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Communications Is Time for Care: An Italian Monocentric Survey on Human Papillomavirus (HPV) Risk Information as Part of Cervical Cancer Screening. J Pers Med 2022; 12:jpm12091387. [PMID: 36143172 PMCID: PMC9505682 DOI: 10.3390/jpm12091387] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
Human papilloma virus (HPV) infection could be considered a social disease, both for its high incidence, especially in younger subjects, and for the risk of neoplastic evolution linked to viral infection. Therefore, the National Health System, in collaboration with the state, must help women to understand the oncological risk of HPV and suitable methods of prevention. We conducted an Italian monocentric survey on HPV risk information as part of cervical cancer screening. An anonymous questionnaire was administered to 200 women with high-risk positive HPV and low-grade cervical lesions during second-level cervical cancer screening at the Gynecology and Obstetrics Unit of the “San Paolo” Hospital. From this survey, the need to improve communication for patients has emerged, as currently it is not exhaustive. In response to this need, organizational changes have been implemented to centralize the moment of counseling in the second levels of screening and to improve the training of health workers in level I as well as family doctors. In addition, psychological support was also proposed to patients who requested it, as was the dissemination of material such as that produced by GISCI (Italian Cervico-Carcinoma Screening Group) and updated in May 2018, which provides 100 answers to questions on HPV in order to achieve effective and comprehensive communication. This investigation requires further development, and the expansion of this investigation to the multicenter level is already underway. Therefore, this survey will represent a cornerstone for further discussion on the topic considering the necessity of appropriate communication in the oncological context.
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O'Connor M, Waller J, Gallagher P, O'Donovan B, Clarke N, Keogh I, MacCarthy D, O'Sullivan E, Timon C, Martin C, O'Leary J, Sharp L. Barriers and facilitators to discussing HPV with head and neck cancer patients: A qualitative study using the theoretical domains framework. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30318-9. [PMID: 32565003 DOI: 10.1016/j.pec.2020.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/11/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The incidence of human papillomavirus-associated head and neck cancers (HPV-HNC) is increasing worldwide. Research in other clinical contexts has shown that healthcare professionals (HCPs) can find discussing HPV with patients challenging. However, limited research has been conducted in HNC. This study aimed to investigate barriers and facilitators to, discussing HPV among HCPs caring for patients with HNC in Ireland. METHODS Semi-structured telephone/face-to-face interviews were conducted with HCPs. Barriers and facilitators to discussing HPV with patients were identified using the Theoretical Domains Framework (TDF). RESULTS 20 HCPs (8 clinicians, 3 nurses, 9 allied healthcare professionals) were interviewed. Barriers to discussing HPV included professionals' lack of HPV knowledge, difficulties in talking about sexual issues with patients and lack of privacy to discuss HPV in busy clinic settings. Facilitators included increasing public and patient awareness of the link between HPV and HNC and professional education and skills development. CONCLUSIONS This is the first theoretically informed study to identify barriers and facilitators to discussing HPV with HNC patients. HCPs consider HPV discussions to be an essential part of HNC patient care. PRACTICE IMPLICATIONS Understanding the issues associated with patient-provider HPV communication will help develop effective interventions to support HCPs in their HPV discussions.
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Affiliation(s)
- M O'Connor
- National Cancer Registry Ireland, Kinsale Road, Cork, Ireland
| | - J Waller
- Department of Behavioural Science and Health, University College London, London, UK
| | - P Gallagher
- School of Psychology, Dublin City University, Dublin, Ireland
| | - B O'Donovan
- National Cancer Registry Ireland, Kinsale Road, Cork, Ireland.
