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Rivera AF, Dussault JM, Oudin Doglioni D, Chyderiotis S, Sicsic J, Barret AS, Raude J, Gauchet A, Gagneux-Brunon A, Bruel S, Michel M, Le Duc-Banaszuk AS, Thilly N, Mueller JE. Sociodemographic determinants of HPV vaccine awareness, uptake, and intention among parents of adolescents in France 2021-22. Hum Vaccin Immunother 2024; 20:2381300. [PMID: 39105306 PMCID: PMC11305024 DOI: 10.1080/21645515.2024.2381300] [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: 05/03/2024] [Revised: 07/11/2024] [Accepted: 07/15/2024] [Indexed: 08/07/2024] Open
Abstract
Human Papillomavirus (HPV) vaccine coverage was <50% in France in 2022 and even lower among socially disadvantaged populations. We aimed to evaluate socio-demographic determinants of HPV vaccine awareness, uptake, and intention among parents of adolescents, and related attitudes and knowledge items. Parents of adolescents attending middle schools across France, who participated in a randomized trial responded to an anonymous baseline survey, conducted between November 2021 and February 2022. We used logistic regression models adjusting for a child's age and sex to explore sociodemographic determinants (including at-home multilingualism, occupational categories, local deprivation index and urbanity) of HPV vaccine awareness, uptake, and intention. Among the 1889 participants from 61 schools, parents working as factory workers/farmers had significantly lower odds of vaccine awareness compared to executives/professionals, both if they reported (OR = 0.07; 0.03-0.15) or not (OR = 0.20; 0.11-0.36) speaking also another language than French at home. Parents in lower occupational categories with multilingual families were less likely to have the intention to vaccinate their child (OR = 0.19; 0.07-0.56). Recent physician visit or vaccine offer was strong positive determinants of awareness, uptake and intention. A substantial gradient across occupational categories was observed for attitudes and knowledge around HPV vaccine usefulness, safety, and accessibility. This study confirms the disparities on HPV vaccine uptake in France and provides insight into mechanisms of social disparities in HPV vaccine awareness, access and intention.
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Affiliation(s)
| | - Josée M. Dussault
- Emerging Disease Epidemiology Unit, Institut Pasteur, Université Paris Cité, Paris, France
| | - Damien Oudin Doglioni
- Emerging Disease Epidemiology Unit, Institut Pasteur, Université Paris Cité, Paris, France
- Uni. Grenoble Alpes, Univ. Savoie Mont-Blanc, Grenoble, France
| | - Sandra Chyderiotis
- Emerging Disease Epidemiology Unit, Institut Pasteur, Université Paris Cité, Paris, France
| | | | | | - Jocelyn Raude
- EHESP French School of Public Health, Paris, France
- CNRS, EHESP, Univ. Rennes, Rennes, France
| | - Aurélie Gauchet
- Univ. Savoie Mont Blanc, Univ. Grenoble Alpes, Grenoble, France
| | - Amandine Gagneux-Brunon
- CHU de Saint-Etienne – Service d’infectiologie, Saint-Etienne, France
- Centre International de Recherche en Infectiologie, Team GIMAP, Université de Lyon, Lyon, France
- CNRS, Université Jean Monnet, Université Claude Bernard Lyon 1, Lyon, France
| | - Sébastien Bruel
- Department of General Practice, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, Université de Lyon, Saint-Etienne, France
- CIC-INSERM 1408, CHU de Saint-Etienne, Saint-Etienne, France
| | - Morgane Michel
- ECEVE, Université Paris Cité, Paris, France
- Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d’épidémiologie clinique, Paris, France
| | | | - Nathalie Thilly
- Université de Lorraine, Nancy, France
- CHRU-Nancy, Département Méthodologie, Promotion, Investigation, Université de Lorraine, Nancy, France
| | - Judith E. Mueller
- EHESP French School of Public Health, Paris, France
- Emerging Disease Epidemiology Unit, Institut Pasteur, Université Paris Cité, Paris, France
- CNRS, EHESP, Univ. Rennes, Rennes, France
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Anandarajah A, Shato T, Humble S, Barnette AR, Brandt HM, Klesges LM, Sanders Thompson VL, Silver MI. The association of caregiver attitudes, information sources, and trust with HPV vaccine initiation among adolescents. Hum Vaccin Immunother 2024; 20:2300879. [PMID: 38174998 PMCID: PMC10773709 DOI: 10.1080/21645515.2023.2300879] [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: 09/04/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024] Open
Abstract
This study described caregiver attitudes and the information sources they access about HPV vaccination for adolescents and determined their influence on human papillomavirus (HPV) vaccination initiation. An online survey was administered to 1,016 adults in July 2021. Participants were eligible if they were the caregiver of a child aged 9-17 residing in Mississippi, Arkansas, Tennessee, Missouri, and select counties in Southern Illinois. Multivariate logistic regression was used to estimate the association of caregiver attitudes and information sources with HPV vaccination. Information from doctors or healthcare providers (87.4%) and internet sources other than social media (31.0%) were the most used sources for HPV vaccine information. The highest proportion of caregivers trusted their doctor or healthcare providers (92.4%) and family or friends (68.5%) as sources of information. The HPV vaccine series was more likely to be initiated in children whose caregivers agreed that the vaccine is beneficial (AOR = 4.39, 95% CI = 2.05, 9.39), but less likely with caregivers who were concerned about side effects (AOR = 0.61, 95% CI = 0.42, 0.88) and who received HPV vaccination information from family or friends (AOR = 0.57, 95% CI = 0.35, 0.93). This study found that caregivers' attitudes, information sources, and trust in those sources were associated with their adolescent's HPV vaccination status. These findings highlight the need to address attitudes and information sources and suggest that tailored interventions considering these factors could increase HPV vaccination rates.
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Affiliation(s)
- Akila Anandarajah
- Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Thembekile Shato
- Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
- Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Sarah Humble
- Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Alan R. Barnette
- Department of Neonatology, Saint Francis Medical Center, Cape Girardeau, MO, USA
| | - Heather M. Brandt
- HPV Cancer Prevention Program, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Lisa M. Klesges
- Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Michelle I. Silver
- Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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3
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Kafadar AH, Sabatini S, Jones KA, Dening T. Categorising interventions to enhance vaccine uptake or reduce vaccine hesitancy in the United Kingdom: A systematic review and meta-analysis. Vaccine 2024; 42:126092. [PMID: 38960789 DOI: 10.1016/j.vaccine.2024.06.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/25/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Vaccination is one of the most important public health interventions to combat infectious disease. However, vaccine hesitancy prevents us reaching the global target of vaccine uptake (e.g., 75 % of influenza vaccination in at-risk groups). This review summarises all interventions designed to reduce vaccine hesitancy and increase vaccine uptake for all types of vaccines offered to adults (≥18 years) since 2000, in the United Kingdom (UK). METHODS PubMed, Cochrane Reviews, CINAHL EBSCO, and Scopus were searched (September 19, 2023). The PRISMA Checklist 2020 was used for quality checking. Data from randomised-controlled trials (RCTs) were analysed with a meta-analysis and narrative analysis. In all included studies, a narrative synthesis was undertaken to summarise, evaluate and characterisethe reported behaviour change interventions into four categories: organisational-level, public demand, provider-level, and multidimensional interventions. Findings are evaluated based on the MINDSPACE framework to understand the possible psychological mechanisms underpinning the interventions. FINDINGS A total of 9,842 articles were identified, 50 met the inclusion criteria. Interventions aimed to boost vaccine uptake or reduce hesitancy of influenza (50 %), COVID-19 (32 %), hepatitis B (6 %), and other vaccines. A meta-analysis was conducted for nine RCTs evaluating various interventions impact on vaccine uptake. The pooled effect was statistically significant (OR with 95 % CI = 1.23 [1.07 to 1.41]). Providing certain and understandableinformation and using a reminder system with personal messages or letters were the most frequently documented and effective interventions to enhance public demand (enhance information salience). Organisational level interventions intended to make vaccinations more accessible (e.g., providing vaccination at alternative places or times). Provider-oriented interventions encouraged healthcare workers to focus on reducing vaccine hesitancy or enhancing vaccine uptake. INTERPRETATION Among the main MINDSPACE techniques, enhancing the salience of vaccine information and priming vaccination by improving access were identified as the most applied and effective interventions in the UK.
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Affiliation(s)
- Aysegul Humeyra Kafadar
- Academic Unit of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom.
| | - Serena Sabatini
- Academic and Research Departments, School of Psychology, University of Surrey, United Kingdom
| | - Katy A Jones
- Academic Unit of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom
| | - Tom Dening
- Academic Unit of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom
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Rana SK, Perkins RB, Carr D, Feldman S, Welch K, Duffey-Lind E, Villa A. Evaluation of Human Papillomavirus Vaccination and Cancer Prevention Behaviors among LGBTQI + Individuals: A Cross-Sectional Study. J Community Health 2024:10.1007/s10900-024-01401-1. [PMID: 39235543 DOI: 10.1007/s10900-024-01401-1] [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] [Accepted: 08/17/2024] [Indexed: 09/06/2024]
Abstract
Human Papillomavirus (HPV) vaccination and cervical cancer screening rates are suboptimal in the US, particularly among historically underserved groups like Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex (LGBTQI+)-identifying women and transgender men. Therefore, our cross-sectional study assessed factors associated with these rates among LGBTQI+-identifying women and transgender men.HPV-related cancer knowledge, HPV vaccination and cervical cancer screening status, and the acceptability of self-collection for screening of 1983 LGBTQI+-identifying women and transgender men was assessed via an online survey available to members of the HER mobile app from March to May 2022. Associations between sociodemographic factors, vaccination, and screening were assessed using multivariable logistic regressions from November 2022 to December 2023.Most participants aged 18-26 (77.0%) and 6.3% of participants aged ≥46 (P < 0.001) had received at least one dose of the HPV vaccine. Cervical cancer screening rates were positively associated with age: 70.5% of those aged 21-26 and 96.1% aged ≥46 (P < 0.001). Screening was negatively associated with male gender identity (OR, 0.13; 95% CI, 0.04-0.42; P < 0.001), being uninsured (OR, 0.40; 95% CI, 0.24-0.67; P < 0.001), and being unvaccinated against HPV (OR, 0.28; 95% CI, 0.18-0.43; P < 0.001). 29.6% of those unscreened believed screening was not needed, and 22.1% were uncomfortable with pelvic exams. 40.4% of all participants would prefer self-collection for screening. Our findings indicate opportunities to increase screening and vaccination. Among under-screened individuals, lack of knowledge about screening necessity and discomfort with pelvic exams were important barriers. Targeted interventions addressing patient knowledge, practitioner communication, and exploring self-screening strategies are warranted.
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Affiliation(s)
| | - Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University Chobanian and Avdesian School of Medicine and Boston Medical Center Cancer Center, Boston, MA, USA
| | - Devan Carr
- Community Benefits Office, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sarah Feldman
- Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Eileen Duffey-Lind
- Team Maureen, North Falmouth, MA, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Alessandro Villa
- Oral Medicine, Oral Oncology and Dentistry, Miami Cancer Institute, Baptist Health South Florida, 8900 North Kendall Drive, Miami, FL, 33176, USA.
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Fisher CL, Mullis MD, McFarlane A, Hansen MD, Vilaro MJ, Bylund CL, Wiggins L, Corbitt H, Staras SAS. Promoting Rural-Residing Parents' Receptivity to HPV Vaccination: Targeting Messages and Mobile Clinic Implementation. Vaccines (Basel) 2024; 12:712. [PMID: 39066350 PMCID: PMC11281438 DOI: 10.3390/vaccines12070712] [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: 05/09/2024] [Revised: 06/14/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
Interventions are needed to increase low HPV vaccination rates within rural areas in the United States, particularly in the state of Florida, which has the seventh highest number of HPV-related cancers. Florida also ranks low compared to other states in terms of HPV vaccination. Rural-residing parents may benefit from two evidence-based strategies to increase vaccination rates: reminder messages informing and prompting vaccination appointments and mobile clinics to reduce transportation barriers. We sought to identify parental attitudes towards (1) message features that promote rural-residing parents' receptivity to HPV vaccination; (2) parents' acceptability of three reminder message modalities (text, postcard, phone); and (3) implementation factors that promote parents' acceptability of using a mobile clinic for vaccination. We recruited 28 rural-residing parents of 9- to 12-year-old children (unvaccinated for HPV) for focus group and individual interviews and thematically analyzed transcripts. Three features promoted parents' receptivity to HPV vaccination messages: source credibility, specific information coverage, and personalization (name and birthday wishes). Parents most preferred text messages and identified three factors promoting parents' mobile clinic use: convenience and feasibility, trustworthiness, and detailed information. The findings indicate rural-residing parents' acceptability of reminder messages and mobile clinics as well as the importance of trust and feasibility when implementing these evidence-based strategies for rural-residing parents.
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Affiliation(s)
- Carla L. Fisher
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (M.D.M.); (M.D.H.); (C.L.B.); (S.A.S.S.)
| | - M. Devyn Mullis
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (M.D.M.); (M.D.H.); (C.L.B.); (S.A.S.S.)
| | - Antionette McFarlane
- Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, FL 32611, USA;
| | - Marta D. Hansen
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (M.D.M.); (M.D.H.); (C.L.B.); (S.A.S.S.)
| | - Melissa J. Vilaro
- Department of Family, Youth and Community Sciences, Institute of Food and Agricultural Sciences, College of Agricultural and Life Sciences, University of Florida, Gainesville, FL 32611, USA;
| | - Carma L. Bylund
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (M.D.M.); (M.D.H.); (C.L.B.); (S.A.S.S.)
| | - Lori Wiggins
- Institute of Food and Agricultural Sciences, College of Agricultural and Life Sciences, University of Florida, Gainesville, FL 32611, USA; (L.W.); (H.C.)
| | - Halie Corbitt
- Institute of Food and Agricultural Sciences, College of Agricultural and Life Sciences, University of Florida, Gainesville, FL 32611, USA; (L.W.); (H.C.)
| | - Stephanie A. S. Staras
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (M.D.M.); (M.D.H.); (C.L.B.); (S.A.S.S.)
