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Choi HC, Leung K, Wu JT. Cervical screening among Chinese females in the era of HPV vaccination: a population-based survey on screening uptake and regular screening following an 18-year organized screening program. J Gynecol Oncol 2024; 35:e20. [PMID: 37921604 PMCID: PMC10948984 DOI: 10.3802/jgo.2024.35.e20] [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: 05/31/2023] [Revised: 09/14/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE China has a substantial disease burden of cervical cancer. To further understand preventive measures for reducing cervical cancer in China, this study aimed to correlate screening attendance and regular screening with human papillomavirus (HPV) vaccination among Chinese females. METHODS This prospective questionnaire-based survey recruited Chinese females aged 25 or above in Hong Kong by random digit dialing telephone interviews in 2022. The survey studied women's practice of cervical screening and adherence to regular screening. Variables including HPV vaccination status and attendance of physical check-ups were involved in the questionnaire. Screening uptake and screening adherence were the main outcomes, which were measured as the proportion of women who reported having attended a cervical screening and screened regularly, respectively. RESULTS Out of 906 valid respondents, the reported cervical screening uptake was over 70% among females aged 30 or above and particularly over 80% among women aged 35-59; however, the uptake was only 46% among those aged 25-29. Adherence to regular screening was 50%-60% across ages 25-59 years and dropped to approximately 40% for women older than 60 years. Both screening uptake and adherence were associated with HPV vaccination, with adjusted odds ratios of 2.37 and 2.23, respectively. A large proportion of regularly screened women may be overscreened for screening more frequently than recommended. CONCLUSION Responded Chinese females showed good cervical screening uptake but were moderately adherent to regular screening. Policymakers should emphasize the importance of regular screening and the recommended screening frequency by HPV vaccination status for better healthcare resource use.
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Affiliation(s)
- Horace Cw Choi
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong, China.
| | - Kathy Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong, China
| | - Joseph T Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong, China
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Ben-Aharon O, Sergienko R, Iskrov G, Greenberg D. Willingness to pay for an mRNA-based anti-cancer treatment: results from a contingent valuation study in Israel. Isr J Health Policy Res 2024; 13:9. [PMID: 38374060 PMCID: PMC10875764 DOI: 10.1186/s13584-024-00594-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 02/02/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND mRNA technology is currently being investigated for a range of oncology indications. We assessed the willingness to pay (WTP) of the general population in Israel for a hypothetical novel mRNA-based treatment for oncology indications. METHODS We used a contingent valuation methodology to elicit WTP using a web-based questionnaire. A sample of adult participants were presented with a hypothetical scenario in which an mRNA-based intervention increased the likelihood of a cure for various cancer types from 20% to 40% (half of the sample), or 60% (the other half of the sample). RESULTS 531 respondents completed the questionnaire. The mean, median and mode WTP for the proposed hypothetical treatment in both scenarios were ILS65,000 (± ILS114,000), ILS20,000 and ILS50,000, respectively (1USD = 3.4ILS). The WTP was skewed towards zero, and 9.6% of the respondents were not willing to pay any amount. WTP higher amounts was significantly associated with higher income (p < 0.01), self-reported good health (p < 0.05), supplementary health insurance (p < 0.05), Jews compared to other populations (p < 0.01), interest in technology (p < 0.001) and a tendency to adopt medical innovations (p < 0.001). No statistical difference between the 40% vs. the 60% potential cure scenarios was found. Logistic and OLS regressions indicated that age, religion, income, and interest in adopting medical innovations were the best predictors of respondents' WTP. CONCLUSION Despite the scientific breakthroughs in oncology treatment over the last few decades, many types of cancer are still incurable. Given the expected development of innovative mRNA-based treatments for cancer, these results should inform policymakers, the pharmaceutical industry and other stakeholders on the future coverage and reimbursement of these technologies incorporating patients' and societal views. To date, WTP considerations have not been given much weight in prioritization of drug reimbursement processes, neither in Israel nor in other countries. As a pioneer in adoption of the mRNA technology, Israel can also lead the incorporation of WTP considerations in this field.
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Affiliation(s)
- Omer Ben-Aharon
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.
| | - Ruslan Sergienko
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Georgi Iskrov
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Dan Greenberg
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
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Ben-Aharon O, Iskrov G, Sagy I, Greenberg D. Willingness to pay for cancer prevention, screening, diagnosis, and treatment: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2023; 23:281-295. [PMID: 36635646 DOI: 10.1080/14737167.2023.2167713] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Willingness to pay (WTP) studies examine the maximum amount of money an individual is willing to pay for a specified health intervention, and can be used to inform coverage and reimbursement decisions. Our objectives were to assess how people value cancer-related interventions, identify differences in the methodologies used, and review the trends in studies' publication. AREAS COVERED We extracted PubMed and EconLit articles published in 1997-2020 that reported WTP for cancer-related interventions, characterized the methodological differences and summarized each intervention's mean and median WTP values. We reviewed 1,331 abstracts and identified 103 relevant WTP studies, of which 37 (36%) focused on treatment followed by screening (26), prevention (21), diagnosis (7) and other interventions (12). The methods used to determine WTP values were primarily discrete-choice questions (n = 54, 52%), bidding games (15), payment cards (12) and open-ended questions (12). We found a wide variation in WTP reported values ranged from below $100 to over $20,000. EXPERT OPINION The WTP literature on oncology interventions has grown rapidly. There is considerable heterogeneity with respect to the type of interventions and diseases assessed, the respondents' characteristics, and the study methodologies. This points to the need to establish international guidelines for best practices in this field.
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Affiliation(s)
- Omer Ben-Aharon
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Georgi Iskrov
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Bulgaria
| | - Iftach Sagy
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.,Soroka Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Dan Greenberg
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
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Choi HCW, Leung K, Chan KKL, Bai Y, Jit M, Wu JT. Maximizing the cost-effectiveness of cervical screening in the context of routine HPV vaccination by optimizing screening strategies with respect to vaccine uptake: a modeling analysis. BMC Med 2023; 21:48. [PMID: 36765349 PMCID: PMC9921628 DOI: 10.1186/s12916-023-02748-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/23/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Regarding primary and secondary cervical cancer prevention, the World Health Organization proposed the cervical cancer elimination strategy that requires countries to achieve 90% uptake of human papillomavirus (HPV) vaccines and 70% screening uptake. The optimal cervical screening strategy is likely different for unvaccinated and vaccinated cohorts upon national HPV immunization. However, health authorities typically only provide a one-size-fits-all recommendation for the general population. We aimed to evaluate the cost-effectiveness for determining the optimal screening strategies for vaccinated and unvaccinated cohorts. METHODS We considered the women population in Hong Kong which has a unique HPV infection and cervical cancer epidemiology compared to other regions in China and Asia. We used mathematical models which comprise a deterministic age-structured compartmental dynamic component and a stochastic individual-based cohort component to evaluate the cost-effectiveness of screening strategies for cervical screening. Following the recommendations in local guidelines in Hong Kong, we considered strategies that involved cytology, HPV testing, or co-testing as primary cervical screening. We also explored the impacts of adopting alternative de-intensified strategies for vaccinated cohorts. The 3-year cytology screening was used as the base comparator while no screening was also considered for vaccinated cohorts. Women's lifetime life years, quality-adjusted life years, and costs of screening and treatment were estimated from the societal perspective based on the year 2022 and were discounted by 3% annually. Incremental cost-effectiveness ratios (ICERs) were compared to a willingness to pay (WTP) threshold of one gross domestic product per capita (US $47,792). Probabilistic and one-way sensitivity analyses were conducted. RESULTS Among unvaccinated cohorts, the strategy that adds reflex HPV to triage mild cytology abnormality generated more life years saved than cytology-only screening and could be a cost-effective alternative. Among vaccinated cohorts, when vaccine uptake was 85% (based on the uptake in 2022), all guideline-based strategies (including the cytology-only screening) had ICERs above the WTP threshold when compared with no screening if the vaccine-induced protection duration was 20 years or longer. Under the same conditions, HPV testing with genotyping triage had ICERs (compared with no screening) below the WTP threshold if the routine screening interval was lengthened to 10 and 15 years or screening was initiated at ages 30 and 35 years. CONCLUSIONS HPV testing is a cost-effective alternative to cytology for vaccinated cohorts, and the associated optimal screening frequency depends on vaccine uptake. Health authorities should optimize screening recommendations by accounting for population vaccine uptake.
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Affiliation(s)
- Horace C W Choi
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Patrick Manson Building (North Wing), 7 Sassoon Road, Hong Kong Special Administrative Region, China.
- Laboratory of Data Discovery for Health Limited, Hong Kong Science Park, Hong Kong Special Administrative Region, China.
| | - Kathy Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Patrick Manson Building (North Wing), 7 Sassoon Road, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health Limited, Hong Kong Science Park, Hong Kong Special Administrative Region, China
| | - Karen K L Chan
- Department of Obstetrics and Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yuan Bai
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Patrick Manson Building (North Wing), 7 Sassoon Road, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health Limited, Hong Kong Science Park, Hong Kong Special Administrative Region, China
| | - Mark Jit
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Patrick Manson Building (North Wing), 7 Sassoon Road, Hong Kong Special Administrative Region, China
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Modelling and Economics Unit, Public Health England, London, UK
| | - Joseph T Wu
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Patrick Manson Building (North Wing), 7 Sassoon Road, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health Limited, Hong Kong Science Park, Hong Kong Special Administrative Region, China
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Pak Chun Chau J, Hoi Shan Lo S, Butt L, Chow Choi K. Evaluating the psychometric properties of the Chinese version of the modified Carolina Human Papillomavirus immunisation attitudes and beliefs scale among Chinese adolescent girls. Prev Med Rep 2022; 28:101902. [PMID: 35845821 PMCID: PMC9284400 DOI: 10.1016/j.pmedr.2022.101902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022] Open
Abstract
Human Papillomavirus (HPV) vaccine uptake among adolescents is influenced by their views and perceptions of the vaccination. The modified Carolina HPV Immunisation Attitudes and Beliefs Scale (CHIAS) is a well-established instrument to measure adolescents’ views of HPV vaccination. However, there is currently no Chinese version available to inform HPV vaccination promotion efforts among Chinese adolescents. This study aimed to translate and validate the Chinese version of the modified CHIAS (CHIAS-C). A cross-sectional descriptive study was carried out with 212 female adolescents recruited from secondary schools. Internal consistency, convergent validity, and construct validity were examined. Cronbach’s alpha of the five domains ranged from 0.60 to 0.89, suggesting acceptable internal consistency. Both positive and negative correlations were found between CHIAS-C domains and HPV vaccination intention, indicating convergent validity. Factorial validity was established through confirmatory factor analysis. Our findings suggest that adolescents had generally positive perceptions of HPV vaccination and were likely to accept vaccination if given more relevant information. It was found that most adolescents had neither attended any school talks about HPV nor spoken about the vaccination with healthcare providers. This illustrates that adolescents experience a lack of communication and education about HPV vaccination, both of which can be enhanced in order to persuade adolescents to receive the vaccination. The results suggest that the CHIAS-C is a reliable and valid tool to measure adolescents’ views of HPV vaccination. The translated scale may therefore be used in future adolescent research and to inform the development of interventions to increase HPV vaccine uptake.
