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Tobaiqy M, MacLure K. A Systematic Review of Human Papillomavirus Vaccination Challenges and Strategies to Enhance Uptake. Vaccines (Basel) 2024; 12:746. [PMID: 39066384 PMCID: PMC11281456 DOI: 10.3390/vaccines12070746] [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: 05/29/2024] [Revised: 06/27/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
Human papillomavirus (HPV) vaccination has revolutionized cervical cancer prevention. Clinical trials confirm that the quadrivalent (HPV types 6, 11, 16, 18) and bivalent (HPV types 16, 18) vaccines effectively prevent HPV infections and cervical neoplasia. The latest HPV vaccine protects against nine virus types responsible for 90% of cervical cancer cases globally. Despite their undoubted effectiveness in reducing morbidity and mortality associated with HPV infections, challenges in vaccine coverage and uptake persist. The current study aimed to identify the primary challenges associated with HPV vaccination, propose effective strategies to improve vaccination uptake, and compile relevant evidence into a comprehensive overview to inform policy and practice. A systematic review protocol, following PRISMA-P and PRISMA guidelines, was established. Articles were sourced from the Web of Science using keywords from a comprehensive review of HPV vaccination challenges and strategies. Studies published between 1 January 2020, and 1 May 2024, including RCTs and observational, qualitative, and cross-sectional studies, were included, while reviews, protocols, and commentaries were excluded. Titles, abstracts, and full texts were screened per PRISMA guidelines. The review identified five key strategies to improve HPV vaccination uptake: parental and school engagement, use of technology and multimedia tools, healthcare providers' role, multicomponent interventions, and targeted interventions for immigrant groups. This review emphasized the need for a multifaceted approach to improving vaccination rates, offering a robust foundation for policy and stakeholder initiatives.
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Affiliation(s)
- Mansour Tobaiqy
- Department of Pharmacology, College of Medicine, University of Jeddah, Jeddah P.O. Box 45311, Saudi Arabia
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Lubeya MK, Mwanahamuntu M, Chibwesha CJ, Mukosha M, Kawonga M. Selecting and Tailoring Implementation Strategies to Improve Human Papillomavirus Vaccine Uptake in Zambia: A Nominal Group Technique Approach. Vaccines (Basel) 2024; 12:542. [PMID: 38793793 PMCID: PMC11126122 DOI: 10.3390/vaccines12050542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
The human papillomavirus (HPV) vaccine is effective in cervical cancer prevention. However, many barriers to uptake exist and strategies to overcome them are needed. Therefore, this study aimed to select and tailor implementation strategies to barriers identified by multiple stakeholders in Zambia. The study was conducted in Lusaka district between January and February 2023. Participants were purposively sampled from three stakeholder groups namely, adolescent girls, parents, and teachers and healthcare workers. With each of the stakeholders' groups (10-13 participants per group), we used the nominal group technique to gain consensus to tailor feasible and acceptable implementation strategies for mitigating the identified contextual barriers. The identified barriers included low levels of knowledge and awareness about the HPV vaccine, being out of school, poor community sensitisation, lack of parental consent to vaccinate daughters, and myths and misinformation about the HPV vaccine. The lack of knowledge and awareness of the HPV vaccine was a common barrier across the three groups. Tailored strategies included conducting educational meetings and consensus-building meetings, using mass media, changing service sites, re-examining implementation, and involving patients/consumers and their relatives. Our study contributes to the available evidence on the process of selecting and tailoring implementation strategies to overcome contextual barriers. Policymakers should consider these tailored strategies to mitigate barriers and improve HPV vaccine uptake.
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Affiliation(s)
- Mwansa Ketty Lubeya
- Department of Obstetrics and Gynaecology, School of Medicine, University of Zambia, Lusaka 10101, Zambia;
- Women and Newborn Hospital, University Teaching Hospitals, Lusaka 10101, Zambia
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2017, South Africa; (M.M.); (M.K.)
| | - Mulindi Mwanahamuntu
- Department of Obstetrics and Gynaecology, School of Medicine, University of Zambia, Lusaka 10101, Zambia;
- Women and Newborn Hospital, University Teaching Hospitals, Lusaka 10101, Zambia
| | - Carla J. Chibwesha
- Clinical HIV Research Unit, Helen Joseph Hospital, Johannesburg 2193, South Africa;
| | - Moses Mukosha
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2017, South Africa; (M.M.); (M.K.)
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka 10101, Zambia
| | - Mary Kawonga
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2017, South Africa; (M.M.); (M.K.)
- Department of Community Health, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg 2193, South Africa
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3
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Flood T, Hughes CM, Wilson I, McLaughlin M. Applying the COM-B behaviour model to understand factors which impact 15-16 year old students' ability to protect themselves against acquirement of Human Papilloma virus (HPV) in Northern Ireland, UK. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003100. [PMID: 38630731 PMCID: PMC11023437 DOI: 10.1371/journal.pgph.0003100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024]
Abstract
High-risk strains of Human Papillomavirus (HPV) can lead to the development of a number of cancers including cervical, vulvar, penile, anal and oropharyngeal. HPV vaccination programmes offer the HPV vaccine to males and females 12-13 years old in schools throughout the UK. However, knowledge of HPV remains low in post-primary schools. The aim of this study is to capture 15-16 year old students' perceptions regarding the current provision of HPV education, and whether providing HPV education to 15-16 year olds could influence their intention to be vaccinated and/or future sexual health decisions related to HPV. Between 5th November 2021 and 6th May 2022, seven focus groups were conducted with 34 students in post-primary schools in Northern Ireland, United Kingdom. The data was analysed using the COM-B behaviour model to explore the perceived facilitators and barriers impacting students' ability to protect themselves from acquirement of HPV. Students perceived their knowledge of HPV to be poor and supported the addition of comprehensive mandatory HPV education at 15-16 years old when many of them were becoming sexually active. They identified barriers including lack of parental education, school ethos and religion and insufficient education regarding their legal rights to self-consent to HPV vaccination. Students felt that removal of these barriers would lead to safer sexual practices, increased awareness of the importance of HPV screening and increased HPV vaccination uptake. The recommendations provided by students need to be supported by the Education Authority in conjunction with the Department of Health in order to be successfully implemented into the post-primary school curriculum.
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Affiliation(s)
- Terri Flood
- School of Health Sciences, Ulster University, Londonderry, Derry, United Kingdom
| | - Ciara M. Hughes
- School of Health Sciences, Ulster University, Londonderry, Derry, United Kingdom
| | - Iseult Wilson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, United Kingdom
| | - Marian McLaughlin
- School of Psychology, Ulster University, Londonderry, Derry, United Kingdom
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Choi J, Gabay EK, Cuccaro PM. School Teachers' Perceptions of Adolescent Human Papillomavirus (HPV) Vaccination: A Systematic Review. Vaccines (Basel) 2024; 12:361. [PMID: 38675743 PMCID: PMC11053788 DOI: 10.3390/vaccines12040361] [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: 02/10/2024] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
School nurses are uniquely positioned to educate students about immunizations, including human papillomavirus (HPV) vaccination, but schools are often without a nurse for different reasons. In lieu of nurses, teachers who closely interact with students and are traditionally well-trusted by parents may be able to communicate about HPV vaccination, alleviating parental vaccine hesitancy. This systematic review explores school teachers' perspectives on adolescent HPV vaccination and factors influencing their willingness to make vaccine recommendations. We searched three databases with appropriate medical subject headings and keywords to identify relevant studies. We reviewed fifteen studies and provided an extensive summary and a comparison of the results across the studies. Teachers had low to moderate levels of HPV knowledge with low self-efficacy to counsel parents about the HPV vaccine and expressed concerns about the vaccine condoning adolescent sexual activity, vaccine side effects, and parental disapproval. Nonetheless, some teachers showed interest in learning about vaccine effectiveness in preventing HPV-associated cancers and wanted guidance on vaccine communication with parents, viewing schools as adequate venues to promote and deliver HPV vaccines. Schools should consider educating teachers on HPV and HPV vaccination, with a focus on effective vaccine communication practices to increase adolescent HPV vaccine uptake.
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Affiliation(s)
- Jihye Choi
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA;
- Center for Health Promotion and Preventive Research, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA;
| | - Efrat K. Gabay
- Center for Health Promotion and Preventive Research, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA;
| | - Paula M. Cuccaro
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA;
- Center for Health Promotion and Preventive Research, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA;
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McNally K, Roess A, Weinstein A, Lindley L, Wallin R. School Nurses' Experiences and Roles in Promoting and Administering the HPV Vaccine: A Systematic Review Using the Socioecological Framework. J Sch Nurs 2024; 40:43-57. [PMID: 37828750 DOI: 10.1177/10598405231206109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
Understanding the school nurse's experience in human papillomavirus (HPV) vaccine promotion can reduce vaccine disparities. HPV vaccination is critical to cancer prevention. Despite the importance of the school nurse in vaccine promotion, there is a lack of understanding. This article aims to examine the knowledge, attitude, experience, and role of school nurses related to HPV vaccination and promotion in school settings. A systematic search for school nurses and their experiences related to HPV vaccination was conducted. A thematic synthesis was undertaken using the socioecological model. This review highlights the complexity of HPV vaccine promotion in schools over time. Multilevel factors impact nursing practice. Nurses have good vaccine knowledge and positive attitudes. Poor workflow processes, competing demands, and vaccine communication challenge school nurses. The themes that were synthesized informed the LEADS model. With the support of school nurses, reaching the goal of eliminating cervical cancer as a public health problem is possible.
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Affiliation(s)
- Kimberly McNally
- George Mason University College of Health and Human Services, Fairfax, VA, USA
| | | | | | - Lisa Lindley
- Alexandria City Public Schools, Alexandria, VA, USA
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Lubeya MK, Chibwesha CJ, Mwanahamuntu M, Mukosha M, Vwalika B, Kawonga M. Determinants of the Implementation of Human Papillomavirus Vaccination in Zambia: Application of the Consolidated Framework for Implementation Research. Vaccines (Basel) 2023; 12:32. [PMID: 38250845 PMCID: PMC10821054 DOI: 10.3390/vaccines12010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/10/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Cervical cancer can be prevented, primarily by the administration of the human papillomavirus (HPV) vaccine. Healthcare workers (HCWs) and teachers play important roles when schools are used for vaccine delivery; however, challenges exist. This study aimed to understand the barriers and facilitators to HPV vaccination that are perceived by HCWs and teachers. Guided by the consolidated framework for implementation research (CFIR), key informant interviews were conducted in Lusaka district between June 2021 and November 2021 using a semi-structured questionnaire. Recorded interviews were transcribed verbatim and imported into NVIVO 12 for data management and analysis. We coded transcripts inductively and deductively based on the adapted CFIR codebook. We reached saturation with 23 participants. We identified barriers and facilitators across the five CFIR domains. Facilitators included offering the HPV vaccine free of charge, HPV vaccine effectiveness, stakeholder engagement, and timely planning of the HPV vaccination. Barriers included vaccine mistrust due to its perceived novelty, low levels of parental knowledge, myths and misinformation about the vaccine, lack of parental consent to vaccinate daughters, lack of transport for vaccination outreach, lack of staff incentives, and inadequate sensitisation. Using the CFIR as a guiding framework, we have identified implementation barriers and facilitators to HPV vaccination among HCWs and teachers. Most of the identified barriers are modifiable, hence it is prudent that these are addressed for a high HPV vaccine uptake.
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Affiliation(s)
- Mwansa Ketty Lubeya
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Zambia, Lusaka 10101, Zambia; (M.M.); (B.V.)
- Women and Newborn Hospital, University Teaching Hospitals, Nationalist Road, Ridgeway, Lusaka 10101, Zambia
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 3193, South Africa; (M.M.); (M.K.)
| | - Carla J. Chibwesha
- Clinical HIV Research Unit, Helen Joseph Hospital, Johannesburg 2193, South Africa;
| | - Mulindi Mwanahamuntu
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Zambia, Lusaka 10101, Zambia; (M.M.); (B.V.)
- Women and Newborn Hospital, University Teaching Hospitals, Nationalist Road, Ridgeway, Lusaka 10101, Zambia
| | - Moses Mukosha
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 3193, South Africa; (M.M.); (M.K.)
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka 10101, Zambia
| | - Bellington Vwalika
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Zambia, Lusaka 10101, Zambia; (M.M.); (B.V.)
- Women and Newborn Hospital, University Teaching Hospitals, Nationalist Road, Ridgeway, Lusaka 10101, Zambia
| | - Mary Kawonga
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 3193, South Africa; (M.M.); (M.K.)