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6
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Al-leimon A, Al-leimon O, Abdulhaq B, Al-salieby F, Jaber AR, Saadeh M, Jaber AR, Aziziye O, Dardas LA. From awareness to action: Unveiling knowledge, attitudes and testing strategies to enhance human papillomavirus vaccination uptake in Jordan. J Virus Erad 2024; 10:100380. [PMID: 39040683 PMCID: PMC11261058 DOI: 10.1016/j.jve.2024.100380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/11/2024] [Indexed: 07/24/2024] Open
Abstract
Purpose Vaccination against HPV plays a crucial role in preventing cervical cancer and related health issues. This study aimed to (1) assess knowledge, awareness, intentions, and attitudes regarding HPV and vaccination among Jordanian parents, and (2) evaluate the efficacy of two intervention strategies in promoting knowledge, awareness, and attitudes towards HPV vaccinations. Methods In study one, a web-based survey was used to collect data from Jordanian parents. In study two, participants were allocated into three groups: video-based intervention, lecture-based intervention, and a control group. Pre-post tests were conducted to evaluate the efficacy of the intervention strategies in promoting knowledge, awareness, and attitudes toward HPV vaccination among Jordanian parents. Results A total of 572 participants took part in the survey. Knowledge levels about HPV and its vaccine were generally low. Intentions regarding HPV vaccination were uncertain for the majority of participants, with 92 % reported as not receiving any guidance from medical professionals about administering the HPV vaccine to themselves or their children. Only 22 % agreed that their children might get infected with HPV at any time in their lives. The pilot randomized clinical trial revealed an improvement in knowledge, awareness, and attitudes towards HPV vaccination in both intervention groups compared to the control group with large effect sizes (eta squared between 0.29 and 0.68). Conclusions Findings highlight the need for increased knowledge and awareness regarding HPV and vaccination. It also supported the potential effectiveness of basic educational efforts in significantly improving knowledge, awareness, and attitudes towards the HPV vaccine.
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Affiliation(s)
- Ahmad Al-leimon
- School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Obada Al-leimon
- School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Bayan Abdulhaq
- School for International Training, Brattleboro, VT, 05302, USA
| | - Fadi Al-salieby
- School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | | | - Mohammed Saadeh
- School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | | | - Omer Aziziye
- School of Medicine, The University of Jordan, Amman, 11942, Jordan
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Chan IL, Schwarz K, Weinstein N, Mansergh G, Nahhas RW, Gelaude D, Alexander R, Rodriguez L, Strauss W, Repetski T, Sullivan N, Long E, Evener SL, Garbarino A, Kollar LMM. An Evaluation of Messages to Promote Parental Intent to Vaccinate Children Aged <12 Years Against COVID-19. Public Health Rep 2024; 139:230-240. [PMID: 38240243 PMCID: PMC10851906 DOI: 10.1177/00333549231218725] [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] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVES Effective health communication can increase intent to vaccinate. We compared 8 messages that may influence parents' intent to vaccinate their children against COVID-19. METHODS In a cross-sectional survey of adults in the United States administered online in August 2021, 1837 parents and legal guardians were exposed to 8 messages (individual choice, gain/practical benefits, nonexpert, health care provider recommendation, altruism/community good, safety/effectiveness, safety, and effectiveness) to determine message reception and influence on intent to vaccinate their children. Parents responded to 10 questions using a Likert scale. We computed odds ratios (ORs) for each message, with an OR >1.0 indicating greater observed odds of participant agreement with the follow-up statement as compared with a reference message. We compared outcomes individually across messages with ordinal logistic regression fit using generalized estimating equations. RESULTS The individual choice message had the highest odds of agreement for understanding intent (OR = 2.10; 95% CI, 1.94-2.27), followed by the health care provider recommendation message (OR = 1.58; 95% CI, 1.46-1.71). The individual choice message had the highest odds of memorability, relatability, and trustworthiness. The altruism/community good message was at or near second best. The altruism/community good message had the highest or near-highest odds of increasing parents' intent to vaccinate their children, asking friends and family for their thoughts, and searching for additional information. The message that most motivated parents to vaccinate their children depended on parental intent to vaccinate prior to being exposed to the tested messages. CONCLUSIONS Messages with themes of individual choice, health care provider recommendation, and altruism/community good may be used in future message campaigns. Further research is needed to refine message concepts related to altruism/community good.
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Affiliation(s)
| | - Kelsey Schwarz
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Gordon Mansergh
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ramzi W. Nahhas
- Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Deborah Gelaude
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | - Nancy Sullivan
- Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | | | | | | | - Laura M. Mercer Kollar
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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8
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Kluczynski MA, Rodriguez EM, McGillicuddy CS, Schlecht NF. Human Papillomavirus Vaccination in Pediatric, Adolescent, and Young Adult Cancer Survivors-Opportunity to Address Gaps in Cancer Prevention and Survivorship. Vaccines (Basel) 2024; 12:114. [PMID: 38400098 PMCID: PMC10892003 DOI: 10.3390/vaccines12020114] [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: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/25/2024] Open
Abstract
The risks of secondary cancers associated with human papillomavirus (HPV) infection are as much as three times higher for survivors of pediatric, adolescent, and young adult cancer (PYAC) compared to the general population. Despite this, HPV vaccination rates among PYAC survivors remain low. Whereas pediatric oncology providers endorse HPV vaccination of PYAC survivors, many lack the resources or opportunities to intervene. The responsibility of HPV vaccination, therefore, falls to primary care providers and practices. This article provides an overview of the challenges with HPV vaccination that are distinct to PYAC survivors and discusses potential strategies to increase HPV vaccine coverage in this population.
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Affiliation(s)
| | | | | | - Nicolas F. Schlecht
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY 14263, USA; (M.A.K.); (E.M.R.); (C.S.M.)
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9
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Dorismond VG, Boscardin WJ, Sawaya GF. The association between YouTube use and knowledge of human papillomavirus-related cancers. PEC INNOVATION 2023; 3:100186. [PMID: 37457670 PMCID: PMC10339240 DOI: 10.1016/j.pecinn.2023.100186] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
Objective To examine the association between YouTube usage and HPV-related cancer knowledge (cervical, anal, oral and penile). Study design Cross-sectional study using data from the Health Information National Trends survey conducted between 2017 and 2020 (N = 16,092). Logistic regression was used to analyze the independent effect of YouTube use on cancer knowledge, controlling for sociodemographic characteristics. Results Respondents' knowledge of HPV-related cancers varied: 49.9% about cervical, 18% anal, 20.1% oral and 20.4% penile cancers. YouTube use was associated with increased knowledge for all cancers (cervical: OR 2.66, 95% CI 2.04, 3.46; anal: OR 1.83, 95% CI 1.32, 2.53; oral: OR 1.89, 95% CI 1.37, 2.61; penile OR 2.00, 95% CI 1.44, 2.77) in models adjusted for all covariates. Other independent predictors of HPV-related cancer knowledge included female gender, younger age, a higher income, and higher education. Conclusions YouTube could play an important role in educating people about HPV-related cancers and should also target other populations, such as males and those with less formal education. Innovation The study provides novel insights into the potential of YouTube as an educational tool for promoting cancer knowledge with the goal of cancer prevention.
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Affiliation(s)
- Vanessa G. Dorismond
- Department of Obstetrics and Gynecology, University of California, San Francisco, CA, USA
| | - W. John Boscardin
- Department Epidemiology & Biostatistics, University of California, San Francisco School of Medicine, 490 Illinois St, San Francisco, CA 94158, USA
| | - George F. Sawaya
- Department of Obstetrics and Gynecology, University of California, San Francisco School of Medicine, 2356 Sutter St, San Francisco, CA 94115, USA
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Okuhara T, Shirabe R, Kagawa Y, Okada H, Kiuchi T. Encouraging COVID-19 vaccination by focusing on anticipated affect: A scoping review. Heliyon 2023; 9:e22655. [PMID: 38076197 PMCID: PMC10709050 DOI: 10.1016/j.heliyon.2023.e22655] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE This study reviewed studies of the anticipated affect related with COVID-19 vaccination to understand gaps in currently available studies and practice implications. METHODS We systematically searched MEDLINE, CINAHL, and other multiple databases for English language articles of studies that investigated COVID-19 vaccination related anticipated affects. RESULTS We identified seventeen studies. Thirteen studies focused anticipated regret from inaction (i.e., not vaccinated). Other studies focused anticipated regret from action (i.e., vaccinated), guilt from inaction, pride from action, and positive feelings from action. Eleven studies showed that anticipated regret from inaction was significantly associated with COVID-19 vaccination behavior or intention. Three of the 11 studies showed that anticipated regret from inaction was more strongly associated with vaccination behavior or intention than cognitive belief. CONCLUSION Most studies showed that positive associations between anticipated regret and COVID-19 vaccination outcomes. The use of messages that target cognitive beliefs as well as those that appeal to anticipated affect may be effective to promote COVID-19 vaccination. However, most studies employed a cross-sectional design and examined negative affect. Future studies should adopt an experimental design as well as examine positive affect.
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Affiliation(s)
- Tsuyoshi Okuhara
- Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ritsuko Shirabe
- Department of Health Communication, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yumi Kagawa
- Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroko Okada
- Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takahiro Kiuchi
- Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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11
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Morbée S, Vansteenkiste M, Waterschoot J, Klein O, Luminet O, Schmitz M, Van den Bergh O, Van Oost P, Yzerbyt V. The Role of Communication Style and External Motivators in Predicting Vaccination Experiences and Intentions: An Experimental Vignette Study. HEALTH COMMUNICATION 2023; 38:2894-2903. [PMID: 36162986 DOI: 10.1080/10410236.2022.2125012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This vignette-based study examined in a sample of unvaccinated Belgian citizens (N = 1918; Mage = 45.99) how health care workers could foster reflection about and intentions to get vaccinated against COVID-19 by experimentally varying their communication style (i.e., autonomy-supportive vs. controlling) and the reference to external motivators (i.e., use of a monetary voucher or corona pass vs. the lack thereof). Each participant was randomly assigned to one of six conditions and rated a vignette in terms of anticipated autonomy satisfaction, perceived effectiveness, reflection, and vaccination intention. An autonomy-supportive, relative to a controlling, communication style predicted greater autonomy need satisfaction, which in turn related positively to perceived effectiveness, reflection, and vaccination intention. External motivators failed to generate positive effects compared to the control condition. The findings highlight the critical role of autonomy support in promoting a self-endorsed decision to get vaccinated.
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Affiliation(s)
- Sofie Morbée
- Department of Developmental, Personality and Social Psychology, Ghent University
| | | | - Joachim Waterschoot
- Department of Developmental, Personality and Social Psychology, Ghent University
| | - Olivier Klein
- Faculty of Psychological Sciences and Education, Université libre de Bruxelles
| | - Olivier Luminet
- Institute for Research in Psychological Sciences, Université catholique de Louvain
| | - Mathias Schmitz
- Institute for Research in Psychological Sciences, Université catholique de Louvain
| | | | - Pascaline Van Oost
- Institute for Research in Psychological Sciences, Université catholique de Louvain
| | - Vincent Yzerbyt
- Institute for Research in Psychological Sciences, Université catholique de Louvain
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12
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Kwek MEJ, Ang JX, Mathur M, Kho LCL. Comparison of awareness, attitudes and knowledge on human papilloma virus vaccination in Singapore: 2019 versus 2013. Singapore Med J 2023:384042. [PMID: 37675669 DOI: 10.4103/singaporemedj.smj-2020-437] [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: 09/08/2023]
Abstract
Introduction This study aimed to assess the changes in the awareness, attitudes and knowledge regarding human papillomavirus (HPV) vaccination among the local population. The secondary aims were to identify barriers and to evaluate the effectiveness of national HPV vaccination campaigns over a six-year period in Singapore. Methods We conducted and compared two cross-sectional surveys in 2013 and 2019 among female participants attending a general gynaecology clinic. Results A total of 597 participants completed the survey in 2013 and 2019. The participants were comparable in their race, marital status, educational level, occupation and monthly household income. Knowledge scores for cervical cancer and HPV infection showed significant improvement from 2013 to 2019. There was no significant difference in knowledge scores for HPV vaccination, which resulted in similar uptake of the HPV vaccine. Age, educational level and knowledge of HPV vaccine were significant predictors of acceptance of the HPV vaccine. The top two reasons for declining the HPV vaccine were the lack of knowledge and cost, as noted in the 2019 survey. Conclusion The Singapore government's efforts to improve cervical cancer awareness through national campaigns and policy changes have led to an improvement in knowledge of HPV infection. However, this has not translated into improvements in the vaccine acceptance rates. The decision for vaccine uptake is complex, and there are multiple factors to be addressed to ensure cost-effective implementation of the strategies. Our study highlights the need for effective dissemination of vaccine information, additional subsidies and consideration of a mandatory school-based vaccination programme.