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Affiliation(s)
- Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Laveeza Butt
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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Zhai ZH, Ning JH, Wang LDL. Psychometric Evaluation of the Chinese Version of Decisional Conflict Scale in Chinese Young Women Making HPV Vaccination Decisions. Patient Prefer Adherence 2022; 16:761-769. [PMID: 35356105 PMCID: PMC8959717 DOI: 10.2147/ppa.s358292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/11/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The Decisional Conflict Scale (DCS) is a well-known scale for measuring personal decisional conflict, particularly when a person feels uninformed about the risks/benefits of choices, is unclear about personal values, and feels unsupported in making a choice. Higher scores of DCS indicate higher decisional conflict. In the present study, we aimed to assess the psychometric properties of the Chinese version of the DCS among Chinese young women making HPV vaccination decisions. METHODS A total of 107 HPV-unvaccinated Chinese women aged 18-26 completed the survey assessing decisional conflict, knowledge and decision of HPV vaccination. Factorial validity, construct validity, and reliability of the DCS were examined. RESULTS The mean score of the DCS-16 was 41.5 (SD=20.0). Principal component analysis extracted a 3-factor model of DCS containing 13 items (DCS-13), but both the original DCS-16 and extracted DCS-13 showed poor factorial validity. An alternative DCS-10 revealed a good fit to the data with Cronbach's alpha 0.86. Some subscales of the three versions of DCS showed inconsistent correlation. CONCLUSION The DCS-10 demonstrated good model fit to the data. By using the DCS-10 total score rather than sub-scores to measure Chinese young women's HPV vaccination decisional conflict a more valid assessment can be obtained.
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Affiliation(s)
- Zi Han Zhai
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, 225001, People’s Republic of China
- Jiangsu Key Laboratory of Experimental & Translational Non-Coding RNA Research, Yangzhou, 225001, People’s Republic of China
| | - Jun Hao Ning
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, 225001, People’s Republic of China
- Jiangsu Key Laboratory of Experimental & Translational Non-Coding RNA Research, Yangzhou, 225001, People’s Republic of China
| | - Linda Dong-Ling Wang
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, 225001, People’s Republic of China
- Centre for Psycho-Oncology Research & Training, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, People’s Republic of China
- Correspondence: Linda Dong-Ling Wang, Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, 225001, People’s Republic of China, Tel +86-051487978925, Email
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Cheung TH, Cheng SSY, Hsu DC, Wong QWL, Pavelyev A, Walia A, Saxena K, Prabhu VS. The impact and cost-effectiveness of 9-valent human papillomavirus vaccine in adolescent females in Hong Kong. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:75. [PMID: 34801050 PMCID: PMC8606050 DOI: 10.1186/s12962-021-00328-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction In Hong Kong (HK), a single-cohort vaccination program for 10–12-year-old girls with the 9-valent human papillomavirus (HPV) vaccine (9vHPV; types 6/11/16/18/31/33/45/52/58) has been launched. This study assessed the public health impact and cost-effectiveness of implementing routine 9vHPV vaccination (12-year-olds) with or without catch-up 9vHPV vaccination (13–18-year-olds) in HK. Methods The health impact and costs of implementing routine 9vHPV vaccination with or without catch-up vaccination over a 100-year time horizon were evaluated using a validated HPV-type transmission dynamic model adapted to the HK population; analyses were performed from a healthcare payer perspective. Routine vaccination (12-year-old girls) and catch-up vaccination (13–18 years) assumed vaccine coverage rates of 70% (base case) and 30%, respectively. The model also assumed herd immunity, lifelong vaccine protection, a discount rate of 3%, and a cost per dose of HK dollars (HKD) 858 [United States dollars (USD) 110] and HKD 1390 (USD 179) for the 2-valent HPV (2vHPV) and 9vHPV vaccines, respectively. HPV disease-related incidence and the incremental cost-effectiveness ratio (ICER) per quality-adjusted-life-year (QALY) were estimated. Cost-effectiveness was determined at a ceiling threshold of HK dollars (HKD) 382,046 (USD 49,142) or 1.0 times the gross domestic product per capita of HK. Results Compared with routine 9vHPV alone, routine plus catch-up 9vHPV is projected to reduce cervical cancer incidence by 3.4%. Routine plus catch-up 9vHPV will also reduce genital warts incident cases for males/females by 2.6%/5.4%. The incremental cost-effectiveness ratios were HKD 29,911 (USD 3847)/quality-adjusted life-year (QALY) for routine plus catch-up 9vHPV versus routine 9vHPV alone and HKD 25,524 (USD 3283)/QALY for routine 9vHPV alone versus screening only. Sensitivity analyses indicated that routine plus catch-up 9vHPV compared with routine 9vHPV alone remained cost-effective at coverage rates of 30% and 90%. Conclusions This analysis predicts that the current HK vaccination strategy can be considered cost-effective and will provide maximum health benefit. These results support addition of the routine 9vHPV vaccine with or without catch-up 9vHPV vaccination to the regional vaccination program in HK. Supplementary Information The online version contains supplementary material available at 10.1186/s12962-021-00328-x.
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Affiliation(s)
- Tak Hong Cheung
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Sally Shuk Yee Cheng
- Global Medical and Scientific Affairs, MSD Asia Ltd, 27/F Lee Gardens Two, 28 Yun Ping Road, Causeway Bay, Hong Kong, People's Republic of China
| | - Danny C Hsu
- Global Medical and Scientific Affairs, MSD Asia Ltd, 27/F Lee Gardens Two, 28 Yun Ping Road, Causeway Bay, Hong Kong, People's Republic of China
| | - Queenie Wing-Lei Wong
- Global Medical and Scientific Affairs, MSD Asia Ltd, 27/F Lee Gardens Two, 28 Yun Ping Road, Causeway Bay, Hong Kong, People's Republic of China
| | - Andrew Pavelyev
- MRL, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA.,HCL America, Inc., Sunnyvale, CA, USA
| | - Anuj Walia
- MRL, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA
| | - Kunal Saxena
- MRL, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA
| | - Vimalanand S Prabhu
- MRL, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA.
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Xie Y, Su LY, Wang F, Tang HY, Yang QG, Liu YJ. Awareness regarding and vaccines acceptability of human papillomavirus among parents of middle school students in Zunyi, Southwest China. Hum Vaccin Immunother 2021; 17:4406-4411. [PMID: 34324411 PMCID: PMC8828083 DOI: 10.1080/21645515.2021.1951931] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022] Open
Abstract
The objective of this study was to investigate the parent cognition of information regarding the human papillomavirus (HPV) and their willingness toward HPV vaccination of their middle-school-aged children in Zunyi, Guizhou Province, China.The results provide a basis for improving the awareness concerning HPV-related information as a key vaccination strategy for implementing the HPV vaccine in the local context. Methods include the random cluster sampling method and questionnaires to survey parents. General descriptive and single-factor analyses were used to assess cognition to determine factors influencing vaccine willingness. Of 1,074 parents, 28.2% (302) and 38.0% (408) had heard of HPV and its vaccine before the survey, and when given HPV-related information, 73.9% (794) parents were willing to vaccinate their children. Reasons why parents did or did not want the vaccination were surveyed, with lack of sufficient knowledge about HPV and its vaccine being the primary reason to refuse vaccination. Concerns about safety, effectiveness, and perceiving low risk are the biggest obstacle in promoting vaccination. When the price is <1000, most parents (56.1%) are willing to vaccinate their children; thus, cost is also one of the concerns. Therefore, strategies for improving public awareness regarding the risk of cervical cancer and confidence in vaccination must be considered by policymakers.If the national authority confirms that the vaccine is safe and effective, the vaccine should be included in the national immunization program to increase publicity, address safety concerns, and allow for price regulation.
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Affiliation(s)
- Yan Xie
- School of Public Health, Zunyi Medical University, Zunyi, China
| | - Li-Yu Su
- School of Public Health, Zunyi Medical University, Zunyi, China
| | - Feng Wang
- School of Public Health, Zunyi Medical University, Zunyi, China
| | - Hai-Yan Tang
- School of Public Health, Zunyi Medical University, Zunyi, China
- Department of Chronic Diseases, Qianxinan Center for Disease Control and Prevention, Qianxinan, China
| | - Qiu-Ge Yang
- Department of Biology, Urumqi 66 Middle School, Urumqi, China
| | - Yi jun Liu
- School of Public Health, Zunyi Medical University, Zunyi, China
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Chau JPC, Lo SHS, Lee VWY, Lui GCY, Butt L, Chan KM, Kwok CY, Lau AYL. Multistakeholder knowledge levels and perspectives of human papillomavirus and its vaccination: An exploratory qualitative study. Eur J Cancer Care (Engl) 2021; 30:e13511. [PMID: 34622502 DOI: 10.1111/ecc.13511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/03/2021] [Accepted: 09/24/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This qualitative study was an integral part in the development of a multidisciplinary team-led school-based human papillomavirus vaccination health-promotion programme (MDL-SHPVP) aiming to increase HPV vaccine uptake in Hong Kong. Study findings will inform the design of the MDL-SHPVP by drawing on interview data regarding the expectations and needs of key stakeholders and potential programme users. METHODS Eight mother-daughter dyads, four secondary school teachers, two school principals, three social workers and one school nurse were interviewed. All interviews were audio-recorded and transcribed verbatim for thematic analysis. RESULTS Most participants had misconceptions about HPV and the vaccine. Alhough there was no immediate perceived need for the vaccination, most participants had favourable attitudes towards HPV inoculation and vaccines in general. Factors affecting vaccine uptake included perceptions about risk of infection, vaccine availability, and cost. Participants were largely open to suggested MDL-SHPVP components (videos, digital game, and group discussions). CONCLUSION Findings have highlighted knowledge gaps among potential users and key stakeholders and will be used to inform the design of the MDL-SHPVP to ensure that their needs and expectations are addressed. Study findings may also aid future HPV vaccine promotion efforts and boost HPV vaccine uptake among youth in the city.
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Affiliation(s)
- Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vivian Wing Yan Lee
- Centre for Learning Enhancement and Research, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Grace Chun Yan Lui
- Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Laveeza Butt
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kam Ming Chan
- Department of Paediatrics & Adolescent Medicine, United Christian Hospital, Hong Kong
| | - Chiu Yin Kwok
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alexander Yuk Lun Lau
- Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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Cadeddu C, Castagna C, Sapienza M, Lanza TE, Messina R, Chiavarini M, Ricciardi W, de Waure C. Understanding the determinants of vaccine hesitancy and vaccine confidence among adolescents: a systematic review. Hum Vaccin Immunother 2021; 17:4470-4486. [PMID: 34473589 DOI: 10.1080/21645515.2021.1961466] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Vaccine hesitancy (VH) in the age of adolescence is a major public health issue, though it has not been widely examined in the scientific literature. This systematic review aims to address the determinants of VH among adolescents aged 10-19. PubMed, Scopus, and Web of Science were searched from the inception until 11 December 2020. Articles in English, assessing adolescents' attitudes toward vaccination in terms of hesitancy and/or confidence were considered eligible. Out of 14,704 articles, 20 studies were included in the qualitative analysis. Quality assessment was performed through the Appraisal tool for Cross-Sectional Studies (AXIS). A better knowledge of vaccine-preventable diseases, a higher confidence in vaccines, as well as an active involvement in the decision-making process showed a positive relationship with adolescents' vaccine uptake. These aspects should be considered to plan tailored interventions for the promotion of vaccination among adolescents and to reduce VH. Major limitations of this review are represented by the high heterogeneity of the tools used in the primary studies and the lack of standardization in outcomes definitions. Future research is needed to disentangle the interrelationship among the different determinants of VH in this age group.
