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Beres LK, Campoamor NB, Hawthorn R, Mugambi ML, Mulabe M, Vhlakis N, Kabongo M, Schuster A, Bridges JFP. Using best-worst scaling to inform policy decisions in Africa: a literature review. BMC Public Health 2024; 24:2607. [PMID: 39334072 PMCID: PMC11438065 DOI: 10.1186/s12889-024-20068-w] [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: 02/10/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Stakeholder engagement in policy decision-making is critical to inform required trade-offs, especially in low-and-middle income settings, such as many African countries. Discrete-choice experiments are now commonly used to engage stakeholders in policy decisions, but other methods such as best-worst scaling (BWS), a theory-driven prioritization technique, could be equally important. We sought to document and explore applications of BWS to assess stakeholder priorities in the African context to bring attention to BWS as a method and to assess how and why it is being used to inform policy. METHODS We conducted a literature review of published applications of BWS for prioritization in Africa. RESULTS Our study identified 35 studies, with the majority published in the past four years. BWS has most commonly been used in agriculture (43%) and health (34%), although its broad applicability is demonstrated through use in fields influencing social and economic determinants of health, including business, environment, and transportation. Published studies from eastern, western, southern, and northern Africa include a broad range of sample sizes, design choices, and analytical approaches. Most studies are of high quality and high policy relevance. Several studies cited benefits of using BWS, with many of those citing potential limitations rather than observed limitations in their study. CONCLUSIONS Growing use of the method across the African continent demonstrates its feasibility and utility, recommending it for consideration among researchers, program implementers, policy makers, and funders when conducting preference research to influence policy and improve health systems. REGISTRATION The review was registered on PROSPERO (CRD42020209745).
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Affiliation(s)
- Laura K Beres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Office, Baltimore, MD, 5032, 21205, USA
| | - Nicola B Campoamor
- Department of Biomedical Informatics, The Ohio State University College of Medicine, 220 Lincoln Tower, 1800 Cannon Drive, Columbus, OH, 43210, USA
| | - Rachael Hawthorn
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University, 700 Ackerman Road, Columbus, OH, 43202, USA
| | - Melissa L Mugambi
- Department of Global Health, University of Washington, UW Box #351620, Seattle, WA, 98195, USA
| | - Musunge Mulabe
- Centre for Infectious Disease Research in Zambia, Stand 378A / 15, Main Street, P.O. Box 34681, Ibex, Lusaka, Zambia
| | - Natlie Vhlakis
- Centre for Infectious Disease Research in Zambia, Stand 378A / 15, Main Street, P.O. Box 34681, Ibex, Lusaka, Zambia
| | - Michael Kabongo
- Centre for Infectious Disease Research in Zambia, Stand 378A / 15, Main Street, P.O. Box 34681, Ibex, Lusaka, Zambia
| | - Anne Schuster
- Department of Biomedical Informatics, The Ohio State University College of Medicine, 220 Lincoln Tower, 1800 Cannon Drive, Columbus, OH, 43210, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, 220 Lincoln Tower, 1800 Cannon Drive, Columbus, OH, 43210, USA.
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Lohiniva AL, Nurzhynska A, Mueed A, Ali A, Ahmed K, Ayiku P, Amo-Adjei J, Kawakatsu Y, Shetye M, Greiner K, McIntosh R. Strengthening polio vaccine demand in Ghana: Understanding the factors influencing uptake of the vaccine and the effectiveness of different message frames. PLoS One 2023; 18:e0279809. [PMID: 36763581 PMCID: PMC9916648 DOI: 10.1371/journal.pone.0279809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 12/15/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Ghana has experienced recent polio outbreaks. Behavioral insights can be used to understand behavior and create demand for the polio vaccine. METHODS This cross-sectional study is based on an interactive mobile phone survey that explored factors influencing the uptake of the polio vaccine among Ghanaian mothers with children younger than five years old. The survey also explores the mothers' intention to vaccinate their children in the future as well as an experiment with short polio vaccine voice message nudges to identify the most effective message frames in encouraging vaccination. The study sample was drawn from volunteers from a mobile service platform. Linear probability