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Affiliation(s)
- Michelle E-Jyn Kwek
- Department of Obstetrics and Gynaecology, KK Women and Children's Hospital, Singapore
| | - Joella Xiaohong Ang
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
| | - Manisha Mathur
- Department of Obstetrics and Gynaecology, KK Women and Children's Hospital, Singapore
| | - Lily Chye Lee Kho
- Department of Obstetrics and Gynaecology, KK Women and Children's Hospital, Singapore
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13
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Lubeya MK, Mwanahamuntu M, Chibwesha CJ, Mukosha M, Monde MW, Kawonga M. Implementation Strategies Used to Increase Human Papillomavirus Vaccination Uptake by Adolescent Girls in Sub-Saharan Africa: A Scoping Review. Vaccines (Basel) 2023; 11:1246. [PMID: 37515061 PMCID: PMC10385137 DOI: 10.3390/vaccines11071246] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/25/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Barriers to successful implementation of the human papillomavirus vaccination exist. However, there is limited evidence on implementation strategies in sub-Saharan Africa (SSA). Therefore, this scoping review aimed to identify implementation strategies used in SSA to increase HPV vaccination uptake for adolescent girls. This scoping review was guided by Joanna Briggs Institute guidelines for scoping reviews and an a priori protocol and reported based on the Preferred Reporting Items for Systematic Reviews and Metanalysis for Scoping Reviews (PRISMA-ScR). We searched PubMed, EMBASE, CINAHL, Scopus, Google Scholar, and gray literature. Two independent reviewers screened article titles and abstracts for possible inclusion, reviewed the full text, and extracted data from eligible articles using a structured data charting table. We identified strategies as specified in the Expert Recommendation for Implementing Change (ERIC) and reported their importance and feasibility. We retrieved 246 articles, included 28 of these, and identified 63 of the 73 ERIC implementation strategies with 667 individual uses, most of which were highly important and feasible. The most frequently used discrete strategies included the following: Build a coalition and change service sites 86% (24/28), distribute educational materials and conduct educational meetings 82% (23/28), develop educational materials, use mass media, involve patients/relatives and families, promote network weaving and stage implementation scale up 79% (22/28), as well as access new funding, promote adaptability, and tailor strategies 75% (21/28). This scoping review shows that implementation strategies of high feasibility and importance were frequently used, suggesting that some strategies may be cross-cutting, but should be contextualized when planned for use in any region.
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Affiliation(s)
- Mwansa Ketty Lubeya
- Department of Obstetrics and Gynaecology, School of Medicine, The 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 2193, South Africa
| | - Mulindi Mwanahamuntu
- Department of Obstetrics and Gynaecology, School of Medicine, The 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 2193, South Africa
- Department of Pharmacy, School of Health Sciences, The University of Zambia, Lusaka 10101, Zambia
| | | | - Mary Kawonga
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
- Department of Community Health, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg 2193, South Africa
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14
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O'Leary ST, Spina CI, Spielvogle H, Robinson JD, Garrett K, Perreira C, Pahud B, Dempsey AF, Opel DJ. Development of PIVOT with MI: A motivational Interviewing-Based vaccine communication training for pediatric clinicians. Vaccine 2023; 41:1760-1767. [PMID: 36775776 DOI: 10.1016/j.vaccine.2023.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/04/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
Delay or refusal of childhood vaccines is common and may be increasing. Pediatricians are parents' most trusted source for vaccine information, yet many struggle with how to communicate with parents who resist recommended vaccines. Evidence-based communication strategies for vaccine conversations are lacking. In this manuscript, we describe the development and perceived usefulness of a curriculum to train clinicians on a specific vaccine communication strategy as part of the PIVOT with MI study, a cluster randomized trial testing the effectiveness of this communication strategy on increasing childhood vaccination uptake among 24 pediatric practices in Colorado and Washington. The communication strategy is based on the existing evidence-based communication strategies of a presumptive format for initiating vaccine conversations and use of motivational interviewing if hesitancy persists. Focus groups and semi-structured interviews with pediatric clinicians helped inform the development of the training curriculum, which consisted of an introductory video module followed by 3 training sessions. Between September 2019 and January 2021, 134 pediatric clinicians (92 pediatricians, 42 advanced practice providers) participated in the training as part of the PIVOT with MI study. Of these, 92 % viewed an introductory video module, 93 % attended or viewed a baseline synchronous training, 82 % attended or viewed a 1st refresher training, and 77 % attended or viewed a 2nd refresher training. A follow-up survey was administered August 2020 through March 2021; among respondents (n = 100), >95 % of participants reported that each component of the training program was very or somewhat useful. These data suggest that the PIVOT with MI training intervention is a useful vaccine communication resource with the potential for high engagement among pediatric clinicians.
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Affiliation(s)
- Sean T O'Leary
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
| | - Christine I Spina
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | | | - Jeffrey D Robinson
- Department of Communication, Portland State University, Portland, OR, United States
| | - Kathleen Garrett
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Cathryn Perreira
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Barbara Pahud
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Amanda F Dempsey
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Douglas J Opel
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States; Seattle Children's Research Institute, Seattle, WA, United States
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15
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Okuhara T, Terada M, Kagawa Y, Okada H, Kiuchi T. Anticipated Affect That Encourages or Discourages Human Papillomavirus Vaccination: A Scoping Review. Vaccines (Basel) 2023; 11:vaccines11010124. [PMID: 36679969 PMCID: PMC9867028 DOI: 10.3390/vaccines11010124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/06/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023] Open
Abstract
We reviewed studies that examined the anticipated affects associated with human papillomavirus (HPV) vaccination to identify gaps in the literature and the currently available practice implications for encouraging HPV vaccination. We systematically searched MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, PsycArticles, Academic Search Complete, Scopus, and Web of Science to find English articles that quantitatively and qualitatively examined anticipated affects associated with HPV vaccination. A total of twenty-one studies were identified. Seventeen studies examined the anticipated inaction regret (i.e., not being vaccinated). Most of the included studies reported that anticipated inaction regret had a significantly positive association with HPV vaccination outcomes, such as vaccination behavior, intention, willingness, and acceptability. Furthermore, seven studies reported that anticipated inaction regret had a significantly positive and stronger association with vaccination outcomes than cognitive beliefs, such as vaccine effectiveness and safety, and perceived susceptibility and severity. The present review indicated that the stronger the participants' anticipated inaction regret, the more likely they were to receive the HPV vaccine. Messages targeting the anticipated affect may be as effective as or more effective than messages targeting cognitive beliefs in encouraging HPV vaccination among people. However, most of the studies included in the present review adopted a cross-sectional design with vaccination intention and willingness as outcomes. Therefore, future studies should examine the influence of anticipated affects on the utilization of HPV vaccines using experimental designs to accumulate stronger evidence.
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16
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Koskan A, Cantley A, Li R, Silvestro K, Helitzer D. College Students' Digital Media Preferences for future HPV Vaccine Campaigns. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1743-1751. [PMID: 33934288 PMCID: PMC8088485 DOI: 10.1007/s13187-021-02022-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/25/2021] [Indexed: 06/12/2023]
Abstract
In the USA, although college-aged populations are at the greatest risk for initial infection with human papillomavirus (HPV), they are one of the age-based populations with lower HPV vaccine rates, largely due to their lack of perceived need to vaccinate against HPV. Health communication campaigns can help address this perception. This research identifies college students' preferred digital media channels for future HPV vaccine communication campaigns. We conducted qualitative small group interviews with 28 students from one large southwestern university. We used an inductive approach to hand-code interview transcripts, develop a coding structure, and analyze themes that emerged from the data. More than half of the study participants had never heard of the HPV vaccine before participating in a small group interview. When asked how they prefer to receive information about the vaccine, students more often recommended creating educational videos featuring healthcare providers and other college students and sharing them on YouTube. Some students recommended creating and posting health information memes and infographics to Instagram to disseminate the most critical information students need to make an informed decision to receive the vaccine. Given the prominent role of social media and the popularity of video-sharing and image-sharing sites, health educators and communicators should utilize these technologies to promote the HPV vaccine, a cancer prevention resource.
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Affiliation(s)
- Alexis Koskan
- College of Health Solutions, Arizona State University, 425 N. 5thStreet, Phoenix, AZ 85004 USA
| | - Alison Cantley
- College of Health Solutions, Arizona State University, 425 N. 5thStreet, Phoenix, AZ 85004 USA
| | - Rina Li
- Arizona State University, Tempe, AZ USA
| | | | - Deborah Helitzer
- College of Health Solutions, Arizona State University, 425 N. 5thStreet, Phoenix, AZ 85004 USA
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17
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Sun L, Hu J, Gao H, Wang S, Wang B, Wang J, Li H, Wang J, Yuan C, Zhang X. Long-term effect of mobile phone-based education and influencing factors of willingness to receive HPV vaccination among female freshmen in Shanxi Province, China. Hum Vaccin Immunother 2022; 18:2051990. [PMID: 35446735 PMCID: PMC9225224 DOI: 10.1080/21645515.2022.2051990] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This study was conducted to characterize the long-term effect of mobile-based education on Chinese female freshmen and disclose the possible predictors of their willingness to get vaccinated based on the information-motivation-behavioral skills (IMB) model. METHODS We randomly assigned 509 participants to a 7-day mobile-based educational intervention or control group and collected information about general information, health, and sexual behavior, HPV vaccination intention and action, HPV-related knowledge, cognition, and behavioral skill by an online self-administrated questionnaire at baseline, post-intervention, and at the 1-month and 3-month follow-ups. RESULTS The intervention arm showed an improvement in IMB scores after education. Despite the persistent improvement in knowledge, the improvement in their motivation and behavioral skills decreased at the 1-month and 3-month follow-ups. Participants' vaccination willingness was elevated after the baseline survey in both the intervention and control groups, while the overall appointment/vaccination rate was only 3.73% 3 months later. The intention to get vaccinated was associated with knowing HPV (adjusted OR: 2.37, 95% CI: 1.44 - 3.89), perceiving more barriers (adjusted OR: 2.16, 95% CI: 1.44 - 3.25), higher subjective norms (adjusted OR: 2.05, 95% CI: 1.26 - 3.32), and having more behavioral skills (adjusted OR: 2.95, 95% CI: 1.79 - 4.87). CONCLUSION Seven-day mobile-based education was effective to increase IMB model scores among female freshmen. However, the improvement in motivation and behavioral skills was not persistent. Information, perceived barriers, subjective norms, and behavioral skills were discovered to be influencing factors of vaccination intention. Future research with longer, more convenient, and more tailored education to the main influencing factors is warranted.
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Affiliation(s)
- Liying Sun
- Department of Pediatrics and Adolescent Gynecology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jingjing Hu
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Huihui Gao
- Department of Pediatrics and Adolescent Gynecology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Sunyi Wang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Binghan Wang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiawen Wang
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hui Li
- Division of Health Promotion, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Jianbing Wang
- Department of Epidemiology and Biostatistics at School of Public Health and National Clinical Research Center for Child Health of the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Changzheng Yuan
- Department of Pediatrics and Adolescent Gynecology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Xi Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, China
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18
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Waser M, Heiss R, Borena W. Factors affecting children's HPV vaccination in Austria: Evidence from a parent survey. Hum Vaccin Immunother 2022; 18:2126251. [PMID: 36251011 DOI: 10.1080/21645515.2022.2126251] [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: 12/15/2022] Open
Abstract
Human papillomavirus (HPV) is a sexually transmitted infection that causes cervical cancer, head and neck cancer, other urogenital cancers, and genital warts. In Austria, where HPV vaccination is free for children, the vaccination rate nevertheless remains insufficient for herd immunity against HPV. Using a cross-sectional survey of parents (N = 334) in the state of Tyrol, Austria, we examined parents' reasons for rejecting children's HPV vaccination and key predictors of vaccination intention for their children, including knowledge about HPV, attitude toward vaccination, sources of information about the HPV vaccine, socioeconomic factors, and HPV vaccination intention. Data analyzed using descriptive statistics and logistic regression modeling revealed an overall 81.9% acceptance rate of HPV vaccination. The most common reasons for vaccine hesitancy were a fear of side effects, a perceived lack of information, and the perception that children are too young to be vaccinated. A high level of knowledge about HPV was significantly associated with vaccine acceptance for female but not male children. Negative attitude toward vaccination was significantly related to lower vaccine acceptance, and parents who reported informing themselves about HPV vaccination from online sources were less likely to accept vaccination. Such results call for more educational measures to reduce misinformation about HPV vaccination and thereby reduce the fear of its side effects and promote early vaccination. More information is also needed to improve parents' attitude toward and their knowledge about vaccination, the dissemination of which should focus on the benefits of vaccines for children of both sexes.
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Affiliation(s)
- Madeleine Waser
- Center for Social & Health Innovation MCI Management Center Innsbruck, Innsbruck, Austria
| | - Raffael Heiss
- Center for Social & Health Innovation MCI Management Center Innsbruck, Innsbruck, Austria
| | - Wegene Borena
- Institute of Virology, Innsbruck Medical University, Innsbruck, Austria
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19
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Lubeya MK, Zekire Nyirenda JC, Chanda Kabwe J, Mukosha M. Knowledge, Attitudes and Practices Towards Human Papillomavirus Vaccination Among Medical Doctors at a Tertiary Hospital: A Cross Sectional Study. Cancer Control 2022; 29:10732748221132646. [PMID: 36214063 PMCID: PMC9558859 DOI: 10.1177/10732748221132646] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Human papillomavirus (HPV) infection is a common sexually transmitted
disease, characterised by persistent infection with high-risk strains
leading to malignant conditions such as cervical cancer. The HPV vaccine is
a well-known primary preventive measure for HPV infections. Previous studies
have shown that medical doctors’ vaccine recommendation is one of the key
strategies in improving HPV vaccine uptake. In 2019, Zambia rolled out the
free national HPV vaccination program targeting 14-year-old girls. However,
the annual coverage for HPV vaccination is variable, with rates as low as
33% for 2021. Materials and Methods We conducted a cross-sectional study between September and December 2020 at
the University Teaching Hospitals in Lusaka, Zambia. We used analysis of
variance to assess the mean differences in the overall scores for knowledge,
attitude and practices towards the HPV vaccine. In addition, we used
structural equation modelling (SEM) to test the traditional education theory
as medical doctors’ HPV vaccine knowledge, attitude, and practices cover
several facets, and SEM can model latent variables. Results We enrolled 121 medical doctors, of whom 67 (44.6%) were male. The majority,
76 (62.8%), were registrars and 79 (65.3%) had more than ten years of
clinical experience. The overall mean knowledge, attitude, and practice
score of the HPV vaccine mean (SD) were 70.2 (15.1), 72.1 (18.5) and 77.1
(28.9), respectively. More than half of the medical doctors would advise
anyone eligible to take the HPV vaccine 66 (54.6%). There was a positive
correlation between attitude and practice towards the HPV vaccine (β = .03,
P = .017). Conversely, there was no evidence of a correlation between
overall HPV knowledge and attitude (β = .01, P = .670) and rank of the
medical doctors (β = −7.87, P = .355). Conclusion Knowledge was high with good attitudes and practices among medical doctors,
which are vital in vaccine recommendation and subsequent uptake.