| | - N Clarke
- School of Psychology, Dublin City University, Dublin, Ireland
| | - I Keogh
- College of Medicine Nursing & Health Sciences, National University of Ireland Galway, Ireland
| | - D MacCarthy
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Dublin, Ireland
| | - E O'Sullivan
- Cork University Dental School and Hospital, Cork, Ireland
| | - C Timon
- St. James's Hospital, James's Street, Dublin, Ireland
| | - C Martin
- Department of Histopathology, University of Dublin, Trinity College, Ireland; Department of Pathology, Coombe Women and Infants University Hospital, Ireland
| | - J O'Leary
- Department of Histopathology, University of Dublin, Trinity College, Ireland; Department of Pathology, Coombe Women and Infants University Hospital, Ireland
| | - L Sharp
- Institute of Health & Society, Newcastle University, UK
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O'Connor M, O'Donovan B, Waller J, Ó Céilleachair A, Gallagher P, Martin CM, O'Leary J, Sharp L. Communicating about HPV in the context of head and neck cancer: A systematic review of quantitative studies. PATIENT EDUCATION AND COUNSELING 2020; 103:462-472. [PMID: 31558324 DOI: 10.1016/j.pec.2019.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/31/2019] [Accepted: 09/14/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Rising incidence of HPV-positive head and neck cancers (HPV-HNC) means HPV infection is increasingly relevant to patient-provider consultations. We performed a systematic review to examine, in the context of patient-provider HNC consultations: discussions about HPV, attitudes towards discussing HPV and information needs. METHODS We searched Embase, PsychINFO, and CINAHL + for studies to August 2018. Eligible studies included: HNC healthcare professionals (HCPs) and/or HNC patients investigated HNC patient-provider communication about HPV. RESULTS Ten studies were identified: six including HCPs and four including HNC patients. HCPs varied in confidence in HPV discussions, which was related to their HPV knowledge. Both HCPs and patients acknowledged the need for reliable HPV information. Factors which facilitated HPV discussions included accessible HPV information for patients and HCPs and good HPV knowledge among HCPs. Barriers included the perception, among HCPs, that HPV was a challenging topic to discuss with patients. CONCLUSIONS Information deficits, communication challenges and barriers to discussing HPV were identified in HNC patient-provider consultations. PRACTICE IMPLICATIONS Appropriate HPV information is needed for HCPs and patients. Professional development initiatives which increase HCPs' HPV knowledge and build their communication skills would be valuable.
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Affiliation(s)
- M O'Connor
- National Cancer Registry Ireland, Kinsale Road, Cork, Ireland
| | - B O'Donovan
- Department of Histopathology, University of Dublin, Trinity College, Ireland; Department of Pathology, Coombe Women and Infants University Hospital Ireland, Ireland.
| | - J Waller
- Cancer Prevention Group, King's College London, London, UK
| | | | - P Gallagher
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - C M Martin
- Department of Histopathology, University of Dublin, Trinity College, Ireland; Department of Pathology, Coombe Women and Infants University Hospital Ireland, Ireland
| | - J O'Leary
- Department of Histopathology, University of Dublin, Trinity College, Ireland; Department of Pathology, Coombe Women and Infants University Hospital Ireland, Ireland
| | - L Sharp
- Institute of Health & Society, Newcastle University, UK
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Fisher H, Harding S, Hickman M, Macleod J, Audrey S. Barriers and enablers to adolescent self-consent for vaccination: A mixed-methods evidence synthesis. Vaccine 2018; 37:417-429. [PMID: 30573357 PMCID: PMC6453814 DOI: 10.1016/j.vaccine.2018.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/06/2018] [Accepted: 12/04/2018] [Indexed: 11/13/2022]
Abstract
Synthesis of studies related to self-consent procedures for adolescent vaccination. Robust systematic review methodology used to identify and appraise the literature. There is a need to clarify policy and address professionals’ misunderstandings. Concerns about professional practice and relationships with parents create barriers. Enabling adolescent self-consent entails disputing the primacy of parental consent.