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Affiliation(s)
- Chiara Cadeddu
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Carolina Castagna
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Martina Sapienza
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Teresa Eleonora Lanza
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Rosaria Messina
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Manuela Chiavarini
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Walter Ricciardi
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Chiara de Waure
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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11
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Paterson P, Mounier-Jack S, Saliba V, Yarwood J, White J, Ramsay M, Chantler T. Strengthening HPV vaccination delivery: findings from a qualitative service evaluation of the adolescent girls' HPV vaccination programme in England. J Public Health (Oxf) 2021; 43:189-196. [PMID: 31219155 PMCID: PMC8042364 DOI: 10.1093/pubmed/fdz061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/30/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 2014, the number of HPV vaccine doses given to adolescent girls as part of the English school-based immunization programme was reduced from three to two. This was based on evidence that a two-dose schedule provides long-lasting protection against HPV infection. In 2015/16 a small decline in HPV vaccination coverage in adolescent girls was noted; from 86.7% for the three-dose schedule in 2013/14 to 85.1% for the two-dose schedule. This evaluation examined whether service-related factors contributed to this decline. METHODS In May-August 2017, we conducted semi-structured qualitative interviews with 39 participants responsible for commissioning or delivering immunization programmes in six local authorities in the South West, North Central Midlands and South Central Midlands, England. RESULTS Effective planning and data management were key for successful service provision of HPV vaccination, as well as close collaboration between commissioners, service providers and data system managers, a team skill mix with experienced staff, pro-active engagement with schools and service providers equipped to respond to parental concerns. CONCLUSIONS To maintain and improve the high HPV adolescent girls' vaccine coverage rates achieved in England, in the context of an expanding school-based immunization programme, it is essential to strengthen the organizational capacity of the delivery system.
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Affiliation(s)
- P Paterson
- The Vaccine Confidence Project, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - S Mounier-Jack
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - V Saliba
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - J Yarwood
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - J White
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - M Ramsay
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - T Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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12
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Shokri Jamnani A, Rezapour A, Moradi N, Langarizadeh M. Willingness to pay for and acceptance of cervical cancer prevention methods: A systematic review and meta-analysis. Med J Islam Repub Iran 2021; 35:81. [PMID: 34291005 PMCID: PMC8285557 DOI: 10.47176/mjiri.35.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Indexed: 11/11/2022] Open
Abstract
Background: The Willingness to pay (WTP) for and acceptance of cervical cancer prevention (CCP) methods have an important role in the control of this type of cancer. Therefore, the aim of this study was to estimate the WTP and acceptance of CCP methods with the contingent valuation method (CVM). Methods: In this systematic review and meta-analysis study, the required information was collected by searching relevant keywords in PubMed, Scopus, Embase, Web of Knowledge, and their Persian equivalent in the Scientific Information Database (SID) and Elmnet databases during January 1, 2000 to June 30, 2020. All studies that reported the WTP and CCP methods with the CVM in English or Persian were included. The reporting quality of studies was assessed by strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Comprehensive meta-analysis (CMA: 2) software was used to conduct the meta-analysis. The content analysis method was used for qualitative data analysis. Results: Finally, 28 articles (with 49610 people) were included in the study. Most of the participants were women (35.7%). The HPV vaccine was the most common method of prevention (75%). The overall acceptance rate was 64% and the overall positive WTP rate was 66%. The average WTP was US$30.44, which accounts for about 0.84% of GDP per capita. The most significant effective factors included income, age, education, high-risk sexual behaviors, and awareness of cervical cancer, belief in the risk of cervical cancer, and belief about the effectiveness of prevention methods. The cost was the most important reason for the unwillingness to pay and accept. Conclusion: Results show that the WTP and acceptance rate of CCP methods are relatively high. It is recommended to reduce the cost of prevention methods, especially the HPV vaccine, and to increase awareness and improve the attitude of people. Also, it is recommended to consider other methods of estimation of WTP and other cancers in future studies.
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Affiliation(s)
- Anahita Shokri Jamnani
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Najmeh Moradi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Langarizadeh
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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13
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Ma Y, Wang C, Liu F, Lian G, Li S, He Q, Li T. Human papillomavirus vaccination coverage and knowledge, perceptions and influencing factors among university students in Guangzhou, China. Hum Vaccin Immunother 2021; 17:3603-3612. [PMID: 34156312 DOI: 10.1080/21645515.2021.1927411] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction: HPV vaccines were administered in mainland China from July 2017 at a gradual rate. We aimed to assess the vaccination rate and vaccination influencing factors among college students in mainland China.Methods: From October to December 2018, we conducted face-to-face questionnaires including 5 sections and 22 questions to collect demographic information, HPV infection and transmission knowledge, HPV vaccine knowledge and attitudes among college students in Guangzhou, China. HPV vaccine vaccination status and cervical screening behaviors were self-reported. Knowledge and attitudes differences between the vaccinate and non-vaccinate groups were analyzed using univariable logistic regression. Vaccination-related influencing factors were estimated using multivariable logistic regression.Results: 5307 of 5414 valid questionnaires were collected. The self-reported cervical screening rate and HPV vaccine coverage were 11.82% (9.03%-14.61%) and 3.09% (2.62%-3.56%). In total, 55.57% of the participants were hesitant about vaccination. Urban residence (OR = 2.1, 95%CI: 1.4-3.3), high monthly consumption (OR = 2.6, 95%CI: 1.9-3.6), awareness of vaccination adaptive population (OR = 3.1, 95%CI: 1.9-5.0), awareness of infection-related risk factors (OR = 2.5, 95%CI: 1.1-5.7), and awareness of HPV vaccine effectiveness (OR = 3.2, 95%CI: 2.0-5.2) were significant in multivariable logistic regression.Conclusion: HPV vaccine coverage is quite low among college students in China Guangzhou. Economic affordability, awareness of HPV infection, and belief in the effectiveness of HPV vaccine are influencing factors for vaccination. In the future, establishing a national financial subsidy and strengthening health education is needed to increase the vaccination rate in China.
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Affiliation(s)
- Yu Ma
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong Province, China.,Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangdong, China.,Disease Control and Prevention Department, Guangzhou Health Committee, Guangzhou, Guangdong Province, P.R. China
| | - Cuixiu Wang
- The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Fanghua Liu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong Province, China.,Disease Control and Prevention Department, Guangzhou Health Committee, Guangzhou, Guangdong Province, P.R. China
| | - Guixiong Lian
- Center for Disease Control and Prevention of Panyu District of Guangzhou City, Guangzhou, Guangdong Province, China
| | - Shuxue Li
- Guangzhou Medical University, Guangzhou, Guangdong Province, P.R. China
| | - Qing He
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong Province, China
| | - Tiegang Li
- Disease Control and Prevention Department, Guangzhou Health Committee, Guangzhou, Guangdong Province, P.R. China
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14
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Markovic-Denic L, Milicevic S, Todorovic J, Nikolic V, Djuric O, Marusic V, Dugalic S, Vasiljevic B, Gojnic-Dugalic M. Uptake of Human Papillomavirus Vaccine and Intention to Vaccinate among Healthy Pregnant Women in Serbia: A Cross-Sectional Study on Awareness, Knowledge, and Attitudes. Viruses 2021; 13:v13050727. [PMID: 33919452 PMCID: PMC8143577 DOI: 10.3390/v13050727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 11/16/2022] Open
Abstract
We aimed to assess awareness, knowledge, and attitudes of healthy pregnant women towards human papillomavirus (HPV), to estimate factors associated with a positive attitude towards HPV immunization and to assess the uptake of the vaccine among their children. A cross-sectional study was conducted at the University Clinic of Gynecology and Obstetrics, Belgrade, Serbia among pregnant women attending their regular gynecological check-ups at the 12th gestational week. Knowledge about HPV and HPV vaccine was assessed using a specifically designed 12-item and 5-item questionnaires. Out of total 265 included women, 79.3% had heard of HPV, and 37.5% knew that HPV vaccine exists. HPV vaccine knowledge score was associated with higher odds for a positive attitude towards vaccination of both female (OR = 4.10, 95% CI 1.50-11.29) and male (OR = 3.71, 95% CI 1.52-9.01) child. The number of children (OR = 1.32, 95% CI 1.04-1.67) and high vaccine knowledge score (OR = 1.64 95% CI 1.13-2.39) were independent predictors associated with willingness to vaccinate child against HPV. The gynecologist was the preferable point of reference for information seeking about the HPV vaccine. Despite relatively high HPV awareness and knowledge among pregnant women in Serbia, about one-third of them are HPV vaccine aware, and are willing to vaccinate their children against HPV.
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Affiliation(s)
- Ljiljana Markovic-Denic
- Faculty of Medicine, Institute of Epidemiology, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia; (V.N.); (V.M.)
- Correspondence:
| | - Srboljub Milicevic
- Clinic for Obstetrics and Gynecology, Clinical Centre of Serbia, Koste Todorovica 26, 11000 Belgrade, Serbia; (S.M.); (S.D.); (M.G.-D.)
| | - Jovana Todorovic
- Faculty of Medicine, Institute of Social Medicine, University of Belgrade, Dr Subotica Starijeg 15, 11000 Belgrade, Serbia;
| | - Vladimir Nikolic
- Faculty of Medicine, Institute of Epidemiology, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia; (V.N.); (V.M.)
| | - Olivera Djuric
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
- Section of Public Health, Center for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Università, 4, 41121 Modena, Italy
| | - Vuk Marusic
- Faculty of Medicine, Institute of Epidemiology, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia; (V.N.); (V.M.)
| | - Stefan Dugalic
- Clinic for Obstetrics and Gynecology, Clinical Centre of Serbia, Koste Todorovica 26, 11000 Belgrade, Serbia; (S.M.); (S.D.); (M.G.-D.)
| | - Brankica Vasiljevic
- Maternity and Child Health Service, NMC Royal Hospital DIP, Dubai Investments Park 1, 00000 Dubai, Saudi Arabia;
| | - Miroslava Gojnic-Dugalic
- Clinic for Obstetrics and Gynecology, Clinical Centre of Serbia, Koste Todorovica 26, 11000 Belgrade, Serbia; (S.M.); (S.D.); (M.G.-D.)
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15
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Chau JPC, Lo SHS, Choi KC, Lee VWY, Lui GCY, Chan KM, Lau AYL. Effects of a multidisciplinary team-led school-based human papillomavirus vaccination health-promotion programme on improving vaccine acceptance and uptake among female adolescents: A cluster randomized controlled trial. Medicine (Baltimore) 2020; 99:e22072. [PMID: 32925744 PMCID: PMC7489727 DOI: 10.1097/md.0000000000022072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Evidence has consistently shown the high efficacy of human papillomavirus (HPV) vaccines in preventing cervical cancers. However, the HPV vaccine uptake rate in Hong Kong is very low. We will develop and evaluate an innovative, theory-based multidisciplinary team-led school-based HPV vaccination health-promotion program (MDL-SHPVP), engaging female adolescents, parents/guardians, and secondary school personnel in multicomponent educational strategies and interactive discussions. METHODS AND ANALYSIS A cluster randomized controlled trial is proposed. We will recruit 2520 female adolescents and their parents/guardians from 18 secondary day schools. The MDL-SHPVP is underpinned by the Health Belief Model and Precaution Adoption Process Model. Multicomponent interventions will be offered, including education sessions with small group dialogues with a registered nurse and trained healthcare and lay volunteers, and educational computer games. A team of volunteers will be established to raise HPV, cervical cancer, and HPV vaccine awareness. Outcomes include adolescents' uptake of the HPV vaccine, adolescents' intention to receive HPV vaccination, vaccine acceptance among parents/guardians, and parents'/guardians' and adolescents' HPV knowledge, attitudes, and beliefs. Data will be collected at baseline, 1 month, and 1 year after intervention. The generalized estimating equations analysis will be used for comparing the outcomes between the 2 groups. ETHICS AND DISSEMINATION Ethical approval was obtained from the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee (Ref. no.: 2019.055). We will disseminate the study findings via peer-reviewed publications and presentations at relevant events and international and local conferences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT04438291.
