HPV related information exposure and injunctive norms affect young Chinese women's intentions to receive the HPV vaccine.

Methods

A structural equation model was developed based on KAP theory, and 567 effective questionnaires were collected through an online survey. We used SPSS 26.0 for the reliability and validity analysis and the differential testing of demographic characteristics, and Amos 26.0 for the goodness-of-fit analysis and paths testing of the model.

Results

Our findings showed that (1) intention to receive HPV vaccine differed significantly in age (P = 0.046), educational background (P = 0.001), and occupation (P = 0.004). (2) Exposure to HPV related information positively affected knowledge about HPV (β = 0.316, P < 0.001) and intention to receive HPV vaccine (β = 0.141, P < 0.001). (3) Knowledge about HPV positively affected attitude toward HPV vaccine (β=0.341, P < 0.001), but negatively affected intention to receive HPV vaccine (β = -0.148, P < 0.05), and attitude toward HPV vaccine positively affected intention to receive HPV vaccine (β = 0.594, P < 0.001). (4) Injunctive norms positively affected attitude toward HPV vaccine (β = 0.362, P < 0.001) and intention to receive HPV vaccine (β = 0.420, P < 0.001).

Conclusions

Exposure to HPV related information influenced young Chinese women's intentions to receive the HPV vaccine and related knowledge, that is, the more frequently they were exposed to HPV related information, the stronger their intentions to receive the vaccine and the higher their HPV knowledge. Also, the perception and support of HPV vaccination by people around them will further influence their attitudes and intentions to receive the HPV vaccine.

Perceptions of Healthcare Workers (HCWs) towards childhood immunization and immunization services in Fiji: a qualitative study

Introduction

Childhood immunization has been globally recognized as the single most effective strategy in preventing childhood diseases and mortality. The perceptions of healthcare workers are important as their behavior and attitudes influence parental decision–making process. This research aimed to explore the factors that influence healthcare workers’ experience and perceptions about delivering childhood immunization in Fiji.

Materials and methods

A qualitative study was conducted in three randomly selected health centers in Suva, Fiji from March 1st to April 5th, 2021. Five focus group discussions were conducted with healthcare workers who were chosen purposively, had worked in the health center for at least 6 months and included either gender. Those that did not consent or did not meet the inclusion criteria were excluded. The interviews were guided by semi–structured open–ended questionnaire and were recorded into a digital voice recorder. The data were coded, sorted, and then categorized into themes, and transcribed onto Microsoft Word. Thematic analysis was utilized to sort the key phrases from the recorded interviews.

Results

There were a total of 22 participants for the focus group discussions, with their ages ranging from 25 to 51 years, included 3 medical officers, 1 nurse practitioner and 18 registered nurses. Three major themes emerged, which included: healthcare worker factors, parental factors and health system factors. Subthemes identified from the healthcare worker factors were worker knowledge and attitudes. The subtheme for parental factors that emerged were defaulters, parental attitudes, perceived behavior and religious beliefs. For health system factors the subthemes were service delivery, registration, infrastructure, staff turnover, staff training and changes to the immunization schedule.

Conclusion

Some of the perceived barriers reported by the healthcare workers were parental religious beliefs, parental knowledge and attitude, social or physical factors (finances, transportation, childcare and work conflicts), access to health services, immunization services and policies, hours of operation, waiting time and missed opportunities. Health workers acknowledged that they have an important role to play in immunization as they are the source of information and motivation for parents. Further studies are needed to be conducted nationally to determine the perceptions of healthcare workers towards immunization and how the services can be improved on a national level.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03665-9.

Segmentation of intentions towards COVID-19 vaccine acceptance through political and health behaviour explanatory models

BACKGROUND

Management of the COVID-19 pandemic has been plagued by an online 'infodemic', not least on the topic of vaccine safety. Failure to vaccinate is often addressed with corrective, factually based information. However, this may be overly simplistic. European vaccine hesitancy levels correlate closely with popularity of populist parties while scientific populism refers specifically to populist distrust in scientific expertise.

AIMS AND METHOD

Combining an evaluation of risk through the health belief model and the cognitive constructs from the theory of planned behaviour, with the influence of populist statements, anticipated regret, trust, and past healthcare behaviour, an online survey explored the components of vaccine decisions amongst a demographically representative Irish adult sample (N = 1995).

RESULTS

The regression model accounted for a large proportion of variance amongst the total sample. A primary set of influences suggests a considered risk evaluative decision-making approach while a second tier of weaker influences incorporates a broader set of values beyond cost-benefit analysis. Six ideological subsets were identified through K-means analysis. Segments were differentiated by subjective norms attitudes (particularly around social media), populist political attitudes, self-efficacy, perceptions of COVID-19 severity, and susceptibility to the condition.

CONCLUSIONS

While the 'right thing to do' is clear when viewed through a lens of scientific expert advice, this is precisely the paradigm which populist movement rejects. Segmentations, such as the outputs from this study, validate the importance of proactively engaging with diverse communities both on and offline and afford a framework for developing and evaluating more refined, targeted, policies and interventions.

Social Media Perceptions and Internet Verification Skills Associated With Human Papillomavirus Vaccine Decision-Making Among Parents of Children and Adolescents: Cross-sectional Survey

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.

Spatiotemporal evolution of online attention to vaccines since 2011: An empirical study in China

Since the outbreak of Coronavirus Disease 2019 (COVID-19), the Chinese government has taken a number of measures to effectively control the pandemic. By the end of 2021, China achieved a full vaccination rate higher than 85%. The Chinese Plan provides an important model for the global fight against COVID-19. Internet search reflects the public's attention toward and potential demand for a particular thing. Research on the spatiotemporal characteristics of online attention to vaccines can determine the spatiotemporal distribution of vaccine demand in China and provides a basis for global public health policy making. This study analyzes the spatiotemporal characteristics of online attention to vaccines and their influencing factors in 31 provinces/municipalities in mainland China with Baidu Index as the data source by using geographic concentration index, coefficient of variation, GeoDetector, and other methods. The following findings are presented. First, online attention to vaccines showed an overall upward trend in China since 2011, especially after 2016. Significant seasonal differences and an unbalanced monthly distribution were observed. Second, there was an obvious geographical imbalance in online attention to vaccines among the provinces/municipalities, generally exhibiting a spatial pattern of “high in the east and low in the west.” Low aggregation and obvious spatial dispersion among the provinces/municipalities were also observed. The geographic distribution of hot and cold spots of online attention to vaccines has clear boundaries. The hot spots are mainly distributed in the central-eastern provinces and the cold spots are in the western provinces. Third, the spatiotemporal differences in online attention to vaccines are the combined result of socioeconomic level, socio-demographic characteristics, and disease control level.