model regressions with Ordinary Least Squares (OLS) estimates were used to analyze the data. RESULTS In total, data from 708 caregivers was assessed. Out of the sample, 35% (n = 250) had not vaccinated their children against polio, around 8% (n = 53) of respondents stated they did not plan to do so, while 28% expressed intent to do so during the next polio vaccination campaign. Higher vaccination of children against polio, i.e. better uptake of the polio vaccine, appeared to be associated with children's caregivers knowing that polio causes paralysis (with a coefficient of 0.13 (95% CI: 0.02, 0.24), i.e. 13% more likely than not to have their child vaccinated). Higher vaccine uptake also appeared to be associated with the perception that the polio vaccine is safe (with a coefficient of 0.11 (95% CI: 0.01, 0.22), i.e. 11% more likely than not to have their child vaccinated). Another factor in increasing vaccine uptake is whether caregivers receive support from healthcare workers with a coefficient of 0.11 (95% CI: 0.02, 0.20), i.e. 11% more likely than not to have their child vaccinated. Crucially, difficulty accessing the polio vaccine appeared to be associate with a negative change in vaccine uptake (with a coefficient of -0.16 (95% CI: -0.23, -0.08), i.e. 16% less likely to have their child vaccinated). Satisfaction with the information provided by vaccinators was also associated with better vaccine uptake (with a coefficient of 0.12 (95% CI: 0.05, 0.20) i.e. 12% more likely than not to have their child vaccinated); and having seen or heard something negative about the polio vaccine with a coefficient of 0.10 (95% CI: 0.03, 0.17), i.e. 10% more likely than not to have their child vaccinated. The social norms message frame was statistically significant with a coefficient of 0.06 (95% CI: -0.004, 012). CONCLUSION The findings from this study suggest that most women with children under the age of 5 appear to have vaccinated their children against polio. Many more caregivers express an intention to vaccinate their children, never having done so before. The behavior and the intention to vaccinate are both driven by a number of factors that must be addressed to create demand for the polio vaccine. Targeted message frames appeared to be statistically significant drivers of vaccine uptake. However, more research is required to understand how they impact vaccine behavior and future intention for vaccination.
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Affiliation(s)
- Anna-Leena Lohiniva
- Social and Behaviour Change Section, UNICEF Ghana Country Office, Accra, Ghana,* E-mail:
| | | | | | | | | | | | - Joshua Amo-Adjei
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Yoshito Kawakatsu
- Department of Data and Analytics, UNICEF HQ, New York, New York, United States of America
| | - Mrunal Shetye
- Health Section, UNICEF Ghana Country Office, Accra, Ghana
| | - Karen Greiner
- Social and Behaviour Change Section, UNICEF West and Central Africa, Dagar, Senegal
| | - Ross McIntosh
- UNICEF Polio, UNICEF HQ, New York, New York, United States of America
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Bell J, Lartey B, Spickernell G, Darrell N, Salt F, Gardner C, Richards E, Fasakin L, Egbeniyi S, Odongo E, Ssenkungu J, Kouadio RK, Cissé M, Rérambyah ABAI, Adou M, West R, Sharma S. Applying a social-ecological model to understand factors impacting demand for childhood vaccinations in Nigeria, Uganda, and Guinea. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:None. [PMID: 36531294 PMCID: PMC9748306 DOI: 10.1016/j.ssmqr.2022.100180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 06/17/2023]
Abstract
Vaccines have reduced child mortality across the world, but low levels of demand for vaccination threatens to undermine progress. Existing frameworks to understand demand tend to prioritise primary caregivers' decision-making processes. We aimed to build a wider understanding of vaccine demand by applying an adapted socio-ecological model to analyse 158 interviews with primary caregivers and fathers of young children, and community influencers in Nigeria, Uganda, and Guinea. We found that several factors come together to inform a primary caregiver's demand for vaccination, including their familial and social relationships, their interactions with government and healthcare institutions, and the wider social and cultural norms in their communities. The study suggests that interventions targeted at families and communities instead of individuals could be effective. The results could be used to ensure that vaccine demand frameworks used by researchers and intervention designers are comprehensive and consider a wider range of influences on the primary caregiver.