- Department of Public Health Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg 2193, South Africa
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Flood T, McLaughlin M, Hughes CM, Wilson IM. Applying the COM-B behaviour model to understand factors which impact school immunisation nurses' attitudes towards designing and delivering a HPV educational intervention in post-primary schools for 15-17 year old students in Northern Ireland, UK. Vaccine 2023; 41:5630-5639. [PMID: 37543445 DOI: 10.1016/j.vaccine.2023.07.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Human Papilloma Virus (HPV) is responsible for the development of cervical, vaginal, vulvar, penile, oropharyngeal and anal cancers. Throughout the UK, Immunisation nurses (IMNs) deliver school-based HPV vaccinations to students 12-13 years old. Providing HPV education to 15-17 year old students may promote decision-making regarding their sexual health and award opportunity for unvaccinated students to self-consent to the vaccination. This study aims to explore the perceptions of IMNs regarding the value of providing HPV education to 15-17 year old students and to explore whether IMNs feel that the design/delivery of this education should form part of their professional role. METHODS Six focus groups were conducted online with IMNs from all five Health and Social Care Trusts in Northern Ireland, UK, between January-June 2021. Data were analysed using the COM-B model to identify factors that might influence IMNs' behaviour towards designing/delivering this education for 15-17 year old students. RESULTS IMNs were highly motivated to design and deliver this HPV education. Facilitators promoting this behaviour included their specialist training, their previous sexual health teaching experience and their desire to educate young people. Barriers negatively influencing this behaviour included lack of time/resources, parental influences, lack of school support and lack of teaching/presentation skills training. CONCLUSION IMNs feel that they are the most appropriate professionals to design/deliver HPV education for 15-17 year old students. National policy change, based on collaboration between the Public Health Agency and Education Authority, is a key factor in facilitating IMNs to implement this school-based HPV education intervention.
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Affiliation(s)
- Terri Flood
- School of Health Sciences, Ulster University, Jordanstown, United Kingdom.
| | | | - Ciara M Hughes
- Institute of Nursing and Health Research, Ulster University, Jordanstown, United Kingdom.
| | - Iseult M Wilson
- School of Nursing and Midwifery, Queen's University Belfast, United Kingdom; College of Nursing and Midwifery, Mohammed Bin Rashid University, Dubai, United Arab Emirates.
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MacDonald SE, Kenzie L, Letendre A, Bill L, Shea-Budgell M, Henderson R, Barnabe C, Guichon JR, Colquhoun A, Ganshorn H, Bedingfield N, Vandenboogaard PD, Bednarczyk RA, Glaze S, Nelson G. Barriers and supports for uptake of human papillomavirus vaccination in Indigenous people globally: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001406. [PMID: 36962871 PMCID: PMC10021254 DOI: 10.1371/journal.pgph.0001406] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/08/2022] [Indexed: 01/09/2023]
Abstract
Despite the availability of effective and safe human papillomavirus (HPV) vaccines that reduce the incidence and impact of cervical cancer and other cancers, HPV vaccine coverage rates remain persistently low and the cervical cancer burden disproportionately high among Indigenous people globally. This study aimed to systematically identify, appraise, and summarize the literature on documented barriers and supports to HPV vaccination in Indigenous populations internationally. Forty-three studies were included and an inductive, qualitative, thematic synthesis was applied. We report on 10 barrier themes and 7 support themes to vaccine uptake, and provide a quantitative summary of metrics. Focusing on Indigenous perspectives reported in the literature, we propose recommendations on community-research collaboration, culturally safe intergenerational and gender-equitable community HPV vaccine education, as well as multi-level transparency to ensure informed consent is secured in the context of reciprocal relationships. Although the voices of key informant groups (e.g., HPV-vaccine eligible youth and community Elders) are underrepresented in the literature, the identification of barriers and supports to HPV vaccination in a global Indigenous context might help inform researchers and health policy makers who aim to improve HPV vaccine uptake in Indigenous populations.
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Affiliation(s)
| | - Lisa Kenzie
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Angeline Letendre
- Cancer Prevention and Screening Innovation, Alberta Health Services, Edmonton, Canada
| | - Lea Bill
- Alberta First Nations Information Governance Centre, Calgary, Canada
| | | | - Rita Henderson
- Department of Family Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Cheryl Barnabe
- Department of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Juliet R Guichon
- Department of Community Health Sciences and Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Amy Colquhoun
- Performance Reporting, Alberta Health, Edmonton, Canada
| | - Heather Ganshorn
- Libraries and Cultural Resources, University of Calgary, Calgary, Canada
| | - Nancy Bedingfield
- Department of Community Health Sciences and Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Robert A Bednarczyk
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Sarah Glaze
- Tom Baker Cancer Centre, University of Calgary, Calgary, Canada
| | - Gregg Nelson
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
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Herbert C, Curtin C, Epstein M, Wang B, Lapane K. Uptake of HPV Vaccine among young adults with disabilities, 2011 to 2018. Disabil Health J 2022; 15:101341. [PMID: 35659860 PMCID: PMC9653512 DOI: 10.1016/j.dhjo.2022.101341] [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: 01/04/2022] [Revised: 04/04/2022] [Accepted: 05/06/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Little is known about human papillomavirus (HPV) vaccine uptake among young adults with disabilities (YAWD), despite this population having a higher risk of HPV infection and related cancers compared to the general population. OBJECTIVE To compare the prevalence of HPV vaccination among young adults with disabilities to young adults without disabilities. We hypothesized that YAWD would have a lower prevalence of HPV vaccination than the general population. METHODS This cross-sectional study used data for the years 2011 to 2018 of the National Health Interview Survey. Our analysis included 14,577 people (weighted n = 34,420,024) aged 18 to 26 years. Univariate and multivariable logistic models were used to estimate the role of disability on HPV vaccination uptake among young adults and to identify potential factors associated with HPV vaccination among YAWD. RESULTS The proportion of female and male YAWD with HPV vaccination was similar to those without disabilities, regardless of sex (Female Adjusted Odds Ratio (OR): 1.16; 95% Confidence Interval (CI): 0.91 to 1.48; Male Adjusted OR: 1.05; 95% CI: 0.69 to 1.60). Among female and male YAWD, the proportion with HPV vaccination was 56.1% and 28.5%, respectively. Other factors significantly associated with HPV vaccination among YAWD included age, country of birth, healthcare utilization, and insurance status. CONCLUSIONS HPV vaccination among YAWD did not differ significantly from those without disabilities; however, the prevalence of HPV vaccination among young adult males and females remains significantly below national goals. Connecting young adults, specifically male YAWD, to the healthcare system is of utmost importance to improve HPV vaccination uptake.
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Affiliation(s)
- Carly Herbert
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Carol Curtin
- Eunice Kennedy Shriver Center, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Mara Epstein
- The Meyers Health Care Institute, A Joint Endeavor of the University of Massachusetts Chan Medical School, Fallon Health, and Reliant Medical Group, Worcester, MA, USA; Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Kate Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Fisher H, Chantler T, Mounier-Jack S, Audrey S. Human papillomavirus vaccine communication materials for young people in English-speaking countries: A content analysis. HEALTH EDUCATION JOURNAL 2022; 81:513-528. [PMID: 35910267 PMCID: PMC9326800 DOI: 10.1177/00178969221092135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To undertake a content analysis of human papillomavirus (HPV) vaccine communication materials available to young people. DESIGN Content analysis. SETTING Majority English-speaking countries. METHODS Between March and April 2020, a web engine was utilised to search for and retrieve relevant communication materials. Content analysis was used to describe how the following key issues were covered: (1) side effects, (2) safety, (3) practicalities related to receiving the HPV vaccine and (4) gender-specific information. RESULTS A total of 44 separate communication materials were retrieved, predominantly videos, webpages and leaflets. There was a focus on mild side effects of the vaccine (43.2%), with less frequent reference being made to moderate or serious side effects (22.7%). Reassurance concerning the safety profile of vaccine was communicated by referencing the widespread use of the HPV vaccine (31.8%). Information regarding formal criteria for entry into the vaccination programme emphasised country-specific eligibility criteria (59.1%), the setting in which vaccination was offered (38.6%) and the number of doses required (38.6%). Content intended to improve young people's experiences of receiving the HPV vaccine was less often provided (22.7%). Gender-specific content usually related to specific HPV-related diseases (52.3%) and/or the availability of cervical cancer screening programmes (52.3%). CONCLUSION A variety of different communication tools were retrieved encompassing a wide variety of formats and content, reflective of different vaccination programmes and the varied priorities of organisations producing the materials. Findings will inform the co-production of a tailored educational package to improve access to information by populations of young people identified as having lower HPV vaccine uptake.
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Affiliation(s)
- Harriet Fisher
- National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tracey Chantler
- National Institute for Health Research Health Protection Research Unit in Vaccinations and Immunisation, London School of Hygiene and Tropical Medicine, London, UK
| | - Sandra Mounier-Jack
- National Institute for Health Research Health Protection Research Unit in Vaccinations and Immunisation, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzanne Audrey
- National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Cullinan L, Dunn L, McLean S, Palombo E. Waterborne disease outbreaks in treated recreational water facilities: a Socio-Ecological Model perspective. Health Promot Int 2022; 37:6646638. [PMID: 35853153 DOI: 10.1093/heapro/daac090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Treated recreational water facilities, including swimming pools and water play parks, have often been implicated in infectious disease outbreaks. Addressing this problem is complex due to the multiple and interrelated factors contributing to outbreaks in these settings. These factors may relate to inappropriate behaviours of users and operators, lack of and inconsistent regulation of these facilities, insufficient facility maintenance, and problems associated with the design of these facilities. Given the complexity of this issue, we argue that the Socio-Ecological Model (SEM) provides a useful framework to help identify the multi-level influences and factors that have implications for designing interventions to prevent this public health problem, whilst assisting in guiding future research in this area. We apply the SEM to the current literature to help identify the influences and factors contributing to infectious disease outbreaks in treated recreational water facilities to support this argument. We also identify several gaps in the existing research that would benefit from further examination to help prevent infectious disease outbreaks in treated recreational water facilities such as public swimming pools and water play parks.
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Affiliation(s)
- Lauren Cullinan
- Department of Chemistry and Biotechnology, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
| | - Louise Dunn
- Department of Chemistry and Biotechnology, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
| | - Sarah McLean
- Department of Chemistry and Biotechnology, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
| | - Enzo Palombo
- Department of Chemistry and Biotechnology, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
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Fisher H, Chantler T, Finn A, Kesten J, Hickman M, Letley L, Mounier-Jack S, Thomas C, Worthington K, Yates J, Audrey S. Development of an educational package for the universal human papillomavirus (HPV) vaccination programme: a co-production study with young people and key informants. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:16. [PMID: 35468845 PMCID: PMC9035505 DOI: 10.1186/s40900-022-00349-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The English schools-based human papillomavirus (HPV) vaccination programme is routinely offered to all young people aged 12-13 years, to prevent cancers affecting the cervix, vulva, vagina, penis, anus and mouth. Lower uptake among some population groups has been identified, in part, because of unmet information needs among young people. To address these unmet needs we report intervention planning and development processes to co-produce an educational package about the HPV vaccine. METHODS We used co-production research methodologies and the 'person-based approach' involving the following iterative stages: (i) collating and analysing primary and secondary evidence, including HPV vaccine communication materials, interviews and workshops; (ii) developing guiding principles; (iii) undertaking a behavioural analysis informed by the Behaviour Change Wheel and the Behaviour Change Technique taxonomy; (iv) development of a preliminary logic model; (v) co-production of resources, and; (vi) refinement of resources informed by feedback from young people and key informants. RESULTS We co-produced EDUCATE, a theory-based educational package, that is designed to be delivered to young people prior to being offered the HPV vaccine to support uptake. Young people and key informants identified the following key issues to include as content: (i) HPV-related information; (ii) how vaccines work; (iii) safety and side-effects of the HPV vaccine; (iii) eligibility for the HPV vaccination programme, and; (iv) preparation of young people to receive the HPV vaccine. A manual for professionals (e.g. immunisation nurses, school staff) delivering the intervention and a PowerPoint presentation, interspersed with five short films, were co-produced with young people and key informants. Following feedback, the content of the EDUCATE package was refined to increase acceptability, engagement, and persuasiveness to the target users. CONCLUSION Engagement with young people and key informants was integral to the development of our rigorously developed, theory-based intervention to address young people's information needs about the HPV vaccination programme. The acceptability and persuasiveness of the package has been maximised by working closely with young people and key informants to develop the content. An implementation study to examine how the EDUCATE package is implemented in practice and the impact on uptake of the HPV vaccination programme is underway.
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Affiliation(s)
- Harriet Fisher
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK.