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Affiliation(s)
- Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong
| | - Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong
| | - Vivian Wing Yan Lee
- Centre for Learning Enhancement And Research, The Chinese University of Hong Kong
| | - Grace Chung Yan Lui
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong
| | - Kam Ming Chan
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hospital Authority, Hong Kong
| | - Alexander Yuk Lun Lau
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong
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16
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Wong LP, Wong PF, Megat Hashim MMAA, Han L, Lin Y, Hu Z, Zhao Q, Zimet GD. Multidimensional social and cultural norms influencing HPV vaccine hesitancy in Asia. Hum Vaccin Immunother 2020; 16:1611-1622. [PMID: 32429731 PMCID: PMC7482900 DOI: 10.1080/21645515.2020.1756670] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/11/2020] [Indexed: 12/27/2022] Open
Abstract
HPV vaccine hesitancy in Asia is unique compared to Western countries due to multidimensional social-cultural norms that influence beliefs regarding vaccination. Reviews on HPV vaccine hesitancy in Asia lack of in-depth discussion regarding the traditional and social-cultural norms dimensions. This paper puts forward opinions in which culture, normative beliefs, and religion influence HPV vaccine hesitancy in Asian countries. Issues surrounding HPV hesitancy among parents, young adult women, adult women, men and the sexual and gender minority people in Asian countries were highlighted. The shortage of HPV vaccine supply would soon be reduced as some Asian countries are on the way to producing the HPV vaccine which production is currently dominated by Western European countries. The culture of favoring imported Western products among many in Asia and in addition to long-existing fake vaccine crisis pose a challenge for the newly emerging HPV vaccine produced in Asia. Some recommendations, research gaps, and future research needs were discussed.
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Affiliation(s)
- Li Ping Wong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pooi-Fong Wong
- Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Liyuan Han
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Yulan Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Qinjian Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian Province, China
| | - Gregory D. Zimet
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, U.S
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17
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Siu JYM, Fung TKF, Leung LHM. Barriers to Receiving HPV Vaccination Among Men in a Chinese Community: A Qualitative Study in Hong Kong. Am J Mens Health 2020; 13:1557988319831912. [PMID: 30776950 PMCID: PMC6775547 DOI: 10.1177/1557988319831912] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Human papillomavirus (HPV) can cause various diseases; low-risk strains can cause
genital warts, whereas high-risk strains can cause cervical cancer and cancer of
the vulva in women and cancers of the penis, anus, and oropharynx in men.
Although HPV affects men, literature has reported that the prevalence of HPV
vaccination is far lower among men than among women. Few studies have examined
perceptions and acceptability of the HPV vaccine among men, particularly in
Chinese communities. In this study, the acceptability of the HPV vaccine to men
was investigated using Hong Kong men as a case group. A qualitative research
approach was adopted. Thirty-nine men were purposively sampled for the in-depth
individual semistructured interviews from June to October 2017 to investigate
their perceptions of the HPV vaccine and the barriers for them to receive the
vaccination. Limited knowledge and awareness of HPV-related issues, low
perceived risk of HPV infection, perceived association between HPV vaccine and
promiscuity, and lack of accessible official information on HPV-related topics
were identified as the key barriers. These barriers intermingled with the
sociocultural environment, cultural values of sexuality, and patriarchal gender
values. HPV vaccine is shown to be socially constructed as a vaccine for women
exclusively and for promiscuity. The participants were discouraged from
receiving HPV vaccination because of its signaling of socially deviant
promiscuity. Cultural taboo on sex served as a social oppression of open
discussion about HPV vaccine and affected the participants’ perceived need of
vaccination. Perceived insignificance of reproductive organs also influenced the
participants’ perceived need of vaccination.
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Affiliation(s)
- Judy Yuen-Man Siu
- 1 Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Timothy K F Fung
- 2 Department of Communication Studies, School of Communication, Hong Kong Baptist University, Hong Kong
| | - Leo Ho-Man Leung
- 1 Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
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18
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Chua GT, Ho FK, Tung KT, Wong RS, Cheong KN, Yip PS, Fan SY, Wong WH, Qiao Y, Chui CS, Li SX, Ip P. Sexual behaviors and intention for cervical screening among HPV-vaccinated young Chinese females. Vaccine 2019; 38:1025-1031. [PMID: 31786002 DOI: 10.1016/j.vaccine.2019.11.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 10/19/2019] [Accepted: 11/18/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Human papillomavirus (HPV) vaccination and cervical screening prevent cervical cancer effectively. However, there are concerns whether vaccination leads to high-risk sexual behaviors and less intention for cervical screening. We aimed to evaluate the influence of HPV vaccination on high-risk sexual behaviors, and intention for cervical screening among young Chinese females. We also reported the latest HPV vaccination uptake in Hong Kong. METHODS A population-based survey was conducted between September 2016 and January 2017. Subjects were school-age girls from twenty-five secondary schools (in-school) and community females between 18 and 27 years (out-school). Demographics, vaccine-related attitudes, intention for cervical screening and participants' sexual behaviors were examined. RESULTS We surveyed 2260 females from in-school (n = 1664) and out-school (n = 596) settings. 11.5% in-school and 23.5% out-school participants received at least one dose of HPV vaccine. Vaccination was not associated with age (in-school Odds Ratio [OR] 0.99, p = 0.87; out-school OR 1, p = 0.94), ethnicity (in-school OR 0.82, p = 0.72; out-school OR 0, p = 0.98), maternal education (in-school OR for secondary school 1.19, p = 0.43; for post-secondary school 1.28, p = 0.48), underage sex (in-school OR 1.22, p = 0.80; out-school OR 0.63, p = 0.67), earlier sexual exposure (in-school β 0.01, p = 0.99; out-school β 0.13, p = 0.68), multiple sex partners (in-school OR 3.27, p = 0.22; out-school OR 1.16, p = 0.43), and unprotected sex (in-school OR 1.14, p = 0.78; out-school OR 0.60, p = 0.10). Out-school females with higher personal education level was associated with higher vaccine uptake (post-secondary OR 3.4, p < 0.001; bachelor's degree or above OR 3.71, p < 0.001). More vaccinated females intended for cervical screening (in-school 23.6% vs. 21.1%; out-school 53.6% vs. 43.6%). Costs and knowledge were important factors for non-vaccination and non-intention for cervical screening. CONCLUSIONS HPV vaccination was not associated with earlier and high risk sexual behavior among Chinese young females. Vaccinated Chinese young females had a higher intention for cervical screening.
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Affiliation(s)
- Gilbert T Chua
- Department of Paedaitrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Frederick K Ho
- Department of Paedaitrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Keith T Tung
- Department of Paedaitrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Rosa S Wong
- Department of Paedaitrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kai Ning Cheong
- Department of Paedaitrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Paul S Yip
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong
| | - Susan Y Fan
- The Family Planning Association of Hong Kong, Hong Kong
| | - Wilfred H Wong
- Department of Paedaitrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Youlin Qiao
- Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Celine S Chui
- Department of Paedaitrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | - Shirley X Li
- Department of Paedaitrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | - Patrick Ip
- Department of Paedaitrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
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Chaw LL, Lim STW, Md Yussof SR. Human Papillomavirus vaccine coverage among female students in Brunei Darussalam: results from the first 4 years of the national school-based vaccination programme. Heliyon 2019; 5:e02588. [PMID: 31692704 PMCID: PMC6806404 DOI: 10.1016/j.heliyon.2019.e02588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/19/2019] [Accepted: 10/02/2019] [Indexed: 11/25/2022] Open
Abstract
Background Human Papillomavirus (HPV) is the leading cause of cervical cancer. HPV vaccination among girls (ages 9-14) is an effective way to prevent infection. Since 2012, Brunei Darussalam has implemented the National School-based HPV Vaccination programme which aims to vaccinate all female school students of 10-17 years old. This study was conducted to calculate and descriptively compare the coverage rates of all private and government secondary school students at both national and district levels, along with the parental consent rate. Methods HPV vaccination records of all female students between January 2012 and December 2015 were retrospectively extracted from the School Health Services, Ministry of Health. Descriptive statistics were used to report the overall and annual vaccination coverage rate (by district, class year, nationality and type of school) and parental consent rate. Results A total of 27,178 female students were recorded during the study period, with an overall complete dose coverage rate of 85.8% (95% CI: 85.4%, 86.2%) and 90.8% (95% CI: 90.4%, 91.2%) for all and Bruneian female students, respectively. A similar trend could be observed each year, where there is a decrease in the coverage rate from the first, second and complete doses. Brunei-Muara had the lowest vaccination coverage and parental consent rates among the country's four districts. We also observed higher HPV vaccination coverage rate for government students. Parental consent rate of Bruneian students were considerably higher than that of non-Bruneian students. Conclusion Overall, the national school-based vaccination programme has achieved a high complete dose coverage rate in its first 4 years of implementation. Issues identified for this programme are vaccine cost and difficulty to reach students who have missed their scheduled vaccination in schools. The programme can be further improved by identifying other barriers of accepting and completing their HPV vaccine dose schedule.
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Affiliation(s)
- Li Ling Chaw
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Brunei
| | - Shaun Tze Wei Lim
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Brunei
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20
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Siu JYM, Fung TKF, Leung LHM. Social and cultural construction processes involved in HPV vaccine hesitancy among Chinese women: a qualitative study. Int J Equity Health 2019; 18:147. [PMID: 31533722 PMCID: PMC6751778 DOI: 10.1186/s12939-019-1052-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/11/2019] [Indexed: 11/15/2022] Open
Abstract
Background HPV vaccine is a prophylactic vaccine to prevent HPV infections. Recommended by the World Health Organization, this vaccine is clinically proven to be one of the most effective preventive measures against the prevalence of cervical cancer and other HPV-associated cancers and chronic genital conditions. However, its uptake rate among women in Hong Kong is insignificant—only approximately 2.9% adolescent girls and 9.7% female university students received HPV vaccination in 2014. With the notion of Critical Medical Anthropology, we aimed to identify if different influential factors, ranging from individual, societal, and cultural, are involved in the decision-making process of whether to receive HPV vaccination. Methods We adopted a qualitative approach and conducted in-depth individual semistructured interviews with 40 women in Hong Kong between May and August 2017. Results We noted that the following factors intertwined to influence the decision-making process: perceptions of HPV and HPV vaccine; perceived worthiness of HPV vaccines, which was in turn influenced by vaccine cost, marriage plans, and experiences of sexual activities; history of experiencing gynecological conditions, stigma associated with HPV vaccination, acquisition of information on HPV vaccines, distrust on HPV vaccines, and absence of preventive care in the healthcare practice. Conclusions HPV vaccination is promoted in a manner that is “feminized” and “moralized” under the patriarchal value system, further imposing the burden of disease on women, and leading to health inequality of women in pursuing the vaccination as a preventive health behaviour as a result. We believe that this ultimately results in an incomplete understanding of HPV, consequently influencing the decision-making process. The “mixed-economy” medical system adopting capitalist logic also molds a weak doctor–patient relationship, leading to distrust in private practice medical system, which affects the accessibility of information regarding HPV vaccination for participants to make the decision.
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Affiliation(s)
- Judy Yuen-Man Siu
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
| | - Timothy K F Fung
- Department of Communication Studies, School of Communication, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Leo Ho-Man Leung
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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21
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Cordoba-Sanchez V, Tovar-Aguirre OL, Franco S, Arias Ortiz NE, Louie K, Sanchez GI, Garces-Palacio IC. Perception about barriers and facilitators of the school-based HPV vaccine program of Manizales, Colombia: A qualitative study in school-enrolled girls and their parents. Prev Med Rep 2019; 16:100977. [PMID: 31508297 PMCID: PMC6722392 DOI: 10.1016/j.pmedr.2019.100977] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 11/24/2022] Open
Abstract
In 2012, Colombia implemented a school-based HPV vaccination program of a 3-dose series for nine year old girls. Following a mass psychogenic response after vaccination in a Colombian town, vaccination rates dropped from 80% in 2012-2013 to 5% in 2016. The study aimed to identify barriers and facilitators of HPV vaccine uptake among girls eligible for vaccination in the initial years of vaccine implementation from 2012 to 2014, and their parents. We conducted 19 individual qualitative interviews and 18 focus groups with an average of 5 girls, in Manizales, Colombia between 2016 and 2017. In total, 49 girls from six schools and 58 of their parents participated in the study. Participants had some degree of awareness about cervical cancer, especially among those of middle and upper socioeconomic level. However, the vaccine was known as a prevention measure only after pap-smears and condoms. The main facilitator for vaccine uptake for parents was the desire to prevent diseases in general and for girls, it was facilitated by receiving positive information about the vaccine. The main barriers for vaccine uptake or for three doses completion were the event in Carmen de Bolivar, fear of adverse effects and fear of needles. Girls and parents stated that they received little or no information from schools or health care services about the HPV vaccine prior to vaccination. Our results suggest that improving HPV vaccination rates in Colombia will require a comprehensive education program including mass media information about HPV vaccine.