Introduction The recent global expansion of routine adolescent vaccination programmes has the potential to protect young people against infectious diseases and improve their health. Although the legal framework in many countries permits young people to consent for vaccinations if competent, lack of written parental consent can still prevent uptake. We aimed to review systematically the associated barriers and enablers to implementation of adolescent self-consent procedures. Methods A comprehensive search strategy of ten databases from inception to June 2018 was undertaken to identify relevant qualitative and quantitative studies. Titles, abstracts and full texts were assessed for eligibility, and the methodological quality of eligible primary studies evaluated. Thematic synthesis methods were used to interpret and combine qualitative data, and to identify overarching themes as well as similarities and differences within themes. Quantitative data were summarised and, because the data were sufficiently similar in focus, were integrated within the qualitative framework. Results Twenty-five publications related to 23 studies were included. Three themes were identified which related to the policy framework, protection, and self-determination. Despite supportive national policy frameworks, implementation of adolescent self-consent procedures can be prevented by local policies, professionals’ misunderstandings of the legal framework and the context in which the vaccination programme is delivered. Motivation to protect young people’s health increased acceptability of adolescent self-consent, but implementation might be prevented to protect the reputation of professionals or relationships with parents. Further, maintaining the role of parents as decision-makers for their child’s healthcare was frequently prioritised over enabling young people’s autonomy to consent. Conclusions Barriers to the implementation of adolescent self-consent procedures have implications for young people’s health and uptake of vaccination programmes. There is a need to clarify the policy framework and challenge the primacy of parental consent. Systematic review registration PROSPERO CRD42017084509.
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Affiliation(s)
- Harriet Fisher
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom.
| | - Sarah Harding
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - John Macleod
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Suzanne Audrey
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
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Bahri P, Castillon Melero M. Listen to the public and fulfil their information interests - translating vaccine communication research findings into guidance for regulators. Br J Clin Pharmacol 2018; 84:1696-1705. [PMID: 29573274 PMCID: PMC6046478 DOI: 10.1111/bcp.13587] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 03/05/2018] [Accepted: 03/13/2018] [Indexed: 11/27/2022] Open
Abstract
Regulatory authorities have a crucial role in communicating about the vaccines they license. In terms of content and timing, their communication to the public is usually driven by data on quality, safety and efficacy. However, concerns over safety and vaccine hesitancy have emerged in some communities in various countries, and this demands a new approach to communication, starting with listening to the public debate. Reviewing communication research findings, coming in particular from the cognitive, decision‐making and media sciences, constitutes one mechanism of listening and has led the European Union (EU) regulatory network to developing guidance about which common concerns and information needs of the public to address through proactive and prepared communication. The guidance has been welcomed by EU and international fora. The current article summarizes the recommendations and shares the underlying research findings, as well as a proof of concept that communication research can be valuable for regulators. It is critical that regulators integrate the communication process with product risk assessment in the framework of pharmacovigilance, to ensure that public concerns are addressed in the assessments and that information about evidence and uncertainty relating to safety is provided to the public and vaccination policy makers in a specific, clear and accurate manner. Additionally, information from regulatory authorities should support healthcare professionals in their communication with patients. Meeting the information interests of the public is the principal prerequisite for informed decisions as well as safe and effective use of vaccines and medicines overall. This is also fundamental for trust in the authorities' commitment to patient and population health.
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Affiliation(s)
- Priya Bahri
- Surveillance & Epidemiology Service, Pharmacovigilance Department, European Medicines Agency, London, UK
| | - Mireia Castillon Melero
- Surveillance & Epidemiology Service, Pharmacovigilance Department, European Medicines Agency, London, UK
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Patel H, Austin-Smith K, Sherman SM, Tincello D, Moss EL. Knowledge, attitudes and awareness of the human papillomavirus amongst primary care practice nurses: an evaluation of current training in England. J Public Health (Oxf) 2018; 39:601-608. [PMID: 27412177 DOI: 10.1093/pubmed/fdw063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 05/23/2016] [Indexed: 11/13/2022] Open
Abstract
Background The incorporation of Human papillomavirus (HPV) testing into the English cervical screening programme has been met with fear and anxiety. Healthcare professionals need to be adequately informed about HPV to help alleviate patient concerns. The aim of this study was to evaluate the HPV training provided to practice nurses (PNs) and determine their level of HPV knowledge. Method A web-based survey was distributed to 147 General Practice surgeries in the Leicester, Leicestershire and Rutland regions, between May and July 2015. The survey explored four broad areas; demographics/level of experience, HPV knowledge, attitudes towards the HPV vaccine and self-perceived adequacy of HPV knowledge. Results A total of 128 surveys were completed, with 94 complete responses. Overall awareness of basic HPV facts was adequate; however, detailed, and in some cases basic, knowledge was lacking. 9.6% failed to identify that HPV can cause cervical cancer and 62.8% believed that HPV requires treatment. Not all PNs felt adequately informed about HPV and a need to improve the provision of training was identified. Conclusion PNs play a key role in increasing public awareness of HPV and implementing cervical cancer screening. The provision of education to PNs needs to be a priority and current methods of training need to be re-evaluated.