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Affiliation(s)
- Mwansa Ketty Lubeya
- Department of Obstetrics and
Gynaecology, School of Medicine, The University of
Zambia, Lusaka,
Zambia,Women and Newborn Hospital,
University Teaching Hospitals, Lusaka,
Zambia,Young Emerging Scientists
Zambia, Lusaka,
Zambia,Mwansa Ketty Lubeya, Department of
Obstetrics and Gynaecology, School of Medicine-The University of Zambia P/B
50110 Nationalist road, Lusaka, Zambia.
| | | | - Jane Chanda Kabwe
- Young Emerging Scientists
Zambia, Lusaka,
Zambia,Department of Anaesthesia and
Critical Care, The
National Heart Hospital, Chongwe,
Zambia
| | - Moses Mukosha
- Department of Pharmacy, School of
Health Sciences, The
University of Zambia, Lusaka,
Zambia,HIV and Women’s Health Research
Group, University
Teaching Hospital, Lusaka, Zambia
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20
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Kazancı F, Yapar D, Yalcınkaya C, Onan MA. Is there still a necessity for awareness and information about HPV infection and vaccine for adolescent in developing countries? J OBSTET GYNAECOL 2022; 42:3073-3079. [PMID: 35815590 DOI: 10.1080/01443615.2022.2092392] [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: 01/06/2023]
Abstract
Increasing awareness of human papilloma virus (HPV) and vaccines among the target population is an important factor for decreasing the rate of malignancies related to HPV. The aim of this cross-sectional study was to determine Turkish high school and college students' knowledge level of HPV and vaccines via a survey. The HPV knowledge scale (HPV-KS) has been developed to measure the level of knowledge about HPV and vaccination. The response rate of 'Yes' to the question of whether the participants have heard of HPV and the vaccine was 60.8% and 58.8%, respectively. The lack of information was the commonest reason for not being vaccinated in 54% of the participants. According to the HPV-KS, the median value of the knowledge level of the participants was 35.7 (IQR; 14.3-57.1). The HPV-KS scores were significantly higher among those with parents who had graduated from university and had an income above the minimum wage than those who did not (p = .013 and p = .029, respectively). Current evidence suggests that Turkish adolescents have limited HPV knowledge. Gender, age, education (particularly university and health-related departments), parents' level of education and income were all important factors in determining the outcome variables. Therefore, it is very important to apply educational programs to raise awareness by medical staff.Impact StatementWhat is already known on this subject? Human papilloma virus (HPV) infection is a major threat due to the reason of many malignancies, especially cervical cancer, and this problem can be overcome by informing the target population about the screening program and vaccination.What do the results of this study add? Lack of knowledge about HPV infection and cost of the vaccine were the main reasons for insufficient vaccination rate among the adolescents.What are the implications of these findings for clinical practice and/or further research? In developing countries such as Turkey, the necessity to raise awareness about HPV infection and vaccination has emerged. As a result, it is critical to implement educational campaigns to enhance awareness, particularly by medical staff.
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Affiliation(s)
- Ferah Kazancı
- Department of Gynecologic Oncology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Dilek Yapar
- Department of Public Health, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Cem Yalcınkaya
- Department of Gynecologic Oncology, İstanbul Ümraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Anil Onan
- Department of Gynecologic Oncology, Gazi University Faculty of Medicine, Ankara, Turkey
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21
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Morgenstern M, Sok J, Klement E. Perception of low social pressure and lack of capacity reduces vaccination compliance - The case of lumpy skin disease. Transbound Emerg Dis 2022; 69:e2779-e2788. [PMID: 35694725 PMCID: PMC9796477 DOI: 10.1111/tbed.14629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/28/2022] [Accepted: 06/09/2022] [Indexed: 01/01/2023]
Abstract
Successful prevention of epidemics depends on implementation of control measures, including vaccine compliance and maintenance of high vaccination coverage for long periods. However, to the best of our knowledge, a study of the temporal dynamics of compliance in voluntary vaccination campaigns and of the factors which influence them was never published. In this study, we investigated the factors influencing the dynamics of vaccination compliance against lumpy skin disease (LSD) after the occurrence of LSD epidemics in Israel in 2012-2013 and 2019. From 2016 to 2019, we followed voluntary LSD annual vaccination among a cohort of 566 farmers and used questionnaires based on the theory of planned behaviour to investigate the incentives influencing vaccine compliance among 90 farmers. The results showed a reduction in vaccination against LSD from 61% in 2016 to 27% in 2019 and a very strong association between prior vaccination and vaccination compliance. The actual vaccination by farmers who stated a positive intention to vaccinate was 4.5 times higher than farmers who did not (p-value = .007). However, half of the highly intended farmers eventually did not vaccinate their herd. These farmers were significantly more concerned by manpower and vaccine price compared to their vaccinating counterparts, pointing to vaccination effort perceptions as a major factor influencing compliance. In addition, we found that farmers who answered the questionnaires before the LSD epidemic of 2019 perceived significantly less pressure to vaccinate imposed by veterinary organizations (private and governmental) than farmers answering them during or after the epidemic. We conclude that the veterinarian-associated social pressure is a major compliance-enhancing factor, influenced by the occurrence of an epidemic. Our findings suggest that the deterioration of vaccination compliance after an epidemic can be mitigated by maintenance of pressure to vaccinate by veterinarians. Manpower support and vaccine discounts may be advocated to promote vaccine compliance.
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Affiliation(s)
- Michal Morgenstern
- Koret School of Veterinary MedicineHebrew University of JerusalemRehovotIsrael
| | - Jaap Sok
- Business EconomicsWageningen University and Research (WUR)Wageningenthe Netherlands
| | - Eyal Klement
- Koret School of Veterinary MedicineHebrew University of JerusalemRehovotIsrael
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22
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Leslie M, Pinto N, Fadaak R. Improving Conversations With COVID-19 Vaccine Hesitant Patients: Action Research to Support Family Physicians. Ann Fam Med 2022; 20:368-373. [PMID: 35443974 PMCID: PMC9328713 DOI: 10.1370/afm.2816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 02/01/2022] [Accepted: 03/02/2022] [Indexed: 11/09/2022] Open
Abstract
Vaccination delivery and efforts to counter vaccine hesitancy have become focal issues for family medicine teams as the COVID-19 pandemic has evolved. Conducting action research, our team developed an interactive web-based guide to improve clinical conversations around a broad range of vaccine hesitancies presented by patients. The paper presents a step-by-step account of the guide being codesigned with family physicians-its targeted end users-in a process that included validation interviews; role-play interviews; and user-tested design. The validation interviews sought to understand the pragmatic realities of vaccine hesitancy in family medicine clinical practice relative to relevant psychological theories. The role-play interviews drew out conversational strategies and advice from family physicians. The principles of motivational interviewing-an evidence-based approach to vaccine hesitancy conversations that supplements information deficit approaches-were used to codesign the content and layout of the guide. User counts, stakeholder engagement, and web-based analytics indicate the guide is being used extensively. Formal evaluation of the guide is presently underway.Originally published as Annals "Online First" article.
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Affiliation(s)
- Myles Leslie
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Pinto
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
| | - Raad Fadaak
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
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23
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DiGregorio BD, Corcoran KE, Scheitle CP. 'God will protect us': Belief in God/Higher Power's ability to intervene and COVID-19 vaccine uptake. REVIEW OF RELIGIOUS RESEARCH 2022; 64:475-495. [PMID: 35702507 PMCID: PMC9183751 DOI: 10.1007/s13644-022-00495-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 06/02/2023]
Abstract
BACKGROUND Vaccines represent one of the best ways to counter the COVID-19 pandemic. However, vaccine hesitancy among the population limits the effectiveness of vaccines. Recent research has explored the role of religion in vaccine hesitancy, but in doing so has encountered a "black box" problem. There is a relationship between religion and vaccine hesitancy, but the explanation for why remains unclear. PURPOSE The purpose of this study is to explore the relationship between religion and vaccine hesitancy. We propose that how an individual conceptualizes God/a higher power is associated with getting vaccinated for COVID-19. METHODS We use data from a nationally representative survey of U.S. adults, collected using the Amerispeak® probability-based panel via the National Opinion Research Center (NORC) at the University of Chicago. We examine the association between individuals' views of God/a higher power as both a supervisory and an intervening figure on vaccine uptake and likelihood of getting vaccinated through logistic regressions. RESULTS We find that belief in God's/a higher power's supervision is not significantly associated with the odds of COVID-19 vaccine uptake or vaccination intent. However, belief in God's/a higher power's ability to intervene in the world is significantly and negatively associated with the odds of COVID-19 vaccine uptake and the odds of having received or planning to receive a COVID-19 vaccine. In addition, in models where belief in the ability of God/a higher power to intervene are included, Christian nationalism ceases to have a statistically significant association with intent to receive a COVID-19 vaccine. CONCLUSIONS AND IMPLICATIONS These findings suggest that how individuals conceptualize God/a higher power is associated with their willingness to get the COVID-19 vaccine. Given this, those who see God/a higher power as more involved in the world may contribute to delays in achieving herd immunity. This information benefits those working on vaccination campaigns in understanding the beliefs of some of those who are most hesitant to get vaccinated. In addition, this intervention mechanism could also mediate other negative relationships between religion and other science and health-related concerns.
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Affiliation(s)
- Bernard D. DiGregorio
- Department of Sociology & Anthropology, West Virginia University, PO Box 6326, 26506-6326 Morgantown, WV United States
| | - Katie E. Corcoran
- Department of Sociology & Anthropology, West Virginia University, PO Box 6326, 26506-6326 Morgantown, WV United States
| | - Christopher P. Scheitle
- Department of Sociology & Anthropology, West Virginia University, PO Box 6326, 26506-6326 Morgantown, WV United States
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24
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Phan TLT, Enlow PT, Wong MK, Lewis AM, Kazak AE, Miller JM. Medical factors associated with caregiver intention to vaccinate their children against COVID-19. Vaccine X 2022; 10:100144. [PMID: 35128377 PMCID: PMC8802490 DOI: 10.1016/j.jvacx.2022.100144] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/23/2021] [Accepted: 01/25/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe medical factors that are associated with caregiver intention to vaccinate their children against COVID-19. METHODS We conducted a cross-sectional study of families receiving primary care in a mid-Atlantic pediatric healthcare system, linking caregiver-reported data from a survey completed March 19 to April 16, 2021 to comprehensive data from the child's EHR. RESULTS 513 families were included (28% Black, 16% Hispanic, 44% public insurance, 21% rural, child age range 0-21 years). 44% of caregivers intended to vaccinate their children against COVID-19, while 41% were not sure and 15% would not. After adjusting for socio-demographics, the only medical factors that were associated with caregiver COVID-19 vaccine hesitancy were caregiver COVID-19 vaccination status at the time of the survey (aOR 3.0 if the caregiver did not receive the vaccine compared to those who did, 95% CI 1.7-5.3) and child seasonal influenza immunization history (aOR 3.3 if the child had not received the influenza vaccine in the 2020-2021 season compared to those who did, 95% CI 2.0-5.4). Other medical factors, including family medical experiences with COVID-19, other child immunization history, child health conditions like obesity and asthma, and family engagement with the healthcare system were not associated with caregiver intention to vaccinate their children against COVID-19. CONCLUSIONS This study highlights important factors, such as general attitudes towards vaccines and understanding of COVID-19 morbidity risk factors, that healthcare providers should address when having conversations with families about the COVID-19 vaccine.