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Affiliation(s)
- Verónica Cordoba-Sanchez
- Grupo Infección y Cáncer, Facultad de Medicina, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia
| | - Olga Lucía Tovar-Aguirre
- Grupo GINEI, Programa de Bacteriología, Universidad Católica de Manizales UCM, Carrera 23 No. 60-63, Manizales, Colombia
| | - Sandra Franco
- Grupo Promoción de la salud y Prevención de la Enfermedad, Facultad de Ciencias para la Salud, Universidad de Caldas, Calle 65 No. 26-10, Manizales, Colombia
| | - Nelson Enrique Arias Ortiz
- Grupo Promoción de la salud y Prevención de la Enfermedad, Facultad de Ciencias para la Salud, Universidad de Caldas, Calle 65 No. 26-10, Manizales, Colombia
| | - Karly Louie
- School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, London SE1 9RT, UK
| | - Gloria Ines Sanchez
- Grupo Infección y Cáncer, Facultad de Medicina, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia
| | - Isabel C Garces-Palacio
- Grupo de Epidemiologia, Facultad Nacional de Salud Pública, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia
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22
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Liu Y, Di N, Tao X. Knowledge, practice and attitude towards HPV vaccination among college students in Beijing, China. Hum Vaccin Immunother 2019; 16:116-123. [PMID: 31373874 DOI: 10.1080/21645515.2019.1638727] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
This cross-sectional study aimed to assess the knowledge, practice and attitude towards HPV vaccination among college students in Beijing, China. Furthermore, the factors influencing vaccination were analyzed. The data were collected via self-administered anonymous questionnaires completed by 884 college students who were recruited from a random sample at Peking University in China between September and December 2018. In total, 72.6% of the participants had previously heard of but had insufficient knowledge about HPV and the vaccine. The level of knowledge was significantly associated with the participants' age, major, and family members' or friends' vaccination status. In total, 68.8% of the students viewed college education as the primary source from which they hoped to receive information about the vaccine. Only 9.5% of the females had received the vaccine. Relationships with doctors, sexual experience and a high level of knowledge were positive predictors of vaccine uptake. Limited knowledge about the HPV vaccine was the primary and most common reason for refusing vaccination and not recommending the vaccine to others. Knowledge of the HPV vaccine among college students at Peking University was low to moderate, and the vaccine uptake was low. Policies and measures, such as college health education, are needed to increase college students knowledge of HPV and the vaccine, which may help improve the vaccination rate.
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Affiliation(s)
- Yingnan Liu
- Department of Obstetrics and Gynecology, Peking University First Hospital, Peking University, Beijing, China
| | - Na Di
- Department of General Medicine, Peking University First Hospital, Peking University, Beijing, China
| | - Xia Tao
- Department of Obstetrics and Gynecology, Peking University First Hospital, Peking University, Beijing, China.,Department of General Medicine, Peking University First Hospital, Peking University, Beijing, China
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23
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24
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Chen R, Wong E. The feasibility of universal HPV vaccination program in Shenzhen of China: a health policy analysis. BMC Public Health 2019; 19:781. [PMID: 31221112 PMCID: PMC6585043 DOI: 10.1186/s12889-019-7120-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/07/2019] [Indexed: 11/22/2022] Open
Abstract
Background HPV vaccination for the prioritized adolescent girls is well accepted and implemented in developed countries as an effective measure for cervical cancer prevention and control with increasing population-level effectiveness evidence accumulated. This study is to assess the feasibility of universal HPV vaccination among adolescent girls to inform strategies to manage political dimensions of policy-making process in Shenzhen, China, offering insights for other low- and middle-income countries undergoing HPV vaccine introduction. Methods Document review and in-depth interviews with identified stakeholders were conducted. The framework of Health Policy Triangle was adapted to guide data collection and analysis in terms of context, actors, process and content. Stakeholder analysis examining actors’ position, power, role and interest and thematic analysis focusing on data coding and theme development were used. Results Shenzhen’s contextual factors include legislative authority under a unitary political system, economic developments and cultural values on immunization and sexuality. Stakeholders’ position and power could be explained by their role and interest in the Top-down health administration. Mothers could be potential bystanders if having little knowledge on HPV vaccination. Themes in policy-making process were problem definition, advocacy activities to promote HPV vaccination, HPV vaccine demand and access, the role of media and political attention on evidence-informed policy-making in Shenzhen. These stakeholders also discussed different aspects of program planning prospectively. Conclusions Shenzhen witnesses a possibility of demonstration projects for local government’s horizontal accountability but no potential advocates were identified at local level for fragmented organization of public health facilities and health professionals’ lacking mobilization skills. A cervical cancer prevention expert could be a policy entrepreneur. Despite of these challenges, the recommendations to enhance the feasibility include multi-participation to engage non-governmental organizations, pharmaceuticals, target girls and their mothers, power enforcement along governing system, as well as better use of the media.
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Affiliation(s)
- Ruirui Chen
- Baoan Maternal and Child Health Hospital, Jinan University, No. 56 Yulv Road, Shenzhen, China.
| | - Eliza Wong
- School of Public Health and Primary Care, the Chinese University of Hong Kong, Shatin, Hong Kong
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25
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Wang LDL, Lam WWT, Fielding R. Development and pre/post testing of a decision aid supporting Chinese parental and young women's HPV vaccination decision-making. Women Health 2019; 60:330-340. [PMID: 31195899 DOI: 10.1080/03630242.2019.1626791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We developed and tested the acceptability and utility of a novel HPV vaccination decision aid (DA) among Chinese young women aged 18-26 years and parents of adolescent girls aged 9-17 years. From March to May 2016, a total of 101 parents plus 109 young women completed baseline surveys assessing their HPV vaccination knowledge, decision self-efficacy, decision conflict, and HPV vaccination intention. Two weeks after receiving the DA, 84 (83.2%) parents and 92 (84.4%) young women completed re-assessments. Chi-square tests or t-tests were performed to compare the before-and-after differences. Cohen's d was calculated to indicate the effect size. After reading the DA, both participating young women's and parents' knowledge of HPV vaccination (Cohen's d = 0.62 among young women and d = 0.59 among parents) and decision self-efficacy (d = 0.38 among young women and d = 0.59 among parents) significantly increased. Both young women's and parents' decision conflict (d = -0 · 98 and -1.06) significantly decreased. The proportion of young women intending to receive HPV vaccination and parents deciding to vaccinate daughters against HPV significantly increased (p < 0 · 0001). The DA showed good acceptability and utility facilitating HPV vaccination decision-making for most Chinese young women and parents of adolescent girls. Further randomized controlled trials of this tool are essential.
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Affiliation(s)
- Linda Dong-Ling Wang
- School of Medicine, Yangzhou University, Yangzhou, China.,Centre for Psycho-Oncology Research and Training, School of Public Health, University of Hong Kong, Pokfulam, Hong Kong
| | - Wendy Wing Tak Lam
- Centre for Psycho-Oncology Research and Training, School of Public Health, University of Hong Kong, Pokfulam, Hong Kong
| | - Richard Fielding
- Centre for Psycho-Oncology Research and Training, School of Public Health, University of Hong Kong, Pokfulam, Hong Kong
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26
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The Acceptability of HPV Vaccines and Perceptions of Vaccination against HPV among Physicians and Nurses in Hong Kong. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101700. [PMID: 31091840 PMCID: PMC6572436 DOI: 10.3390/ijerph16101700] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/04/2019] [Accepted: 05/10/2019] [Indexed: 12/22/2022]
Abstract
Background: Human papillomavirus (HPV) is one of the most common sexually transmitted infections nationwide. Methods: This is the first cross-sectional survey assessing physicians’ and nurses’ knowledge of HPV and recording their attitudes to HPV vaccination in Hong Kong. Survey questions were derived from the Health Belief Model. Results: 1152 clinicians (170 physicians and 982 nurses) aged 21 and 60 participated in this study. A multiple stepwise regression model was used to examine associations between cognitive factors (clinicians’ attitudes) and subjects’ intention to HPV vaccine uptake. Results showed that only 30.2% of physicians and 21.2% nurses found vaccinating for HPV acceptable. Conclusions: Perceived self-efficacy was the only significant background and cognitive variable associated with physicians’ and nurses’ accepting HPV vaccines. Further, when nurses found HPV vaccination acceptable, cues to action was featured as a significant background variable in their choice.
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27
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Wang Y, Zhang L. Status of public-private partnership recognition and willingness to pay for private health care in China. Int J Health Plann Manage 2019; 34:e1188-e1199. [PMID: 30861613 DOI: 10.1002/hpm.2757] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The Chinese government has been increasingly engaging and interacting with the private sectors to initiate public-private partnerships (PPPs) to enhance the capacity of the health care system. Thus, the availability of private health services and copays are increasing. However, Chinese residents appear to be more accustomed to public health care because it has long been the dominant health service provider in China. Therefore, learning how the Chinese recognize PPPs, whether they would like to use private health services and how much they are willing to pay out of pocket are important for policymakers. METHODS A bibliographical search was performed through PubMed in Medline, the Chinese National Knowledge Infrastructure and key government websites using a combination of keywords from seminal papers on PPPs and then sequentially added "willingness to pay (WTP), health, and private." The papers selected were closely related to PPPs and WTP for health care in China, and then, over 100 peer-reviewed literature, opinion, or commentary papers and postgraduate theses on the particular topics were carefully reviewed. RESULTS Out of 139 papers closely related to WTP for private health care, 37 were extensively reviewed and substantially analyzed. The results corroborate that Chinese residents are generally willing to pay for high-risk disease screening, improved therapies, and health insurance, although the WTP intentions and the amounts they are willing to pay are different among distinct populations for the various types of health services. The results also present conditions that the responders are not explicitly willing to pay for or are willing to pay additional fees for their health promotion. Education level, family per capita income, self-reported health status, and dwelling districts (such as urban or rural residents) are the main factors that affect cost-sharing intention. CONCLUSIONS PPPs are increasingly recognized as an effective means to mobilize resources in the private sector to relieve the pressure/burden placed on the public system during medical reform in China. Responders in China are generally willing to pay reasonable fees out of pocket for primary health care services or for improved therapies; however, cost-sharing intentions are affected by multiple factors. Health-related policymakers should learn the general health concerns/demands of the residents and their WTP status to perfect the design of PPPs for the benefit of the majority population in China.