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Affiliation(s)
- H Patel
- Department of Gynaecology, University Hospitals Leicester, Gwendolen Road, Leicester LE5 4PW, UK
| | - K Austin-Smith
- Department of Gynaecology, Kettering General Hospital, Rothwell Road, KetteringNN16 8UZ, UK
| | | | - D Tincello
- University of Leicester, Centre for Medicine, Leicester LE1 7RH, UK
| | - E L Moss
- University Hospitals Leicester, Gwendolen Road, Leicester LE5 4PW, UK
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Bahri P, Fogd J, Morales D, Kurz X. Application of real-time global media monitoring and 'derived questions' for enhancing communication by regulatory bodies: the case of human papillomavirus vaccines. BMC Med 2017; 15:91. [PMID: 28464900 PMCID: PMC5414293 DOI: 10.1186/s12916-017-0850-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The benefit-risk balance of vaccines is regularly debated by the public, but the utility of media monitoring for regulatory bodies is unclear. A media monitoring study was conducted at the European Medicines Agency (EMA) concerning human papillomavirus (HPV) vaccines during a European Union (EU) referral procedure assessing the potential causality of complex regional pain syndrome (CRPS) and postural orthostatic tachycardia syndrome (POTS) reported to the authorities as suspected adverse reactions. METHODS To evaluate the utility of media monitoring in real life, prospective real-time monitoring of worldwide online news was conducted from September to December 2015 with inductive content analysis, generating 'derived questions'. The evaluation was performed through the validation of the predictive capacity of these questions against journalists' queries, review of the EMA's public statement and feedback from EU regulators. RESULTS A total of 4230 news items were identified, containing personal stories, scientific and policy/process-related topics. Explicit and implicit concerns were identified, including those raised due to lack of knowledge or anticipated once more information would be published. Fifty derived questions were generated and categorised into 12 themes. The evaluation demonstrated that providing the media monitoring findings to assessors and communicators resulted in (1) confirming that public concerns regarding CRPS and POTS would be covered by the assessment; (2) meeting specific information needs proactively in the public statement; (3) predicting all queries from journalists; and (4) altering the tone of the public statement with respectful acknowledgement of the health status of patients with CRSP or POTS. CONCLUSIONS The study demonstrated the potential utility of media monitoring for regulatory bodies to support communication proactivity and preparedness, intended to support trusted safe and effective vaccine use. Derived questions seem to be a familiar and effective format for presenting media monitoring results in the scientific-regulatory environment. It is suggested that media monitoring could form part of regular surveillance for medicines of high public interest. Future work is recommended to develop efficient monitoring strategies for that purpose.