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Affiliation(s)
- James Bell
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
| | - Belinda Lartey
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
| | | | | | - Frances Salt
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
| | - Cassie Gardner
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
| | - Emily Richards
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
| | - Lanre Fasakin
- CMRG, 24A, Eric Moore Street, Wemabod Estate, Off Ajao Road, Ikeja, Lagos, Nigeria
| | - Shadrach Egbeniyi
- CMRG, 24A, Eric Moore Street, Wemabod Estate, Off Ajao Road, Ikeja, Lagos, Nigeria
| | - Emmanuel Odongo
- Ipsos Uganda, 3rd Floor Padre Pio House, Plot 32, Lumumba Avenue P.O. Box 21571, Kampala, Uganda
| | - James Ssenkungu
- Ipsos Uganda, 3rd Floor Padre Pio House, Plot 32, Lumumba Avenue P.O. Box 21571, Kampala, Uganda
| | | | - Mamadi Cissé
- Ciblage, En Face de l’Ecole les Ecureuils, Lambanyi, Ratoma, Conakry, Guinea
| | | | - Maikol Adou
- Ciblage, Face SODECI, Imm. Hué, Porte B10, Riviera Attoban, Cocody, 09 BP 799, Abidjan 09, Cote d’Ivoire
| | - Rebecca West
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
- Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, United States
| | - Sunny Sharma
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
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Egbon M, Ojo T, Aliyu A, Bagudu ZS. Challenges and lessons from a school-based human papillomavirus (HPV) vaccination program for adolescent girls in a rural Nigerian community. BMC Public Health 2022; 22:1611. [PMID: 36002832 PMCID: PMC9400556 DOI: 10.1186/s12889-022-13975-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 06/23/2022] [Indexed: 11/19/2022] Open
Abstract
Background Over 80% of new cervical cancer cases occur in women living in low- and middle-income countries. It is the second highest cause of female cancer deaths in Nigeria. School based vaccination programs are an effective strategy for delivering the HPV vaccine to adolescent girls. This study aims to understand the challenges to implementing school-based HPV vaccination programs, particularly in a remote rural setting where vaccine hesitancy is high. Methods A 22- item interviewer administered questionnaire was used to evaluate HPV knowledge and willingness to get the HPV vaccinate among 100 female secondary school students as part of an HPV vaccination pilot in a rural community in Kebbi State, Nigeria. Additionally, semi-structured interviews were used to assess community knowledge and attitudes on cervical cancer and HPV vaccination. Data collected were analyzed thematically to understand challenges and generate lessons for vaccine delivery in the study setting. Results Knowledge of HPV and cervical cancer among junior secondary school aged girls was fair with a mean score of 66.05%. For senior secondary school aged girls, the knowledge score ranged from 70 to 100% with a mean of 96.25% indicating good knowledge of HPV and cervical cancer. All participants (n = 100) received the first vaccine dose but due to COVID-19, 33 participants were not able to complete the vaccine dosage within the recommended 6-month schedule. Of the parents who provided consent, none could afford the vaccine out of pocket. Challenges to vaccine delivery included operational costs exacerbated by lack of adequate health workforce and infrastructure in the study setting. Conclusion An exploration of sociocultural perspectives and contextual realities is crucial to understanding the complexities of HPV vaccine introduction from the perspective of the target audience, and the local community. Strategies for introducing the HPV vaccine should address community concerns through effective communication, appropriate delivery, and targeted advocacy to make the vaccination program locally relevant. While school-based HPV immunization programs have been shown to be successful, adequate design, planning and monitoring is important. Additionally, considerations must be made to account for the high operational cost of vaccine delivery in rural, hard to reach areas where human resources and infrastructure are limited.
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Affiliation(s)
| | - Tolulope Ojo
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
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Kulkarni S, Sengeh P, Eboh V, Jalloh MB, Conteh L, Sesay T, Ibrahim N, Manneh PO, Kaiser R, Jinnai Y, Wallace AS, Prybylski D, Jalloh MF. Role of Information Sources in Vaccination Uptake: Insights From a Cross-Sectional Household Survey in Sierra Leone, 2019. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00237. [PMID: 35294376 PMCID: PMC8885335 DOI: 10.9745/ghsp-d-21-00237] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
Abstract
Our findings suggest that health workers and faith leaders are important sources of information to deliver vaccination messages, given their strong association with vaccination confidence and uptake. In this context, vaccination promotion efforts that integrate faith leaders and health workers may help increase vaccination uptake. Introduction: There is limited understanding of the potential impact of information sources on vaccination attitudes and behaviors in low-income countries. We examined how exposure to immunization information sources may be associated with vaccination uptake in Sierra Leone. Methods: In 2019, a household survey was conducted using multistage cluster sampling to randomly select 621 caregivers of children aged 12–23 months in 4 districts in Sierra Leone. We measured exposure to various sources of immunization information and 2 outcomes: (1) vaccination confidence using an aggregate score (from 12 Likert items, informed by previously validated scale) that was dichotomized into a binary variable; (2) uptake of the third dose of diphtheria-pertussis-tetanus-hepatitis B-Haemophilus influenzae type-b-pentavalent vaccine (penta-3) based on card record or through caregiver recall when card was unavailable. Associations between information sources and the outcomes were examined using modified Poisson regression with robust variance estimator. Results: Weighted estimate for penta-3 uptake was 81% (75.2%–85.5%). The likelihood of uptake of penta-3 was significantly greater when caregiver received information from health facilities (adjusted prevalence ratio [aPR]=1.26, 95% confidence interval [CI]=1.1, 1.5), faith leaders (aPR=1.16, 95% CI=1.1, 1.3), and community health workers (aPR=1.13, 95% CI=1.003, 1.3). Exposure to greater number of information sources was associated with high penta-3 uptake (aPR=1.05, 95% CI=1.02, 1.1). Discussion: Immunization information received during health facility visits and through engagement with religious leaders may enhance vaccination uptake. Assessments to understand context-specific information dynamics should be prioritized in optimizing immunization outcomes.