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, UK.
| | - Tracey Chantler
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Adam Finn
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Joanna Kesten
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Hickman
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Louise Letley
- Immunisation and Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Sandra Mounier-Jack
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Clare Thomas
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Julie Yates
- Screening and Immunisation, NHS England and Improvement South West, Bristol, UK
| | - Suzanne Audrey
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Mitchell H, Lim R, Gill PK, Dhanoa J, Dubé È, Bettinger JA. What do adolescents think about vaccines? Systematic review of qualitative studies. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001109. [PMID: 36962668 PMCID: PMC10022047 DOI: 10.1371/journal.pgph.0001109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/02/2022] [Indexed: 11/19/2022]
Abstract
Adolescence presents a key opportunity to build vaccine-related health literacy and promote vaccine confidence and uptake. Although adolescents are central to vaccination programs, their views around vaccines are frequently underrepresented in qualitative literature. We reviewed qualitative studies to systematically identify and summarize existing evidence on adolescents' own understanding of vaccines and experiences with vaccine decision-making, including self-consent when applicable. CINAHL; Embase; Ovid Medline; and Psych Info database searches were last updated on May 28, 2022. Data pertaining to general study characteristics, participant demographics, and qualitative content were extracted independently by two reviewers and analyzed using textual narrative synthesis. Out of 3559 individual records, 59 studies were included. The majority of the studies were conducted in high-income countries and 75% focused on human papilloma virus vaccines, with the remaining studies looking at COVID-19, meningococcal, hepatitis B and influenza vaccines or adolescent experiences with vaccines in general. Adolescent self-consent was explored in 7 studies. Perspectives from sexual and gender minorities were lacking across studies. Adolescents often had limited understanding of different vaccines and commonly perceived vaccine information to be directed towards their parents rather than themselves. Many adolescents felt school-based vaccine education and information available through healthcare providers were insufficient to make informed decisions about vaccines. While adolescents described obtaining vaccine information from traditional and online media, face-to-face interactions and opinions from trusted adults remained important. Adolescents generally relied on their parents for vaccine-decision making, even when self-consent was an option. A notable exception to this included marginalized adolescents who could not rely on parents for health-related advice. Qualitative literature about adolescent vaccines would be enriched by studies examining vaccines other than the HPV vaccine, studies examining adolescent vaccine programs in low and middle-income countries, and by deliberately eliciting vaccine experiences of adolescent with diverse sexual orientation and gender identities.
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Affiliation(s)
- Hana Mitchell
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Rebecca Lim
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Prubjot K Gill
- University of British Columbia Library, University of British Columbia, Vancouver, BC, Canada
| | - Joban Dhanoa
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Ève Dubé
- Institut National de Santé Publique du Québec, Québec City, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
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Nahum AS, Vongsachang H, Friedman DS, Collins ME. Parental Trust in School-Based Health Care: A Systematic Review. THE JOURNAL OF SCHOOL HEALTH 2022; 92:79-91. [PMID: 34773404 DOI: 10.1111/josh.13106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/18/2021] [Accepted: 04/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Health care delivery in schools is a frequently adopted approach to reduce health care inequalities. Lack of parental trust has been identified as impacting participation in school-based health care programs (SBHPs). The aim of our systematic review is to outline themes related to parental trust in SBHPs. METHODS We searched MEDLINE, Embase, CINHAL, ERIC, PsycInfo, and Web of Science for articles published between 1969 and 2019. Eligible studies (1) were peer-reviewed primary research articles; (2) were school-based health interventions or screening programs; (3) included parental trust data; and (4) were carried out on schoolchildren from pre-K to grade 12. Study location, data collection date, number of participants, demographics, intervention type, study aim and methodology, and all trust themes mentioned, were extracted. Studies were critically appraised using the CASP checklist for qualitative research. RESULTS We identified 9 themes related to parental trust in SBHPs: (1) safety; (2) effectiveness; (3) health professionals' training and credentials; (4) communication; (5) confidentiality; (6) providers; (7) government, authorities, and health service; (8) the pharmaceutical industry; and (9) research and data sharing. CONCLUSIONS The themes identified provide a framework for examining trust in SBHPs, and may guide the development of interventions to increase trust and engagement in SBHPs.
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Affiliation(s)
- Andrea S Nahum
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287
- UCL Medical School, University College London, 74 Huntley Street, Bloomsbury, London, WC1E 6DE, UK
| | - Hursuong Vongsachang
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - David S Friedman
- Massachusetts Eye and Ear Infirmary, Glaucoma Center of Excellence, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA
| | - Megan E Collins
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287, USA
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Ramezankhani A, Yarmohammadi S, Ghaffari M, Mashayekhi P, Mirzaei J. Strategies for improving participation in human papillomavirus vaccination among young adults in the capital of Iran: A qualitative–exploratory study. Int J Prev Med 2022; 13:1. [PMID: 35281978 PMCID: PMC8883668 DOI: 10.4103/ijpvm.ijpvm_599_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 05/18/2021] [Indexed: 11/05/2022] Open
Abstract
Background: Different strategies can promote healthy behaviors. Although the human papillomavirus (HPV) vaccine is very important due to its effect in reducing cervical cancer, the behavior of HPV vaccination is low among young adults in Iran. Therefore, this study aimed to determine strategies for improving HPV vaccination among young adults. Methods: The present study was conducted with a qualitative content analysis method. The participants were 30 health professionals and young adults in Tehran city who were selected using purposive and snowball sampling. The data were collected through semistructured interviews and analyzed by Graneheim and Lundman's approach. Results: In total, two categories were identified: (1) access to services: access to the vaccine, vaccine insurance coverage; (2) educational coverage: subgroup training, educational content, time for training, educational channels, education strategies, and educational conditions. Conclusions: This is the first study conducted to determine strategies for improving HPV vaccination in Iran. The policymakers and planners, schools, and health centers are recommended to use the strategies obtained from this study to increase HPV vaccine imports, as well as increase the community members’ knowledge and acceptance of the HPV vaccine.
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Footer R, Foster O. The introduction of electronic consent for the school aged immunization program. Public Health Nurs 2021; 39:320-325. [PMID: 34878195 DOI: 10.1111/phn.13016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022]
Abstract
Historically, consent for treatment in the United Kingdom's National Health Service has been collected using traditional paper forms. For public health services, such as immunizations, this process involved significant time, space, paper, and staff resources. In a bid to provide a more modern, secure, cost-effective and paperless service, an electronic consent (eConsent) form for the routine school aged immunization program was designed and successfully piloted for the HPV 1 vaccine in 25 schools during the summer of 2019, with an average of 80% return rate. This was not only significantly higher than paper consent returns, there was also a significantly quicker return rate. These factors resulted in the clinical record being updated more quickly than ever before which reduced clinical risk. Following the pilot, the program was launched countywide for all school aged immunizations in September 2020. Since its launch some minor issues have been identified but resolved quickly and efficiently. Although still in its early days it is felt that the eConsent system has promoted a more informed and easier collaboration across sectors and has reduced operating costs. Although the use of electronic consent needs to be used more widely, it is felt that this new practice is a success.
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Affiliation(s)
- Rebecca Footer
- Northamptonshire Healthcare Foundation Trust, Clinical Team Lead for the School Aged Immunisation Team, John Notley Building, St Marys Hospital, Kettering, Northamptonshire
| | - Owen Foster
- Northamptonshire Healthcare Foundation Trust, Senior Developer, Digital Technology Services (Enabling, Supporting, Innovating), Northamptonshire Healthcare NHS Foundation Trust, Kettering, Northants
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17
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Runngren E, Eriksson M, Blomberg K. Parents' reasoning about HPV vaccination in Sweden. Scand J Caring Sci 2021; 36:1113-1122. [PMID: 34672006 DOI: 10.1111/scs.13041] [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: 05/03/2021] [Accepted: 10/10/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of this study was to describe parents' reasoning in making decisions about vaccinating their daughters against human papilloma virus (HPV), a part of the Swedish vaccination programme. METHOD Twenty parents whose daughter had been offered HPV vaccination participated. Semi-structured individual interviews were conducted and analysed using thematic analysis. RESULTS The findings reveal that the decision-making process is complex. The parents trusted the vaccination programme and saw it as beneficial to society. They also described using different resources to decide about HPV vaccination, but they did not include their daughters in making the decision. DISCUSSION Parents need better vaccine and health literacy to be able to decide, based on evidence and in consultation with their daughters, on HPV vaccination. School nurses can play an important role in evidence-based decision-making about HPV vaccination and introducing children to this health-promoting intervention.
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Affiliation(s)
- Eva Runngren
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Vujovich-Dunn C, Skinner SR, Brotherton J, Wand H, Sisnowski J, Lorch R, Veitch M, Sheppeard V, Effler P, Gidding H, Venn A, Davies C, Hocking J, Whop LJ, Leask J, Canfell K, Sanci L, Smith M, Kang M, Temple-Smith M, Kidd M, Burns S, Selvey L, Meijer D, Ennis S, Thomson CA, Lane N, Kaldor J, Guy R. School-Level Variation in Coverage of Co-Administered dTpa and HPV Dose 1 in Three Australian States. Vaccines (Basel) 2021; 9:vaccines9101202. [PMID: 34696310 PMCID: PMC8537995 DOI: 10.3390/vaccines9101202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/14/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Australian adolescents are routinely offered HPV and dTpa (diphtheria, tetanus, pertussis) vaccines simultaneously in the secondary school vaccination program. We identified schools where HPV initiation was lower than dTpa coverage and associated school-level factors across three states. METHODS HPV vaccination initiation rates and dTpa vaccination coverage in 2016 were calculated using vaccine databases and school enrolment data. A multivariate analysis assessed sociodemographic and school-level factors associated with HPV initiation being >5% absolute lower than dTpa coverage. RESULTS Of 1280 schools included, the median school-level HPV initiation rate was 85% (interquartile range (IQR):75-90%) and the median dTpa coverage was 86% (IQR:75-92%). Nearly a quarter (24%) of all schools had HPV vaccination initiation >5% lower than dTpa coverage and 11 % had >10% difference. School-level factors independently associated with >5% difference were remote schools (aOR:3.5, 95% CI = 1.7-7.2) and schools in major cities (aOR:1.8, 95% CI = 1.0-3.0), small schools (aOR:3.3, 95% CI = 2.3-5.7), higher socioeconomic advantage (aOR:1.7, 95% CI = 1.1-2.6), and lower proportions of Language-background-other-than-English (aOR:1.9, 95% CI = 1.2-3.0). CONCLUSION The results identified a quarter of schools had lower HPV than dTpa initiation coverage, which may indicate HPV vaccine hesitancy, and the difference was more likely in socioeconomically advantaged schools. As hesitancy is context specific, it is important to understand the potential drivers of hesitancy and future research needs to understand the reasons driving differential uptake.
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Affiliation(s)
- Cassandra Vujovich-Dunn
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
- Correspondence: ; Tel.: +61-2-9348-0033
| | - Susan Rachel Skinner
- Children’s Hospital Westmead, Sydney Children’s Hospitals Network, Sydney 2145, Australia; (S.R.S.); (C.D.)
- Faculty of Medicine and Health, University of Sydney, Specialty of Child and Adolescent Health, Sydney 2006, Australia
| | - Julia Brotherton
- Population Health, VCS Foundation Ltd., East Melbourne, Melbourne 3053, Australia;
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Melbourne 3010, Australia;
| | - Handan Wand
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
| | - Jana Sisnowski
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
- National Centre for Epidemiology & Population Health, Australian National University, Canberra 0200, Australia;
| | - Rebecca Lorch
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
| | - Mark Veitch
- Department of Health and Human Services, Tasmanian Government, Hobart 7001, Australia; (M.V.); (N.L.)
| | - Vicky Sheppeard
- Communicable Diseases Branch, Health Protection NSW, St Leonards, Sydney 2065, Australia;
- School of Public Health, University of Sydney, Camperdown, Sydney 2006, Australia;
| | - Paul Effler
- Department of Health, Communicable Disease Control Directorate, East Perth 6000, Australia; (P.E.); (C.A.T.)
| | - Heather Gidding
- School of Population Health, University of New Souh Wales, Sydney 2052, Australia;
- Norther Clinical School of Sydney, University of Sydney, Camperdown, Sydney 2006, Australia
- Women and Babies Research, Kollin Intstitye, Northern Sydney Local Health District, St Leaonards, Sydney 2064, Australia
- National Centre for Immunisation Research and Surveillance, Westmead, Sydney 2145, Australia
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Tasmanian 7000, Australia;
| | - Cristyn Davies
- Children’s Hospital Westmead, Sydney Children’s Hospitals Network, Sydney 2145, Australia; (S.R.S.); (C.D.)