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Affiliation(s)
- Priya Bahri
- European Medicines Agency, 30 Churchill Place, Canary Wharf, London, E14 5EU UK
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK
| | - Julianna Fogd
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK
| | - Daniel Morales
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK
- Division of Population Health Sciences, University of Dundee, Dundee, UK
| | - Xavier Kurz
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK
| | - on behalf of the ADVANCE consortium
- European Medicines Agency, 30 Churchill Place, Canary Wharf, London, E14 5EU UK
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK
- Division of Population Health Sciences, University of Dundee, Dundee, UK
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8
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Patel H, Jeve YB, Sherman SM, Moss EL. Knowledge of human papillomavirus and the human papillomavirus vaccine in European adolescents: a systematic review. Sex Transm Infect 2016; 92:474-9. [DOI: 10.1136/sextrans-2015-052341] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 12/28/2015] [Indexed: 11/04/2022] Open
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Skinner SR, Davies C, Cooper S, Stoney T, Marshall H, Jones J, Collins J, Hutton H, Parrella A, Zimet G, Regan DG, Whyte P, Brotherton JML, Richmond P, McCaffrey K, Garland SM, Leask J, Kang M, Braunack-Mayer A, Kaldor J, McGeechan K. HPV.edu study protocol: a cluster randomised controlled evaluation of education, decisional support and logistical strategies in school-based human papillomavirus (HPV) vaccination of adolescents. BMC Public Health 2015; 15:896. [PMID: 26373926 PMCID: PMC4572679 DOI: 10.1186/s12889-015-2168-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 08/18/2015] [Indexed: 11/24/2022] Open
Abstract
Background The National Human Papillomavirus (HPV) Vaccination Program in Australia commenced in 2007 for females and in 2013 for males, using the quadrivalent HPV vaccine (HPV 6,11,16,18). Thus far, we have demonstrated very substantial reductions in genital warts and in the prevalence of HPV among young Australian women, providing early evidence for the success of this public health initiative. Australia has a long history of school-based vaccination programs for adolescents, with comparatively high coverage. However, it is not clear what factors promote success in a school vaccination program. The HPV.edu study aims to examine: 1) student knowledge about HPV vaccination; 2) psycho-social outcomes and 3) vaccination uptake. Methods/Design HPV.edu is a cluster randomised trial of a complex intervention in schools aiming to recruit 40 schools with year-8 enrolments above 100 students (approximately 4400 students). The schools will be stratified by Government, Catholic, and Independent sectors and geographical location, with up to 20 schools recruited in each of two states, Western Australia (WA) and South Australia (SA), and randomly allocated to intervention or control (usual practice). Intervention schools will receive the complex intervention which includes an adolescent intervention (education and distraction); a decisional support tool for parents and adolescents and logistical strategies (consent form returns strategies, in-school mop-up vaccination and vaccination-day guidelines). Careful process evaluation including an embedded qualitative evaluation will be undertaken to explore in depth possible mechanisms for any observed effect of the intervention on primary and secondary outcomes. Discussion This study is the first to evaluate the relative effectiveness of various strategies to promote best practice in school-based vaccination against HPV. The study aims to improve vaccination-related psychosocial outcomes, including adolescent knowledge and attitudes, decision-making involvement, self-efficacy, and to reduce fear and anxiety. The study also aims to improve school vaccination program logistics including reduction in time spent vaccinating adolescents and increased number of consent forms returned (regardless of decision). Less anxiety in adolescents will likely promote more efficient vaccination, which will be more acceptable to teachers, nurses and parents. Through these interventions, it is hoped that vaccination uptake will be increased. Trial registration Australian and New Zealand Clinical Trials Registry, ACTRN12614000404628, 14.04.2014. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2168-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Rachel Skinner
- Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2054, Australia.
| | - Cristyn Davies
- Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2054, Australia.
| | - Spring Cooper
- CUNY School of Public Health, City University New York, New York City, NY, USA.
| | - Tanya Stoney
- Vaccine Trials Group, Telethon Kids Institute, Perth, WA, Australia.
| | - Helen Marshall
- Vaccinology & Immunology Research Trials Unit, Women's & Children's Hospital, Adelaide, South Australia, Australia.
| | - Jane Jones
- Vaccine Trials Group, Telethon Kids Institute, Perth, WA, Australia.
| | - Joanne Collins
- Vaccinology & Immunology Research Trials Unit, Women's & Children's Hospital, Adelaide, South Australia, Australia.
| | - Heidi Hutton
- Vaccine Trials Group, Telethon Kids Institute, Perth, WA, Australia.
| | - Adriana Parrella
- Vaccinology & Immunology Research Trials Unit, Women's & Children's Hospital, Adelaide, South Australia, Australia.
| | - Gregory Zimet
- Pediatrics & Clinical Psychology, Indiana University, Indianapolis, IN, USA.
| | - David G Regan
- The Kirby Institute, Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia.
| | - Patti Whyte
- Deakin University, SRC Population Health, Deakin Health Economics, Melbourne, VIC, Australia.
| | - Julia M L Brotherton
- National HPV Vaccination Program Register, VCS, and School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Peter Richmond
- Vaccine Trials Group, Telethon Kids Institute, Perth, WA, Australia. .,School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia.
| | - Kirsten McCaffrey
- School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Suzanne M Garland
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Melbourne, VIC, Australia.
| | - Julie Leask
- School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Melissa Kang
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.
| | | | - John Kaldor
- The Kirby Institute, Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia.
| | - Kevin McGeechan
- School of Public Health, University of Sydney, Sydney, NSW, Australia.