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Affiliation(s)
- Shibani Kulkarni
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | | | - Victor Eboh
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Lansana Conteh
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Tom Sesay
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Reinhard Kaiser
- U.S. Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Yuka Jinnai
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Aaron S Wallace
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dimitri Prybylski
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mohamed F Jalloh
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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Dizbay İE, Öztürkoğlu Ö. Factors affecting recommended childhood vaccine demand. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2021. [DOI: 10.3233/jifs-219184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Reaching a high vaccination coverage level is of vital essence when preventing epidemic diseases. For mandatory vaccines, the demand can be forecasted using some demographics such as birth rates or populations between certain ages. However, it has been difficult to forecast non-mandatory vaccine demands because of vaccine hesitation, alongside other factors such as social norms, literacy rate, or healthcare infrastructure. Consequently, the purpose of this study is to explore the predominant factors that affect the non-mandatory vaccine demand, focusing on the recommended childhood vaccines, which are usually excluded from national immunization programs. For this study, fifty-nine factors were determined and categorized as system-oriented and human-oriented factors. After a focus group study conducted with ten experts, seven system-oriented and eight human-oriented factors were determined. To reveal the cause and effect relationship between factors, one of the multi-criteria decision-making methods called Fuzzy-DEMATEL was implemented. The results of the analysis showed that “Immunization-related beliefs”, “Media/social media contents/messaging”, and “Social, cultural, religious norms” have a strong influence on non-mandatory childhood vaccine demand. Furthermore, whereas “Availability and access to health care facilities” and “Political/ financial support to health systems” are identified as cause group factors, “Quality of vaccine and service delivery management” is considered an effect group factor. Lastly, a guide was generated for decision-makers to help their forecasting process of non-mandatory vaccine demands to avoid vaccine waste or shortage.
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Affiliation(s)
- İkbal Ece Dizbay
- Department of Management & Organization, Yasar University, İzmir, Turkey
| | - Ömer Öztürkoğlu
- Department of Business Administration, Yasar University, İzmir, Turkey
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Bauck A, Jalloh UH, Kargbo A, Hodges MH, Doledec D. Gender intersections identified whilst transitioning mass vitamin A supplementation into an integrated reproductive and child health programme in Sierra Leone. Health Policy Plan 2021; 36:673-683. [PMID: 33847742 DOI: 10.1093/heapol/czab037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/03/2020] [Accepted: 03/15/2021] [Indexed: 11/12/2022] Open
Abstract
Since 2006, Sierra Leone has achieved high rates of vitamin A supplementation (VAS) coverage (>88%) during mass campaigns. In 2017, campaigns started transitioning to routine VAS within a six-monthly contact point for integrated reproductive and child health (RCH) services. This contact point included improved counselling and provision of modern contraceptives; throughout this transition high VAS coverage (>85%) has been maintained. VAS programmes have traditionally operated on the assumption that they are gender-neutral, but recent research suggests these programmes should re-examine how they interact with gender. This qualitative study examined intersections between gender and Sierra Leone's integrated VAS programming by conducting 32 individual interviews with parents, district health management and national staff, and six focus group discussions with health workers and community health workers (CHWs) in three pilot program districts. The study found that most senior health positions are held by males, and the lower cadres of majority female health workers often felt unsupported/disrespected by their male superiors and male CHW supervisees, or that their years of experience were overlooked in favour of the academic qualifications of less experienced male colleagues. Gender was not included in program training, and most staff did not have a good understanding of gender intersections; however, health workers actively engaged in awareness raising with male stakeholders to increase male involvement in RCH. Routine delivery requires mothers to invest time and money to access health facilities, where most mothers felt that better qualified staff were able to offer better advice and more services. Health workers felt that outreach services utilizing CHWs could decrease this time/money burden; however, CHWs are unqualified to provide counselling and provision of modern contraception, and there are fewer female CHWs. Records kept in health facilities record VAS by sex, but monthly reports submitted to the district and onwards to the national Health Management Information System are not disaggregated by sex. Programme and policymakers should consider improving the representation by females in senior, decision-making positions, integrating gender information into all trainings, supporting female health workers, training and recruiting more female CHWs, and reporting VAS coverage by sex.