- Faculty of Medicine and Health, University of Sydney, Specialty of Child and Adolescent Health, Sydney 2006, Australia
| | - Jane Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Melbourne 3010, Australia;
| | - Lisa J. Whop
- National Centre for Epidemiology & Population Health, Australian National University, Canberra 0200, Australia;
- Menzies School of Health Research, Charles Darwin University, Brisbane 4000, Australia
| | - Julie Leask
- Faculty of Medicine and Health, Sydney Nursing School, University of Sydney, Camperdown, Sydney 2006, Australia;
| | - Karen Canfell
- Cancer Research Division, Cancer Council, Brisbane 2011, Australia;
| | - Lena Sanci
- Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Melbourne 3010, Australia; (L.S.); (M.T.-S.)
| | - Megan Smith
- School of Public Health, University of Sydney, Camperdown, Sydney 2006, Australia;
- Cancer Research Division, Cancer Council, Brisbane 2011, Australia;
| | - Melissa Kang
- Westmead Clinical School, University of Sydney, Sydney 2006, Australia;
| | - Meredith Temple-Smith
- Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Melbourne 3010, Australia; (L.S.); (M.T.-S.)
| | - Michael Kidd
- Southgate Institute for Health, Flinders University, Adelaide 5042, Australia;
| | - Sharyn Burns
- School of Population Health, Curtin University, Perth 6102, Australia;
| | - Linda Selvey
- School of Public Health, University of Queensland, Brisbane 4072, Australia;
| | - Dennis Meijer
- Immunisation Unit, Health Protection NSW, St Leonards, Sydney 2065, Australia; (D.M.); (S.E.)
| | - Sonya Ennis
- Immunisation Unit, Health Protection NSW, St Leonards, Sydney 2065, Australia; (D.M.); (S.E.)
| | - Chloe A. Thomson
- Department of Health, Communicable Disease Control Directorate, East Perth 6000, Australia; (P.E.); (C.A.T.)
| | - Nikole Lane
- Department of Health and Human Services, Tasmanian Government, Hobart 7001, Australia; (M.V.); (N.L.)
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
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Bedford H, Firman N, Waller J, Marlow L, Forster A, Dezateux C. Which young women are not being vaccinated against HPV? Cross-sectional analysis of a UK national cohort study. Vaccine 2021; 39:5934-5939. [PMID: 34419303 DOI: 10.1016/j.vaccine.2021.07.094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES HPV vaccination is highly effective in preventing HPV-associated disease, including cervical cancer, which disproportionately affects women from disadvantaged and minority ethnic backgrounds. We examined inequalities in initiation of the HPV vaccination schedule among young women in the UK and reasons given by their parents for non-initiation. DESIGN Cross sectional analyses of a prospective nationally representative cohort study. SETTING Four UK countries. PARTICIPANTS 5,695 young women (39.9% from households in lowest income quintiles, 5.1% ever excluded from school, 0.5% not attending school) whose parents (14.3% from minority ethnic backgrounds; 54.1% with no stated religious faith) took part in interviews conducted when their daughters were 14 years old. MAIN OUTCOME MEASURES Parent-reported initiation of HPV vaccination and reasons for non-initiation. The adjusted odds (aORs) and 95% Confidence Intervals (CI) of initiating HPV vaccination were estimated using logistic regression after mutual adjustment for household income, school exclusion, school attendance and parental ethnic background and religious faith. RESULTS 92.3% (5265) had initiated HPV vaccination at time of interview. Initiation was less likely among those living in the poorest households (aOR; 95% CI: 0.44; 0.30 to 0.64 for those in lowest household income quintile), who did not attend school (0.11; 0.04 to 0.33), had ever been excluded from school (0.47; 0.29 to 0.76), or whose parents were from Black African (0.49; 0.26 to 0.95) or Any Other (0.34; 0.17 to 0.66) ethnic backgrounds. A reason consistent with a conscious or practical decision was reported by 53.3% (219) and 24.1% (90) parents respectively. CONCLUSIONS Although most young women are immunised, marked social inequalities in access to HPV vaccination initiation remain. Practical steps to address this are possible and should be implemented to reduce inequalities in primary prevention of cancers and to ensure equitable access to this important public health intervention.
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Affiliation(s)
- Helen Bedford
- Life Course Epidemiology and Biostatistics, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK.
| | - Nicola Firman
- Life Course Epidemiology and Biostatistics, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK; Clinical Effectiveness Group, Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University London, 58 Turner Street, London E1 2AB, UK
| | - Jo Waller
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Laura Marlow
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Alice Forster
- Department of Behavioural Science & Health, Institute of Epidemiology and Health Care, UCL, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Carol Dezateux
- Life Course Epidemiology and Biostatistics, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK; Clinical Effectiveness Group, Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University London, 58 Turner Street, London E1 2AB, UK.
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Dodd RH, Freeman M, Dekaj F, Bamforth J, Miah A, Sasieni P, Louie KS. Awareness of the link between human papillomavirus and oral cancer in UK university students. Prev Med 2021; 150:106660. [PMID: 34081936 DOI: 10.1016/j.ypmed.2021.106660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 05/18/2021] [Accepted: 05/29/2021] [Indexed: 10/21/2022]
Abstract
Awareness of the link between human papillomavirus (HPV) and oral cancer varies across populations. Levels of awareness and factors may impact HPV vaccine uptake in women and the intent to obtain the vaccine in men if it becomes available. A cross-sectional survey of 1415 UK university students (495 men and 920 women) aged 18-25 years was conducted. Women who had and had not received the HPV vaccine were included. Vaccination was not available for men at the time of the survey. Seventy percent of participants had heard of oral cancer but only 25% were aware of the link between HPV and oral cancer. Women who ever engaged in sexual activity (adjusted odds ratio, aOR = 1.74; 95% CI: 1.12-2.72) or had at least one dose of the HPV vaccine (aOR = 1.71; 95% CI: 1.24-2.37) were more likely to be aware. Men who intend to receive the HPV vaccine in the future were more likely to be aware (aOR = 1.62; 95% CI: 1.04-2.53). Non-white women were less likely to be vaccinated (aOR = 0.56; 95% CI: 0.41-0.77). However, being aware was associated with HPV vaccine uptake in women (aOR = 1.65; 95% CI: 1.19-2.28) and borderline associated with the intent to obtain the HPV vaccine in men (aOR = 1.52; 95% CI: 0.99-2.35). Non-heterosexual men were more willing than heterosexuals to receive the vaccine. Following the UK gender-neutral HPV vaccination programme, there is an opportunity to increase awareness about the link between HPV and oral cancers aside from the cervical cancer link to influence HPV vaccine uptake.
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Affiliation(s)
- Rachael H Dodd
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, NSW 2006, Australia.
| | - Madeleine Freeman
- Wolfson Institute of Preventive Medicine, Queen Mary University of London (formerly), UK
| | - Fatjon Dekaj
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | | | - Peter Sasieni
- King's College London, School of Cancer and Pharmaceutical Sciences, Guy's Hospital, London SE1 9RT, UK
| | - Karly S Louie
- Wolfson Institute of Preventive Medicine, Queen Mary University of London (formerly), UK
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Experiences of the coronavirus disease-19 (COVID-19) pandemic from the perspectives of young people: Rapid qualitative study. PUBLIC HEALTH IN PRACTICE 2021; 2:100162. [PMID: 34254057 PMCID: PMC8264271 DOI: 10.1016/j.puhip.2021.100162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/08/2021] [Accepted: 06/28/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives Young people are considered at lower risk from coronavirus disease-19 (COVID-19). However, measures to limit the population health impact of the current COVID-19 pandemic have caused significant disruptions to their lives. The objective of this study was to explore the experiences of young people predominantly living in the south-west of England during the COVID-19 pandemic. Study design Rapid qualitative study. Methods Following advertisement on social media, a purposive sample of young people by age and gender who had expressed an interest were invited to participate. In June 2020, 21 young people (12–17 years) took part in 18 semi-structured interviews, either through a digital platform or by telephone. Interviews were recorded digitally and transcribed verbatim. Thematic analysis was undertaken, assisted by NVvivo Software. Results Young people felt the greatest impacts of the pandemic have been disruption to how they learned because of school closures and limited face-to-face interaction with their social networks. There was variation in terms of how satisfied young people were with self-directed learning at home, and some anxieties in relation to its effectiveness outside the school environment. Most young people reported maintaining social relationships remotely, but some young people appeared to have little social interaction outside their household. High levels of adherence to social distancing and handwashing were reported, which could lead to a sense of injustice resulting from visibility of other people breaching social distancing guidance. Young people were willing to be vaccinated against COVID-19 if a vaccine became available, with the greatest motivator being to protect others above themselves. Conclusions Young people have experienced significant disruption to their education and social networks during the COVID-19 pandemic. During lockdown, high levels of compliance to government public health guidelines to reduce transmission of COVID-19 were reported by young people. If an effective vaccine is developed, a schools-based vaccination programme could be an efficient method to interrupt transmission to more at-risk populations and prevent further disruptions to young people's education. Young people reported mixed experiences of self-directed learning at home. Judgements against those not adhering to social-distancing guidelines were apparent. Motivations to be vaccinated against COVID-19 were driven by high levels of altruism.
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Fisher H, Evans K, Reynolds R, Yates J, Roderick M, Ferrie J, Macleod J, Hickman M, Audrey S. Secondary analyses to test the impact on inequalities and uptake of the schools-based human papillomavirus (HPV) vaccination programme by stage of implementation of a new consent policy in the south-west of England. BMJ Open 2021; 11:e044980. [PMID: 34233969 PMCID: PMC8264897 DOI: 10.1136/bmjopen-2020-044980] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To test the impact on inequalities and uptake of the schools-based human papillomavirus (HPV) vaccination programme by stage of implementation of a new policy providing additional opportunities to consent. SETTING Two local authorities in the south-west of England. PARTICIPANTS Young women (n=7129) routinely eligible for HPV vaccination aged 12-13 years during the intervention period (2017/2018 to 2018/2019 programme years). INTERVENTIONS Local policy change that included additional opportunities to provide consent (parental verbal consent and adolescent self-consent). OUTCOMES Secondary analyses of cross-sectional intervention data were undertaken to examine uptake by: (1) receipt of parental written consent forms and; (2) percentage of unvaccinated young women by stage of implementation. RESULTS During the intervention period, 6341 (89.0%) eligible young women initiated the HPV vaccination series. Parental written consent forms were less likely to be returned where young women attended alternative education provider settings (p<0.001), belonged to non-white British ethnic groups (p<0.01) or more deprived quintiles (p<0.001). Implementation of parental verbal consent and adolescent self-consent reduced the percentage of unvaccinated young women from 21.3% to 16.5% (risk difference: 4.8%). The effect was greater for young women belonging to the most deprived compared with the least deprived quintile (risk difference: 7.4% vs 2.3%, p<0.001), and for young women classified as Unknown ethnic category compared with white British young women (6.7% vs 4.2%, p<0.001). No difference was found for non-white British young women (5.4%, p<0.21). CONCLUSIONS Local policy change to consent procedures that allowed parents to consent verbally and adolescents to self-consent overcame some of the barriers to vaccination of young women belonging to families less likely to respond to paper-based methods of gaining consent and at greater risk of developing cervical cancer. TRIAL REGISTRATION NUMBER 49 086 105.
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Affiliation(s)
- Harriet Fisher
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Karen Evans
- Sirona Care and Health CIC, Kingswood, South Gloucestershire, UK
| | - Rosy Reynolds
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Julie Yates
- Screening and Immunisations South West, Public Health England, London, UK
| | - Marion Roderick
- Department of Paediatric Immunology & Infectious Diseases, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, Bristol, UK
| | - Jo Ferrie
- Screening and Immunisations South West, Public Health England, London, UK
| | - John Macleod
- Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Biomedical Research Centre and NIHR CLAHRC West, University of Bristol, Bristol, UK
| | | | - Suzanne Audrey
- Bristol Medical School, University of Bristol, Bristol, UK
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Paterson P, Mounier-Jack S, Saliba V, Yarwood J, White J, Ramsay M, Chantler T. Strengthening HPV vaccination delivery: findings from a qualitative service evaluation of the adolescent girls' HPV vaccination programme in England. J Public Health (Oxf) 2021; 43:189-196. [PMID: 31219155 PMCID: PMC8042364 DOI: 10.1093/pubmed/fdz061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/30/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 2014, the number of HPV vaccine doses given to adolescent girls as part of the English school-based immunization programme was reduced from three to two. This was based on evidence that a two-dose schedule provides long-lasting protection against HPV infection. In 2015/16 a small decline in HPV vaccination coverage in adolescent girls was noted; from 86.7% for the three-dose schedule in 2013/14 to 85.1% for the two-dose schedule. This evaluation examined whether service-related factors contributed to this decline. METHODS In May-August 2017, we conducted semi-structured qualitative interviews with 39 participants responsible for commissioning or delivering immunization programmes in six local authorities in the South West, North Central Midlands and South Central Midlands, England. RESULTS Effective planning and data management were key for successful service provision of HPV vaccination, as well as close collaboration between commissioners, service providers and data system managers, a team skill mix with experienced staff, pro-active engagement with schools and service providers equipped to respond to parental concerns. CONCLUSIONS To maintain and improve the high HPV adolescent girls' vaccine coverage rates achieved in England, in the context of an expanding school-based immunization programme, it is essential to strengthen the organizational capacity of the delivery system.