Promoting Social Distancing and COVID-19 Vaccine Intentions to Mothers: Randomized Comparison of Information Sources in Social Media Messages

Background

Social media disseminated information and spread misinformation during the COVID-19 pandemic that affected prevention measures, including social distancing and vaccine acceptance.

Objective

In this study, we aimed to test the effect of a series of social media posts promoting COVID-19 nonpharmaceutical interventions (NPIs) and vaccine intentions and compare effects among 3 common types of information sources: government agency, near-peer parents, and news media.

Methods

A sample of mothers of teen daughters (N=303) recruited from a prior trial were enrolled in a 3 (information source) × 4 (assessment period) randomized factorial trial from January to March 2021 to evaluate the effects of information sources in a social media campaign addressing NPIs (ie, social distancing), COVID-19 vaccinations, media literacy, and mother-daughter communication about COVID-19. Mothers received 1 social media post per day in 3 randomly assigned Facebook private groups, Monday-Friday, covering all 4 topics each week, plus 1 additional post on a positive nonpandemic topic to promote engagement. Posts in the 3 groups had the same messages but differed by links to information from government agencies, near-peer parents, or news media in the post. Mothers reported on social distancing behavior and COVID-19 vaccine intentions for self and daughter, theoretic mediators, and covariates in baseline and 3-, 6-, and 9-week postrandomization assessments. Views, reactions, and comments related to each post were counted to measure engagement with the messages.

Results

Nearly all mothers (n=298, 98.3%) remained in the Facebook private groups throughout the 9-week trial period, and follow-up rates were high (n=276, 91.1%, completed the 3-week posttest; n=273, 90.1%, completed the 6-week posttest; n=275, 90.8%, completed the 9-week posttest; and n=244, 80.5%, completed all assessments). In intent-to-treat analyses, social distancing behavior by mothers (b=-0.10, 95% CI -0.12 to -0.08, P<.001) and daughters (b=-0.10, 95% CI -0.18 to -0.03, P<.001) decreased over time but vaccine intentions increased (mothers: b=0.34, 95% CI 0.19-0.49, P<.001; daughters: b=0.17, 95% CI 0.04-0.29, P=.01). Decrease in social distancing by daughters was greater in the near-peer source group (b=-0.04, 95% CI -0.07 to 0.00, P=.03) and lesser in the government agency group (b=0.05, 95% CI 0.02-0.09, P=.003). The higher perceived credibility of the assigned information source increased social distancing (mothers: b=0.29, 95% CI 0.09-0.49, P<.01; daughters: b=0.31, 95% CI 0.11-0.51, P<.01) and vaccine intentions (mothers: b=4.18, 95% CI 1.83-6.53, P<.001; daughters: b=3.36, 95% CI 1.67-5.04, P<.001). Mothers' intentions to vaccinate self may have increased when they considered the near-peer source to be not credible (b=-0.50, 95% CI -0.99 to -0.01, P=.05).

Conclusions

Decreasing case counts, relaxation of government restrictions, and vaccine distribution during the study may explain the decreased social distancing and increased vaccine intentions. When promoting COVID-19 prevention, campaign planners may be more effective when selecting information sources that audiences consider credible, as no source was more credible in general.

Trial Registration

ClinicalTrials.gov NCT02835807; https://clinicaltrials.gov/ct2/show/NCT02835807.

Promoting HPV vaccination among Latinx: an application of the extended parallel processing model

Vaccine hesitancy is a substantial barrier to increasing HPV vaccination rates among Latinx in the US who experience disproportional rates of HPV-related cancers. The current research tests the effectiveness of culturally-targeted, fear-appeal messages designed using the Extended Parallel Processing Model (EPPM). We compared differences among Latinx young adults and parents of adolescents of the effectiveness of messages that highlight HPV-related cancers, genital warts, or a control condition to promote online information seeking about the HPV vaccine-a known precursor to vaccination intention. Results found messages containing EPPM messaging elements produced significantly higher self-reported intention to seek information about HPV vaccines in comparison to a control message group. However, participants who received control messages had the highest percentage of hyperlink clicks to more information about HPV (a novel measure of information seeking). Findings suggest that fear appeals may be effective for promoting information seeking about HPV vaccination, which in turn could increase vaccine utilization, among Latinx participants. Clinical trial registration number (NCT05206669) retrospectively registered January 25, 2022.

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

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

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

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

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

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

Testing Messages on Facebook to Promote Use of an HPV Educational Web-Intervention

In the US, the human papillomavirus (HPV) vaccine remains underutilized leading to disparities in HPV-related diseases. Latinx have some of the highest rates of cancer caused by HPV. In a previous study, we developed a tailored-messaging based online educational intervention (CHICOS) that was found to increase HPV vaccination intention among Latinx participants. The current research uses Facebook Advertising to test the comparative effectiveness of messages designed using the Extended Parallel Processing Model (EPPM) to promote the use of CHICOS among Latinx young adults and parents of adolescents. We also looked at differences in the effectiveness of messages that highlighted HPV-related cancers, genital warts, or a control condition as well as differences in Spanish vs. English messages. Results found Latinx young adults and parents, were more likely to click on Facebook Advertisements containing messages in Spanish and those that mention cancer risks pertinent to this population compared to those in English or messages that discuss genital warts. Thus, findings suggest that Facebook Advertising has the potential to be a useful tool for motivating information seeking online about HPV vaccination.