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Affiliation(s)
- Aubrey Bauck
- Helen Keller International - Regional Office, 122 Toundoup Rya, BP 29.898, Dakar, Senegal
| | - Umu H Jalloh
- Helen Keller International, 35 Nelson Lane, Freetown, Sierra Leone
| | - Anita Kargbo
- Helen Keller International, 35 Nelson Lane, Freetown, Sierra Leone
| | - Mary H Hodges
- Helen Keller International, 35 Nelson Lane, Freetown, Sierra Leone
| | - David Doledec
- Helen Keller International - Regional Office, Nairobi, Kenya
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Quantifying the Burden of Hyperphagia in Prader-Willi Syndrome Using Quality-Adjusted Life-years. Clin Ther 2021; 43:1164-1178.e4. [PMID: 34193348 DOI: 10.1016/j.clinthera.2021.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 05/14/2021] [Accepted: 05/21/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is a rare disease associated with cognitive impairment, hypotonia, hyperphagia (an insatiable hunger), and obesity. Therapies that target hyperphagia are in development, but understanding the value of these therapies to inform patient-focused drug development (PFDD) requires valid data on disease burden. We estimated disease burden by measuring and comparing quality-adjusted life-years (QALYs) for 3 PWS health states relevant to current PFDD initiatives. METHODS Time trade-off (TTO) and a visual analog scale (VAS) were used to elicit PWS caregivers' values for 3 fixed health states for a standardized patient described with (1) untreated PWS, (2) PWS with controlled obesity, and (3) PWS with controlled obesity and hyperphagia. We excluded participants who left at least 1 TTO or VAS question blank or incomplete (noncompleters) and respondents who reported the same answer for all TTO scenarios (nontraders). The remaining group of respondents (traders) were used for all primary analyses. We assessed validity and bias of QALY estimates by comparing differences in health state valuations, treatment priorities, and characteristics among respondents who did and did not complete the TTO. RESULTS A total of 458 respondents completed the survey, including 226 traders, 93 nontraders, and 139 noncompleters. Traders valued untreated PWS at 0.69 QALYs, PWS with controlled obesity at 0.79 QALYs, and controlled hyperphagia/obesity at 0.91 QALY (P < 0.01 for differences among health state values). Reported VAS ratings were similar for traders versus nontraders for untreated PWS (38.64 vs 38.95, P = 0.89) and PWS with controlled obesity (57.36 vs 55.14, P = 0.35) but varied for PWS with controlled obesity and hyperphagia (70.70 vs 64.46, P = 0.02). Exclusion of noncompleters did not introduce obvious bias because traders and noncompleters were similar in treatment priorities and characteristics. The exclusion of nontraders did not meaningfully alter mean or distribution of valuations. CONCLUSIONS This study found that avoiding hyperphagia decreases the burden of PWS and that these results are robust, even once imposing strict inclusion criteria. Use of fixed health states to estimate QALYs addresses many of the complexities of measuring disease burden in rare and pediatric conditions, indicating the potential value of this approach to inform premarket decision makers in identifying outcome importance. (Clin Ther. 2021;XX:XXX-XXX) © 2021 Elsevier HS Journals, Inc.
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CELLA PAOLA, VOGLINO GIANLUCA, BARBERIS ILARIA, ALAGNA ENRICO, ALESSANDRONI CLAUDIA, CUDA ALESSANDRO, D’ALOISIO FRANCESCO, DALLAGIACOMA GIULIA, DE NITTO SARA, DI GASPARE FRANCESCA, GALLIPOLI ORIANA, GENTILE LEANDRO, KUNDISOV LUCIA, NAVARO MONICA, PROVENZANO SANDRO, SANTANGELO OMARENZO, STEFANIZZI PASQUALE, GIANFREDI VINCENZA. Resources for assessing parents' vaccine hesitancy: a systematic review of the literature. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E340-E373. [PMID: 33150224 PMCID: PMC7595070 DOI: 10.15167/2421-4248/jpmh2020.61.3.1448] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 07/22/2020] [Indexed: 11/17/2022]
Abstract
The concept of Vaccine Hesitancy has begun to appear in the scientific landscape, referring to the reluctance of a growing proportion of people to accept the vaccination offer. A variety of factors were identified as being associated with vaccine hesitancy but there was no universal algorithm and currently there aren’t any established metrics to assess either the presence or impact of vaccine hesitancy. The aim of this study was to systematically review the published questionnaires evaluating parental vaccine hesitancy, to highlight the differences among these surveys and offer a general overview on this matter. This study offers a deeper perspective on the available questionnaires, helping future researches to identify the most suitable one according to their own aim and study setting.