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Affiliation(s)
- P Paterson
- The Vaccine Confidence Project, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - S Mounier-Jack
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - V Saliba
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - J Yarwood
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - J White
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - M Ramsay
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - T Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Toh ZQ, Russell FM, Garland SM, Mulholland EK, Patton G, Licciardi PV. Human Papillomavirus Vaccination After COVID-19. JNCI Cancer Spectr 2021; 5:pkab011. [PMID: 33748668 PMCID: PMC7962726 DOI: 10.1093/jncics/pkab011] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/22/2020] [Accepted: 01/12/2021] [Indexed: 12/24/2022] Open
Abstract
The current global novel coronavirus disease 2019 (COVID-19) pandemic threatens to derail the uptake of human papillomavirus (HPV) vaccination in low- and lower-middle income countries with major disruptions to routine immunization and the introduction of new vaccines delayed. This has a major impact on the World Health Organization cervical cancer elimination strategy, where it is dependent on HPV vaccination as well as cervical cancer screening and treatment. We discuss current opportunities and barriers to achieve high uptake of HPV vaccination in low- and lower-middle income countries as well as the impact of COVID-19. Implementation of 4 key recommendations for HPV vaccination in low- and lower-middle income countries is needed: increased global financial investment; improved vaccine supply and accelerated use of a single-dose schedule; education and social marketing; and adoption of universal school-based delivery. With the commitment of the global health community, the adoption of these strategies would underpin the effective elimination of cervical cancer.
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Affiliation(s)
- Zheng Quan Toh
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Fiona M Russell
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Suzanne M Garland
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynecology, The University of Melbourne, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Parkville, Australia
| | - Edward K Mulholland
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - George Patton
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Paul V Licciardi
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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Frio GS, França MTA. Human papillomavirus vaccine and risky sexual behavior: Regression discontinuity design evidence from Brazil. ECONOMICS AND HUMAN BIOLOGY 2021; 40:100946. [PMID: 33264703 DOI: 10.1016/j.ehb.2020.100946] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 08/16/2020] [Accepted: 11/06/2020] [Indexed: 06/12/2023]
Abstract
This study aims to analyze the hypothesis of moral hazard caused by vaccination against human papillomavirus (HPV), regarding girls' beginning of sex life and, once they have begun their sex life, to understand whether it reduces the probability of girls using a condom in their first sexual intercourse. The data are from the 2015 National Survey of School Health (PeNSE). The model used is the regression discontinuity, with the discontinuity in the age of the girls who were able to participate in the public vaccination campaign. The results of the so-called Fuzzy-RDD show that the campaign was effective in increasing the likelihood of vaccination by 26.7-27.6 percentage points. There is no observable effect on young women initiating their sex lives or refraining from using condoms. The results are tested by several robustness methods. This is the first work to use quasi-experimental models in a developing country with low vaccination coverage in Latin America and show that it is necessary to increase awareness campaigns with parents, so they will know that there is no effect of vaccination on the beginning of sex life and condom use.
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de Munter AC, Ruijs WLM, Ruiter RAC, van Nimwegen DJJ, Oerlemans AJM, van Ginkel R, Hulscher MEJL, Hautvast JLA. Decision-making on maternal pertussis vaccination among women in a vaccine-hesitant religious group: Stages and needs. PLoS One 2020; 15:e0242261. [PMID: 33180859 PMCID: PMC7660565 DOI: 10.1371/journal.pone.0242261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 10/29/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION As of December 2019, pregnant women in the Netherlands are offered pertussis vaccination to protect their newborn infant against pertussis infection. However, the manner in which pregnant women decide about this maternal pertussis vaccination is largely unknown. The aim of this study is to gain insight into the decision-making process regarding maternal pertussis vaccination, and to explore the related needs among the vaccine-hesitant subgroup of orthodox Protestant women. METHODS Charmaz's grounded theory approach was used to develop a decision-making framework. To construct this framework we used an explorative multimethod approach in which in-depth interviews and online focus groups were supplemented by a literature search and research group meetings. This study was carried out in a hypothetical situation since the maternal pertussis vaccination had yet to be implemented in the Dutch immunisation programme at the time of the study. RESULTS Twenty-five orthodox Protestant women participated in an interview, an online focus group, or in both. The findings of this study resulted in a decision-making framework that included three stages of decision-making; an Orientation stage, a value-based Deliberation stage, and Final decision stage. The Orientation stage included the needs for decision-making categorised into Information needs and Conversation needs. Women indicated that -if they were to receive sufficient time for Orientation and Deliberation- they would be able to reach the stage of Final decision. CONCLUSION The decision-making framework resulting from our findings can be used by health care professionals to provide women with information and consultation in the decision-making process. Future studies should investigate whether the stages of and needs for decision-making can be found across other vaccine-hesitant subgroups and vaccinations.
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Affiliation(s)
- Anne C. de Munter
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Infectious Disease Control, GGD Gelderland-Zuid, Nijmegen, The Netherlands
| | - Wilhelmina L. M. Ruijs
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Infectious Disease Control, GGD Gelderland-Zuid, Nijmegen, The Netherlands
| | - Robert A. C. Ruiter
- Department of Work & Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Dagmar J. J. van Nimwegen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Infectious Disease Control, GGD Gelderland-Zuid, Nijmegen, The Netherlands
| | - Anke J. M. Oerlemans
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rijk van Ginkel
- “Fruits of Passion; Together Fighting Human Suffering”, Bodegraven, The Netherlands
| | - Marlies E. J. L. Hulscher
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeannine L. A. Hautvast
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Fisher H, Evans K, Ferrie J, Yates J, Roderick M, Audrey S. Young women's autonomy and information needs in the schools-based HPV vaccination programme: a qualitative study. BMC Public Health 2020; 20:1680. [PMID: 33172415 PMCID: PMC7654043 DOI: 10.1186/s12889-020-09815-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 11/02/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Until 2019, the English schools-based human papillomavirus (HPV) vaccination programme was offered to young women (but not young men) aged 12 to 13 years to reduce HPV-related morbidity and mortality. The aim of this study is to explore the extent to which young women were able to exercise autonomy within the HPV vaccination programme. We consider the perspectives of young women, parents and professionals and how this was influenced by the content and form of information provided. METHODS Recruitment was facilitated through a healthcare organisation, schools and community organisations in a local authority in the south-west of England. Researcher observations of HPV vaccination sessions were carried out in three schools. Semi-structured interviews took place with 53 participants (young women, parents of adolescent children, school staff and immunisation nurses) during the 2017/18 and 2018/19 programme years. Interviews were recorded digitally and transcribed verbatim. Thematic analysis was undertaken, assisted by NVivo software. RESULTS Young women's active participation and independence within the HPV vaccination programme was constrained by the setting of vaccination and the primacy of parental consent procedures. The authoritarian school structure influenced the degree to which young women were able to actively participate in decisions about the HPV vaccination programme. Young women exercised some power, either to avoid or receive the vaccine, by intercepting parental consent forms and procedures. Reliance on leaflets to communicate information led to unmet information needs for young women and their families. Communication may be improved by healthcare professional advocacy, accessible formats of information, and delivery of educational sessions. CONCLUSIONS Strategies to improve communication about the HPV vaccine may increase young people's autonomy in consent procedures, clarify young people's rights and responsibilities in relation to their health care services, and result in higher uptake of the HPV vaccination programme. TRIAL REGISTRATION ISRCTN 49086105 ; Date of registration: 12 January 2018; Prospectively registered.
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Affiliation(s)
- Harriet Fisher
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Karen Evans
- Head of School Nursing and Specialist Nursing Services, Sirona Health & Care, Bristol, South Gloucestershire, UK
| | - Jo Ferrie
- Screening and Immunisations South West, Public Health England, Bristol, UK
| | - Julie Yates
- Screening and Immunisations South West, Public Health England, Bristol, UK
| | - Marion Roderick
- Department of Paediatric Immunology & Infectious Diseases, University Hospitals Bristol and Weston NHS Trust, Bristol, UK
| | - Suzanne Audrey
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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Fisher H, Audrey S, Chantler T, Finn A, Letley L, Mounier-Jack S, Thomas C, Yates J, Hickman M. Co-production of an educational package for the universal human papillomavirus (HPV) vaccination programme tailored for schools with low uptake: a participatory study protocol. BMJ Open 2020; 10:e039029. [PMID: 33148744 PMCID: PMC7643513 DOI: 10.1136/bmjopen-2020-039029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/01/2020] [Accepted: 10/11/2020] [Indexed: 11/24/2022] Open
Abstract
AIM To co-produce with young people an educational package about the human papillomavirus (HPV) vaccine that is tailored to increase vaccine uptake in schools and populations with lower uptake. INTRODUCTION Persistent infection with HPV can result in cancers affecting men and especially women. From September 2019, the English-schools-based HPV vaccination programme was expanded to include young men (in addition to young women) aged 12-13 years. Some young people attending schools with lower uptake of the vaccine have unmet information needs. We hypothesise that mechanisms to address information needs and increase young people's autonomy in consent procedures will result in higher uptake. METHODS AND ANALYSIS The Medical Research Council's framework for development and evaluation of complex interventions will inform intervention development. Recruitment of young people aged 12-15 years and key stakeholders (National Health Service commissioners, school staff, immunisation nurses and youth workers/practitioners) will be facilitated through existing links with healthcare organisations, schools and youth organisations in areas with lower uptake of the HPV vaccination programme. The proposed research will comprise three phases: (1) a rapid review of adolescent immunisation materials and preliminary qualitative interviews with young people and key stakeholders, (2) theory development and co-production of HPV vaccine communication materials through an iterative process with young people and (iii) testing delivery mechanisms and acceptability of the educational package in four schools with lower uptake. ETHICS AND DISSEMINATION The University of Bristol's Faculty of Health Sciences and London School of Hygiene and Tropical Medicine's Research Ethics Committees provided approvals for the study. A dissemination event for young people and key stakeholders and webinar with the National Immunisation Network will be organised. The study findings will be published in peer-reviewed journals and presented at conferences. Recommendations for a future larger scale study will be made.
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Affiliation(s)
- Harriet Fisher
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Suzanne Audrey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tracey Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Adam Finn
- Division of Clinical Sciences, University of Bristol, Bristol, UK
| | - Louise Letley
- National Infection Service, Public Health England, London, UK
| | - Sandra Mounier-Jack
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Clare Thomas
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Chantler T, Pringle E, Bell S, Cooper R, Edmundson E, Nielsen H, Roberts S, Edelstein M, Mounier-Jack S. Does electronic consent improve the logistics and uptake of HPV vaccination in adolescent girls? A mixed-methods theory informed evaluation of a pilot intervention. BMJ Open 2020; 10:e038963. [PMID: 33148741 PMCID: PMC7640514 DOI: 10.1136/bmjopen-2020-038963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate the usability and acceptability of an electronic consent pilot intervention for school-based immunisations and assess its impact on consent form returns and human papilloma virus (HPV) vaccine uptake. DESIGN Mixed-methods theory-informed study applying qualitative methods to examine the usability and acceptability of the intervention and quantitative methods to assess its impact. SETTING AND PARTICIPANTS The intervention was piloted in 14 secondary schools in seven London boroughs in 2018. Intervention schools were matched with schools using paper consent based on the proportion of students with English as a second language and students receiving free school meals. Participants included nurses, data managers, school-link staff, parents and adolescents. INTERVENTIONS An electronic consent portal where parents could record whether they agreed to or declined vaccination, and nurses could access data to help them manage the immunisation programme. PRIMARY AND SECONDARY OUTCOME MEASURES Comparison of consent form return rates and HPV vaccine uptake between intervention and matched schools. RESULTS HPV vaccination uptake did not differ between intervention and matched schools, but timely consent form return was significantly lower in intervention schools (73.3% vs 91.6%, p=0.008). The transition to using electronic consent was not straightforward, while schools and staff understood the potential benefits, they found it difficult to adapt to new ways of working which removed some level of control from schools. Reasons for lower consent form return in e-consent schools included difficulties encountered by some parents in accessing and using the intervention. Adolescents highlighted the potential for electronic consent to by-pass their information needs. CONCLUSIONS The pilot intervention did not improve consent form return or vaccine uptake due to challenges encountered in transitioning to new working practice. New technologies require embedding before they become incorporated in everyday practice. A re-evaluation once stakeholders are accustomed with electronic consent may be required to understand its impact.