Linking digital health divide to HPV awareness, HPV knowledge, and cervical cancer screening among women in the United States: A trend analysis from 2008 to 2017

The author aims to explore the trend of HPV awareness, HPV knowledge, and cervical cancer screening among American female adults, and the influence of digital health divide throughout the past decade. Data from the 2008, 2013, and 2017 iterations of the nationally representative survey of Health Information National Trends Survey (HINTS) were employed for this research. The author found that cervical cancer screening continuously increased in the past decade. Women's HPV awareness and knowledge remain low. Internet access, Internet health information seeking, and eHealth activities were significant determinants of HPV awareness and knowledge over the three iterations.

From bad to worse II: Risk amplification of the HPV vaccine on Facebook

BACKGROUND

The HPV vaccine is seen by many audiences as a health risk, but this perspective has seen little analysis. This study is the continuation of an analysis of the first decade of public, HPV-vaccine related Facebook posts. For this study, social amplification of risk framework concepts were analyzed to measure their relationships with post characteristics, engagement, and to see how those variables changed over time.

METHODS

There were 6,506 public HPV vaccine-related Facebook posts (n = 6,506) within the first ten years after HPV vaccine's FDA approval (June 8, 2006 - June 8, 2016). Post characteristics, engagement, and social amplification of risk framework messages were coded (Krippendorf's alpha range: 0.67-1.00).

RESULTS

HPV vaccine risk amplification messages appeared in 39.5% of posts (n = 2,568), attenuated in 2.9% of post (n = 186), with the remaining 57.7% (n = 3,752) doing neither. Compared to groups, individuals were overrepresented in authoring HPV vaccine risk amplifying messages. Hyperlinks and negative tone towards the HPV vaccine. HPV vaccine risk amplifying messages also received significantly greater reaction (r = 0.050, p < 0.0001), comment (r = 0.030, p < 0.0001), and share counts (r = 0.028, p < 0.0001). The data showed evidence of forward momentum (Durbin-Watson values) of HPV vaccine risk amplification (0.006), related ripples (0.530), and impacts (1.376).

CONCLUSION

Nearly four out of every ten Facebook posts about the HPV vaccine contained messages that amplified the risk of HPV vaccine and the data suggest that these posts had momentum over time. Research must continue to address the perception of vaccine safety where the vaccine is perceived as the health threat, with deep research into online communities to discover the perceived ripples and impacts.

Online Health Information Seeking by Parents for Their Children: Systematic Review and Agenda for Further Research

Background

Parents commonly use the internet to search for information about their child’s health-related symptoms and guide parental health-related decisions. Despite the impact of parental online health seeking on offline health behaviors, this area of research remains understudied. Previous literature has not adequately distinguished searched behaviors when searching for oneself or one`s child.

Objective

The purpose of this review is to examine prevalences and associated variables of parent-child online health information seeking; investigate parents’ health-related online behavior regarding how they find, use, and evaluate information; and identify barriers and concerns that they experience during the search. Based on this analysis, we develop a conceptual model of potentially important variables of proxy online health information seeking, with a focus on building an agenda for further research.

Methods

We conducted a comprehensive systematic literature review of the PsycINFO, JMIR, and PubMed electronic databases. Studies between January 1994 and June 2018 were considered. The conceptual model was developed using an inductive mixed methods approach based on the investigated variables in the study sample.

Results

A total of 33 studies met the inclusion criteria. Findings suggest that parents worldwide are heavy online users of health-related information for their children across highly diverse circumstances. A total of 6 studies found high parental health anxiety, with prevalences ranging from 14% to 52%. Although parents reported wishing for more guidance from their pediatrician on how to find reliable information, they rarely discussed retrieved information from the web. The conceptual model of proxy online health information seeking includes 49 variables.

Conclusions

This systematic review identifies important gaps regarding the influence of health-related information on parents’ health behavior and outcomes. Follow-up studies are required to offer parents guidance on how to use the web for health purposes in an effective way, as well as solutions to the multifaceted problems during or after online health information seeking for their child. The conceptual model with the number of studies in each model category listed highlights how previous studies have hardly considered relational variables between the parent and child. An agenda for future research is presented.

HPV prevention is not just for girls: an examination of college-age-students' adoption of HPV vaccines

This study identifies source(s) of information young adults found to be persuasive in choosing/declining HPV vaccines. The results indicate that males are not getting HPV vaccination information from either their physician, parent, or DTC advertising. Females reported that physicians and their mothers were the most influential sources of information. Additionally, females found that risk message frames focusing on empowerment, reduced dread, control and benefit in the DTC HPV vaccine advertisements were persuasive; males did not. With the rapid rise of HPV related cancers found in males, there is a need to inform males and their parents about for HPV vaccines.

Quality Assessment of Websites Providing Information on Human Papillomavirus Vaccines in Thailand

OBJECTIVES

To assess the quality of websites that provide information about human papillomavirus (HPV) vaccination using the criteria laid out by the World Health Organization Global Advisory Committee on Vaccine Safety.

METHODS

This study assessed the quality of 154 Thai-language websites accessible in November 2018 via the three most popular search engines. Differences in scores were reported as mean difference (MD) and 95% confidence interval (CI).

RESULTS

With regard to credibility, all of the websites examined indicated their mission but, in most cases (91.6%), lacked transparency with regard to sponsorship. In terms of content, almost all of the websites (97.4%) met our writing/editing and content accuracy standards but did not provide complete information regarding the benefits of vaccination or adverse events associated with it. None of the websites contained information regarding their editorial/review process. All of the websites were accessible and were designed to be adaptable to mobile device screens. News and personal websites had lower credit scores than those of academic institutions (MD -0.63, 95% CI -1.05 to -0.20; MD -0.71, 95% CI -1.16 to -0.25, respectively).

CONCLUSION

Most of the websites met standards in terms of writing/editing and content accuracy. However, fundamental information regarding the benefits and adverse events associated with HPV vaccination were infrequently reported, the editorial process and transparency issues were rarely addressed.

Teaching It Forward: Educating Parents About HPV/HPV Vaccine

BACKGROUND

Human papillomavirus (HPV) vaccines are available to prevent HPV-associated cancers. However, parents are reluctant to make the decision to immunize their children. Nationally, HPV vaccination rates remain low.

OBJECTIVE

The objectives were to improve parents' attitudes and knowledge about HPV/HPV vaccine, increase parental intent to vaccinate, and increase HPV vaccination rates in a primary care office.