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Mazza D, Petrovic K, Grech C, Harris N. HPV vaccination in women aged 27 to 45 years: what do general practitioners think? BMC WOMENS HEALTH 2014; 14:91. [PMID: 25074404 PMCID: PMC4149036 DOI: 10.1186/1472-6874-14-91] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/18/2014] [Indexed: 11/10/2022]
Abstract
Background Although the Human Papillomavirus (HPV) vaccine is registered in Australia for females aged 9 to 45 years, females aged 27 to 45 years have shown limited vaccine uptake. Our study explored general practitioners’ (GPs) views concerning HPV vaccination of females in this age group, with particular focus on the barriers and the facilitators to the delivery of the HPV vaccine. Methods Semi-structured telephone interviews were conducted with 24 randomly selected general practitioners from metropolitan Melbourne. Questions were based on a theoretical framework that explained the barriers and facilitators to professional behaviour change. Results According to the GPs, the major barriers to the uptake of the HPV vaccine included the cost of the vaccine, time constraints, and the three-dose schedule. Other barriers that were identified included GPs’ and patients’ beliefs that females in this age group were at low risk of contracting HPV, lack of awareness about the vaccine, and uncertainty about the benefits of this vaccine for females in this age group. In contrast, the facilitators that were identified included the availability of the vaccine on site, the availability of vaccine clinics or nurses for administering the vaccine, the availability of information related to the vaccine either on site or online, and positive opinions from experts in the field. Conclusions Our study has identified some of the barriers and facilitators to the delivery and uptake of the HPV vaccine in females aged 27 to 45 years, as perceived by GPs. Further studies should be conducted to determine which of these should be targeted or prioritised for intervention. The views of women in this age group should also be considered as these would also be influential in designing effective intervention strategies for improving the delivery and uptake of the HPV vaccine.
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Affiliation(s)
- Danielle Mazza
- Department of General Practice, School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia.
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11
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"HPV? Never heard of it!": a systematic review of girls' and parents' information needs, views and preferences about human papillomavirus vaccination. Vaccine 2013; 31:5152-67. [PMID: 24029117 DOI: 10.1016/j.vaccine.2013.08.091] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 08/22/2013] [Accepted: 08/28/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Two human papillomavirus vaccines were licenced in 2006/2007 for cervical cancer prevention. National vaccination programmes for schoolgirls were subsequently introduced in some European countries, North America and Australia. To understand factors influencing vaccine uptake and to inform the development of appropriate UK educational materials, we aimed to synthesise evidence of girls' and parents' information needs, views and preferences regarding HPV vaccination. DESIGN Systematic review and mixed method synthesis of qualitative and survey data. DATA SOURCES Twelve electronic databases; bibliographies of included studies 1980 to August 2011. REVIEW METHODS Two reviewers independently screened papers and appraised study quality. Studies were synthesised collaboratively using framework methods for qualitative data, and survey results integrated where they supported, contrasted or added to the themes identified. RESULTS Twenty-eight qualitative studies and 44 surveys were included. Where vaccination was offered, uptake was high. Intention to decline was related to a preference for vaccinating later to avoid appearing to condone early sexual activity, concerns about vaccine safety and low perception of risk of HPV infection. Knowledge was poor and there were many misconceptions; participants tried to assess the potential benefits and harms of vaccination but struggled to interpret limited information about HPV in the context of existing knowledge about sexually transmitted infections and cancer. Conclusion Many girls and their parents have limited understanding to an extent that impinges on their ability to make informed choices about HPV vaccination and could impact on future uptake of cervical screening. This is a considerable challenge to those who design and provide information, but getting the messages right for this programme could help in developing patient information about other HPV related cancers.