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Affiliation(s)
- Thao-Ly T Phan
- Nemours Center for Healthcare Delivery Science, 1600 Rockland Rd, Wilmington, DE 19803, USA.,Sidney Kimmel Medical College at Thomas Jefferson University, 833 Chestnut St, Philadelphia, PA 19107, USA
| | - Paul T Enlow
- Nemours Center for Healthcare Delivery Science, 1600 Rockland Rd, Wilmington, DE 19803, USA.,Sidney Kimmel Medical College at Thomas Jefferson University, 833 Chestnut St, Philadelphia, PA 19107, USA
| | - Michael K Wong
- Sidney Kimmel Medical College at Thomas Jefferson University, 833 Chestnut St, Philadelphia, PA 19107, USA
| | - Amanda M Lewis
- Nemours Center for Healthcare Delivery Science, 1600 Rockland Rd, Wilmington, DE 19803, USA
| | - Anne E Kazak
- Nemours Center for Healthcare Delivery Science, 1600 Rockland Rd, Wilmington, DE 19803, USA.,Sidney Kimmel Medical College at Thomas Jefferson University, 833 Chestnut St, Philadelphia, PA 19107, USA
| | - Jonathan M Miller
- Sidney Kimmel Medical College at Thomas Jefferson University, 833 Chestnut St, Philadelphia, PA 19107, USA.,Nemours Value-Based Services Organization, 1600 Rockland Rd, Wilmington, DE 19803, USA
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25
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Sasaki S, Saito T, Ohtake F. Nudges for COVID-19 voluntary vaccination: How to explain peer information? Soc Sci Med 2022; 292:114561. [PMID: 34823128 PMCID: PMC8577869 DOI: 10.1016/j.socscimed.2021.114561] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 11/23/2022]
Abstract
Vaccination promotion is a crucial strategy to end the COVID-19 pandemic; however, individual autonomy should also be respected. This study aimed to discover other-regarding information nudges that can reinforce people's intention to receive the COVID-19 vaccine without impeding their autonomous decision-making. In March 2021, we conducted an online experiment with 1595 people living throughout Japan, and randomly assigned them either of one control group and three treatment groups that received messages differently describing peer information: control, comparison, influence-gain, and influence-loss. We compared each message's effects on vaccination intention, autonomous decision-making, and emotional response. We found that the influence-gain nudge was effective in increasing the number of older adults who newly decided to receive the vaccine. The comparison and influence-loss nudges further reinforced the intention of older adults who had already planned to receive it. However, the influence-loss nudge, which conveys similar information to the influence-gain nudge but with loss-framing, increased viewers' negative emotion. These messages had no promoting effect for young adults with lower vaccination intentions at baseline. Based on the findings, we propose governments should use different messages depending on their purposes and targets, such as comparison instead of influence-loss, to encourage voluntary vaccination behavior.
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Affiliation(s)
- Shusaku Sasaki
- Faculty of Economics, Tohoku Gakuin University, 1-3-1 Tsuchitoi, Aoba-ku, Sendai, Miyagi 985-8537, Japan; Center for Infectious Disease Education and Research, Osaka University, Japan.
| | - Tomoya Saito
- Center for Emergency Preparedness and Response, National Institute of Infectious Diseases, Japan
| | - Fumio Ohtake
- Center for Infectious Disease Education and Research, Osaka University, Japan; Graduate School of Economics, Osaka University, Japan
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26
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Corcoran KE, Scheitle CP, DiGregorio BD. Christian nationalism and COVID-19 vaccine hesitancy and uptake. Vaccine 2021; 39:6614-6621. [PMID: 34629205 PMCID: PMC8489517 DOI: 10.1016/j.vaccine.2021.09.074] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/24/2021] [Accepted: 09/29/2021] [Indexed: 11/10/2022]
Abstract
Understanding COVID-19 vaccine hesitancy and uptake is vital for informing public health interventions. Prior U.S. research has found that religious conservatism is positively associated with anti-vaccine attitudes. One of the strongest predictors of anti-vaccine attitudes in the U.S. is Christian nationalism-a U.S. cultural ideology that wants civic life to be permeated by their particular form of nationalist Christianity. However, there are no studies examining the relationship between Christian nationalism and COVID-19 vaccine hesitancy and uptake. Using a new nationally representative sample of U.S. adults, we find that Christian nationalism is one of the strongest predictors of COVID-19 vaccine hesitancy and is negatively associated with having received or planning to receive a COVID-19 vaccine. Since Christian nationalists make up approximately 20 percent of the population, these findings could have important implications for achieving herd immunity.
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Affiliation(s)
- Katie E Corcoran
- West Virginia University, Department of Sociology & Anthropology, PO Box 6326, Morgantown, WV 26506-6326, United States.
| | - Christopher P Scheitle
- West Virginia University, Department of Sociology & Anthropology, PO Box 6326, Morgantown, WV 26506-6326, United States.
| | - Bernard D DiGregorio
- West Virginia University, Department of Sociology & Anthropology, PO Box 6326, Morgantown, WV 26506-6326, United States.
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27
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Ma GX, Zhu L, Tan Y, Zhai S, Lin TR, Zambrano C, Siu P, Lai S, Wang MQ. A Multilevel Intervention to Increase HPV Vaccination among Asian American Adolescents. J Community Health 2021; 47:9-16. [PMID: 34232452 PMCID: PMC8738771 DOI: 10.1007/s10900-021-01013-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 12/05/2022]
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infection in the US. HPV vaccine is a viable source of prevention against high-risk strains that are likely to cause cancer. However, particularly among racial and ethnic minorities such as Chinese Americans, HPV vaccination rates are suboptimal. The goal of this study was to evaluate the effect of a culturally tailored intervention on HPV vaccine uptake in Chinese Americans. We designed and implemented a multilevel longitudinal pilot study to examine the efficacy of the HPV intervention among Chinese American parents/guardians. We recruited 180 participants from federally qualified health center and community-based clinics that serve predominantly low-income Chinese Americans in Philadelphia. Participants were randomized into an intervention group (n = 110) or a control group (n = 70). The intervention group received an HPV specific intervention, while the control group received a general health intervention. The primary outcome was medical record-confirmed receipt of first shot and completion of HPV vaccine within six months of receiving the interventions. Repeated measure ANOVA was utilized to examine the intervention effect on knowledge between intervention and control groups. Knowledge differed significantly, with participants in the intervention group demonstrating the greatest improvement following the intervention. A multivariable logistic regression was used to examine the association between HPV vaccine initiation and study group assignment. There was a significant effect of provider recommendation, parent’s gender, and health insurance status on HPV vaccine uptake. This study demonstrated positive impact of a culturally tailored intervention on HPV vaccination uptake among Chinese Americans.
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Affiliation(s)
- Grace X Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA, 19140, USA.
- Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA, 19140, USA.
- Fox Chase Cancer Center, Temple University Health System, 333 Cottman Ave, Philadelphia, PA, 19111, USA.
| | - Lin Zhu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Yin Tan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Shumenghui Zhai
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Timmy R Lin
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Cristina Zambrano
- Hunter College Center for Cancer Health Disparities Research, 695 Park Avenue, New York, NY, 10065, USA
| | - Philip Siu
- Greater Philadelphia Health Action, Inc., 432 N 6th St, Philadelphia, PA, 19123, USA
| | - Sarah Lai
- Greater Philadelphia Health Action, Inc., 432 N 6th St, Philadelphia, PA, 19123, USA
| | - Min Qi Wang
- School of Public Health, University of Maryland, 4200 Valley Dr, College Park, MD, 20742, USA
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28
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Easing Human Papillomavirus Vaccine Hesitancy: A Communication Experiment With U.S. Parents. Am J Prev Med 2021; 61:88-95. [PMID: 33975768 PMCID: PMC8217248 DOI: 10.1016/j.amepre.2021.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 01/18/2021] [Accepted: 02/16/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The Announcement Approach using presumptive announcements increases human papillomavirus vaccine uptake. This study seeks to understand the impact of the final Announcement Approach steps-easing parents' vaccine concerns and then encouraging them to get human papillomavirus vaccine for their children-on parents' human papillomavirus vaccine hesitancy and confidence in the vaccine's benefits. METHODS In 2017-2018, investigators recruited an online national sample of 1,196 U.S. parents of children aged 9-17 years who had not yet completed the human papillomavirus vaccine series. Following the steps of the Announcement Approach, participants viewed brief videos of a pediatrician announcing that a child was due for human papillomavirus vaccine (shown to all the parents). In the 2 × 2 experiment, parents saw (1) a video of the pediatrician attempting to ease a concern that the parent had raised earlier in the survey (Ease video), (2) a video of the pediatrician encouraging the parent to get their child vaccinated (Encourage video), (3) both videos, or (4) neither of the videos. Data analysis was conducted in spring 2020. RESULTS Seeing the Ease video message led to lower human papillomavirus vaccine hesitancy than not seeing it (mean=2.71, SD=1.29 vs mean=2.97, SD=1.33; p<0.001). The beneficial impact of easing concerns on lower vaccine hesitancy was explained by higher confidence (p<0.05). By contrast, the Encourage video had no impact on human papillomavirus vaccine hesitancy or confidence. CONCLUSIONS Addressing parents' concerns can decrease human papillomavirus vaccine hesitancy and increase confidence. On the basis of these findings, the Announcement Approach retained its emphasis on announcing that children are due for vaccination and easing parent concerns.
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29
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Oh NL, Biddell CB, Rhodes BE, Brewer NT. Provider communication and HPV vaccine uptake: A meta-analysis and systematic review. Prev Med 2021; 148:106554. [PMID: 33857561 DOI: 10.1016/j.ypmed.2021.106554] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/06/2021] [Accepted: 04/11/2021] [Indexed: 12/13/2022]
Abstract
Provider communication can be critically important to families as they consider HPV vaccination. We sought to characterize the association of provider communication and HPV vaccine uptake, and when communication better motivates vaccination. We searched four databases for studies published between 2006 and 2019. Eligible studies examined health care provider communication (defined as recommendation or discussion) and HPV vaccine uptake (defined as initiation, completion, or follow-through) in the US. Two coders independently identified eligible studies and coded effect sizes and study characteristics. We pooled effect sizes using random-effects meta-analysis. We identified 59 eligible studies of 265,083 patients. Receiving a provider recommendation was associated with higher HPV vaccine initiation (pooled OR = 10.1, 95% CI: 7.6-13.4). HPV vaccine initiation was 24% for patients without and 60% for patients with a provider recommendation. The pooled effect size for provider recommendation and initiation was smaller for probability samples, clinical records, and NIS-Teen (all p < 0.002). Recommendations were equally effective for males and females, for different patient ages, and over time. Provider recommendation was also associated with higher HPV vaccine series completion and follow-through. Provider discussion was similarly associated with higher HPV vaccine initiation (OR = 12.4, 95% CI: 6.3-24.3). In summary, provider communication was robustly associated with HPV vaccination initiation, completion, and follow-through. These findings suggest that US public health efforts to increase HPV vaccine coverage should continue to emphasize provider communication.
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Affiliation(s)
- N Loren Oh
- University of North Carolina School of Medicine, United States of America; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States of America
| | - Caitlin B Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States of America
| | - Blythe E Rhodes
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, United States of America
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina, United States of America.
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30
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Daniel CL, Lawson F, Vickers M, Green C, Wright A, Coyne-Beasley T, Lee HY, Turberville S. Enrolling a rural community pharmacy as a Vaccines for Children provider to increase HPV vaccination: a feasibility study. BMC Public Health 2021; 21:1266. [PMID: 34187438 PMCID: PMC8240772 DOI: 10.1186/s12889-021-11304-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/19/2021] [Indexed: 11/14/2022] Open
Abstract
Background Human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S. with over 80 million infected individuals. High-risk strains are associated with 6 different cancers. Although infection is preventable, U.S. vaccination rates remain suboptimal and there are noted disparities between urban and rural communities due to economic barriers, lack of access, and low awareness and education. Methods The current pilot study sought to overcome these barriers through an interprofessional collaborative enrolling a community pharmacy in a rural, medically underserved Alabama county as a Vaccines for Children (VFC) provider to provide free vaccines to eligible adolescents. Program evaluation was conducted to determine the intervention’s feasibility. Potential efficacy was assessed by analyzing county-level HPV vaccination uptake and completion rates using state immunization registry data. Results Over the 8-month study, 166 total vaccines were administered to 89 adolescents ages 10–18, including 55 doses of HPV vaccine, 53 doses of Tdap vaccine, 45 doses of meningococcal vaccine, and 13 doses of influenza vaccine. Among these adolescents, mean age was 12.6 years old, and 64 (71.9%) were VFC patients. The pharmacy recorded an increase in total vaccine administration of 158.8%, an increase in prescription revenue of 34.8%, and an increase in total revenue by 24.4% during the course of the study, compared to the previous year. Conclusions Findings from the current work demonstrate the potential of this strategy and can serve as a blueprint for statewide and national dissemination and implementation to ultimately increase access to vaccination services, increase vaccination rates, and reduce urban-rural vaccine disparities.
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Affiliation(s)
- Casey L Daniel
- Division of Cancer Control and Prevention, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604, USA.
| | - Frances Lawson
- Division of Cancer Control and Prevention, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604, USA
| | - Macy Vickers
- Division of Cancer Control and Prevention, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604, USA
| | - Chelsea Green
- Division of Cancer Control and Prevention, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604, USA
| | - Anna Wright
- Division of Cancer Control and Prevention, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604, USA
| | - Tamera Coyne-Beasley
- Division of Adolescent Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hee Y Lee
- School of Social Work, University of Alabama, Tuscaloosa, AL, USA
| | - Stacie Turberville
- Division of Cancer Control and Prevention, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604, USA
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HPV vaccine communication training in healthcare systems: Evaluating a train-the-trainer model. Vaccine 2021; 39:3731-3736. [PMID: 34078555 DOI: 10.1016/j.vaccine.2021.05.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Large healthcare systems provide an opportunity to disseminate evidence-based interventions to primary care. We evaluated the impact of a train-the-trainer model in two large systems to disseminate the Announcement Approach Training, which teaches providers to communicate about HPV vaccination more effectively. METHODS In collaboration with the American Cancer Society, we partnered with two midwestern healthcare systems that served over 77,000 patients ages 11 through 17. Both systems hosted a 2-hour train-the-trainer workshop. Providers from one system then conducted in-person 1-hour CME-eligible trainings, using our standard slide set and script (available at hpvIQ.org). The other system did not implement trainings, providing a natural experiment. RESULTS The train-the-trainer workshop included physicians, nurses and other clinical staff (n = 11/13 for intervention/comparison systems). The intervention system delivered 18 trainings to 234 physicians, nurses, and other clinic staff. From baseline to 6-month follow-up, the intervention system had an increase in HPV vaccine uptake that was larger than that of the comparison system for adolescents ages 11 through 12 (1.9%, p = .002) and ages 13 through 17 (1.5%, p = .015). Attending the training was associated with increased intentions to routinely recommend HPV vaccine when patients turn 11 or 12 (mean 4.19 (SD = 0.95) vs. 4.43 (SD = 0.83) as well as increased positive vaccine attitudes, self-efficacy, and norms (all p < .001). Participant satisfaction with the trainings was high (90%-94%). CONCLUSION The train-the-trainer model was effective in increasing provider motivation to recommend HPV vaccination and led to a small increase in vaccine uptake. Dissemination through large healthcare systems is promising but faces some challenges.