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Affiliation(s)
- PAOLA CELLA
- Post Graduate School of Hygiene and Preventive Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | - GIANLUCA VOGLINO
- Post Graduate School of Hygiene and Preventive Medicine, Department of Public Health, University of Turin, Italy
| | - ILARIA BARBERIS
- Health Science Department, University of Genoa, Italy
- Correspondence: Ilaria Barberis, Health Science Department, University of Genoa, largo Rosanna Benzi 10, Pad. 3 San Martino Hospital, Italy - Tel./Fax +39 010 3538502 - E-mail:
| | - ENRICO ALAGNA
- Post Graduate School of Hygiene and Preventive Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Italy
| | - CLAUDIA ALESSANDRONI
- Post Graduate School of Hygiene and Preventive Medicine, University of Rome Tor Vergata, Rome, Italy
| | - ALESSANDRO CUDA
- Post Graduate School of Hygiene and Preventive Medicine, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - FRANCESCO D’ALOISIO
- Post Graduate School of Hygiene and Preventive Medicine, Department of Life, Health and Environmental Sciences, University of L’Aquila, Italy
| | - GIULIA DALLAGIACOMA
- Post Graduate School of Hygiene and Preventive Medicine, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - SARA DE NITTO
- Post Graduate School of Hygiene and Preventive Medicine, Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Italy
| | - FRANCESCA DI GASPARE
- Post Graduate School of Hygiene and Preventive Medicine, University of Rome Tor Vergata, Rome, Italy
| | - ORIANA GALLIPOLI
- Post Graduate School of Hygiene and Preventive Medicine, Department of Life, Health and Environmental Sciences, University of L’Aquila, Italy
| | - LEANDRO GENTILE
- Post Graduate School of Hygiene and Preventive Medicine, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - LUCIA KUNDISOV
- Post Graduate School of Public Health, University of Siena, Italy
| | - MONICA NAVARO
- Post Graduate School of Hygiene and Preventive Medicine, Department of Experimental Medicine, University of Campania “L. Vanvitelli”, Italy
| | - SANDRO PROVENZANO
- Post Graduate School of Hygiene and Preventive Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Italy
| | - OMAR ENZO SANTANGELO
- Post Graduate School of Hygiene and Preventive Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Italy
| | - PASQUALE STEFANIZZI
- Post Graduate School of Hygiene and Preventive Medicine, Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Italy
| | - VINCENZA GIANFREDI
- Post Graduate School of Hygiene and Preventive Medicine, Department of Experimental Medicine, University of Perugia, Italy
- School of Medicine, University Vita-Salute San Raffaele, Milan, Italy
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10
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Oduwole EO, Pienaar ED, Mahomed H, Wiysonge CS. Current tools available for investigating vaccine hesitancy: a scoping review protocol. BMJ Open 2019; 9:e033245. [PMID: 31831547 PMCID: PMC6924801 DOI: 10.1136/bmjopen-2019-033245] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/24/2019] [Accepted: 11/15/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Vaccine hesitancy, defined as the delay in acceptance or refusal of vaccination despite availability of vaccination services is responsible in part for suboptimal levels of vaccination coverage worldwide. The WHO recommends that countries incorporate plans to measure and address vaccine hesitancy into their immunisation programmes. This requires that governments and health institutions be able to detect concerns about vaccination in the population and monitor changes in vaccination behaviours. To do this effectively, tools to detect and measure vaccine hesitancy are required. The purpose of this scoping review is to give a broad overview of currently available vaccine hesitancy measuring tools and present a summary of their nature, similarities and differences. METHODS AND ANALYSIS The review will be conducted using the framework for scoping review proffered by Arksey and O'Malley. It will comply with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews' guidelines. The broader research question of this review is: what vaccine hesitancy measuring tools are currently available?Search strategies will be developed using controlled vocabulary and selected keywords. PubMed, Web of Science, Scopus and reference lists of relevant publications will be searched. Titles and abstracts will be independently screened by two authors and data from full-text articles meeting the inclusion criteria will be extracted independently by two authors using a pretested data charting form. Discrepancies will be resolved by discussion and consensus. Results will be presented using descriptive statistics such as percentages, tables, charts and flow diagrams as appropriate. Narrative analysis will be used to summarise the findings of the review. ETHICS AND DISSEMINATION Ethics approval is not required for the review. It will be submitted as part of a doctoral thesis, presented at conferences and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER https://osf.io/x8fjk/.