METHODS

A one-group, pretest/posttest design was used to assess participants' attitude, knowledge, and intent to vaccinate before and after viewing an HPV educational video. Pre-post project HPV vaccination rates were compared.

RESULTS

Participants' attitudes toward HPV/HPV vaccine improved while knowledge increased. Intent to vaccine increased by 31% after viewing the HPV educational video. HPV vaccination rates increased 6% (females) and 9% (males).

CONCLUSIONS

Primary care providers (PCPs) should look for innovative ways to educate parents about HPV, help parents make informed decisions about the HPV vaccine, and work toward a common goal of preventing HPV-associated cancers.

IMPLICATIONS FOR NURSING

Implications are three-fold benefiting parents, PCPs, and society. Parents will be more knowledgeable, providers will understand they are an important key in the vaccine process, and society will benefit from a decrease in HPV-associated cancers.

Characterizing Trends in Human Papillomavirus Vaccine Discourse on Reddit (2007-2015): An Observational Study

Background

Despite the introduction of the human papillomavirus (HPV) vaccination as a preventive measure in 2006 for cervical and other cancers, uptake rates remain suboptimal, resulting in preventable cancer mortality. Social media, widely used for information seeking, can influence users’ knowledge and attitudes regarding HPV vaccination. Little is known regarding attitudes related to HPV vaccination on Reddit (a popular news aggregation site and online community), particularly related to cancer risk and sexual activity. Examining HPV vaccine–related messages on Reddit may provide insight into how HPV discussions are characterized on forums online and influence decision making related to vaccination.

Objective

We observed how the HPV vaccine is characterized on Reddit over time and by user gender. Specifically, this study aimed to determine (1) if Reddit messages are more related to cancer risks or sexual behavior and (2) what other HPV vaccine–related discussion topics appear on Reddit.

Methods

We gathered all public Reddit comments from January 2007 to September 2015. We manually annotated 400 messages to generate keywords and identify salient themes. We then measured the similarity between each comment and lists of keywords associated with sexual behavior and cancer risk using Latent Semantic Analysis (LSA). Next, we used Latent Dirichlet Allocation (LDA) to characterize remaining topics within the Reddit data.

Results

We analyzed 22,729 messages containing the strings hpv or human papillomavirus and vaccin. LSA findings show that HPV vaccine discussions are significantly more related to cancer compared with sexual behavior from 2008 to 2015 (P<.001). We did not find a significant difference between genders in discussions of cancer and sexual activity (P>.05). LDA analyses demonstrated that although topics related to cancer risk and sexual activity were both frequently discussed (16.1% and 14.5% of word tokens, respectively), the majority of online discussions featured other topics. The most frequently discussed topic was politics associated with the vaccine (17.2%). Other topics included HPV disease and/or immunity (13.5%), the HPV vaccine schedule (11.5%), HPV vaccine side effects (9.7%), hyperlinks to outside sources (9.1%), and the risks and benefit of HPV vaccination (8.5%).

Conclusions

Reddit discourse on HPV vaccine encompasses a broad range of topics among men and women, with HPV political debates and cancer risk making up the plurality of the discussion. Our findings demonstrated that women and men both discussed HPV, highlighting that Reddit users do not perceive HPV as an issue that only pertains to women. Given the increasing use of social media as a source of health information, these results can inform the development of targeted online health communication strategies to promote HPV vaccination to young adult users of Reddit. Analyzing online discussions on Reddit can inform health communication efforts by identifying relevant, important HPV-related topics among online communities.

A content analysis of HPV related posts on instagram

Human papillomavirus, or HPV, is the most common sexually transmitted disease in the United States. Despite the potential deleterious effects of HPV, vaccine uptake remains suboptimal. One potential venue for educating the public about HPV and vaccinations is through social media such as the widely used Instagram platform. Given the widespread reach of a platform with such a vast user base, the aim of this study was to describe posts related to HPV on Instagram. Content categories were established using fact sheets from the Centers for Disease Control HPV index page. Important content categories were created and the resultant coding sheet was used to analyze posts from the hashtag #HPV. Of the 150 posts analyzed, 53 posts (35%) mentioned the HPV vaccine. More were pro-vaccine (28%) versus anti-vaccine (7%). Posts mentioned the association of HPV with cancer (35%) and prevention of HPV (32%). Posts with a higher number of likes were more likely to mention cancer (p = 0.016) and HPV screening (p = 0.041). Among those that mentioned the HPV vaccine, posts that were anti-vaccine were more likely to mention prevention (p < 0.001) and cancer (p < 0.001). As new technology emerges and is widely adopted, health professionals should be aware and adept at using what is popular to influence given audiences. This applies to adolescents in particular, who, by and large are frequent users of technology for communication.

Determining parents' patterns of behaviour when searching for online information on their child's health

AIM

The internet has enabled parents to become informed medical consumers and take an active role in their child's treatment. We aimed to determine parents' online medical information-seeking behaviour about their child's health. This included sources of information, reasons for searching, use and assessment of information and whether parents wanted assistance with searching and assessing information.

METHODS

A questionnaire was distributed to 331 parents and carers of inpatients and outpatients at Children's Hospital at Westmead in 2015. Most questions involved tick-box responses and a few free-text responses. Responses were tabulated and described by frequencies and percentages. Associations between participant demographics and responses were examined using chi-square tests.

RESULTS

In all, 308 (93%) questionnaires were returned. Most participants (90%) reported searching for medical information about their child's health. Of these, 96% searched the internet, and of these, 63% used a smartphone. The most common reason for searching before seeing the doctor was to prepare questions. The most common reasons for searching after seeing the doctor were to know more and because participants had more questions. Only half (57%) ascertained whether an information source was reliable. Most wanted guidance on searching (69%) and assessing reliability (77%).

CONCLUSIONS

Almost all parents search for online information about their child's health, but most are unsure whether the information they find is trustworthy and are hesitant to act on or present it to their child's doctor. Health professionals could discuss this with parents during consultations to dispel potential misunderstandings and provide guidance on searching and assessing.