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Usability Evaluation of the Novel Smartphone Application, HPV Vaccine: Same Way, Same Day, Among Pediatric Residents. Acad Pediatr 2021; 21:742-749. [PMID: 33279739 DOI: 10.1016/j.acap.2020.11.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Scalable, deliberate practice training strategies to administer evidence-based recommendations are necessary to improve human papillomavirus (HPV) vaccination rates. We sought to characterize resident clinicians' perceptions regarding the usability of the HPV Vaccine: Same Way, Same Day smartphone application (app). Usability, a critical aspect of digital programs to promote behavior change, was evaluated. METHODS Fifteen third-year pediatric residents were recruited to complete a usability evaluation of the HPV Vaccine: Same Way, Same Day app, which includes simulated role-play scenarios in which users interact, as a pediatrician avatar, with an animated parent hesitant to accept the vaccine for her child. The app provides information about the vaccine and utilizes deliberate practice, a purposeful and systematic approach to improve performance, to teach evidence-based vaccine recommendation practices, including motivational interviewing skills. Data were derived from in-depth, semistructured interviews with pediatric residents. We used a constructivist general inductive approach to illuminate perspectives via inductive coding and pattern identification. Garrison's theoretical construct on self-directed learning was used to cluster themes into conceptual categories. RESULTS We classified interview data in 3 conceptual categories: self-management, internal monitoring and motivational principles. Residents described the app as interactive, easy to use, succinct, informative, engaging, and practical. All residents would recommend the HPV Vaccine: Same Way, Same Day app to a colleague. Residents suggested adding more complex cases for future iterations. CONCLUSIONS From their perspective, pediatric residents reported that an app using deliberate practice principles has the potential to inform and advance providers' counseling skills regarding the HPV vaccine.
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33
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Mansfield LN, Vance A, Nikpour JA, Gonzalez-Guarda RM. A systematic review of human papillomavirus vaccination among US adolescents. Res Nurs Health 2021; 44:473-489. [PMID: 33860541 DOI: 10.1002/nur.22135] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 11/07/2022]
Abstract
The human papillomavirus (HPV) causes many anogenital and oral cancers affecting young adults in the United States. Vaccination during adolescence can prevent HPV-associated cancers, but vaccine uptake among adolescents is low and influenced by factors serving as barriers and facilitators to HPV vaccination. In this systematic review, we synthesized research using the socioecological framework model to examine individual-level, relationship-level, community-level, and societal-level factors that influence HPV vaccine initiation and completion among US adolescents. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to guide the methodology for this review. An electronic search was conducted in January 2020 using PubMed, Cumulative Index of Nursing and Allied Health Literature, ProQuest Central, Scopus, and American Psychological Association PsycInfo databases. The Joanna Briggs Institute tools were used to assess the quality for the 57 studies included in this review. The most consistent influences of HPV vaccination included age at vaccination, awareness, and knowledge about HPV vaccination, socioeconomic status, insurance status, race/ethnicity, and preventative care behaviors at the individual level. Provider recommendation, familial/peer support of vaccination, and parental health behaviors were influences at the relationship level. Although fewer findings elucidated community-level and societal-level influences, high-poverty areas, high-risk communities with large proportions of racial/ethnic minority groups, healthcare facilities servicing children, and combined health policies appear to serve as facilitators of HPV initiation and completion. Findings from this review can inform culturally relevant and age-specific interventions and multi-level policies aiming to improve HPV vaccination coverage in the United States.
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Affiliation(s)
- Lisa N Mansfield
- School of Nursing, Duke University, Durham, North Carolina, USA.,Division of General Internal Medicine and Health Services Research, National Clinician Scholars Program, University of California, Los Angeles, Los Angeles, California, USA
| | - Ashlee Vance
- Institute for Healthcare Policy and Innovation, National Clinical Scholars Program, University of Michigan, Ann Arbor, Michigan, USA
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Kuter BJ, Browne S, Momplaisir FM, Feemster KA, Shen AK, Green-McKenzie J, Faig W, Offit PA. Perspectives on the receipt of a COVID-19 vaccine: A survey of employees in two large hospitals in Philadelphia. Vaccine 2021; 39:1693-1700. [PMID: 33632563 PMCID: PMC7885691 DOI: 10.1016/j.vaccine.2021.02.029] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Health care personnel have been identified by the ACIP as a priority group for COVID-19 vaccination. We conducted a survey in November-December 2020 at two large, academic hospitals in Philadelphia to evaluate the intention of hospital employees to be vaccinated. METHODS The survey was sent electronically to all employees (clinical and nonclinical staff) at a children's hospital and an adult hospital. The survey was voluntary and confidential. Questions focused on plans to receive a COVID-19 vaccine when available, reasons why employees would/would not get vaccinated, when employees planned to be vaccinated, vaccine safety and efficacy features that would be acceptable, and past history of receipt of other vaccines by the employee and family. Responses were analyzed using univariate and multiple logistic regression methods. RESULTS A total of 12,034 hospital employees completed the survey (a 34.5% response rate). Overall, 63.7% of employees reported that they planned to receive a COVID-19 vaccine, 26.3% were unsure, and 10.0% did not plan to be vaccinated. Over 80% of those unsure or unwilling to be vaccinated expressed concerns about vaccine side effects and the vaccines' newness. In multivariable logistic regression, persons planning to take a COVID-19 vaccine were more likely to be older, male, more educated, Asian or White, up-to-date on vaccinations, without direct patient contact, and tested for COVID-19 in the past. No significant difference in intention to be vaccinated was found between those with higher versus lower levels of exposure to COVID-19 patients or the number of previous exposures to patients with COVID-19. CONCLUSIONS While the majority of hospital employees are planning to receive a COVID-19 vaccine, many are unsure or not planning to do so. Further education of hospital employees about the safety, efficacy, and value of the currently available COVID-19 vaccines is critical to vaccine acceptance in this population.
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Affiliation(s)
- Barbara J Kuter
- Vaccine Education Center, Children's Hospital of Philadelphia, United States.
| | - Safa Browne
- Vaccine Education Center, Children's Hospital of Philadelphia, United States
| | | | - Kristen A Feemster
- Vaccine Education Center, Children's Hospital of Philadelphia, United States
| | - Angela K Shen
- Vaccine Education Center, Children's Hospital of Philadelphia, United States
| | | | - Walter Faig
- Children's Hospital of Philadelphia, United States
| | - Paul A Offit
- Vaccine Education Center, Children's Hospital of Philadelphia, United States
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Staras SAS, Richardson E, Merlo LJ, Bian J, Thompson LA, Krieger JL, Gurka MJ, Sanders AH, Shenkman EA. A feasibility trial of parent HPV vaccine reminders and phone-based motivational interviewing. BMC Public Health 2021; 21:109. [PMID: 33422047 PMCID: PMC7797089 DOI: 10.1186/s12889-020-10132-6] [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: 06/04/2020] [Accepted: 12/25/2020] [Indexed: 11/28/2022] Open
Abstract
Background We assessed the feasibility and acceptability of a sequential approach of parent-targeted HPV vaccine reminders and phone-based Motivation Interviewing (MI). Methods In 2016, we selected all 11- to 12-year-old boys and girls seen in one clinic whose vaccine records did not include the HPV vaccine (n=286). By gender, we individually randomized parents of adolescents to an interactive text message (74 girls and 45 boys), postcard reminder (46 boys and no girls because of previously demonstrated efficacy), or standard care group (75 girls and 46 boys). Reminders were sent with medical director permission and a HIPAA waiver. Two months after reminders, among the adolescents whose vaccine records still did not include the HPV vaccine, we selected a gender-stratified random sample of 20 parents for phone-based MI. We assessed the percentage of deliverable messages, the percentage of parents’ responding to the interactive text message, parent acceptability of receiving a text message, and MI parent responsiveness and interviewer competence (MI Treatment Integrity Coding system). Results Nearly all messages were deliverable (98% of postcards and 74% of text messages). Six of the 88 parents (7%) receiving text messages scheduled an appointment through our interactive system. The acceptability survey response rate was 37% (38/102). Respondents were favorable toward vaccine reminders for all parents (82%). Among 20 sampled parents, 17 were reached by phone of whom 7 completed MI, 4 had or were getting the HPV vaccine for their child, and 5 expressed disinterest. Across the 7 MI calls, the interviewer was rated 100% MI adherent and scored an average 4.19 rating for Global Spirit. Conclusion Without providing explicit consent to receive vaccine-related messages, parents nonetheless found postcards and interactive text messages acceptable. Centralizing MI to phone calls with trained staff was acceptable to parents and resulted in highly MI-adherent interviews. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10132-6.
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Affiliation(s)
- Stephanie A S Staras
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA. .,The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Eric Richardson
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lisa J Merlo
- The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA.,Department of Psychiatry, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lindsay A Thompson
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.,The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA.,Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Janice L Krieger
- Department of Advertising, College of Journalism and Communication, University of Florida, Gainesville, FL, USA
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.,The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ashley H Sanders
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.,The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.,The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA
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Cates JR, Fuemmeler BF, Stockton LL, Diehl SJ, Crandell JL, Coyne-Beasley T. Evaluation of a Serious Video Game to Facilitate Conversations About Human Papillomavirus Vaccination for Preteens: Pilot Randomized Controlled Trial. JMIR Serious Games 2020; 8:e16883. [PMID: 33270028 PMCID: PMC7746502 DOI: 10.2196/16883] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 05/09/2020] [Accepted: 07/24/2020] [Indexed: 11/13/2022] Open
Abstract
Background In the United States, the most common sexually transmitted infection, human papillomavirus (HPV), causes genital warts and is associated with an estimated 33,700 newly diagnosed cancer cases annually. HPV vaccination, especially for preteens aged 11 to 12 years, is effective in preventing the acquisition of HPV and HPV-associated cancers. However, as of 2018, completion of the 2- or 3-dose HPV vaccination series increased only from 48.6% to 51.1% in teens aged 13 to 17 years, and this increase was observed only in boys. By comparison, 88.7% of teens had more than one dose of the recommended vaccine against tetanus, diphtheria, and acellular pertussis (Tdap), and 85.1% of teens had more than one dose of meningococcal vaccine. Immunizations for Tdap, meningococcal disease, and HPV can occur at the same clinical visit but often do not. Objective Vaccination against HPV is recommended for routine use in those aged 11 to 12 years in the United States, yet it is underutilized. We aimed to develop an educational video game to engage preteens in the decision to vaccinate. Methods Land of Secret Gardens is a metaphor for protecting seedlings (body) with a potion (vaccine). We screened 131 dyads of parents and preteens from 18 primary practices in North Carolina who had not initiated HPV vaccination. We measured vaccination intentions, story immersion, and game play and documented HPV vaccination rates. A total of 55 dyads were enrolled, and we randomly assigned 28 (21 completed) to play the game and 27 (26 completed) to the comparison group. Results In total, 18 preteens reported playing the game. The vaccination self-efficacy score was higher in the comparison group than the intervention group (1.65 vs 1.45; P=.05). The overall mean decisional balance score trended toward greater support of vaccination, although differences between the groups were not significant.. Vaccine initiation and completion rates were higher in the intervention group (22% vs 15%; P=.31) than in the comparison group (9% vs 2%; P=.10), although the difference was not significant. Conclusions Video games help preteens in the decision to pursue HPV vaccination. A serious video game on HPV vaccination is acceptable to parents and preteens and can be played as intended. Gamification is effective in increasing preteen interest in HPV vaccination, as game features support decision making for HPV vaccination. Trial Registration ClinicalTrials.gov NCT04627298; https://www.clinicaltrials.gov/ct2/show/NCT04627298
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Affiliation(s)
- Joan R Cates
- UNC Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Bernard F Fuemmeler
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Laurie L Stockton
- UNC Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sandra J Diehl
- UNC Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jamie L Crandell
- UNC Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Tamera Coyne-Beasley
- Department of Pediatrics, Children's of Alabama, University of Alabama, Birmingham, AL, United States
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Gilkey MB, Grabert BK, Malo TL, Hall ME, Brewer NT. Physicians' rhetorical strategies for motivating HPV vaccination. Soc Sci Med 2020; 266:113441. [PMID: 33069959 PMCID: PMC7550258 DOI: 10.1016/j.socscimed.2020.113441] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/12/2020] [Accepted: 10/09/2020] [Indexed: 11/02/2022]
Abstract
RATIONALE Receiving a healthcare provider's recommendation is a well-documented predictor of human papillomavirus (HPV) vaccination, and yet recommendations remain understudied and undertheorized. OBJECTIVE To qualitatively describe strategies providers use to motivate HPV vaccination. METHOD We surveyed a national sample of 771 U.S. primary care physicians. Data came from an open-ended item that assessed physicians' perspectives on the most effective thing they could say to persuade parents to get HPV vaccine for their 11- to 12-year-old children. Using a standardized codebook and two independent coders, we conducted a thematic analysis to identify rhetorical strategies underlying physicians' responses. RESULTS We identified two sets of strategies for motivating HPV vaccination. One set drew parents' attention to specific actors or vaccine characteristics. Physicians using these strategies asked parents to consider their children's individual risk in the short-term, named specific diseases that could be prevented, emphasized the novelty of HPV vaccine as a cancer prevention tool, and gave their personal endorsement for HPV vaccination. In contrast, the second set of strategies was more distancing and impersonal. Physicians using these strategies referenced future risk, described cancer prevention in general terms, framed HPV vaccine as similar to other vaccines, and shared organizational endorsements for HPV vaccination. Across these two sets of strategies, a tension emerged between the goals of engaging parents' perceptions of HPV as a threat to their children versus framing HPV vaccination as a normative standard of care. CONCLUSIONS Our findings suggest that theoretical frameworks, such as Construal Level Theory, may be helpful for positioning provider recommendations in the broader literature on persuasive communication. By identifying competing approaches to motivating HPV vaccination, this study lays the groundwork for future research to test the acceptability and impact of strategies for recommending routine preventive care.