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Affiliation(s)
- Elizabeth O Oduwole
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, Western Cape, South Africa
| | - Elizabeth D Pienaar
- Cochrane South Africa, South African Medical Research Council, Cape Town, Western Cape, South Africa
| | - Hassan Mahomed
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
- Metro Health Services, Western Cape Government: Health, Cape Town, Western Cape Province, South Africa
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, Western Cape, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape Province, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
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11
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Nordhagen S, Bauck A, Doledec D. Gender Equity and Vitamin A Supplementation: Moving Beyond Equal Coverage. Food Nutr Bull 2019; 41:38-49. [DOI: 10.1177/0379572119860310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Vitamin A supplementation (VAS) is currently implemented in over 80 countries worldwide, but little attention has been paid to gender equity in the design or implementation of these programs. Objective: This article describes the ways in which gender equity can impact or be impacted by VAS programs and suggests ways to ensure these programs better support gender equity in the future. Methods: We undertook a desk review of research on gender equity in health services and extrapolated findings to VAS, highlighting gender equity issues throughout the VAS implementation process and across delivery platform types. We also amassed secondary data on VAS coverage from 45 surveys in 13 countries and analyzed it to examine differences in VAS coverage between boys and girls. Results: Despite few significant differences in coverage between boys and girls, we identify numerous ways in which gender equity can impact or be impacted by VAS programs, including through the choice of VAS distributors and the communication materials used to promote VAS campaigns. Examining these different entry points reveals that there are several missed opportunities for better integration of gender within VAS. Conclusions: VAS program implementers and policymakers should revisit VAS approaches to identify opportunities for advancing gender equity through this wide-reaching platform.
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Affiliation(s)
- Stella Nordhagen
- Africa Regional Office, Helen Keller International, Dakar, Senegal
| | - Aubrey Bauck
- Africa Regional Office, Helen Keller International, Dakar, Senegal
| | - David Doledec
- Africa Regional Office, Helen Keller International, Nairobi, Kenya
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12
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Evans DR, Yemeke TT, Kiracho EE, Mutebi A, Apolot RR, Ssebagereka A, Ozawa S. Trust in vaccines and medicines in Uganda. Vaccine 2019; 37:6008-6015. [PMID: 31447127 DOI: 10.1016/j.vaccine.2019.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 07/03/2019] [Accepted: 07/06/2019] [Indexed: 01/10/2023]
Abstract
Trust underlies numerous decisions in health care, affecting vaccine uptake as well as care seeking rates, treatment adherence, and health outcomes. Although trust in the doctor-patient relationship has garnered much attention, trust in health care commodities such as vaccines and medicines has rarely been examined. We report findings from a cross-sectional survey to assess trust in vaccines vis-à-vis their trust in conventional medicines and traditional medicines in Uganda. Trust in vaccines, conventional and traditional medicines were assessed by adapting the vaccine hesitancy scale developed by the SAGE Working Group on Vaccine Hesitancy. Reported trust in vaccines and conventional medicines was much higher than trust in traditional medicines. Significant associations were observed between trust in vaccines and trust in conventional medicines. Of the trust components explored, respondents were most concerned about access to and safety of vaccines and medicines. Further, respondents' previous health care experiences, primary source of health information, and trust in providers' skills were significantly associated with reported trust in vaccines and medicines. Although strong levels of trust in vaccines and conventional medicines were observed overall, the findings identify areas where policies and communication efforts can focus to strengthen trust.
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Affiliation(s)
| | - Tatenda T Yemeke
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth E Kiracho
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Aloysius Mutebi
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Rebecca R Apolot
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Anthony Ssebagereka
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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13
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Gilkey MB, Mohan D, Janssen EM, McRee AL, Kornides ML, Bridges JFP. Exploring variation in parental worries about HPV vaccination: a latent-class analysis. Hum Vaccin Immunother 2019; 15:1745-1751. [PMID: 30951396 PMCID: PMC6746473 DOI: 10.1080/21645515.2019.1574157] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/05/2019] [Accepted: 01/21/2019] [Indexed: 10/27/2022] Open
Abstract
Background. Prior research has identified diverse worries that parents have about HPV vaccination. We sought to understand how parents prioritize worries and to identify subgroups of parents according to shared patterns of worry. Methods. We surveyed a national sample of 431 U.S. parents of adolescents who reported never having talked to their child's healthcare provider about HPV vaccination. Parents completed a best-worst scaling experiment designed to prioritize 11 common worries about HPV vaccination. The experiment used a balanced incomplete block design to present 11 choice tasks consisting of repeated subsets of worries. We used conditional logistic regression to prioritize worries and latent class models with 1-10 classes to identify subgroups of parents with shared worries. Results. Parents most often worried about long-term side effects of HPV vaccination, which about one-third (36%) ranked as their top worry. Other common top-ranked worries were how new the vaccine is (12%), motives of drug companies (12%), short-term side effects (10%), and that it may be unnecessary (10%). Latent class analyses suggested a relatively large number of distinct worry profiles, with most classes characterized by a worry about long-term side effects in combination with one other worry. Discussion. Our findings suggest that providers should be prepared to address concerns about long-term side effects, as this worry was prioritized across many subgroups of parents. However, to best address worry, a tailored, rather than targeted, communication approach may be needed.