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Affiliation(s)
- Tracey Chantler
- Department of Global Health and Development, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ellen Pringle
- Department of Immunisation, Hepatitis and Blood Safety, Public Health England, London, UK
| | - Sadie Bell
- Department of Global Health and Development, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rosie Cooper
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Emily Edmundson
- Hounslow and Richmond Community Healthcare NHS Trust, Teddington, Greater London, UK
| | - Heidi Nielsen
- Hounslow and Richmond Community Healthcare NHS Trust, Teddington, Greater London, UK
| | - Sheila Roberts
- Hounslow and Richmond Community Healthcare NHS Trust, Teddington, Greater London, UK
| | - Michael Edelstein
- Department of Immunisation, Hepatitis and Blood Safety, Public Health England, London, UK
| | - Sandra Mounier-Jack
- Department of Global Health and Development, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
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Audrey S, Farr M, Roderick M, Evans K, Fisher H. How acceptable is adolescent self-consent for the HPV vaccination: Findings from a qualitative study in south-west England. Vaccine 2020; 38:7472-7478. [PMID: 33041101 PMCID: PMC7604563 DOI: 10.1016/j.vaccine.2020.09.074] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 09/17/2020] [Accepted: 09/25/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Human Papillomavirus (HPV) vaccination programmes have the potential to reduce the incidence of cervical cancer. The preferred age for HPV vaccination is 12-13 years for optimal benefit. The legal framework in England allows adolescents to be vaccinated without parental consent if they are assessed as competent. A 'South West Template Pathway on Self Consent for School Aged Immunisations' was developed to improve uptake of immunisations in south-west England. STUDY AIM To examine how acceptable the new procedures are to the young women, parents and carers, school staff and immunisation nurses involved. METHODS The research was undertaken in two local authorities in south-west England during the 2017/18 and 2018/19 programme years. Semi-structured digitally recorded interviews were undertaken with 53 participants: one health service manager, three immunisation nurses, five staff at alternative education providers, three staff at mainstream schools, 19 young women and 22 parents. All recordings were transcribed verbatim and thematic analysis was undertaken, assisted by NVivo software. RESULTS Most participants were not fully aware of the legal framework that enables a young person to self-consent to vaccination. There was a strong presumption that parents should make decisions affecting the health of their children. The preferred age at which the HPV vaccination is administered (12-13 years) contributed to reluctance in endorsing self-consent which was thought to have the potential to break down trust between parents and school staff, and within families. In practice, formal self-consent was rare. CONCLUSION Unresolved issues in relation to adolescent self-consent include public and professional perceptions of young people's rights and abilities to take responsibility for decisions affecting their health, and concerns about the impact of self-consent on relationships both within families and between professionals and the families they serve.
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Affiliation(s)
- Suzanne Audrey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Michelle Farr
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Marion Roderick
- Department of Paediatric Immunology & Infectious Diseases, Bristol Children's Hospital, Bristol, UK
| | - Karen Evans
- Head of School Nursing (Sirona) and Specialist Nursing Services, Bristol and South Gloucestershire, UK
| | - Harriet Fisher
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Fisher H, Hickman M, Ferrie J, Evans K, Bell M, Yates J, Roderick M, Reynolds R, MacLeod J, Audrey S. Impact of new consent procedures on uptake of the schools-based human papillomavirus (HPV) vaccination programme. J Public Health (Oxf) 2020; 44:199-206. [PMID: 32978614 PMCID: PMC8904199 DOI: 10.1093/pubmed/fdaa164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 08/18/2020] [Accepted: 08/22/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Local policy change initiating new consent procedures was introduced during 2017-2018 for the human papillomavirus (HPV) vaccination programme year in two local authorities in the south-west of England. This study aims to assess impact on uptake and inequalities. METHODS Publicly available aggregate and individual-level routine data were retrieved for the programme years 2015-2016 to 2018-2019. Statistical analyses were undertaken to show: (i) change in uptake in intervention local authorities in comparison to matched local authorities and (ii) change in uptake overall, and by local authority, school type, ethnicity and deprivation. RESULTS Aggregate data showed uptake in Local Authority One increased from 76.3% to 82.5% in the post-intervention period (risk difference: 6.2% P = 0.17), with a difference-in-differences effect of 11.5% (P = 0.03). There was no evidence for a difference-in-differences effect in Local Authority Two (P = 0.76). Individual-level data showed overall uptake increased post-intervention (risk difference: +1.1%, P = 0.05), and for young women attending school in Local Authority One (risk difference: 2.3%, P < 0.01). No strong evidence for change by school category, ethnic group and deprivation was found. CONCLUSION Implementation of new consent procedures can improve and overcome trends for decreasing uptake among matched local authorities. However, no evidence for reduction in inequalities was found. IMPLICATIONS AND DISCUSSION The new consent procedures increased uptake in one of the intervention sites and appeared to overcome trends for decreasing uptake in matched sites. There are issues in relation to the quality of data which require addressing.
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Affiliation(s)
- Harriet Fisher
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joanne Ferrie
- Screening and Immunisations South West, Public Health England, Tauton, UK
| | - Karen Evans
- Sirona Care & Health, Bristol and South Gloucestershire, Bristol, UK
| | - Michael Bell
- Bristol Biomedical Research Centre and NIHR CLAHRC West, Bristol, UK
| | - Julie Yates
- Screening and Immunisations South West, Public Health England, Tauton, UK
| | - Marion Roderick
- Department of Paediatric Immunology & Infectious Disease, Bristol Royal Hospital for Children, Bristol, UK
| | - Rosy Reynolds
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - John MacLeod
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Suzanne Audrey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Rockliffe L, McBride E, Heffernan C, Forster AS. Factors Affecting Delivery of the HPV Vaccination: A Focus Group Study With NHS School-Aged Vaccination Teams in London. J Sch Nurs 2020; 36:135-143. [PMID: 30079792 PMCID: PMC7323732 DOI: 10.1177/1059840518792078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study sought to identify barriers and facilitators to delivery of human papillomavirus (HPV) vaccination in schools. Four focus groups were conducted with 28 staff members, from four National Health Service school-aged vaccination (SAV) teams in London. Data were analyzed using thematic analysis. School engagement and support, and understanding and education about the vaccination (or conversely, a lack of) were identified as both barriers and facilitators. Limited school and team resources, fear of the vaccination, and poor consent form return were identified as barriers. Explanations for why some girls do not complete the vaccination series were provided. Individualizing approaches used to promote and encourage the vaccination was identified as a facilitating factor. Optimal delivery of the HPV vaccination program is dependent on school engagement and the allocation of time for SAV teams to promote vaccination uptake. Immunization program providers should work with schools to improve understanding and support of the HPV vaccination program.
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Affiliation(s)
- Lauren Rockliffe
- Research Department of Behavioural Science and Health, UCL, London, UK
| | - Emily McBride
- Research Department of Behavioural Science and Health, UCL, London, UK
| | | | - Alice S. Forster
- Research Department of Behavioural Science and Health, UCL, London, UK
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George C, Roberts R, Brennen D, Deveaux L, Read SE. Knowledge and awareness of Human Papillomavirus (HPV) and HPV vaccines among Caribbean youth: the case of the Bahamas. Hum Vaccin Immunother 2019; 16:573-580. [PMID: 31464555 PMCID: PMC7227632 DOI: 10.1080/21645515.2019.1661205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
There is a high burden of cervical cancer in the Caribbean region, particularly in the Bahamas, yet there are few studies of Human Papillomavirus (HPV) and HPV vaccine in the region. The objective of this study was to assess the knowledge and awareness of HPV and the HPV vaccine among school-aged youth (15–18 years) living in the Bahamas. Cross-sectional data were obtained from the “Getting to Zero” HIV study in the Bahamas conducted in 2014/2015 (n = 1553). The questionnaire elicited information on knowledge of HPV and HPV vaccines, using previously validated scales. Data analysis included Chi-square tests and Mann Whitney U test. In this sample of school-aged youth, only 10.7% (146/1364) had ever heard of HPV. With respect to those who were sexually active (n = 685), only 10.7% had ever heard of HPV. For those who had heard of HPV, knowledge of HPV and HPV vaccines was assessed on an HPV Knowledge and HPV Vaccine Knowledge scale, respectively. There was no statistically significant difference in mean HPV knowledge score between males and females, or HPV vaccine knowledge scores, between males and females. There was a general lack of awareness of HPV and HPV vaccines among school-aged youth in the Bahamas. This is an important gap in the HPV vaccine strategy and cancer prevention, as this is the age at which most people acquire HPV. It emphasizes the importance of developing a careful implementation plan, with an evaluation of knowledge and attitudes, in order to have an effective HPV vaccine uptake.
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Affiliation(s)
- Clemon George
- University of Ontario Institute of Technology and Faculty of Medical Sciences, Oshawa, Ontario and the University of the West Indies, Cave Hill, Barbados
| | - Robin Roberts
- UWI School of Clinical Medicine and Research, Nassau, The Bahamas
| | | | | | - Stanley E Read
- Division of Infectious Diseases, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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O'Neill J, Newall F, Antolovich G, Lima S, Danchin MH. Adolescent immunisation in young people with disabilities in Australia. Med J Aust 2019; 211:199-200.e1. [PMID: 31342525 DOI: 10.5694/mja2.50293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jenny O'Neill
- University of Melbourne, Melbourne, VIC.,Royal Children's Hospital, Melbourne, VIC
| | | | - Giuliana Antolovich
- Royal Children's Hospital, Melbourne, VIC.,Murdoch Children's Research Institute, Melbourne, VIC
| | - Sally Lima
- University of Melbourne, Melbourne, VIC.,Bendigo Health, Bendigo, VIC
| | - Margie H Danchin
- Royal Children's Hospital, Melbourne, VIC.,Murdoch Children's Research Institute, Melbourne, VIC
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Chantler T, Letley L, Paterson P, Yarwood J, Saliba V, Mounier-Jack S. Optimising informed consent in school-based adolescent vaccination programmes in England: A multiple methods analysis. Vaccine 2019; 37:5218-5224. [PMID: 31351797 DOI: 10.1016/j.vaccine.2019.07.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/29/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Abstract
The process of obtaining informed consent for school-based adolescent immunisation provides an opportunity to engage families. However, the fact that parental consent needs to be obtained remotely adds complexity to the process and can have a detrimental effect on vaccine uptake. We conducted a multiple methods analysis to examine the practice of obtaining informed consent in adolescent immunisation programmes. This involved a thematic analysis of consent related data from 39 interviews with immunisation managers and providers collected as part of a 2017 service evaluation of the English adolescent girls' HPV vaccine programme and a descriptive statistical analysis of data from questions related to consent included in a 2017 survey of parents' and adolescents' attitudes to adolescent vaccination. The findings indicated that the non-return of consent forms was a significant logistical challenge for immunisation teams, and some were piloting opt-out consent mechanisms, increasing the proportion of adolescents consenting for their own immunisations, and introducing electronic consent. Communicating vaccine related information to parents and schools and managing uncertainties about obtaining adolescent self-consent for vaccination were the main practical challenges encountered. Survey data showed that parents and adolescents generally agreed on vaccine decisions although only 32% of parents discussed vaccination with their teenager. Parental awareness about the option for adolescents to self-consent for vaccination was limited and adolescents favoured leaving the decision-making to parents. From the interviews and variability of consent forms it was evident that health professionals were not always clear about the best way to manage the consent process. Some were also unfamiliar with self-consent processes and lacked confidence in assessing for 'Gillick competency'. Developing pathways and related interventions to improve the logistics and practice of consent in school-based adolescent immunisation programmes could help improve uptake.
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Affiliation(s)
- Tracey Chantler
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, UK.
| | - Louise Letley
- Department of Immunisation, Hepatitis and Blood Safety, Public Health England, UK
| | - Pauline Paterson
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, UK
| | - Joanne Yarwood
- Department of Immunisation, Hepatitis and Blood Safety, Public Health England, UK
| | - Vanessa Saliba
- Department of Immunisation, Hepatitis and Blood Safety, Public Health England, UK
| | - Sandra Mounier-Jack
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, UK
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Mammas IN, Dalianis T, Doukas SG, Zaravinos A, Achtsidis V, Thiagarajan P, Theodoridou M, Spandidos DA. Paediatric virology and human papillomaviruses: An update. Exp Ther Med 2019; 17:4337-4343. [PMID: 31186676 PMCID: PMC6507507 DOI: 10.3892/etm.2019.7516] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/17/2019] [Indexed: 12/12/2022] Open
Abstract
Almost 10 years ago, in October, 2008, the scientist who reported for the first time the association between human papillomaviruses (HPV) and cervical cancer, was awarded with the Nobel prize. In the years that followed, Professor Harald zur Hausen actively supported the value of the HPV vaccination in the prevention of different types of cancer and highlighted the necessity of its introduction in both girls and boys. However, to date, in the majority of countries, HPV vaccination among male adolescents has not been implemented into the national vaccination schemes, while in several countries, including Greece, the participation rate to HPV vaccination among female adolescents still remains low. Recent data indicate that catch-up HPV vaccination among young women has been extremely useful and has exhibited a significant effect in decreasing the prevalence of HPV. While the marketed current HPV vaccines prevent anogenital HPV infection, their impact on the natural history of oral HPV and their efficacy in preventing HPV-related head and neck carcinomas need to be further investigated. Juvenile onset recurrent respiratory papillomatosis, as well as HPV-associated conjunctival papillomas continue to be observed in childhood and their clinical management involves different therapeutic approaches with controversial outcomes. This review article provides an overview of recent views and advances on HPV infections and prevention in childhood that were presented at the '4th Workshop on Paediatric Virology' on Saturday September 22, 2018 in Athens, Greece.