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Affiliation(s)
- Melissa B Gilkey
- Department of Health Behavior & Lineberger Comprehensive Cancer Center, University of North Carolina, CB# 7440, Chapel Hill, NC, 27599, USA.
| | - Brigid K Grabert
- Lineberger Comprehensive Cancer Center, University of North Carolina, CB# 7440, Chapel Hill, NC, 27599, USA.
| | - Teri L Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina, CB# 7293, Chapel Hill, NC, 27599, USA.
| | - Megan E Hall
- Department of Health Behavior, University of North Carolina; CB# 7440, Chapel Hill, NC, 27599, USA.
| | - Noel T Brewer
- Department of Health Behavior & Lineberger Comprehensive Cancer Center, University of North Carolina, CB# 7440, Chapel Hill, NC, 27599, USA.
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Záhumenský J, Pšenková P, Nadzámová A, Drabiščáková P, Hruban L, Weinberger V, Kacerovský M, Dosedla E. Comparison of opinions of Slovak and Czech female medical students on HPV vaccination. Cent Eur J Public Health 2020; 28:178-186. [PMID: 32997472 DOI: 10.21101/cejph.a5989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 07/23/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aims to identify the differences in the use of HPV vaccination between female medical students in the Czech and Slovak Republics and their possible causes. METHODS We performed a cross-sectional survey among female students of general medicine in all faculties of medicine in the Czech and Slovak Republics. RESULTS We obtained 630 questionnaires from the Czech Republic and 776 questionnaires from the Slovak Republic. In the Czech Republic, 65.4% of female medical students underwent HPV vaccination, while in the Slovak Republic, the figure was 21.1%. In the Czech Republic, residency and religion of students did not influence their rate of vaccination. However, in the Slovak Republic, village residency with less than 5,000 inhabitants lowered the probability of vaccination with OR = 0.56 (95% CI: 0.38-0.84), and the Catholic religion lowered the probability of vaccination with OR = 0.40 (95% CI: 0.28-0.57). Czech students were informed about the possibility of vaccination by a paediatrician in 55.7% of cases, while the figure for Slovak students was 26.8%. In the Czech Republic, 75.7% of students participated in regular cervical oncologic screening, while in the Slovak Republic, the figure was 57.7%. Vaccination of relatives would be recommended by 86.5% and 80.5% of Czech and Slovak students, respectively. CONCLUSIONS The adoption of an oncologic prevention programme and the more extensive propagation by paediatricians are probably the medical reasons for the higher HPV vaccination among Czech students. Demographic factors - village residency and religion - are also important.
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Affiliation(s)
- Jozef Záhumenský
- Second Department of Gynaecology and Obstetrics, University Hospital Bratislava, Bratislava, Slovak Republic
| | - Petra Pšenková
- Second Department of Gynaecology and Obstetrics, University Hospital Bratislava, Bratislava, Slovak Republic
| | - Alexandra Nadzámová
- Second Department of Gynaecology and Obstetrics, University Hospital Bratislava, Bratislava, Slovak Republic
| | - Paula Drabiščáková
- Second Department of Gynaecology and Obstetrics, University Hospital Bratislava, Bratislava, Slovak Republic
| | - Lukáš Hruban
- Department of Obstetrics and Gynaecology, Masaryk University Hospital, Brno, Czech Republic
| | - Vít Weinberger
- Department of Obstetrics and Gynaecology, Masaryk University Hospital, Brno, Czech Republic
| | - Marian Kacerovský
- Department of Gynaecology and Obstetrics, University Hospital Hradec Kralove, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Erik Dosedla
- Department of Obstetrics and Gynaecology, University of Pavel Jozef Safarik, Hospital AGEL Kosice-Saca, Kosice, Slovak Republic
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Kobayashi KI, Chanyasanha C, Sujirarat D. Parental decision-making on human papillomavirus vaccination for daughters in Japan. Int J Adolesc Med Health 2020; 33:95-105. [PMID: 32304302 DOI: 10.1515/ijamh-2018-0140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/06/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND In June 2013, the fear of adverse events compelled the government to withdraw its recommendation of the Human papillomavirus (HPV) vaccine. Since then, the rate of vaccination among Japanese girls has dropped dramatically. OBJECTIVE This study aims to assess how the Japanese government's policy change against HPV vaccination influenced the degree to which parents in remote areas in Japan accepted the vaccine for their daughters, and to analyze related factors. METHODS A self-administered questionnaire was distributed to parents with daughters attending secondary schools or high schools in two remote areas of the country. RESULTS Out of 700 eligible parents, 246 (35%) responded. The percentage of parents in the "accept group" (those whose daughters had already been vaccinated or those who intended to have their daughters vaccinated) dropped from 54% before the government withdrew its HPV vaccine recommendation to only 4.5% after the withdrawal (1.5% of whom intended to vaccinate and 3% of whom had already had their daughters vaccinated). Vaccine acceptance was higher in parents who were employed as healthcare workers, had been educated through to the completion of high school, had good levels of knowledge about cervical cancer and the HPV vaccine, had low perceived barriers against the HPV vaccine, and received high levels of social support. CONCLUSION The acceptance of HPV vaccination among parents was low overall. Higher acceptance may be possible if the government restores its recommendation and healthcare providers disseminate appropriate information about the HPV vaccination and cervical cancer.
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Affiliation(s)
- Ken-Ichiro Kobayashi
- Department of Microbiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand.,Department of Infectious Diseases, Japanese Red CrossWakayama Medical Center, Wakayama, Japan
| | | | - Dusit Sujirarat
- Department of Epidemiology, Faculty of Public Health, Mahidol University, Bangkok, Thailands
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Opel DJ, Robinson JD, Spielvogle H, Spina C, Garrett K, Dempsey AF, Perreira C, Dickinson M, Zhou C, Pahud B, Taylor JA, O'Leary ST. 'Presumptively Initiating Vaccines and Optimizing Talk with Motivational Interviewing' (PIVOT with MI) trial: a protocol for a cluster randomised controlled trial of a clinician vaccine communication intervention. BMJ Open 2020; 10:e039299. [PMID: 32784263 PMCID: PMC7418671 DOI: 10.1136/bmjopen-2020-039299] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION A key contributor to underimmunisation is parental refusal or delay of vaccines due to vaccine concerns. Many clinicians lack confidence in communicating with vaccine-hesitant parents (VHP) and perceive that their discussions will do little to change parents' minds. Improving clinician communication with VHPs is critical to increasing childhood vaccine uptake. METHODS AND ANALYSIS We describe the protocol for a cluster randomised controlled trial to test the impact of a novel, multifaceted clinician vaccine communication strategy on child immunisation status. The trial will be conducted in 24 primary care practices in two US states (Washington and Colorado). The strategy is called Presumptively Initiating Vaccines and Optimizing Talk with Motivational Interviewing (PIVOT with MI), and involves clinicians initiating the vaccine conversation with all parents of young children using the presumptive format, and among those parents who resist vaccines, pivoting to using MI. Our primary outcome is the immunisation status of children of VHPs at 19 months, 0 day of age expressed as the percentage of days underimmunised from birth to 19 months for 22 doses of eight vaccines recommended during this interval. Secondary outcomes include clinician experience communicating with VHPs, parent visit experience and clinician adherence to the PIVOT with MI communication strategy. ETHICS AND DISSEMINATION This study is approved by the following institutional review boards: Colorado Multiple Institutional Review Board, Washington State Institutional Review Board and Swedish Health Services Institutional Review Board. Results will be disseminated through peer-reviewed manuscripts and conference presentations. TRIAL REGISTRATION NUMBER NCT03885232.
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Affiliation(s)
- Douglas J Opel
- Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jeffrey D Robinson
- Department of Communication, Portland State University, Portland, Oregon, USA
| | | | - Christine Spina
- Children's Hospital Colorado, Aurora, Colorado, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Denver, CO, USA
| | - Kathleen Garrett
- Children's Hospital Colorado, Aurora, Colorado, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Denver, CO, USA
| | - Amanda F Dempsey
- Children's Hospital Colorado, Aurora, Colorado, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Denver, CO, USA
- Department of Pediatrics, University of Colorado, Denver, Colorado, USA
| | - Cathryn Perreira
- Children's Hospital Colorado, Aurora, Colorado, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Denver, CO, USA
| | - Miriam Dickinson
- Children's Hospital Colorado, Aurora, Colorado, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Denver, CO, USA
| | - Chuan Zhou
- Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Barbara Pahud
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - James A Taylor
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Sean T O'Leary
- Children's Hospital Colorado, Aurora, Colorado, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Denver, CO, USA
- Department of Pediatrics, University of Colorado, Denver, Colorado, USA
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Amith M, Lin R, Cunningham R, Wu QL, Savas LS, Gong Y, Boom JA, Tang L, Tao C. Examining Potential Usability and Health Beliefs Among Young Adults Using a Conversational Agent for HPV Vaccine Counseling. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2020; 2020:43-52. [PMID: 32477622 PMCID: PMC7233050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The human papillomavirus (HPV) vaccine is the most effective way to prevent HPV-related cancers. Integrating provider vaccine counseling is crucial to improving HPV vaccine completion rates. Automating the counseling experience through a conversational agent could help improve HPV vaccine coverage and reduce the burden of vaccine counseling for providers. In a previous study, we tested a simulated conversational agent that provided HPV vaccine counseling for parents using the Wizard of OZ protocol. In the current study, we assessed the conversational agent among young college adults (n=24), a population that may have missed the HPV vaccine during their adolescence when vaccination is recommended. We also administered surveys for system and voice usability, and for health beliefs concerning the HPV vaccine. Participants perceived the agent to have high usability that is slightly better or equivalent to other voice interactive interfaces, and there is some evidence that the agent impacted their beliefs concerning the harms, uncertainty, and risk denials for the HPV vaccine. Overall, this study demonstrates the potential for conversational agents to be an impactful tool for health promotion endeavors.
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Affiliation(s)
- Muhammad Amith
- The University of Texas Health Science Center at Houston, Houston, TX
| | | | | | | | - Lara S. Savas
- The University of Texas Health Science Center at Houston, Houston, TX
| | - Yang Gong
- The University of Texas Health Science Center at Houston, Houston, TX
| | | | - Lu Tang
- Texas A&M University, College Station, TX
| | - Cui Tao
- The University of Texas Health Science Center at Houston, Houston, TX
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Qin S, Fu JX, Chen MZ, Meng YT, Xu C, Luo Y. Acceptability of vaccination against human papillomavirus among women aged 20 to 45 in rural Hunan Province, China: A cross-sectional study. Vaccine 2020; 38:4732-4739. [PMID: 32471777 DOI: 10.1016/j.vaccine.2020.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/21/2020] [Accepted: 05/06/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study aimed to examine the intentions of and barriers to vaccination against human papillomavirus (HPV) among women aged 20 to 45 in rural areas, and to determine the popular sources to getting information about HPV vaccine and vaccination. METHODS This cross-sectional study was conducted in 2018 with a sample of women aged 20 to 45 from rural areas of Hunan Province in China. Anonymous self-administered questionnaires were used to collect sociodemographic information and characteristics related to reproductive health of participants, and intentions of and barriers to HPV vaccination. All statistical analysis methods were performed with SPSS 18.0. RESULTS A total of 2101 women participated in the study, with 58.55% intended to vaccinate against HPV. Increased intention of HPV vaccination was associated with higher age (adjusted odds ratio [AOR] = 1.35 and 1.50, respectively) and education level (AOR = 1.13 and 1.47, respectively). Women who have heard of HPV vaccine (AOR = 2.67, 95% confidence interval [CI]: 1.20-5.98) and have been aware of that cervical cancer could be prevented (AOR = 2.01, 95%CI: 1.44-2.82) were more willing to vaccinate. Having never heard of HPV vaccine and worry about efficacy and safety of vaccines were the most commonly cited reasons to refuse vaccination. The preferred source to get the knowledge was medical personnel (58.45%), followed by WeChat or Microblog, TV programs, and Internet. CONCLUSION We found the intention of HPV vaccination among women aged 20 to 45 in rural China is low. Findings highlighted the importance of knowledge and trust in HPV vaccine, and suggested strengthening educational interventions on HPV vaccine and vaccination through multiple sources, including HPV vaccine coverage in health insurance to increase access.
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Affiliation(s)
- Si Qin
- Xiangya Nursing School of Central South University, Changsha, PR China.
| | - Jing-Xia Fu
- Xiangya Nursing School of Central South University, Changsha, PR China.
| | - Ming-Zhu Chen
- Xiangya Nursing School of Central South University, Changsha, PR China.
| | - Yan-Ting Meng
- Xiangya Nursing School of Central South University, Changsha, PR China.
| | - Chen Xu
- Xiangya Nursing School of Central South University, Changsha, PR China.
| | - Yang Luo
- Xiangya Nursing School of Central South University, Changsha, PR China.