Readability of online information about HPV Immunization

The human papillomavirus (HPV) vaccine is highly effective in preventing anogenital cancers, but vaccination rates in the United States remain low. In deciding whether to vaccinate their children, parents are increasingly using the internet to gather information. This study aimed to examine the level of readability of information on HPV vaccines written on 100 websites that were found via an internet search. To create the website sample, the first 50 websites from the search "HPV immunization" were recorded, followed by the first 50 non-duplicated websites from the search "Gardasil." The content of the sites was analyzed using established readability scales. Websites were compared based on keyword search and on whether they had a commercial or non-commercial URL extension. The majority of websites were found to have information of a difficult reading level. Websites with commercial URL extensions and websites found using the search "Gardasil" had higher mean readability scores. These results suggest that many parents may not understand the information currently presented on the internet and that interventions aimed at improving the readability of online information could help to increase parental approval of the vaccine.

Development and Evaluation of a Social Media Health Intervention to Improve Adolescents' Knowledge About and Vaccination Against the Human Papillomavirus

This study describes the formative research, execution, and evaluation of a social media health intervention to improve adolescents’ knowledge about and vaccination against human papillomavirus (HPV). Based on the results from formative focus groups with adolescents (N = 38) to determine intervention feasibility, parameters, and message preferences, we developed and conducted a pretest/posttest evaluation of a 3-month social media health intervention for adolescents who had not completed the HPV vaccine series (N = 108). Results revealed that adolescents who fully engaged with the intervention improved in their knowledge compared with a control group, and many were also likely to have interpersonal discussions with others about what they learned. Adolescents are generally interested in receiving information about HPV and the vaccine, along with other relevant health information, through social media channels if messages are considered interesting, their privacy is protected, and the source is credible.

The Relationship of Health Beliefs with Information Sources and HPV Vaccine Acceptance among Young Adults in Korea

Despite the HPV vaccine&rsquo;s efficacy in preventing cervical cancer, its coverage rates among Asians are very low. To increase immunization coverage among these populations, understanding the psychological factors that affect HPV acceptability is critical. To this end, this study examined the relationships between multidimensional health beliefs and HPV vaccine acceptance, and what information sources effectively foster HPV vaccination-related health beliefs. Data were collected using a survey of 323 undergraduate students in Korea. Results showed that perceived susceptibility, perceived severity, perceived benefits, and perceived vaccine safety concerns predicted vaccine acceptance. Multiple dimensions of perceived barriers showed differing impacts on vaccine acceptance. In addition, interpersonal information sources were effective in boosting various health beliefs for HPV vaccination. The Internet also was effective in reducing social barriers, but the effects were opposite to those of social media. Theoretical and practical implications are discussed.

Using Social Marketing Theory as a Framework for Understanding and Increasing HPV Vaccine Series Completion Among Hispanic Adolescents: A Qualitative Study

HPV vaccine series completion rates among adolescent Hispanic females and males (~39 and 21 %, respectively) are far below the Healthy People 80 % coverage goal. Completion of the 3-dose vaccine series is critical to reducing the incidence of HPV-associated cancers. This formative study applies social marketing theory to assess the needs and preferences of Hispanic mothers in order to guide the development of interventions to increase HPV vaccine completion. We conducted 51 in-depth interviews with Hispanic mothers of adolescents to identify the key concepts of social marketing theory (i.e., the four P's: product, price, place and promotion). Results suggest that a desire complete the vaccine series, vaccine reminders and preventing illnesses and protecting their children against illnesses and HPV all influence vaccination (product). The majority of Completed mothers did not experience barriers that prevented vaccine series completion and Initiated mothers perceived a lack of health insurance and the cost of the vaccine as potential barriers. Informational barriers were prevalent across both market segments (price). Clinics are important locations for deciding to complete the vaccine series (place). They are the preferred sources to obtain information about the HPV vaccine thus making them ideal locations to deliver intervention messages, followed by television, the child's school and brochures (promotion). Increasing HPV vaccine coverage among Hispanic adolescents will reduce the rates of HPV-associated cancers and the cervical cancer health disparity among Hispanic women. This research can inform the development of an intervention to increase HPV vaccine series completion in this population.

Diverse Families' Experiences with HPV Vaccine Information Sources: A Community-Based Participatory Approach

Current sources of publicly available human papillomavirus (HPV) information may not adequately meet the needs of diverse families. This study sought to describe associations between sociodemographic and acculturation factors, and sources of HPV information among diverse parents and caregivers. Community organizations purposively recruited participants from African American, African refugee, Hispanic/Latino, American Indian, and Native Hawaiian and Pacific Islander communities for a 21-item survey (N = 228). Ninenty-three of these participants also participated in ten focus groups conducted in three languages. Descriptive statistics and Fishers' Exact Test for Count Data were produced and triangulated with focus group data to provide additional context. Overall, HPV vaccine awareness and knowledge in the five communities was low. This study found that a greater proportion of lower-acculturated participants had heard of HPV through personal networks (foreign-born = 50 % vs US-born = 30 %, p < 0.05; medium acculturation = 60 % vs high acculturation = 26 %, p = 0.01), while greater proportions of US-born participants reported media sources (49 % vs foreign-born = 29 %, p < 0.05). Across communities, healthcare system sources were described as important and preferred sources of HPV information. Hearing about the HPV vaccine from healthcare settings was significantly associated with increased accuracy in HPV vaccine knowledge (p < 0.05). Communities described a need for more in-depth information about the HPV vaccine, and culturally and linguistically appropriate educational materials. Culturally-competent delivery of HPV information through the healthcare system sources may be important in improving knowledge and acceptability of the HPV vaccine among diverse families.

The Need to Optimize Adolescent Immunization

The adolescent period heralds the pediatric patient's transition into adulthood. It is a time of dynamic development during which effective preventive care measures can promote safe behaviors and the development of lifelong health habits. One of the foundations of preventive adolescent health care is timely vaccination, and every visit can be viewed as an opportunity to update and complete an adolescent's immunizations.In the past decade, the adolescent immunization schedule has expanded to include 2 doses of quadrivalent meningococcal conjugate vaccine, 1 dose of tetanus, diphtheria, acellular pertussis, absorbed vaccine, 2 or 3 doses of human papillomavirus vaccine, depending on the child's age, and an annual influenza vaccine. In addition, during adolescent visits, health care providers can determine whether catch-up vaccination is needed to meet early childhood recommendations for hepatitis B; hepatitis A; measles, mumps, rubella; poliovirus; and varicella vaccines. New serogroup B meningococcal vaccines are now available for those at increased risk for meningococcal disease; in addition, these serogroup B meningococcal vaccines received a Category B recommendation for healthy adolescents, where individual counseling and risk-benefit evaluation based on health care provider judgements and patient preferences are indicated. This clinical report focuses on the epidemiology of adolescent vaccine-preventable diseases by reviewing the rationale for the annual universally recommended adolescent immunization schedule of the American Academy of Pediatrics, the American Academy of Family Physicians, the Centers for Disease Control and Prevention, and the American Congress of Obstetricians and Gynecologists. In addition, the barriers that negatively influence adherence to this current adolescent immunization schedule will be highlighted.