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Affiliation(s)
- Yongfei Wang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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28
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Lee YY, Wang Z. Facilitators and barriers for healthcare providers to recommend HPV vaccination to attendees of public sexually transmitted diseases clinics in Hong Kong, China. PLoS One 2019; 14:e0209942. [PMID: 30625211 PMCID: PMC6326499 DOI: 10.1371/journal.pone.0209942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 12/13/2018] [Indexed: 11/29/2022] Open
Abstract
Background Attendees of sexually transmitted diseases (STD) clinics could also benefit from HPV vaccination. Healthcare providers’ recommendation is the most effective published method in motivating HPV vaccination initiation. This study was to investigate practice of recommending HPV vaccination to attendees among healthcare providers (doctors and nurses) working in public STD clinics in Hong Kong, China. Method Participants were medical doctors, registered nurses and enrolled nurses working in all eight public STD clinics in Hong Kong. All of them (29 doctors and 82 nurses) were approached by telephone. A self-administered questionnaire was mailed to them. A total of 98 completed questionnaires were received (28 doctors and 70 nurses). The study was conducted during January to May, 2018. Using recommendation of HPV vaccination to any attendees in the last year as the dependent variable, univariate and multiple logistic regression models were fitted. Results In the last 12 months, 16.3% and 36.7% of the participants had recommended HPV vaccination to any male attendees and to any female attendees of their clinics; 41.8% had recommended it to either male or female attendees. Adjusting for significant background variables (professions and years of working experience in the clinic), three constructs of the Theory of Planned Behavior were significantly associated with the dependent variable in expected directions. They were: 1) the Positive Attitude Scale (adjusted odds ratios, AOR: 1.20, 95%CI: 1.02, 1.41), 2) the Negative Attitude Scale (AOR: 0.85, 95%CI: 0.77, 0.94), and 3) the Perceived Behavioral Control Scale (AOR: 1.37, 95%CI: 1.08, 1.75). Conclusion STD clinics are ideal settings that allow healthcare providers to access individuals who are at high-risk of HPV infection and promote HPV vaccination. Health promotion targeting these healthcare providers is warranted to enhance their perceived importance of recommending HPV vaccination. Such promotion should modify their attitudes and perceived behavioral control related to recommending HPV vaccination to attendees.
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Affiliation(s)
| | - Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- * E-mail:
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29
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Chen L, Song Y, Ruan G, Zhang Q, Lin F, Zhang J, Wu T, An J, Dong B, Sun P. Knowledge and Attitudes Regarding HPV and Vaccination Among Chinese Women Aged 20 to 35 Years in Fujian Province: A Cross-Sectional Study. Cancer Control 2018; 25:1073274818775356. [PMID: 29761723 PMCID: PMC6028175 DOI: 10.1177/1073274818775356] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The use of the human papillomavirus (HPV) vaccine was recently approved in Mainland China. This study determined the knowledge and attitudes of young women aged 20 to 35 years in Fujian Province, China, with regard to HPV and vaccination and explored the potential factors influencing their attitudes toward HPV vaccination. This was a cross-sectional study that collected data regarding the knowledge on and attitudes toward HPV and vaccination using questionnaires. Furthermore, the prevalence of HPV was determined from the sampled participants. A total of 1001 young women were included in the survey. This study demonstrated that the HPV prevalence rate was 15.7% (157/1001). Among all patients, 44.9% (n = 449) had heard of HPV; however, detailed knowledge about HPV was lacking. The majority (83.7%) expressed a willingness to be vaccinated. Specifically, knowledge of the dangers of HPV infection was significantly associated with the willingness to be vaccinated. In this study, women cited some concerns and expressed high expectations for the HPV vaccine, but the costs of vaccination reduced their willingness to be vaccinated. This study found that most patients did not have a detailed knowledge of HPV. Thus, there is a need for continued HPV promotion and education efforts, especially on the dangers of HPV infection, among young women aged 20 to 35 years in Fujian Province, China. Furthermore, it is important to subsidize the costs of vaccination for promoting vaccination campaigns in China.
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Affiliation(s)
- Lihua Chen
- 1 Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Yiyi Song
- 2 Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Guanyu Ruan
- 1 Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Qiaoyu Zhang
- 1 Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Fen Lin
- 1 Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Jun Zhang
- 3 Research Center for Medical Molecular Virology of Fujian Province, School of Public Health, Xiamen University, Xiamen, Fujian, People's Republic of China
| | - Ting Wu
- 3 Research Center for Medical Molecular Virology of Fujian Province, School of Public Health, Xiamen University, Xiamen, Fujian, People's Republic of China
| | - Jian An
- 1 Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Binhua Dong
- 1 Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Pengming Sun
- 1 Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,2 Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
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30
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Choi HCW, Jit M, Leung GM, Tsui KL, Wu JT. Simultaneously characterizing the comparative economics of routine female adolescent nonavalent human papillomavirus (HPV) vaccination and assortativity of sexual mixing in Hong Kong Chinese: a modeling analysis. BMC Med 2018; 16:127. [PMID: 30115065 PMCID: PMC6097427 DOI: 10.1186/s12916-018-1118-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/04/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Although routine vaccination of females before sexual debut against human papillomavirus (HPV) has been found to be cost-effective around the world, its cost-benefit has rarely been examined. We evaluate both the cost-effectiveness and cost-benefit of routine female adolescent nonavalent HPV vaccination in Hong Kong to guide its policy, and by extension that of mainland China, on HPV vaccination. One major obstacle is the lack of data on assortativity of sexual mixing. Such difficulty could be overcome by inferring sexual mixing parameters from HPV epidemiologic data. METHODS We use an age-structured transmission model coupled with stochastic individual-based simulations to estimate the health and economic impact of routine nonavalent HPV vaccination for girls at age 12 on cervical cancer burden and consider vaccine uptake at 25%, 50%, and 75% with at least 20 years of vaccine protection. Bayesian inference was employed to parameterize the model using local data on HPV prevalence and cervical cancer incidence. We use the human capital approach in the cost-benefit analysis (CBA) and GDP per capita as the indicative willingness-to-pay threshold in the cost-effectiveness analysis (CEA). Finally, we estimate the threshold vaccine cost (TVC), which is the maximum cost for fully vaccinating one girl at which routine female adolescent nonavalent HPV vaccination is cost-beneficial or cost-effective. RESULTS As vaccine uptake increased, TVC decreased (i.e., economically more stringent) in the CBA but increased in the CEA. When vaccine uptake was 75% and the vaccine provided only 20 years of protection, the TVC was US$444 ($373-506) and $689 ($646-734) in the CBA and CEA, respectively, increasing by approximately 2-4% if vaccine protection was assumed lifelong. TVC is likely to be far higher when non-cervical diseases are included. The inferred sexual mixing parameters suggest that sexual mixing in Hong Kong is highly assortative by both age and sexual activity level. CONCLUSIONS Routine HPV vaccination of 12-year-old females is highly likely to be cost-beneficial and cost-effective in Hong Kong. Inference of sexual mixing parameters from epidemiologic data of prevalent sexually transmitted diseases (i.e., HPV, chlamydia, etc.) is a potentially fruitful but largely untapped methodology for understanding sexual behaviors in the population.
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Affiliation(s)
- Horace C W Choi
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F North Wing, Patrick Manson Building, 7 Sassoon Road, Pok Fu Lam, Hong Kong.,Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon Tong, Hong Kong.,Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Mark Jit
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F North Wing, Patrick Manson Building, 7 Sassoon Road, Pok Fu Lam, Hong Kong.,Modelling and Economics Unit, Public Health England, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Gabriel M Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F North Wing, Patrick Manson Building, 7 Sassoon Road, Pok Fu Lam, Hong Kong
| | - Kwok-Leung Tsui
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Joseph T Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F North Wing, Patrick Manson Building, 7 Sassoon Road, Pok Fu Lam, Hong Kong.
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Gender and Sexual Orientation Differences in Human Papillomavirus (HPV) Vaccine Uptake among Chinese Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061099. [PMID: 29843439 PMCID: PMC6025058 DOI: 10.3390/ijerph15061099] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/16/2018] [Accepted: 05/25/2018] [Indexed: 11/16/2022]
Abstract
To date, empirical studies on HPV vaccine uptake are still limited in Chinese populations and mainly conducted in female cohorts. In order to inform health services planning and health promotion programmes for HPV vaccination, this cross-sectional study aimed to report the prevalence of self-reported HPV vaccination status and to examine gender and sexual orientation differences in the uptake of HPV vaccine in Chinese college students. The overall prevalence of HPV vaccine uptake was 27.6% (n = 242), with a significantly higher prevalence in females (39.7%) than in males (4.7%). 91.4% of subjects heard about HPV vaccination, with a significantly higher prevalence in females (93.8%) than in males (86.8%). The prevalence of HPV vaccine uptake was only 2.6% for bisexual/ homosexual males and 5.0% for heterosexual males. Only 45.8% of the overall subjects knew HPV vaccination is not for females only, with a significantly higher prevalence in females (49.7%) than in males (38.6%). The low prevalence of male HPV vaccine uptake and awareness called for the need to have more male-specific HPV campaigns to promote HPV vaccination awareness and uptake in males to reduce the overall prevalence of HPV infection.
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Wong CKH, Man KKC, Ip P, Kwan M, McGhee SM. Mothers' Preferences and Willingness to Pay for Human Papillomavirus Vaccination for Their Daughters: A Discrete Choice Experiment in Hong Kong. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:622-629. [PMID: 29753361 DOI: 10.1016/j.jval.2017.10.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 10/05/2017] [Accepted: 10/13/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To determine the preference of mothers in Hong Kong and their willingness to pay (WTP) for human papillomavirus (HPV) vaccination for their daughters. METHOD A discrete choice experiment survey with a two-alternative study design was developed. Data were collected from pediatric specialist outpatient clinics from 482 mothers with daughters aged between 8 and 17 years. Preferences of the four attributes of HPV vaccines (protection against cervical cancer, protection duration, side effects, and out-of-pocket costs) were evaluated. The marginal and overall WTP were estimated using multinomial logistic regression. A subgroup analysis was conducted to explore the impact of socioeconomic factors on mothers' WTP. RESULTS Side effects, protection against cervical cancer, protection duration, and out-of-pocket cost determined the decision to receive or not receive the vaccine. All attributes had a statistically significant effect on the preference of and the WTP for the vaccine. Maximum WTP for ideal vaccines (i.e., 100% protection, lifetime protection duration, and 0% side effects) was HK$8976 (US $1129). The estimated WTP for vaccines currently available was HK$1620 (US $208), lower than the current market price. Among those who had a monthly household income of more than HK$100,000 (US $12,821), the WTP for vaccines currently offered was higher than the market price. CONCLUSIONS This study provides new data on how features of the HPV vaccine are viewed and valued by mothers by determining their perception of ideal or improved and current vaccine technologies. These findings could contribute to future policies on the improvement of HPV vaccine and be useful for the immunization service in Hong Kong.
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Affiliation(s)
- Carlos K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong.
| | - Kenneth K C Man
- Department of Paediatrics and Adolescent Medicine, Pok Fu Lam, The University of Hong Kong, Hong Kong
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Pok Fu Lam, The University of Hong Kong, Hong Kong
| | - Mike Kwan
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Lai Chi Kok, Kowloon, Hong Kong
| | - Sarah M McGhee
- School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong
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Parental acceptability of HPV vaccination for boys and girls aged 9-13 years in China - A population-based study. Vaccine 2018; 36:2657-2665. [PMID: 29606519 DOI: 10.1016/j.vaccine.2018.03.057] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study was to investigate parental acceptability of HPV vaccination for their sons and daughters aged 9-13 years under different cost scenarios, and factors associated with parental acceptability at market price. METHODS Participants were: (1) Chinese speaking parents aged 18-60 years with a Hong Kong ID card; (2) had a son or a daughter aged 9-13 years at the date of the survey; (3) the child had the right to abode in Hong Kong. Random telephone numbers were selected from up-to-date telephone directories of Hong Kong. A total of 300 eligible parents (boys' parents: 162; girls' parents: 138, response rate: 68.9% & 69%) provided verbal informed consent and completed the anonymous telephone interview during March to October 2016. Using parental acceptability of HPV vaccination at market price as the dependent variable, univariate and multiple logistic regression models were fitted. RESULTS The prevalence of HPV vaccination was very low among boys and girls (0.6% vs. 2.2%, p = 0.242). Among those whose children had not taken up HPV vaccination, the prevalence of parental acceptability of HPV vaccination for the index son and daughter were: 14.9% and 27.4% (market price), and 51.6% and 63.0% (free vaccination). Adjusted for sociodemographic variables, attitudinal variables based on the Health Belief Model were associated with parental acceptability of HPV vaccination for their sons (perception that it was not worthy, perceived cue to action from mass media and perceived self-efficacy) and for their daughters (perceived susceptibility and perceived severity of HPV infection among females, perceived benefit of HPV vaccination and perceived self-efficacy). CONCLUSION Coverage of HPV vaccination among children aged 9-13 years was very low. Instead of waiting for the free universal vaccination to become available, promotion of self-paid HPV vaccination targeting parents is urgently needed. Different strategies should be applied to boys' and girls' parents.