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Della Polla G, Pelullo CP, Napolitano F, Angelillo IF. HPV vaccine hesitancy among parents in Italy: a cross-sectional study. Hum Vaccin Immunother 2020; 16:2744-2751. [PMID: 32298210 PMCID: PMC7734096 DOI: 10.1080/21645515.2020.1744367] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This cross-sectional survey determined the vaccine hesitancy related to Human papillomavirus (HPV) and the determinants among parents of adolescents aged 12 and 13 years in Italy. Data was collected through a self-administered questionnaire. Two-thirds of the parents (66.7%) had heard of HPV infection and knew that the vaccination was a preventive measure. Parents who had vaccinated their child against the HPV were more likely to have this knowledge. The vast majority (88%) considered the immunization useful for the prevention of HPV-related cancers with an average value of 8.4. This positive attitude was higher among parents who had heard of HPV infection and knew that vaccination was a preventive measure, who had received information from physicians, who had vaccinated their child against the HPV, who were concerned that their child could contract the HPV infection, and who needed information on HPV vaccination. More than half (57.9%) self-reported that they had vaccinated their child against HPV and only 6.2% had delayed the administration of a dose. One-third (33.3%) were hesitant toward anti-HPV vaccination with a total Parent Attitudes about Childhood Vaccines Survey (PACV) score ≥50. Unmarried respondents, those who had not heard of HPV infection and did not know that the vaccination was a preventive measure, who did not believe that the vaccination was useful for the prevention of HPV-related cancers, and who needed information on HPV vaccination were more likely to be hesitant. Communication and education strategies must be undertaken to ensure that parents are fully informed and health-care professionals should provide materials with details regarding the risk of acquiring a HPV infection and vaccine usefulness.
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Affiliation(s)
- Giorgia Della Polla
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Concetta Paola Pelullo
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Francesco Napolitano
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli" , Naples, Italy
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Jacobson RM, St Sauver JL, Griffin JM, MacLaughlin KL, Finney Rutten LJ. How health care providers should address vaccine hesitancy in the clinical setting: Evidence for presumptive language in making a strong recommendation. Hum Vaccin Immunother 2020; 16:2131-2135. [PMID: 32242766 PMCID: PMC7553710 DOI: 10.1080/21645515.2020.1735226] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Vaccine hesitancy occurs throughout the world and can result in poor vaccine uptake and vaccine-preventable disease-outbreaks. Vaccine hesitancy dates back to the days of Edward Jenner and the smallpox vaccine. It persists despite the preponderance of evidence supporting vaccine safety and effectiveness. Studies show even among parents of well-vaccinated children that 15–35% of those parents are vaccine-hesitant. Studies have failed to show the efficacy of educational interventions, and, indeed, a number of studies of educational interventions show a contrarian effect leaving the vaccine-hesitant more entrenched in their views. Still dozens of studies support health care provider recommendation as a major factor in achieving high rates of vaccine uptake. Furthermore, studies find those recommendations perceived as stronger are more effective than those perceived as weaker. What makes for a stronger recommendation? Several observational studies indicate that presumptive, announcement language as contrasted with participatory, conversational language makes for a stronger more effective recommendation. Several trials now demonstrate that health care providers and practices can implement this language and obtain higher vaccination uptake. The authors recommend the practice be adopted as a routine practice in the clinical setting for all vaccinations
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Affiliation(s)
- Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic , Rochester, MN, USA.,Department of Health Sciences Research, Mayo Clinic , Rochester, MN, USA
| | | | - Joan M Griffin
- Department of Health Sciences Research, Mayo Clinic , Rochester, MN, USA
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45
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Noyman-Veksler G, Greenberg D, Grotto I, Shahar G. Parents' malevolent personification of mass vaccination solidifies vaccine hesitancy. J Health Psychol 2020; 26:2164-2172. [PMID: 32098523 DOI: 10.1177/1359105320903475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Parental hesitancy to vaccinate their children derails the success of mass vaccination campaigns. We examined the effect of parents' personification of the vaccinating agency on vaccine hesitancy (i.e. negative or positive mind change) in 555 parents in a mass wild poliovirus vaccination campaign. Parents were assessed before and after the campaign on attitudes toward vaccination and the vaccinating agency ("The Israeli MoH is caring" vs "hysteric"). Positive mind change was predicted by a gender and malevolent personification. A negative mind change was predicted by parental anxiety. We conclude that parental hesitancy is influenced by parents' attachment to the vaccinating agency.
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Affiliation(s)
| | - David Greenberg
- Pediatrics Department, Infectious Diseases Unit, Soroka Hospital, Israel.,Ben-Gurion University School of Medicine, Israel
| | - Itamar Grotto
- Israeli Ministry of Health, Public Health Unit, Israel.,Department of Epidemiology and Public Health, Ben-Gurion University School of Medicine, Israel
| | - Golan Shahar
- Department of Psychology, Ben-Gurion University of the Negev, Israel
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46
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The power of anticipated regret: Predictors of HPV vaccination and seasonal influenza vaccination acceptability among young Romanians. Vaccine 2020; 38:1572-1578. [DOI: 10.1016/j.vaccine.2019.11.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 10/27/2019] [Accepted: 11/11/2019] [Indexed: 11/18/2022]
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47
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Teitelman AM, Gregory EF, Jayasinghe J, Wermers Z, Koo JH, Morone JF, Leri DC, Davis A, Feemster KA. Vaccipack, A Mobile App to Promote Human Papillomavirus Vaccine Uptake Among Adolescents Aged 11 to 14 Years: Development and Usability Study. JMIR Nurs 2020; 3:e19503. [PMID: 34345789 PMCID: PMC8279454 DOI: 10.2196/19503] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/31/2020] [Accepted: 09/28/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND More than 90% of human papillomavirus (HPV)-related cancers could be prevented by widespread uptake of the HPV vaccine, yet vaccine use in the United States falls short of public health goals. OBJECTIVE The purpose of this study was to describe the development, acceptability, and intention to use the mobile app Vaccipack, which was designed to promote uptake and completion of the adolescent HPV vaccine series. METHODS Development of the mobile health (mHealth) content was based on the integrated behavioral model (IBM). The technology acceptance model (TAM) was used to guide the app usability evaluation. App design utilized an iterative process involving providers and potential users who were parents and adolescents. App features include a vaccine-tracking function, a discussion forum, and stories with embedded messages to promote intention to vaccinate. Parents and adolescents completed surveys before and after introducing the app in a pediatric primary care setting with low HPV vaccination rates. RESULTS Surveys were completed by 54 participants (20 adolescents aged 11 to 14 years and 34 parents). Notably, 75% (15/20) of adolescents and 88% (30/34) of parents intended to use the app in the next 2 weeks. Acceptability of the app was high among both groups: 88% (30/34) of parents and 75% (15/20) of adolescents indicated that Vaccipack was easy to use, and 82% (28/34) of parents and 85% (17/20) of adolescents perceived the app to be beneficial. Higher levels of app acceptability were found among parents with strong intentions to use the app (P=.09; 95% CI -2.15 to 0.15). CONCLUSIONS mHealth technology, such as Vaccipack, may be an acceptable and nimble platform for providing information to parents and adolescents and advancing the uptake of important vaccines.
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Affiliation(s)
- Anne M Teitelman
- University of Pennsylvania School of Nursing Philadelphia, PA United States
| | - Emily F Gregory
- Children's Hospital of Philadelphia Philadelphia, PA United States
- Perelman School of Medicine University of Pennsylvania Philadelphia, PA United States
| | - Joshua Jayasinghe
- University of Pennsylvania School of Nursing Philadelphia, PA United States
| | | | - Ja H Koo
- University of Pennsylvania School of Nursing Philadelphia, PA United States
| | - Jennifer F Morone
- Yale University New Haven, CT United States
- Veterans Affairs West Haven, CT United States
| | - Damien C Leri
- Big Yellow Star, Inc. Philadelphia, PA United States
| | - Annet Davis
- University of Pennsylvania School of Nursing Philadelphia, PA United States
| | - Kristen A Feemster
- Children's Hospital of Philadelphia Philadelphia, PA United States
- Perelman School of Medicine University of Pennsylvania Philadelphia, PA United States
- Division of Disease Control Department of Public Health Philadelphia, PA United States
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48
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Factors Associated with Intention of Human Papillomavirus (HPV) Vaccine Initiation Among Females With and Without a History of Childhood Cancer. J Clin Psychol Med Settings 2019; 27:716-726. [PMID: 31587132 DOI: 10.1007/s10880-019-09664-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Vaccination is available to prevent human papillomavirus (HPV) types that cause cervical and other cancers. This study aimed to describe and compare vaccine intention among young females with and without a cancer history, in addition to identifying factors associated with a HPV vaccination intention. Vaccine-naïve females (aged 18-26 years, n = 120) and maternal caregivers with vaccine-naïve daughters (aged 9-17 years, n = 197) completed surveys querying HPV vaccination intention, HPV knowledge, and communication, along with sociodemographic, medical, and health belief factors. Multivariable logistic regression was utilized to calculate odds ratio (OR) and 95% confidence intervals for HPV vaccination intention. No differences in vaccine intention were identified across cancer and comparison groups. Vaccine intention and predictors of intention among vaccine-naïve females differ by age, and there is variation in the factors which influence vaccine intention by age group. These results suggest interventions should be tailored based on developmental level.
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49
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Shibli R, Rishpon S. The factors associated with maternal consent to human papillomavirus vaccination among adolescents in Israel. Hum Vaccin Immunother 2019; 15:3009-3015. [PMID: 31339452 DOI: 10.1080/21645515.2019.1631139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose: To evaluate the knowledge and attitudes toward the human papillomavirus (HPV) vaccine among mothers of 8th graders in Israel, and to determine the factors associated with maternal consent to the HPV vaccine.Methods: We conducted a cross-sectional study among mothers of 8th grade students in 27 schools in Haifa and Northern districts of Israel during the 2016-17 school year. Data were collected using a structured telephone questionnaire.Results: 313 mothers answered the questionnaire (response rate = 91.8%). The mean knowledge level score was low (3.96 points [out of 10] ±2.68). Knowledge level was positively associated with Jewish nationality, being secular in religious practice and higher education. The attitude mean score was low-moderate (11.22 points [out of 18] ± 5.01). Attitude score was positively associated with Arab nationality. No significant association was found between knowledge level and attitudes. According to multivariate analysis, mothers' consent to the HPV vaccine was associated with the knowledge level score (OR = 0.82; 95%CI 0.68-0.98), the attitude score (OR = 1.76; 95%CI 1.53-2.02) and nationality (OR = 27.86, 95%CI 3.41-227.56).Conclusions: The knowledge level and attitudes toward the HPV vaccine were found to be unsatisfactory with racial disparities between Arabs and Jews. Jewish mothers compared with Arab mothers, mothers with a higher knowledge level or less positive attitudes were less likely to consent to the vaccine. These findings could contribute toward adapting programs to the different Israeli sectors in order to improve the rates of HPV vaccine receipt among adolescents.
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Affiliation(s)
- Rana Shibli
- Department of Epidemiology, Haifa District Health Office, Haifa, Israel
| | - Shmuel Rishpon
- Department of Epidemiology, Haifa District Health Office, Haifa, Israel.,School of Public Health, University of Haifa, Haifa, Israel
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50
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Cherven B, Castellino SM, Chen Y, Wong FL, York JM, Wasilewski-Masker K, Hudson MM, Bhatia S, Klosky JL, Landier W. Intent and subsequent initiation of human papillomavirus vaccine among young cancer survivors. Cancer 2019; 125:3810-3817. [PMID: 31291010 DOI: 10.1002/cncr.32379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/06/2019] [Accepted: 05/31/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Despite an increased risk of subsequent human papillomavirus (HPV)-related malignancies, HPV vaccine initiation rates among cancer survivors remain critically low. The purpose of this study was to determine the relationship between HPV vaccine intent and subsequent vaccine initiation among cancer survivors by linking data from a cross-sectional survey with state-based immunization registry records. METHODS Cancer survivors who were 9 to 26 years old were surveyed 1 to 5 years after their treatment to assess their HPV vaccine initiation status, HPV vaccine intent, sociodemographic factors, and vaccine-related health beliefs. HPV vaccine doses/dates were abstracted from the Georgia Registry for Immunization Transactions for 3.5 years after survey participation. Logistic regression models identified factors associated with vaccine intent and subsequent vaccine initiation. RESULTS Among survivors who were HPV vaccine-naive at survey participation (n = 103), factors associated with vaccine intent included the following: 1) provider recommendation for the HPV vaccine (odds ratio [OR], 5.0; 95% confidence interval [CI], 1.4-18.1; P = .014), 2) positive general attitude toward vaccines (OR, 4.8; 95% CI, 2.0-11.2; P < .001), and 3) perceived severity of HPV disease (OR, 3.5; 95% CI, 1.2-9.9; P = .02). Of the vaccine-naive patients, 28 initiated the HPV vaccine at a median of 1.1 years after the survey. Initiation was more likely among survivors who had reported vaccine intent (OR, 3.9; 95% CI, 1.2-12.5; P = .02) and was less likely among older survivors (OR per year, 0.7; 95% CI, 0.6-0.9; P < .001). CONCLUSIONS These findings suggest that provider recommendation for the HPV vaccine plays a role in establishing intent, which then translates into subsequent initiation.
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Affiliation(s)
- Brooke Cherven
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Yanjun Chen
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Jocelyn M York
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - James L Klosky
- Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.,St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wendy Landier
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.,Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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