How often people google for vaccination: Qualitative and quantitative insights from a systematic search of the web-based activities using Google Trends

Nowadays, more and more people surf the Internet seeking health-related information. Information and communication technologies (ICTs) can represent an important opportunities in the field of Public Health and vaccinology. The aim of our current research was to investigate a) how often people search the Internet for vaccination-related information, b) if this search is spontaneous or induced by media, and c) which kind of information is in particular searched. We used Google Trends (GT) for monitoring the interest for preventable infections and related vaccines. When looking for vaccine preventable infectious diseases, vaccine was not a popular topic, with some valuable exceptions, including the vaccine against Human Papillomavirus (HPV). Vaccines-related queries represented approximately one third of the volumes regarding preventable infections, greatly differing among the vaccines. However, the interest for vaccines is increasing throughout time: in particular, users seek information about possible vaccine-related side-effects. The five most searched vaccines are those against 1) influenza; 2) meningitis; 3) diphtheria, pertussis (whooping cough), and tetanus; 4) yellow fever; and 5) chickenpox. ICTs can have a positive influence on parental vaccine-related knowledge, attitudes, beliefs and vaccination willingness. GT can be used for monitoring the interest for vaccinations and the main information searched.

To Consent or Decline HPV Vaccination: A Pilot Study at the Start of the National School-Based Vaccination Program in Sweden

BACKGROUND

Parents' beliefs about human papillomavirus (HPV) vaccination influence whether they allow their daughters to be vaccinated. We examined the association between parents' refusal and sociodemographic background, knowledge and beliefs about HPV, and the HPV vaccination in relation to the Health Belief Model.

METHODS

The sample consisted of 200 (55%) parents of children aged 11-12 years in the Swedish national vaccination program. Data were collected using a self-reported questionnaire. Most parents (N = 186) agreed to the vaccination. Pearson's chi-square, Fisher's exact test, and the Mann-Whitney U test were used to analyze data.

RESULTS

Declining parents saw more risks and fewer benefits of HPV vaccination but no differences in beliefs regarding the severity or young girls' susceptibility to HPV were found. There was an association between refusing the HPV vaccine and lower acceptance of previous childhood vaccinations, and their main source of information was the Internet. Parents who declined the vaccine believed it could adversely affect condom use, the age of their daughter's sexual debut, and the number of sexual partners.

CONCLUSION

Parents should have the possibility to discuss HPV and HPV vaccine with a school nurse or other health care professionals, and should have access to evidence-based information on the Internet.

Influence of Sources of Information and Parental Attitudes on Human Papillomavirus Vaccine Uptake among Adolescents

STUDY OBJECTIVE

The purpose of this study was to: 1) describe parental sources of information about human papillomavirus (HPV) vaccination for adolescents, 2) understand how parental sources of information about HPV vaccine are associated with adolescent HPV vaccine uptake, and 3) understand if the relationship between a greater number of HPV-related information sources and HPV vaccine uptake among adolescents is mediated by parental attitudes.

DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS

We conducted a 3-arm randomized controlled trial in middle and high schools in eastern Georgia from 2011 to 2013. As part of the trial, we surveyed parents during the final year to understand their sources of information about HPV vaccine for their adolescent. Data were collected from 360 parents via phone and online surveys.

MAIN OUTCOME MEASURES

Parents responded to a survey that asked them to identify demographic information, parental HPV attitudes, sources of information about HPV vaccination, and HPV vaccine uptake.

RESULTS

Most of the sample was African American (74%; n = 267) and 53% of parents (n = 192) reported that their adolescent received at least 1 HPV vaccine dose. The top sources of information about HPV vaccine reported by parents were a doctor or medical professional (80%; n = 287) and television (64%; n = 232). A mediation analysis showed sources of information about HPV vaccine are associated with parental attitudes, and parental attitudes about HPV vaccine are associated with vaccine uptake among adolescents.

CONCLUSION

These findings highlight the importance of HPV sources of information on parental attitudes.

Parental Refusal of the Human Papillomavirus Vaccine

INTRODUCTION

The purpose of this study was to explore reasons why parents may defer administration of the human papillomavirus (HPV) vaccine to their children. The literature suggests that parents choose to defer administration of this vaccine for several reasons. Data from this pilot study will contribute to our understanding of why parents defer administration of the vaccine.

METHOD

This mixed-methods study took place in a pediatric practice. After a health care visit in which the vaccine was deferred, a survey was provided to the parent in a private room. The survey was confidential and anonymous.

RESULTS

A total of 23 surveys were completed. Demographic data were reported. Data were analyzed for descriptive statistics and themes from open-ended questions. The majority of parents (75%) deferred administration of the HPV vaccine because they believed it was too new or required further research.

DISCUSSION

Nurse practitioners are in an excellent position to dispel myths and clarify information about HPV vaccination. The data are useful in communicating with parents and promoting best practices to facilitate good health in children.

Cross sectional study investigating the differences in knowledge and behaviors about HPV between vaccinated and non-vaccinated girls

INTRODUCTION

The aim of the presents study was to compare the level of knowledge about Human Papilloma Virus (HPV) in vaccinated and non-vaccinated girls and to highlight the reasons why non-vaccinated girls refuse vaccination.

METHODS

A cross-sectional study was conducted from October 2012 to June 2013 in Turin (Piemonte Region, Italy). Questionnaires were administered to girls attending secondary and high schools randomly selected.