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Mazza D, Petrovic K, Chakraborty S. HPV vaccination of adult women: An audit of Australian general practitioners. Aust N Z J Obstet Gynaecol 2012; 52:528-33. [DOI: 10.1111/ajo.12002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 08/26/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Danielle Mazza
- Department of General Practice, School of Primary Health Care, Faculty of Medicine Nursing and Health Sciences; Monash University; Notting Hill; Victoria; Australia
| | - Katja Petrovic
- Department of General Practice, School of Primary Health Care, Faculty of Medicine Nursing and Health Sciences; Monash University; Notting Hill; Victoria; Australia
| | - Samantha Chakraborty
- Department of General Practice, School of Primary Health Care, Faculty of Medicine Nursing and Health Sciences; Monash University; Notting Hill; Victoria; Australia
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Hughes CC, Jones AL, Feemster KA, Fiks AG. HPV vaccine decision making in pediatric primary care: a semi-structured interview study. BMC Pediatr 2011; 11:74. [PMID: 21878128 PMCID: PMC3175168 DOI: 10.1186/1471-2431-11-74] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 08/30/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite national recommendations, as of 2009 human papillomavirus (HPV) vaccination rates were low with < 30% of adolescent girls fully vaccinated. Research on barriers to vaccination has focused separately on parents, adolescents, or clinicians and not on the decision making process among all participants at the point of care. By incorporating three distinct perspectives, we sought to generate hypotheses to inform interventions to increase vaccine receipt. METHODS Between March and June, 2010, we conducted qualitative interviews with 20 adolescent-mother-clinician triads (60 individual interviews) directly after a preventive visit with the initial HPV vaccine due. Interviews followed a guide based on published HPV literature, involved 9 practices, and continued until saturation of the primary themes was achieved. Purposive sampling balanced adolescent ages and practice type (urban resident teaching versus non-teaching). Using a modified grounded theory approach, we analyzed data with NVivo8 software both within and across triads to generate primary themes. RESULTS The study population was comprised of 20 mothers (12 Black, 9 < high school diploma), 20 adolescents (ten 11-12 years old), and 20 clinicians (16 female). Nine adolescents received the HPV vaccine at the visit, eight of whom were African American. Among the 11 not vaccinated, all either concurrently received or were already up-to-date on Tdap and MCV4. We did not observe systematic patterns of vaccine acceptance or refusal based on adolescent age or years of clinician experience. We identified 3 themes: (1) Parents delayed, rather than refused vaccination, and when they expressed reluctance, clinicians were hesitant to engage them in discussion. (2) Clinicians used one of two strategies to present the HPV vaccine, either presenting it as a routine vaccine with no additional information or presenting it as optional and highlighting risks and benefits. (3) Teens considered themselves passive participants in decision making, even when parents and clinicians reported including them in the process. CONCLUSIONS Programs to improve HPV vaccine delivery in primary care should focus on promoting effective parent-clinician communication. Research is needed to evaluate strategies to help clinicians engage reluctant parents and passive teens in discussion and measure the impact of distinct clinician decision making approaches on HPV vaccine delivery.
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Affiliation(s)
- Cayce C Hughes
- Center for Pediatric Clinical Effectiveness and Policy Lab, The Children's Hospital of Philadelphia, 3535 Market Suite, Philadelphia, PA 19104, USA
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Kumar VM, Whynes DK. Explaining variation in the uptake of HPV vaccination in England. BMC Public Health 2011; 11:172. [PMID: 21426539 PMCID: PMC3070653 DOI: 10.1186/1471-2458-11-172] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 03/22/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In England, two national programmes of HPV vaccination for girls have been instituted, a routine programme for 12- and 13-year-olds and a catch-up programme for 17- and 18-year-olds. Uptake rates across the country have been far from uniform, and this research sought to identify factors explaining the variation in uptake by locality. METHODS An association between uptake, deprivation and ethnic background had been established in pilot research. The present analysis was conducted at an aggregate, Primary Care Trust (PCT), level for the first year of the programmes. Published measures of HPV vaccination uptake, material deprivation, ethnic composition of PCT populations, primary care quality, and uptake of cervical screening and of other childhood immunisations were collated. Strong evidence of collinearity amongst the explanatory variables required a factor analysis to be undertaken. This provided four independent factors, used thereafter in regression models to explain uptake by PCT. RESULTS The factor analysis revealed that ethnic composition was associated with attitudes towards cervical screening and other childhood vaccinations, whilst material deprivation and quality of primary care were orthogonal. Ethnic composition, early childhood vaccination, cervical screening and primary care quality were found to be influential in predicting uptake in both the routine and the catch-up cohorts, although with a lower degree of confidence in the case of the last two independent variables. Lower primary care quality was significant in explaining a greater fall in vaccination uptake between the first two doses in the catch-up cohort. Greater deprivation was a significant explanatory factor for both uptake and the fall in uptake between doses for the catch-up cohort but not for uptake in the routine cohort. CONCLUSION These results for uptake of the first year of the national programme using aggregate data corroborate findings from intentions surveys and pilot studies. Deprivation, the ethnic composition of the population, the effectiveness of primary care and the acceptability of childhood vaccinations are salient factors in explaining local HPV vaccine uptake in England.