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Yuen WWY, Lee A, Chan PKS, Tran L, Sayko E. Uptake of human papillomavirus (HPV) vaccination in Hong Kong: Facilitators and barriers among adolescent girls and their parents. PLoS One 2018; 13:e0194159. [PMID: 29543839 PMCID: PMC5854366 DOI: 10.1371/journal.pone.0194159] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 02/26/2018] [Indexed: 12/31/2022] Open
Abstract
The present study is aimed at assessing the feasibility of delivering the HPV (human papillomavirus) vaccine to girls through a school-based program in Hong Kong, as well as to examine the facilitators and barriers associated with their participation. We approached 1,229 eligible girls aged 9 to 14 at eight schools in Hong Kong to join the program and then delivered the bivalent HPV vaccine at 0 and 6 months over the course of one school year. The students and their parents completed separate questionnaires to indicate their decision on whether or not to participate, and to assess their knowledge of cervical cancer and the HPV vaccine. The overall vaccine uptake was 81.4% (1,000/1,229) for the first dose and 80.8% (993/1,229) for the second dose. Parents and students were given separate questionnaires and asked whether or not they would like to participate in the vaccination program. 87.1% (1,010/1,160) of parents and 84.9% (974/1,147) of students indicated that they would join the program. The reasons associated with parents’ decision not to vaccinate their daughters primarily included concerns around side effects and safety. Multivariate regression analysis showed that parents who thought that the vaccine would protect their daughter from getting cervical cancer (OR = 3.16, 95% CI = 1.39–7.15, p < .01), and those who reported having a doctor’s recommendation (OR = 4.54, 95% CI = 1.05–19.57, p < .05) were more likely to join the program. In contrast, parents who had never heard of the vaccine (OR = .15, 95% CI = .03–.71, p < .02), those who were willing to pay more than HK$2,000 for the vaccine (OR = .39, 95% CI = .19–.81, p < .05), or had a preference to access it through a private clinic (OR = .44, 95% CI = .26–.75, p < .01) were significantly less likely to allow their daughter to join the program. Delivery of the HPV vaccine with high uptake rate in a school setting is feasible in Hong Kong. Engaging key stakeholders including school administrators, teachers and community physicians, and providing relevant information on safety and vaccine effectiveness to parents were important to the success of the program.
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Affiliation(s)
| | - Albert Lee
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Paul K S Chan
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Lynn Tran
- Karen Leung Foundation Limited, Hong Kong SAR, China
| | - Erica Sayko
- Karen Leung Foundation Limited, Hong Kong SAR, China
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Factors influencing intention to obtain the HPV vaccine in South East Asian and Western Pacific regions: A systematic review and meta-analysis. Sci Rep 2018; 8:3640. [PMID: 29483541 PMCID: PMC5832144 DOI: 10.1038/s41598-018-21912-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 02/09/2018] [Indexed: 12/11/2022] Open
Abstract
Since licensing in 2006, there has been poor uptake of the HPV vaccine among the targeted population in the South East Asia Region (SEAR) and Western Pacific Region (WPR). A systematic review was conducted to identify the studies exploring the relationship between factors and intention for HPV vaccination among women in SEAR and WPR countries. Nineteen studies were identified as suitable for qualitative synthesis, and three as suitable for meta-analysis. Most women had a positive intention to have an HPV vaccine (range 57%-85%). Having a positive intention to vaccinate was significantly higher among women not aware of HPV infection (OR: 1.34, 95% CI: 1.02-1.76) and HPV vaccine (OR: 1.57, 95% CI: 1.26-1.96). Lower knowledge level and less confidence in safety and efficacy of the vaccine, negatively affected intention to vaccinate. Perceiving the vaccine to be expensive, low perception of contracting HPV infection and cervical cancer, and lack of concrete recommendations from healthcare providers also negatively affected intention to vaccinate. This review suggests the decision-making processes of women in SEAR and WPR is influenced by the cost of vaccination, perceived efficacy and safety of vaccine, provision of information on vaccination, and the awareness about HPV infection and the HPV vaccine.
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Santhanes D, Wong CP, Yap YY, San SP, Chaiyakunapruk N, Khan TM. Factors involved in human papillomavirus (HPV) vaccine hesitancy among women in the South-East Asian Region (SEAR) and Western Pacific Region (WPR): A scoping review. Hum Vaccin Immunother 2018; 14:124-133. [PMID: 28933635 PMCID: PMC5791566 DOI: 10.1080/21645515.2017.1381811] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/19/2017] [Accepted: 09/15/2017] [Indexed: 01/23/2023] Open
Abstract
A scoping review was performed to identify factors that may lead to human papillomavirus (HPV) vaccine hesitancy among women in low- and middle-income countries in South East Asian Region (SEAR) and Western Pacific Region (WPR). A systematic search of English and non-English articles using Pubmed, EMBASE, PsycINFO, Cochrane, MEDLINE, and CINAHL plus was conducted. Only 63 studies conducted in SEAR and WPR were included from inception until December 2016. Results of these studies have shown that poor awareness and knowledge of practices on cervical cancer prevention was evident in both SEAR and WPR. Concerns on safety and efficacy of the vaccine, and costs in getting vaccinated were significant barriers. Most women stated that they needed more information, and strongly welcomed a physician's recommendation in both geographical regions. Women also felt they have a low risk of acquiring HPV infection and cervical cancer. Most women in SEAR and WPR were unable to decide on whether to accept HPV vaccination.
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Affiliation(s)
- Diviya Santhanes
- School of Pharmacy, Department of Pharmacy Practice, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Che Pui Wong
- School of Pharmacy, Department of Pharmacy Practice, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Yan Ye Yap
- School of Pharmacy, Department of Pharmacy Practice, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Saw Pui San
- School of Pharmacy, Department of Pharmacy Practice, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Department of Pharmacy Practice, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
- Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
- School of Pharmacy, University of Wisconsin, Madison, WI, USA
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Tahir Mehmood Khan
- School of Pharmacy, Department of Pharmacy Practice, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
- College of Pharmacy, Department of Pharmacy, Abasyn University, Peshawar, Pakistan
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Loke AY, Kwan ML, Wong YT, Wong AKY. The Uptake of Human Papillomavirus Vaccination and Its Associated Factors Among Adolescents: A Systematic Review. J Prim Care Community Health 2017; 8:349-362. [PMID: 29161946 PMCID: PMC5932744 DOI: 10.1177/2150131917742299] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: The purpose of this review was to explore the uptake of the human papillomavirus (HPV) vaccination, its associated factors, and the facilitators of and barriers to HPV vaccination among adolescents. Methods: A comprehensive literature search was conducted through 5 electronic databases, including PubMed, CINAHL, Cochrane Library, Medline, and PsycInfo from January 2006 to March 2015 for studies examining the uptake, awareness, knowledge, acceptability, and intention of adolescents with regard to HPV vaccination. Results: Twenty-eight studies were identified and included. The HPV vaccination uptake rate (at least 1 dose) varied significantly among countries, ranging from 2.4% to 94.4%. Scotland achieved the highest uptake of all the studies included in this review, while Hong Kong had the lowest, at 2.4% to 9.1%. This review also showed that adolescents had limited awareness and knowledge of HPV infections and vaccines, even 10 years after the vaccine had become available. Conclusions: It is recommended that barriers to the uptake of the vaccine should be addressed, and that school-based sexual health education of HPV infection and vaccine promotion should be reinforced.
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Affiliation(s)
- Alice Yuen Loke
- 1 The Hong Kong Polytechnic University, Kowloon, Hung Hom, Hong Kong SAR
| | - Miu Ling Kwan
- 1 The Hong Kong Polytechnic University, Kowloon, Hung Hom, Hong Kong SAR.,2 Tuen Mun Hospital, Hospital Authority, Hong Kong SAR
| | - Yuen-Ting Wong
- 1 The Hong Kong Polytechnic University, Kowloon, Hung Hom, Hong Kong SAR
| | - Alice Kar Yan Wong
- 1 The Hong Kong Polytechnic University, Kowloon, Hung Hom, Hong Kong SAR
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Wang LDL, Lam WWT, Fielding R. Determinants of human papillomavirus vaccination uptake among adolescent girls: A theory-based longitudinal study among Hong Kong Chinese parents. Prev Med 2017; 102:24-30. [PMID: 28652087 DOI: 10.1016/j.ypmed.2017.06.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 05/24/2017] [Accepted: 06/18/2017] [Indexed: 01/13/2023]
Abstract
Human papillomavirus (HPV) vaccination uptake among Chinese adolescent girls remains extremely low. This two-year longitudinal study examined theoretical predictors of adolescent girls' HPV vaccination uptake using an extended Theory of Planned Behaviour (TPB). Between February and November 2014, a random sample of 1996 (response rate 60%) Hong Kong Chinese parents of 12- to 17-year-old HPV unvaccinated girls completed baseline telephone interviews assessing attitudes and intention towards HPV vaccination. Six and 12months later 1255 and 979 parents reported their daughters' HPV vaccination status, respectively. Structural equation modelling tested data fit to an TPB-derived hypothesized model of baseline factors predicting parental decisionmaking for adolescent girls' subsequent HPV vaccination uptake. Overall, at 1-year follow-up, only 9.8% (97/988) of participants' daughters received at least one dose of HPV vaccines. Descriptive norms (β=0.28), perceived greater benefits of HPV vaccination (β=0.17), anticipated affective consequences (β=0.32), and attitude to general optional vaccines (β=0.09) were associated with parental vaccination intention. Barriers to HPV vaccination (β=-0.31), descriptive norms (β=0.17), perceived self-efficacy (β=0.73), and vaccination intention (β=0.11) were associated with vaccination planning. Vaccination intention (β=0.31) and planning (β=0.18) modestly predicted vaccination uptake. The lack of government-organized HPV vaccination programme may result in persistent low HPV vaccination uptake and many young women may remain vulnerable to future cervical cancer risk in Hong Kong.
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Affiliation(s)
- Linda Dong-Ling Wang
- College of Medicine, Yangzhou University, Jiangsu Province, China; Division of Behavioural Sciences, School of Public Health, University of Hong Kong, Hong Kong.
| | - Wendy Wing Tak Lam
- Division of Behavioural Sciences, School of Public Health, University of Hong Kong, Hong Kong.
| | - Richard Fielding
- Division of Behavioural Sciences, School of Public Health, University of Hong Kong, Hong Kong.
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Wong CK, Liao Q, Guo VY, Xin Y, Lam CL. Cost-effectiveness analysis of vaccinations and decision makings on vaccination programmes in Hong Kong: A systematic review. Vaccine 2017; 35:3153-3161. [DOI: 10.1016/j.vaccine.2017.04.050] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/12/2017] [Accepted: 04/19/2017] [Indexed: 12/13/2022]
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Chiang VCL, Wong HT, Yeung PCA, Choi YK, Fok MSY, Mak OI, Wong HY, Wong KH, Wong SY, Wong YS, Wong EYY. Attitude, Acceptability and Knowledge of HPV Vaccination among Local University Students in Hong Kong. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13050486. [PMID: 27187424 PMCID: PMC4881111 DOI: 10.3390/ijerph13050486] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/27/2016] [Accepted: 05/05/2016] [Indexed: 11/16/2022]
Abstract
The Human Papillomavirus (HPV) vaccine has the great potential to prevent HPV-related infections for millions of women and men worldwide. However, the success of the vaccine is highly dependent on the vaccination rate. Factors influencing the attitudes of undergraduate students towards HPV vaccination should be studied. This is a cross-sectional survey that was conducted to estimate the HPV vaccination rate among undergraduate students in Hong Kong, and to identify the predictors of their attitude towards HPV vaccination. The results showed that the HPV vaccination rate was 13.3%. Factors related to knowledge of vaccination were the main predictors of the students’ attitude towards vaccination (there were seven predictors, with B = 1.36 to 2.30; p < 0.05), followed by gender (B = −1.40; p < 0.05), acceptable maximum price (B = 0.35; p < 0.05), and willingness to receive the HPV vaccine if it can protect against cervical/anal cancer and genital warts (B = −1.90; p < 0.001). The regression model that was developed based on the predictors had a moderate effect size (adj-R2 = 0.33). To conclude, the HPV vaccination rate among undergraduate students in Hong Kong was low. They should be provided with more active education and activities to promote HPV vaccination to improve their knowledge on the subject.