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Affiliation(s)
- Ioannis N. Mammas
- Department of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Tina Dalianis
- Karolinska Institutet, Karolinska University Hospital, SE-117 77 Stockholm, Sweden
| | - Sotiros G. Doukas
- Department of Surgery (Otolaryngology), Yale School of Medicine, New Haven, CT 06519, USA
| | - Apostolos Zaravinos
- Department of Life Sciences, School of Sciences, European University Cyprus, 1516 Nicosia, Cyprus
| | - Vassilis Achtsidis
- Department of Ophthalmology, Royal Cornwall Hospitals NHS Trust, TR1 3LQ Cornwall, UK
| | - Prakash Thiagarajan
- Neonatal Unit, Division for Women and Children's Health, Noble's Hospital, IM4 4RJ Douglas, Isle of Man, British Isles
| | - Maria Theodoridou
- First Department of Paediatrics, ‘Aghia Sophia’ Children's Hospital, University of Athens School of Medicine, 115 27 Athens, Greece
| | - Demetrios A. Spandidos
- Department of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
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Dubé E, Gagnon D, Clément P, Bettinger JA, Comeau JL, Deeks S, Guay M, MacDonald S, MacDonald NE, Mijovic H, Paragg J, Rubincam C, Sauvageau C, Steenbeck A, Wilson S. Challenges and opportunities of school-based HPV vaccination in Canada. Hum Vaccin Immunother 2019; 15:1650-1655. [PMID: 30633622 DOI: 10.1080/21645515.2018.1564440] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Primary prevention of human papillomavirus (HPV) through vaccination is a high priority in Canada's cancer prevention efforts. All Canadian provinces and territories have introduced publicly funded, school-based vaccination programs against HPV, but vaccine uptake remains suboptimal in some jurisdictions. We conducted a descriptive qualitative study to better understand the determinants of low HPV vaccine uptake and identify strategies to enhance vaccine acceptance using the socio-ecological model. In Quebec, interviews and focus groups were held in 2015-2016 with 70 key informants including immunization managers, school nurses, school principals, teachers and parents of Grade 4 students (9 years of age). Our findings showed that HPV vaccine uptake was dependent on many interrelated factors at the individual and interpersonal level (e.g. knowledge and attitudes of the different players involved in the vaccination system), at the community level (e.g. social group values and norms, media coverage around the HPV vaccine), at the organizational level (e.g. allocated resources, information provision, consent process, immunization setting and environment) and at the policy level (e.g. changes in provincial HPV vaccine program). We are using the data collection and interpretation tools and approaches developed by our team and used in Quebec to expand our study to four other provinces (British Columbia, Alberta, Ontario and Nova Scotia). We are conducting environmental scans, semi-structured interviews and a survey to better understand the determinants of low HPV vaccine uptake and identify strategies to enhance vaccine acceptance. Having an in-depth understanding of the determinants of HPV vaccination in school settings is critical in order to identify root causes of the suboptimal vaccine uptake and to develop tailored interventions to address these on both supply- and demand-side issues.
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Affiliation(s)
- Eve Dubé
- a Département des risques biologiques et de la santé au travail, Institut national de santé publique du Québec (INSPQ) , Québec , QC , Canada.,b Axe maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec-Université Laval , Québec , QC , Canada.,c Départements d'anthropologie et de médecine sociale et communautaire, Université Laval , Québec , QC , Canada
| | - Dominique Gagnon
- a Département des risques biologiques et de la santé au travail, Institut national de santé publique du Québec (INSPQ) , Québec , QC , Canada
| | - Paule Clément
- a Département des risques biologiques et de la santé au travail, Institut national de santé publique du Québec (INSPQ) , Québec , QC , Canada
| | - Julie A Bettinger
- d Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia , Vancouver , British Columbia , Canada
| | - Jeannette L Comeau
- e Department of Pediatrics, Dalhousie University and IWK Health Centre , Halifax , Nova Scotia , Canada
| | - Shelley Deeks
- f Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario , Toronto , Ontario , Canada.,g Dalla Lana School of Public Health, University of Toronto , Toronto , Ontario , Canada
| | - Maryse Guay
- a Département des risques biologiques et de la santé au travail, Institut national de santé publique du Québec (INSPQ) , Québec , QC , Canada.,h Centre de recherche CSIS, Université de Sherbrooke , Longueuil , QC , Canada
| | - Shannon MacDonald
- i Faculty of Nursing, University of Alberta , Edmonton , AB , Canada
| | - Noni E MacDonald
- e Department of Pediatrics, Dalhousie University and IWK Health Centre , Halifax , Nova Scotia , Canada
| | - Hana Mijovic
- d Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia , Vancouver , British Columbia , Canada
| | - Jillian Paragg
- h Centre de recherche CSIS, Université de Sherbrooke , Longueuil , QC , Canada
| | - Clara Rubincam
- d Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia , Vancouver , British Columbia , Canada
| | - Chantal Sauvageau
- a Département des risques biologiques et de la santé au travail, Institut national de santé publique du Québec (INSPQ) , Québec , QC , Canada.,b Axe maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec-Université Laval , Québec , QC , Canada.,c Départements d'anthropologie et de médecine sociale et communautaire, Université Laval , Québec , QC , Canada
| | - Audrey Steenbeck
- e Department of Pediatrics, Dalhousie University and IWK Health Centre , Halifax , Nova Scotia , Canada
| | - Sarah Wilson
- f Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario , Toronto , Ontario , Canada.,g Dalla Lana School of Public Health, University of Toronto , Toronto , Ontario , Canada
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Carvalho AMCD, Andrade EMLR, Nogueira LT, Araújo TMED. HPV VACCINE ADHERENCE AMONG ADOLESCENTS: INTEGRATIVE REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2019. [DOI: 10.1590/1980-265x-tce-2018-0257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to identify what factors are connected to adolescent adherence to the vaccination against Human Papillomavirus. Method: integrative developed using the following data base: Medical Literature Analysis and Retrieval System Online and Web of Science, Cumulative Index to Nursing and Allied Health Literature, Literatura Latino-Americana e do Caribe em Ciências da Saúde (Latin-American and Caribbean Literature in Health Sciences), and Base de dados de Enfermagem (Nursing Database); using the descriptors and keywords: Papillomaviridae, immunization, vaccines. The final sample had 31 original articles. Result: Vaccine adherence predictors were identified as: knowledge about virus infection risk, vaccination and its benefits; cervical cancer and genital warts prevention; sexual activity; being over 14 years old; mothers’ intention to adhere to vaccination; mother-child communication about sexually transmitted infections, contraception and condoms; vaccination offered in school; recommendation by teachers and health professionals; vaccine safety and effectiveness. Conclusion: Evidence points towards the necessity to redesign the presentation strategy of the vaccine, because despite the cultural differences among the countries where the studies were carried out, it is noticeable that society shelters adolescents aged from 10 to 14 years old, considering it early for sexual initiation and presenting difficulties to broach sexuality-related topics with children.
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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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Abstract
INTRODUCTION The recent global expansion of routine adolescent vaccination programmes has the potential to protect young people against the acquisition of infectious disease and improve their health. Although in many countries the legal framework supports young people to provide consent for medical interventions if they are considered competent, written parental consent can act as a barrier to uptake as it is frequently a condition of adolescent vaccination programmes. The aim of this systematic review protocol is to document the methods which will be used to identify, appraise and synthesise the available qualitative and quantitative evidence to address: (1) whether implementation of adolescent self-consent procedures can increase vaccination uptake and (2) the barriers and facilitators to implementation of adolescent self-consent procedures. METHODS AND ANALYSIS Comprehensive search strategy of all relevant electronic databases for both qualitative and quantitative studies using predefined inclusion and exclusion criteria. At least two authors will independently review titles and abstracts, extract data and assess the methodological quality of eligible primary studies, resolving disagreements by consensus. Quantitative studies will be reported narratively and where possible pooled in a meta-analysis using a random-effects model. The findings of qualitative primary studies will be extracted, interpreted and synthesised to identify overarching themes as well as similarities and differences within those themes. ETHICS AND DISSEMINATION As this systematic review involves analysis of secondary data, the study does not require ethical approvals. We will use our findings to assess whether the evidence supports the hypothesis that self-consent procedures can increase coverage of adolescent vaccination programmes. We will identify barriers and facilitators to the implementation of adolescent self-consent for vaccination and make recommendations for policy makers and practitioners in relation to consent procedures within vaccination programmes for young people. PROSPERO REGISTRATION NUMBER CRD42017084509.
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Affiliation(s)
- Harriet Fisher
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - John Macleod
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Suzanne Audrey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Wiley DJ, Mastro KA. An effective human papillomavirus vaccination policy will reduce infection- and malignancy-related morbidity and mortality. Nurs Outlook 2018; 66:319-324. [PMID: 29724449 DOI: 10.1016/j.outlook.2018.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Audrey S, Batista Ferrer H, Ferrie J, Evans K, Bell M, Yates J, Roderick M, MacLeod J, Hickman M. Impact and acceptability of self-consent procedures for the school-based human papillomavirus vaccine: a mixed-methods study protocol. BMJ Open 2018; 8:e021321. [PMID: 29502095 PMCID: PMC5879539 DOI: 10.1136/bmjopen-2017-021321] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The human papillomavirus (HPV) vaccine, administered in early adolescence, can substantially reduce cervical cancer incidence and mortality. However, lack of written parental consent is a key reason why some young women do not receive the vaccine. The national legal framework allows girls to be vaccinated without parental consent provided they are deemed Gillick competent, but there is some reticence about vaccinating without written parental consent. Self-consent procedures are being implemented in Bristol and South Gloucestershire. This study will examine the implementation, acceptability and impact of these new procedures. METHODS AND ANALYSIS Statistical analyses of routine data from Public Health England and the Child Health Information System will test if there has been an increase in HPV vaccination uptake in two ways: (a) Is there an increase when comparing before and after the change in our intervention sites? and (b) Does the percentage change in our intervention sites differ from comparison sites (similar to our intervention sites in terms of initial HPV uptake, ethnicity and deprivation levels) in England where no such intervention took place and how? For the process evaluation, we will develop a logic model and use questionnaires, observations and audio-recorded interviews with young women, school nurses, school staff and parents to examine the context, implementation of self-consent and response to the new procedures. ETHICS AND DISSEMINATION The University of Bristol Faculty of Health Sciences Research Ethics Committee and the National Health Service Health Research Authority provided approvals for the study. We will produce a report with recommendations about self-consent procedures in conjunction with key stakeholders. At least two papers will be written for publication in peer-reviewed journals and for conference presentations. A summary of results will be shared with participating immunisation nurses, school staff, young people and parents as requested. TRIAL REGISTRATION NUMBER ISRCTN49086105; Pre-results.