RESULTS

A total of 576 were compiled. The principle sources of information were parents and health workers. The main reported reasons for non-adherence to vaccination were the disagreement of the parents among the 11-12 years group (45.3%) and the lack of evidence on efficacy among the 18 years group (26.8%). By comparing the level of knowledge there was a statistically significant difference between groups: vaccinated girls reported higher score than the unvaccinated group in several questions (p ≤ 0.05).

CONCLUSIONS

Our findings show a lack of information about HPV infection. Parents, school and health care workers have a central role in girl's education and choices about HPV vaccination. The communication campaign for the prevention of cervical cancer must therefore be characterised by messages able to clarify and consolidate messages that may have been partially received or misunderstood.

How Are Information Seeking, Scanning, and Processing Related to Beliefs About the Roles of Genetics and Behavior in Cancer Causation?

Understanding that cancer is caused by both genetic and behavioral risk factors is an important component of genomic literacy. However, a considerable percentage of people in the United States do not endorse such multifactorial beliefs. Using nationally representative cross-sectional data from the U.S. Health Information National Trends Survey (N = 2,529), we examined how information seeking, information scanning, and key information-processing characteristics were associated with endorsing a multifactorial model of cancer causation. Multifactorial beliefs about cancer were more common among respondents who engaged in cancer information scanning (p = .001), were motivated to process health information (p = .005), and reported a family history of cancer (p = .0002). Respondents who reported having previous negative information-seeking experiences had lower odds of endorsing multifactorial beliefs (p = .01). Multifactorial beliefs were not associated with cancer information seeking, trusting cancer information obtained from the Internet, trusting cancer information from a physician, self-efficacy for obtaining cancer information, numeracy, or being aware of direct-to-consumer genetic testing (ps > .05). Gaining additional understanding of how people access, process, and use health information will be critical for the continued development and dissemination of effective health communication interventions and for the further translation of genomics research to public health and clinical practice.

Bad News: Analysis of the Quality of Information on Influenza Prevention Returned by Google in English and Italian

Information available to the public influences the approach of the population toward vaccination against influenza compared with other preventative approaches. In this study, we have analyzed the first 200 websites returned by searching Google on two topics (prevention of influenza and influenza vaccine), in English and Italian. For all the four searches above, websites were classified according to their typology (government, commercial, professional, portals, etc.) and for their trustworthiness as defined by the Journal of the American Medical Association (JAMA) score, which assesses whether they provide some basic elements of information quality (IQ): authorship, currency, disclosure, and references. The type of information described was also assessed to add another dimension of IQ. Websites on influenza prevention were classified according to the type of preventative approach mentioned (vaccine, lifestyle, hygiene, complementary medicine, etc.), whether the approaches were in agreement with evidence-based medicine (EBM) or not. Websites on influenza vaccination were classified as pro- or anti-vaccine, or neutral. The great majority of websites described EBM approaches to influenza prevention and had a pro-vaccine orientation. Government websites mainly pointed at EBM preventative approaches and had a pro-vaccine orientation, while there was a higher proportion of commercial websites among those which promote non-EBM approaches. Although the JAMA score was lower in commercial websites, it did not correlate with the preventative approaches suggested or the orientation toward vaccines. For each of the four search engine result pages (SERP), only one website displayed the health-of-the-net (HON) seal. In the SERP on vaccines, journalistic websites were the most abundant category and ranked higher than average in both languages. Analysis using natural language processing showed that journalistic websites were mostly reporting news about two specific topics (different in the two languages). While the ranking by Google favors EBM approaches and, in English, does not promote commercial websites, in both languages it gives a great advantage to news. Thus, the type of news published during the influenza season probably has a key importance in orienting the public opinion due to its high visibility. This raises important questions on the relationships between health IQ, trustworthiness, and newsworthiness.

An appraisal of theoretical approaches to examining behaviours in relation to Human Papillomavirus (HPV) vaccination of young women

BACKGROUND

Interventions to increase uptake of Human Papillomavirus (HPV) vaccination by young women may be more effective if they are underpinned by an appropriate theoretical model or framework. The aims of this review were: to describe the theoretical models or frameworks used to explain behaviours in relation to HPV vaccination of young women, and: to consider the appropriateness of the theoretical models or frameworks used for informing the development of interventions to increase uptake.

METHODS

Primary studies were identified through a comprehensive search of databases from inception to December 2013.

RESULTS

Thirty-four relevant studies were identified, of which 31 incorporated psychological health behaviour models or frameworks and three used socio-cultural models or theories. The primary studies used a variety of approaches to measure a diverse range of outcomes in relation to behaviours of professionals, parents, and young women. The majority appeared to use theory appropriately throughout. About half of the quantitative studies presented data in relation to goodness of fit tests and the proportion of the variability in the data.

CONCLUSION

Due to diverse approaches and inconsistent findings across studies, the current contribution of theory to understanding and promoting HPV vaccination uptake is difficult to assess. Ecological frameworks encourage the integration of individual and social approaches by encouraging exploration of the intrapersonal, interpersonal, organisational, community and policy levels when examining public health issues. Given the small number of studies using such approach, combined with the importance of these factors in predicting behaviour, more research in this area is warranted.

Parental intention regarding the administration of the HPV vaccine for adolescent daughters in Taiwan

This study aimed to investigate parental intention regarding the human papilloma virus (HPV) vaccination for adolescent daughters. Parents or guardians of adolescent girls, aged 12-14 years, from junior high schools in Taiwan participated and completed a HPV vaccination intention survey based on the Theory of Planned Behavior. The survey was conducted from October to November, 2009. Most, 78%, of the respondents reported a high intention to vaccinate daughters against HPV. A high intention of vaccination was associated with a family history of gynecological tumors (adjusted odds ratio [OR]: 2.22, 95% confidence interval [CI]: 1.10-4.51) and HPV awareness (adjusted OR: 2.33, 95% CI: 1.45-3.76). Higher parental intention was reported by respondents with a positive attitude toward the HPV vaccine (adjusted OR: 6.83, 95% CI: 4.16-11.22), perceived greater influence of subjective norms (adjusted OR: 121.23, 95% CI: 42.69-344.21), greater perceived behavioral control (adjusted OR: 67.69, 95% CI: 16.40-279.41), and perceived that the vaccine had limited influence on adolescent sexual behavior (adjusted OR: 2.24, 95% CI: 1.41-3.78). Health-care professionals must be knowledgeable about the HPV and actively promote vaccination among adolescent girls. Improvements in vaccination can be achieved through recommendations by physicians and nurses.