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Affiliation(s)
- Melissa B. Gilkey
- Department of Health Behavior & Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Divya Mohan
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | | | - Melanie L. Kornides
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - John F. P. Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
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Gilkey MB, Zhou M, McRee AL, Kornides ML, Bridges JFP. Parents' Views on the Best and Worst Reasons for Guideline-Consistent HPV Vaccination. Cancer Epidemiol Biomarkers Prev 2018; 27:762-767. [PMID: 29903744 PMCID: PMC6035066 DOI: 10.1158/1055-9965.epi-17-1067] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/25/2018] [Accepted: 04/13/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Human papillomavirus (HPV) vaccination could prevent most HPV-associated cancers, but few U.S. adolescents are vaccinated according to guidelines. To inform efforts to counsel parents more effectively, we sought to quantify their views on the best and worst reasons for guideline-consistent HPV vaccination. We hypothesized that parents' views would differ according to their vaccination confidence.Methods: We developed a best-worst scaling experiment to evaluate 11 reasons healthcare providers commonly give for HPV vaccination. The instrument was administered in 2016 via a national online survey to 1,177 parents of adolescents. Parents completed 11 choice tasks of 5 reasons each, indicating the best and worst reason in each task. We used conditional logistic regression to rank reasons for the sample overall and by vaccination confidence (low/high).Results: Parents viewed cancer prevention as the best reason for HPV vaccination (P < 0.001). Other commonly endorsed reasons were preventing a common infection, having lasting benefits, or being a safe vaccine (all P < 0.001). Reasons viewed as worst were: It is a scientific breakthrough; I got it for my own child; and your child is due (all P < 0.001). Stratified analyses indicated small differences in how often parents with low versus high vaccination confidence endorsed messages (P < 0.001), but the two groups ranked reasons similarly overall.Conclusions: Parents prioritized cancer prevention as the best reason for guideline-consistent HPV vaccination. Several other common reasons, including having vaccinated one's own child, may warrant additional testing.Impact: Providers should emphasize cancer prevention when discussing HPV vaccination, as recommended by the Centers for Disease Control and Prevention, the President's Cancer Panel, and others. Cancer Epidemiol Biomarkers Prev; 27(7); 762-7. ©2018 AACR.
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Affiliation(s)
- Melissa B Gilkey
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina.
| | - Mo Zhou
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Annie-Laurie McRee
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Melanie L Kornides
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - John F P Bridges
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Parents' preferences for interventions to improve childhood immunization uptake in northern Nigeria. Vaccine 2018; 36:2833-2841. [PMID: 29661582 DOI: 10.1016/j.vaccine.2018.03.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Routine childhood immunization coverage has been low in northern Nigeria. While local authorities and international partners have been working hard to improve coverage, population preferences for interventions have not been documented. This study aimed to understand parents' preferences and identify possible interventions to improve uptake of childhood immunization. METHODS Preferences for immunization interventions were elicited using a best-worst scaling (BWS) instrument among parents with children under five. We explored the value of six program attributes (each varying across three levels) identified through a literature review and engagement with local stakeholders. In each of 18 hypothetical programs identified through a main effect orthogonal design, respondents selected the best and worst attributes that may facilitate vaccination of children. Assuming sequential best-worst responses, we used conditional logit to estimate preferences. We employed latent class analysis (LCA) to categorize and examine respondents' preferences across interventions. RESULTS 97 men and 101 women in 198 households were surveyed. The most preferred level for each attribute included door-to-door vaccinations, free food supplements, bundling with nutritional support programs, involvement of religious leaders, information dissemination through media campaigns, and strengthening of health services by the government. Three types of preferences were recognized in the LCA. The value-driven group (14%) characterized by youngest age, predominantly female, and lower education perceived bundled services with food and nutritional programs as the most important feature of an intervention. Convenience and information seekers (28%) characterized by oldest age and the lowest employment preferred door-to-door vaccinations and media campaigns. The remaining complacent group (58%), characterized by highest education and highest employment, did not show strong preferences to any intervention compared to the other two groups. CONCLUSIONS Routine immunization programs should consider joining forces with food and nutritional programs to improve vaccination uptake. Incorporating door-to-door visits and media campaigns to target older and unemployed populations may increase childhood immunization uptake in northern Nigeria.
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