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Affiliation(s)
- Suzanne Audrey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Joanne Ferrie
- Screening and Immunisations South West, Public Health England, Bristol, UK
| | - Karen Evans
- Head of School Nursing (South Gloucestershire) and Specialist Nursing Services, South Gloucestershire, UK
| | - Michael Bell
- Bristol Biomedical Research Centre and NIHR CLAHRC West, Bristol, UK
| | - Julie Yates
- Screening and Immunisations South West, Public Health England, Bristol, UK
| | - Marion Roderick
- Department of Paediatric Immunology, Bristol Children's Hospital, Bristol, UK
| | - John MacLeod
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Jackson C, Dyson L, Bedford H, Cheater FM, Condon L, Crocker A, Emslie C, Ireland L, Kemsley P, Kerr S, Lewis HJ, Mytton J, Overend K, Redsell S, Richardson Z, Shepherd C, Smith L. UNderstanding uptake of Immunisations in TravellIng aNd Gypsy communities (UNITING): a qualitative interview study. Health Technol Assess 2018; 20:1-176. [PMID: 27686875 DOI: 10.3310/hta20720] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Gypsies, Travellers and Roma (referred to as Travellers) are less likely to access health services, including immunisation. To improve immunisation rates, we need to understand what helps and hinders individuals in these communities in taking up immunisations. AIMS (1) Investigate the barriers to and facilitators of acceptability and uptake of immunisations among six Traveller communities across four UK cities; and (2) identify possible interventions to increase uptake of immunisations in these Traveller communities that could be tested in a subsequent feasibility study. METHODS Three-phase qualitative study underpinned by the social ecological model. Phase 1: interviews with 174 Travellers from six communities: Romanian Roma (Bristol); English Gypsy/Irish Traveller (Bristol); English Gypsy (York); Romanian/Slovakian Roma (Glasgow); Scottish Showpeople (Glasgow); and Irish Traveller (London). Focus on childhood and adult vaccines. Phase 2: interviews with 39 service providers. Data were analysed using the framework approach. Interventions were identified using a modified intervention mapping approach. Phase 3: 51 Travellers and 25 service providers attended workshops and produced a prioritised list of potentially acceptable and feasible interventions. RESULTS There were many common accounts of barriers and facilitators across communities, particularly across the English-speaking communities. Scottish Showpeople were the most similar to the general population. Roma communities experienced additional barriers of language and being in a new country. Men, women and service providers described similar barriers and facilitators. There was widespread acceptance of childhood and adult immunisation, with current parents perceived as more positive than their elders. A minority of English-speaking Travellers worried about multiple/combined childhood vaccines, adult flu and whooping cough. Cultural concerns about vaccines offered during pregnancy and about human papillomavirus were most evident in the Bristol English Gypsy/Irish Traveller community. Language, literacy, discrimination, poor school attendance, poverty and housing were identified by Travellers and service providers as barriers for some. Trustful relationships with health professionals were important and continuity of care was valued. A few English-speaking Travellers described problems of booking and attending for immunisation. Service providers tailored their approach to Travellers, particularly the Roma. Funding cuts, NHS reforms and poor monitoring challenged their work. Five 'top-priority' interventions were agreed across communities and service providers to improve the immunisation among Travellers who are housed or settled on an authorised site: (1) cultural competence training for health professionals and frontline staff; (2) identification of Travellers in health records to tailor support and monitor uptake; (3) provision of a named frontline person in general practitioner practices to provide respectful and supportive service; (4) flexible and diverse systems for booking appointments, recall and reminders; and (5) protected funding for health visitors specialising in Traveller health, including immunisation. LIMITATIONS No Travellers living on the roadside or on unofficial encampments were interviewed. We should exert caution in generalising to these groups. FUTURE WORK To include development, implementation and evaluation of a national policy plan (and practice guidance plan) to promote the uptake of immunisation among Traveller communities. STUDY REGISTRATION Current Controlled Trials ISRCTN20019630 and UK Clinical Research Network Portfolio number 15182. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 72. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Cath Jackson
- Visiting Senior Research Fellow, Department of Health Sciences, University of York, York, UK
| | - Lisa Dyson
- Department of Health Sciences, University of York, York, UK
| | - Helen Bedford
- Institute of Child Health, University College London, London, UK
| | | | - Louise Condon
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | | | - Carol Emslie
- Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lana Ireland
- Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Philippa Kemsley
- Institute of Child Health, University College London, London, UK
| | - Susan Kerr
- Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Helen J Lewis
- Department of Health Sciences, University of York, York, UK
| | - Julie Mytton
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Karen Overend
- Department of Health Sciences, University of York, York, UK
| | - Sarah Redsell
- Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge, UK
| | - Zoe Richardson
- Department of Health Sciences, University of York, York, UK
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Forster AS, Cornelius V, Rockliffe L, Marlow LAV, Bedford H, Waller J. A cluster randomised feasibility study of an adolescent incentive intervention to increase uptake of HPV vaccination. Br J Cancer 2017; 117:1121-1127. [PMID: 28829766 PMCID: PMC5674104 DOI: 10.1038/bjc.2017.284] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Uptake of human papillomavirus (HPV) vaccination is suboptimal among some groups. We aimed to determine the feasibility of undertaking a cluster randomised controlled trial (RCT) of incentives to improve HPV vaccination uptake by increasing consent form return. METHODS An equal-allocation, two-arm cluster RCT design was used. We invited 60 London schools to participate. Those agreeing were randomised to either a standard invitation or incentive intervention arm, in which Year 8 girls had the chance to win a £50 shopping voucher if they returned a vaccination consent form, regardless of whether consent was provided. We collected data on school and parent participation rates and questionnaire response rates. Analyses were descriptive. RESULTS Six schools completed the trial and only 3% of parents opted out. The response rate was 70% for the girls' questionnaire and 17% for the parents'. In the intervention arm, 87% of girls returned a consent form compared with 67% in the standard invitation arm. The proportion of girls whose parents gave consent for vaccination was higher in the intervention arm (76%) than the standard invitation arm (61%). CONCLUSIONS An RCT of an incentive intervention is feasible. The intervention may improve vaccination uptake but a fully powered RCT is needed.
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Affiliation(s)
- Alice S Forster
- Research Department of Behavioural Science and Health, UCL, Gower Street, London WC1E 6BT, UK
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Lauren Rockliffe
- Research Department of Behavioural Science and Health, UCL, Gower Street, London WC1E 6BT, UK
| | - Laura AV Marlow
- Research Department of Behavioural Science and Health, UCL, Gower Street, London WC1E 6BT, UK
| | - Helen Bedford
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Jo Waller
- Research Department of Behavioural Science and Health, UCL, Gower Street, London WC1E 6BT, UK
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Forster AS, Rockliffe L, Marlow LA, Bedford H, McBride E, Waller J. Exploring human papillomavirus vaccination refusal among ethnic minorities in England: A comparative qualitative study. Psychooncology 2017; 26:1278-1284. [PMID: 28231418 PMCID: PMC5599953 DOI: 10.1002/pon.4405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/13/2017] [Accepted: 02/17/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVES In England, uptake of human papillomavirus (HPV) vaccination to prevent HPV-related cancer is lower among girls from ethnic minority backgrounds. We aimed to explore the factors that prevented ethnic minority parents from vaccinating, compared to White British nonvaccinating parents and vaccinating ethnic minority parents. METHODS Interviews with 33 parents (n = 14 ethnic minority non-vaccinating, n = 10 White British nonvaccinating, and n = 9 ethnic minority vaccinating) explored parents' reasons for giving or withholding consent for HPV vaccination. Data were analysed using Framework Analysis. RESULTS Concerns about the vaccine were raised by all nonvaccinating ethnic minority parents, and they wanted information to address these concerns. External and internal influences affected parents' decisions, as well as parents' perceptions that HPV could be prevented using means other than vaccination. Reasons were not always exclusive to nonvaccinating ethnic minority parents, although some were, including a preference for abstinence from sex before marriage. Only ethnic minority parents wanted information provided via workshops. CONCLUSIONS Ethnic differences in HPV vaccination uptake may be partly explained by concerns that were only reported by parents from some ethnic groups. Interventions to improve uptake may need to tackle difficult topics like abstinence from sex before marriage, and use a targeted format.
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Affiliation(s)
| | | | | | - Helen Bedford
- Institute of Child HealthUniversity College LondonLondonUK
| | - Emily McBride
- Behavioural Science and HealthUniversity College LondonLondonUK
| | - Jo Waller
- Behavioural Science and HealthUniversity College LondonLondonUK
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Carnegie E, Whittaker A, Gray Brunton C, Hogg R, Kennedy C, Hilton S, Harding S, Pollock KG, Pow J. Development of a cross-cultural HPV community engagement model within Scotland. HEALTH EDUCATION JOURNAL 2017; 76:398-410. [PMID: 28596618 PMCID: PMC5446167 DOI: 10.1177/0017896916685592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To examine cultural barriers and participant solutions regarding acceptance and uptake of the human papillomavirus (HPV) vaccine from the perspective of Black African, White-Caribbean, Arab, Indian, Bangladeshi and Pakistani young people. METHODS In total, 40 young people from minority ethnic communities in Scotland took part in a qualitative study, involving seven focus groups and four paired interviews, to explore their views and experiences of the HPV vaccine. Using critical discursive psychology, the analysis focused on young people's accounts of barriers and enablers to information, access and uptake of the HPV vaccination programme. RESULTS Participants suggested innovative strategies to tackle intergenerational concerns, information design and accessibility, and public health communications across diverse contexts. A cross-cultural community engagement model was developed, embracing diversity and contradiction across different ethnic groups. This included four inter-related strategies: providing targeted and flexible information for young people, vaccine provision across the life-course, intergenerational information and specific cross-cultural communications. CONCLUSION This is the first HPV cross-cultural model inductively derived from accounts of young people from different ethnic communities. We recommend public health practitioners and policymakers consider using the processes and strategies within this model to increase dialogue around public engagement, awareness and receptivity towards HPV vaccination.
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Affiliation(s)
- Elaine Carnegie
- School of Health & Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, UK
| | - Anne Whittaker
- School of Health & Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, UK
| | - Carol Gray Brunton
- School of Health & Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, UK
| | - Rhona Hogg
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Catriona Kennedy
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Seeromanie Harding
- Division of Diabetes & Nutritional Sciences, King’s College London, London, UK
| | - Kevin G Pollock
- Vaccine Preventable Diseases, Health Protection Scotland, Glasgow, UK
| | - Janette Pow
- School of Health & Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, UK
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Perman S, Turner S, Ramsay AIG, Baim-Lance A, Utley M, Fulop NJ. School-based vaccination programmes: a systematic review of the evidence on organisation and delivery in high income countries. BMC Public Health 2017; 17:252. [PMID: 28288597 PMCID: PMC5348876 DOI: 10.1186/s12889-017-4168-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 03/03/2017] [Indexed: 11/10/2022] Open
Abstract
Background Many countries have recently expanded their childhood immunisation programmes. Schools are an increasingly attractive setting for delivery of these new immunisations because of their ability to reach large numbers of children in a short period of time. However, there are organisational challenges to delivery of large-scale vaccination programmes in schools. Understanding the facilitators and barriers is important for improving the delivery of future school-based vaccination programmes. Methods We undertook a systematic review of evidence on school-based vaccination programmes in order to understand the influence of organisational factors on the delivery of programmes. Our eligibility criteria were studies that (1) focused on childhood or adolescent vaccination programmes delivered in schools; (2) considered organisational factors that influenced the preparation or delivery of programmes; (3) were conducted in a developed or high-income country; and (4) had been peer reviewed. We searched for articles published in English between 2000 and 2015 using MEDLINE and HMIC electronic databases. Additional studies were identified by searching the Cochrane Library and bibliographies. We extracted data from the studies, assessed quality and the risk of bias, and categorised findings using a thematic framework of eight organisational factors. Results We found that most of the recent published literature is from the United States and is concerned with the delivery of pandemic or seasonal flu vaccination programmes at a regional (state) or local level. We found that the literature is largely descriptive and not informed by the use of theory. Despite this, we identified common factors that influence the implementation of programmes. These factors included programme leadership and governance, organisational models and institutional relationships, workforce capacity and roles particularly concerning the school nurse, communication with parents and students, including methods for obtaining consent, and clinic organisation and delivery. Conclusions This is the first time that information has been brought together on the organisational factors influencing the delivery of vaccination programmes in school-based settings. An understanding of these factors, underpinned by robust theory-informed research, may help policy-makers and managers design and deliver better programmes. We identified several gaps in the research literature to propose a future research agenda, informed by theories of implementation and organisational change. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4168-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah Perman
- Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK.,Present address: Redbridge Clinical Commissioning Group, Becketts House, 2-14 Ilford Hill, Ilford, IG1 2QX, UK
| | - Simon Turner
- Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Angus I G Ramsay
- Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Abigail Baim-Lance
- Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Martin Utley
- Clinical Operational Research Unit, UCL, 4 Taviton Street, London, WC1H 0BT, UK
| | - Naomi J Fulop
- Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK.
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Forster AS, Waller J, Bowyer HL, Marlow LAV. Girls' explanations for being unvaccinated or under vaccinated against human papillomavirus: a content analysis of survey responses. BMC Public Health 2015; 15:1278. [PMID: 26696229 PMCID: PMC4689042 DOI: 10.1186/s12889-015-2657-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 12/21/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In England HPV vaccination is offered to all girls age 12-13 years, free-at-the-point-of-receipt, mostly in schools. Coverage is good, but around 20% of girls remain unvaccinated. This research sought to explore reasons for being un-/under vaccinated. METHODS An ethnically diverse sample of girls aged 15-16 years attending one of twelve London schools completed a survey three years after being offered HPV vaccination. Girls reported their HPV vaccine status and those who were unvaccinated (had not received any doses of the vaccine) or under vaccinated (had not completed the recommended 3-dose course) recorded reasons for their un-/under vaccinated status. Reasons were reported using free-text and content analysis was used to analyse responses. RESULTS Around 74% of un-/under vaccinated girls provided a reason for their vaccination status (n = 259). Among unvaccinated girls, the most common reasons related to lack of perceived need for vaccination, concerns about safety and lack of parental consent. Girls who were under vaccinated gave practical reasons, including the need for more information (e.g. not knowing that multiple doses were needed), administrative issues (e.g. school absence), health and procedural concerns (e.g. fear of needles). Descriptively, there were few differences in the reasons given between girls from different ethnic backgrounds. Girls from Black and Asian backgrounds more commonly thought that the vaccine was not needed. Lack of parental consent without providing further explanation was most often cited by girls from Black backgrounds. CONCLUSIONS Safety concerns and lack of perceived need should be addressed to encourage informed uptake of HPV vaccination. Immunisation programme coordinators may be able to increase series completion by tackling practical problems facing under vaccinated girls.
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Affiliation(s)
- Alice S Forster
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, UCL, Gower Street, WC1E 6BT, London, UK.
| | - Jo Waller
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, UCL, Gower Street, WC1E 6BT, London, UK.
| | - Harriet L Bowyer
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, UCL, Gower Street, WC1E 6BT, London, UK.
| | - Laura A V Marlow
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, UCL, Gower Street, WC1E 6BT, London, UK.
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