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Affiliation(s)
| | - Ho Ting Wong
- School of Nursing, the Hong Kong Polytechnic University, Hong Kong, China.
| | - Pui Chun Au Yeung
- School of Nursing, the Hong Kong Polytechnic University, Hong Kong, China.
| | - Yuk Ki Choi
- School of Nursing, the Hong Kong Polytechnic University, Hong Kong, China.
| | | | - Oi In Mak
- School of Nursing, the Hong Kong Polytechnic University, Hong Kong, China.
| | - Hing Yu Wong
- School of Nursing, the Hong Kong Polytechnic University, Hong Kong, China.
| | - Kim Ho Wong
- School of Nursing, the Hong Kong Polytechnic University, Hong Kong, China.
| | - Shui Yan Wong
- School of Nursing, the Hong Kong Polytechnic University, Hong Kong, China.
| | - Yee Shan Wong
- School of Nursing, the Hong Kong Polytechnic University, Hong Kong, China.
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Zhang Y, Wang Y, Liu L, Fan Y, Liu Z, Wang Y, Nie S. Awareness and knowledge about human papillomavirus vaccination and its acceptance in China: a meta-analysis of 58 observational studies. BMC Public Health 2016; 16:216. [PMID: 26936076 PMCID: PMC4776385 DOI: 10.1186/s12889-016-2873-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 02/16/2016] [Indexed: 11/25/2022] Open
Abstract
Background The human papillomavirus (HPV) vaccines have been widely introduced in immunization programs worldwide, however, it is not accepted in mainland China. We aimed to investigate the awareness and knowledge about HPV vaccines and explore the acceptability of vaccination among the Chinese population. Methods A meta-analysis was conducted across two English (PubMed, EMBASE) and three Chinese (China National Knowledge Infrastructure, Wan Fang Database and VIP Database for Chinese Technical Periodicals) electronic databases in order to identify HPV vaccination studies conducted in mainland China. We conducted and reported the analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Fifty-eight unique studies representing 19 provinces and municipalities in mainland China were assessed. The pooled awareness and knowledge rates about HPV vaccination were 15.95 % (95 % CI: 12.87–19.29, I2 = 98.9 %) and 17.55 % (95 % CI: 12.38–24.88, I2 = 99.8 %), respectively. The female population (17.39 %; 95 % CI: 13.06–22.20, I2 = 98.8 %) and mixed population (18.55 %; 95 % CI: 14.14–23.42, I2 = 98.8 %) exhibited higher HPV vaccine awareness than the male population (1.82 %; 95 % CI: 0.50–11.20, I2 = 98.5 %). Populations of mixed ethnicity had lower HPV vaccine awareness (9.61 %; 95 % CI: 5.95–14.03, I2 = 99.0 %) than the Han population (20.17 %; 95 % CI: 16.42–24.20, I2 = 98.3 %). Among different regions, the HPV vaccine awareness was higher in EDA (17.57 %; 95 % CI: 13.36–22.21, I2 = 98.0 %) and CLDA (17.78 %; 95 % CI: 12.18–24.19, I2 = 97.6 %) than in WUDA (1.80 %; 95 % CI: 0.02–6.33, I2 = 98.9 %). Furthermore, 67.25 % (95 % CI: 58.75–75.21, I2 = 99.8 %) of participants were willing to be vaccinated, while this number was lower for their daughters (60.32 %; 95 % CI: 51.25–69.04, I2 = 99.2 %). The general adult population (64.72 %; 95 % CI: 55.57–73.36, I2 = 99.2 %) was more willing to vaccinate their daughters than the parent population (33.78 %; 95 % CI: 26.26–41.74, I2 = 88.3 %). Safety (50.46 %; 95 % CI: 40.00–60.89, I2 = 96.6 %) was the main concern about vaccination among the adult population whereas the safety and efficacy (68.19 %; 95 % CI: 53.13–81.52, I2 = 98.6 %) were the main concerns for unwillingness to vaccinate their daughters. Conclusions Low HPV vaccine awareness and knowledge was observed among the Chinese population. HPV vaccine awareness differed across sexes, ethnicities, and regions. Given the limited quality and number of studies included, further research with improved study designis necessary. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-2873-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yanru Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Ying Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. .,Mental Health Center, Renmin Hospital of Wuhan University, Hubei Provincial Mental Health Center Wuchang District, Wuhan, Hubei, P. R. China.
| | - Li Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Yunzhou Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Zhihua Liu
- Shenzhen Maternity and Child Health Hospitals, Shenzhen, Guangdong, P. R. China.
| | - Yueyun Wang
- Shenzhen Maternity and Child Health Hospitals, Shenzhen, Guangdong, P. R. China.
| | - Shaofa Nie
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Hong Kong Chinese parental attitudes towards vaccination and associated socio-demographic disparities. Vaccine 2016; 34:1426-9. [DOI: 10.1016/j.vaccine.2016.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 01/29/2016] [Accepted: 02/01/2016] [Indexed: 11/23/2022]
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Lee A, Wong MCS, Chan TT, Chan PKS. A home-school-doctor model to break the barriers for uptake of human papillomavirus vaccine. BMC Public Health 2015; 15:935. [PMID: 26392084 PMCID: PMC4578840 DOI: 10.1186/s12889-015-2269-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 09/14/2015] [Indexed: 11/17/2022] Open
Abstract
Background A high coverage of human papillomavirus (HPV) vaccination is required to achieve a clinically significant reduction in disease burden. Countries implementing free-of-charge national vaccination program for adolescent girls are still challenged by the sub-optimal uptake rate. Voluntary on-site school-based mass vaccination programs have demonstrated high coverage. Here, we tested whether this could be an option for countries without a government-supported vaccination program as in Hong Kong. Method A Home-School-Doctor model was evolved based on extensive literature review of various health promotion models together with studies on HPV vaccination among adolescent girls. The outcome measure was uptake of vaccination. Factors associated with the outcome were measured by validated surveys in which 4,631 students from 24 school territory wide participated. Chi-square test was used to analyze association between the categorical variables and the outcome. Multivariate analysis was performed to identify independent variables associated with the outcome with vaccine group as case and non-vaccine group as control. Results In multivariate analysis, parental perception of usefulness of the Home-School-Doctor model had a very high odds ratio for uptake of HPV vaccination (OR 26.6, 95 % CI 16.4, 41.9). Paying a reasonable price was another independent factor associated with increased uptake (OR 1.71, 95 % CI 1.39, 2.1 for those with parents willing to pay US$125-250 for vaccination). For parents and adolescents who were not sure where to get vaccination, this model was significantly associated with improved uptake rate (OR 1.66, 95 % CI 1.23, 2.23). Concerns with side effects of vaccine (OR 0.70, 95 % CI 0.55, 0.88), allowing daughters to make their own decisions (OR 0.49, 95 % CI 0.38, 0.64) and not caring much about daughters’ social life (95 % CI 0.45, 0.92) were factors associated with a lower uptake. Discussion The findings of this study have added knowledge on how a school-based vaccination program would improve vaccine uptake rate even when the users need to pay. Our findings are consistent with other study that the most acceptable way to achieve high uptake of HPV vaccine is to offer voluntary school-based vaccination. Conclusion A model of care incorporating the efforts and expertise of academics and health professionals working closely with school can be applied to improve the uptake of vaccine among adolescent girls. Subsidized voluntary school-based vaccination scheme can be an option.
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Affiliation(s)
- Albert Lee
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4th Floor, School of Public Heath, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. .,Centre for Health Education and Health Promotion, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4th Floor, Lek Yuen Health Centre, Shatin, New Territories, Hong Kong.
| | - Martin C S Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4th Floor, School of Public Heath, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
| | - Tracy T Chan
- Centre for Health Education and Health Promotion, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4th Floor, Lek Yuen Health Centre, Shatin, New Territories, Hong Kong.
| | - Paul K S Chan
- Department of Microbiology, The Chinese University of Hong Kong, 1st Floor, Clinical Sciences Building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
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Wang LDL, Lam WWT, Fielding R. Cervical cancer prevention practices through screening and vaccination: A cross-sectional study among Hong Kong Chinese women. Gynecol Oncol 2015; 138:311-6. [DOI: 10.1016/j.ygyno.2015.05.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/20/2015] [Accepted: 05/21/2015] [Indexed: 11/30/2022]
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Wang LDL, Lam WWT, Wu J, Fielding R. Psychosocial determinants of Chinese parental HPV vaccination intention for adolescent girls: preventing cervical cancer. Psychooncology 2015; 24:1233-1240. [PMID: 26042656 DOI: 10.1002/pon.3859] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 03/20/2015] [Accepted: 04/27/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND Intention is an important precursor of decisions to undergo vaccination. Using an extensively modified theory of planned behaviour, we explored psychosocial determinants of vaccination intention against human papillomavirus (HPV) among Hong Kong Chinese parents. METHODS A random sample of 368 (response rate 54.6%) Chinese parents who had at least one daughter aged 12-17 years, had heard of HPV vaccine before but had not vaccinated daughters against HPV and had completed telephone interviews between February and April 2014. Hierarchical multiple regression analysis examined the additive effect of theoretical constructs. Stepwise multiple regression analysis determined which variables contributed the most to the prediction of vaccination intention. RESULTS Principal determinants of parental HPV vaccination intention were anticipated worry if not vaccinated (β = 0.23, p = 0.001), anticipated anxiety reduction after HPV vaccination (β = 0.19, p = 0.005), proneness to peer influence (β = 0.17, p = 0.002), private health insurance for children (β = 0.14, p = 0.009), perceiving daughter's susceptibility to cervical cancer (β = 0.17, p = 0.003), number of daughters (β = -0.13, p = 0.011), descriptive norms of HPV vaccination (β = 0.13, p = 0.021), perceiving cervical cancer as behaviour-preventable disease (β = -0.11, p = 0.031) and anticipated regret if not vaccinated (β = 0.14, p = 0.046). Cervical cancer-related worry/anxiety explained 32.8% of the variance in parental HPV vaccination intention. CONCLUSIONS Results suggest that cervical cancer-related worry/anxiety is the most important predictor of parental HPV vaccination intention in Hong Kong Chinese and possibly other populations. Social influences also play an important role affecting parental vaccination intention, particularly peer influence and descriptive norm beliefs. Implications of these results are discussed in terms of future HPV vaccination promotion and cervical cancer prevention programme. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Linda Dong-Ling Wang
- Centre for Psycho-Oncology Research and Training, School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Wendy Wing Tak Lam
- Centre for Psycho-Oncology Research and Training, School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Joseph Wu
- Division of Epidemiology and Biostatistics, School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Richard Fielding
- Centre for Psycho-Oncology Research and Training, School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
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Wang LDL, Lam WWT, Wu J, Fielding R. Hong Kong Chinese Women's Lay Beliefs about Cervical Cancer Causation and Prevention. Asian Pac J Cancer Prev 2014; 15:7679-86. [DOI: 10.7314/apjcp.2014.15.18.7679] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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