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Affiliation(s)
- Varun M Kumar
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham NG5 1PB, UK
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Kang HS, Shin H, Hyun MS, Kim MJ. Human papilloma virus vaccination: perceptions of young Korean women. J Adv Nurs 2010; 66:1946-52. [PMID: 20626486 DOI: 10.1111/j.1365-2648.2010.05369.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper is a report of a descriptive study of young Korean women's perceptions of use of the human papilloma virus vaccine. BACKGROUND In Korea, cervical cancer is one of the leading cancers in women, and the rate of human papilloma virus infection is increasing. A national media campaign has recently begun to promote human papilloma virus vaccination. However, research addressing the acceptability of this vaccine to women in Korea has been limited. METHOD Twenty-five Korean women, 21-30 years of age, participated in seven focus groups. The data were collected in 2007. FINDINGS Participants were concerned about the potential harmful effects of the human papilloma virus vaccine, a possible increase in unsafe sexual behaviours, and the high cost of the vaccine, which is not covered by health insurance. They suggested group vaccination at-cost or free of charge. They discussed ambivalence about the vaccination, the need for more information about the vaccine, and questions about its effectiveness. Most preferred to wait until more people have been vaccinated. CONCLUSION There is a need for more aggressive dissemination of information about the safety and efficacy of the human papilloma virus vaccine. More reasonable cost, insurance coverage, or free vaccination using a group approach might increase young Korean women's acceptance and use of the human papilloma virus vaccine.
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Affiliation(s)
- Hee Sun Kang
- Department of Nursing, College of Medicine, Chung-Ang University, South Korea
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Robbins SCC, Bernard D, McCaffery K, Skinner SR. 'It's a logistical nightmare!' Recommendations for optimising human papillomavirus school-based vaccination experience. Sex Health 2010; 7:271-8. [DOI: 10.1071/sh09140] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Accepted: 05/28/2010] [Indexed: 11/23/2022]
Abstract
Introduction: To date, no published studies examine procedural factors of the school-based human papillomavirus (HPV) vaccination program from the perspective of those involved. This study examines the factors that were perceived to impact optimal vaccination experience. Methods: Schools across Sydney were selected to reflect a range of vaccination coverage at the school level and different school types to ensure a range of experiences. Semi-structured focus groups were conducted with girls; and one-on-one interviews were undertaken with parents, teachers and nurses until saturation of data in all emergent themes was reached. Focus groups and interviews explored participants’ experiences in school-based HPV vaccination. Transcripts were analysed, letting themes emerge. Results: Themes related to participants’ experience of the organisational, logistical and procedural aspects of the vaccination program and their perceptions of an optimal process were organised into two categories: (1) preparation for the vaccination program and (2) vaccination day strategies. In (1), themes emerged regarding commitment to the process from those involved, planning time and space for vaccinations, communication within and between agencies, and flexibility. In (2), themes included vaccinating the most anxious girls first, facilitating peer support, use of distraction techniques, minimising waiting time girls, and support staff. Discussion: A range of views exists on what constitutes an optimal school-based program. Several findings were identified that should be considered in the development of guidelines for implementing school-based programs. Future research should evaluate how different approaches to acquiring parental consent, and the use of anxiety and fear reduction strategies impact experience and uptake in the school-based setting.
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