A feminist information engagement framework for gynecological cancer patients

Purpose

– The purpose of this paper is to present a three-part framework of information engagement for situated gynecological cancers. These particular cancers intertwine with medicalization of sexuality and gender power dynamics, situating information behaviors and interactions in women’s socio-health perceptions. Using Kavanagh and Broom’s feminist risk framework, the framework establishes functional and temporal parameters for sense-making and information engagement.

Design/methodology/approach

– This paper employs a structured, reiterative literature review with emergent thematic analysis. Nine indices from medicine, information studies, and sociology were searched using combinations of five terms on cervical cancer (CC) and 14 terms on information engagement in the title, abstract, and subject fields. Results were examined on a reiterative basis to identify emergent themes pertaining to knowledge development and information interactions.

Findings

– Environmentally, social stigma and gender roles inhibit information seeking; normalizing CC helps integrate medical, moral, and sexual information. Internally, living with the dichotomy between “having” a body and “being” a body requires high-trust information resources that are presented gradually. Actively, choosing to make or cede medical decision-making requires personally relevant information delivered in the form of concrete facts and explanations.

Research limitations/implications

– The study covers only one country.

Originality/value

– This study’s information framework and suggestions for future research encourage consideration of gender power dynamics, medicalization of sexuality, and autonomy in women’s health information interactions.

Men's Intentions to Engage in Behaviors to Protect Against Human Papillomavirus (HPV): Testing the Risk Perception Attitude Framework

Guided by the risk perception attitude framework (RPA), this study examined men's perceptions of risk and efficacy beliefs as predictors of their intentions to engage in self-protective behaviors. The results of multiple regression analyses did not provide support for the RPA prediction that efficacy beliefs moderate the relationship between risk perceptions and self-protective behavior. However, the results provide support for the main effects of risk and efficacy on all four behavioral intentions examined (i.e., Internet information seeking, communication with a health provider, HPV vaccination, and condom use). Risk and efficacy were positively related to (and significant individual predictors of) all four behavioral intentions. Scholarly and practical implications of these findings are discussed.

Mass media coverage of HPV vaccination in Romania: a content analysis

Romania has the highest cervical cancer burden in Europe. Despite the implementation of two human papillomavirus (HPV) vaccination programmes, the uptake remained extremely low and the programmes were discontinued. Given that media are a common source of information for the public and may influence vaccination decisions, this article sought to explore the content and quality of HPV vaccine media coverage in Romania. We conducted a content analysis of 271 media reports (from newspapers, magazines, videos and informational websites) published online between November 2007 and January 2012. Overall, results indicated that 31.4% of the materials were neutral, 28% were negative or extremely negative, 17% were mixed, while 23.6% were positive towards the vaccine. The most dominant vaccine-related concerns were side effects and insufficient testing. Elementary information about the vaccine and HPV was constantly left out and sometimes inaccuracies were found. Negatively disposed reports were more likely to contain incorrect data about vaccine efficacy and less likely to provide comprehensive information about the vaccine and HPV-related diseases. Some dimensions of media coverage varied across time and media outlets. The present findings suggest that educational interventions are greatly needed as a response to suboptimal and incomplete media coverage of HPV vaccination.

Information is in the eye of the beholder: Seeking information on the MMR vaccine through an Internet search engine

Vaccination campaigns are one of the most important and successful public health programs ever undertaken. People who want to learn about vaccines in order to make an informed decision on whether to vaccinate are faced with a wealth of information on the Internet, both for and against vaccinations. In this paper we develop an automated way to score Internet search queries and web pages as to the likelihood that a person making these queries or reading those pages would decide to vaccinate. We apply this method to data from a major Internet search engine, while people seek information about the Measles, Mumps and Rubella (MMR) vaccine. We show that our method is accurate, and use it to learn about the information acquisition process of people. Our results show that people who are pro-vaccination as well as people who are anti-vaccination seek similar information, but browsing this information has differing effect on their future browsing. These findings demonstrate the need for health authorities to tailor their information according to the current stance of users.

Race, ethnicity, and income factors impacting human papillomavirus vaccination rates

BACKGROUND

Human papillomavirus (HPV) infection and cervical cancer disproportionately affect low-income and minority women. HPV vaccines have the potential to either reduce or exacerbate racial disparities in HPV-related diseases and cervical cancers, depending on the equitability of vaccine uptake.

OBJECTIVES

This review aims to identify barriers and facilitators of equitable uptake of HPV vaccination among low-income and minority girls. This review discusses factors related to race, ethnicity, and income that are associated with initiation and completion rates of the 3-dose HPV vaccine series and presents targets for intervention.

METHODS

We reviewed relevant English-language literature to identify current vaccination rates and factors associated with vaccine uptake. Study findings related to race (black, Latino, Asian), and incomes were summarized.

RESULTS

Current trends in the United States indicate low uptake among all adolescents, and that rates stagnated between 2011 and 2012. Low-income and minority adolescents are equally or more likely to start the HPV vaccination series than are white and higher-income adolescents, but are less likely to complete all 3 shots. Provider recommendation is a key factor in HPV vaccination, and minorities are less likely to report receiving recommendations for HPV vaccination.

CONCLUSIONS

As black, Hispanic, and Asian populations continue to grow in the United States over the next several decades, it is imperative that we not only improve HPV vaccination rates overall, but also focus on high-risk populations to prevent an increase in cervical cancer disparities.

The internet's role in HPV vaccine education

The internet is the second most popular source, after healthcare providers, of information regarding human papillomavirus (HPV). These online searches usually begin with the user entering generic terms in the search engine, and then reading the first few results that the engine returns. Unfortunately, research shows that much of this information obtained about the HPV vaccine is inaccurate and incomplete. In this review, we summarize the literature pertaining to online information concerning the HPV vaccine and review concerns related to obtaining online medical information. Finally, we propose possible solutions medical providers can employ in their everyday practice to help their patients obtain accurate information through their online searches.