1
|
Song D, Liu P, Wu D, Zhao F, Wang Y, Zhang Y. Knowledge and Attitudes towards Human Papillomavirus Vaccination (HPV) among Healthcare Providers Involved in the Governmental Free HPV Vaccination Program in Shenzhen, Southern China. Vaccines (Basel) 2023; 11:vaccines11050997. [PMID: 37243101 DOI: 10.3390/vaccines11050997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/13/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
No research has been conducted to explore the variables associated with healthcare providers' (HCPs) knowledge and attitudes toward the human papillomavirus vaccine (HPV) since the vaccine was approved for free use in some Chinese cities. In Shenzhen, southern China, a convenience sample strategy was used to distribute questionnaires to HCPs involved in the government's HPV vaccination program from Shenzhen. There were 828 questionnaires collected in total, with 770 used in the analysis. The mean HPV and HPV vaccine knowledge score was 12.0 among HCPs involved in the government HPV vaccination program (with a total score of 15). the average scores for HPV and HPV vaccine knowledge varied among different types of medical institutions. District hospitals had the highest mean score of 12.4, while private hospitals ranked fourth with a mean score of 10.9. Multivariate logistic regression results revealed significant disparities in the type of license and after-tax annual income across HCPs (p < 0.05). The future education and training for HCPs should focus on private community health centers (CHCs), HCPs whose license type is other than a doctor, and HCPs with low after-tax annual income.
Collapse
Affiliation(s)
- Danhong Song
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| | - Peiyi Liu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen 518000, China
| | - Dadong Wu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen 518000, China
| | - Fanghui Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| | - Yueyun Wang
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen 518000, China
| | - Yong Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| |
Collapse
|
2
|
Richman AR, Torres E, Wu Q, Eldridge D, Lawson L. HPV vaccine recommendation practices of current and future physicians in North Carolina: an exploratory study. HEALTH EDUCATION RESEARCH 2022; 37:213-226. [PMID: 35788319 DOI: 10.1093/her/cyac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 06/02/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
We assessed human papillomavirus (HPV) prevention practices and HPV literacy of pediatricians, family physicians and medical students in North Carolina. An online survey was distributed to physicians in 2018, and paper surveys were collected among medical students in 2019. Surveys measured HPV literacy, HPV prevention practices and HPV prevention self-efficacy. In terms of comfort, 27% of medical students and 24% of physicians anticipated having an uncomfortable conversion when recommending the vaccine to patients. Most physicians (76%, n = 230) followed the HPV vaccine age recommendation guidelines; however, those with higher HPV vaccine knowledge were more compliant with the guidelines (P < 0.01). Female physicians were more likely to start routinely recommending the HPV vaccine to women (84%, n = 134 versus 72%, n = 92) and men (81%, n = 127 versus 71%, n = 84) between the ages of 9 and 12 years (P < 0.05). Only 27%, n = 73 of physicians and 18%, n = 19 of medical students followed/knew the 'provider-driven' HPV-recommended style. Female physicians were more likely to use this communication style (32%, n = 48 versus 20%, n = 23, P = 0.03). HPV prevention curriculum should be incorporated into medical programs. The gender-related practice patterns found indicate a need for training of male providers specifically. Quality improvement efforts are needed for all physicians to strengthen vaccine communication, recommendation practices and guideline adherence.
Collapse
Affiliation(s)
- Alice R Richman
- Department of Health Education and Promotion, East Carolina University, College of Health and Human Performance, 238 Rivers West, Greenville, NC 27858, USA
| | - Essie Torres
- Department of Health Education and Promotion, East Carolina University, College of Health and Human Performance, 238 Rivers West, Greenville, NC 27858, USA
| | - Qiang Wu
- Department of Biostatistics, East Carolina University, College of Allied Health Sciences, 2150 West 5th Street, Greenville, NC 27858, USA
| | - David Eldridge
- Department of Pediatrics, East Carolina University, Brody School of Medicine, 600 Moye Blvd, Greenville, NC 27858, USA
| | - Luan Lawson
- Department of Emergency Medicine, East Carolina University, Brody School of Medicine, 600 Moye Blvd, Greenville, NC 27858, USA
| |
Collapse
|
3
|
Efua Sackey M, Markey K, Grealish A. Healthcare professional's promotional strategies in improving Human papillomavirus (HPV) vaccination uptake in adolescents: A systematic review. Vaccine 2022; 40:2656-2666. [PMID: 35367068 DOI: 10.1016/j.vaccine.2022.03.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/08/2022] [Accepted: 03/22/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Human papillomavirus (HPV) vaccination coverage remains suboptimal with a global vaccination rate ranging from 12 to 90%. This review examined the approaches used by healthcare professionals in improving the uptake of HPV vaccine and reducing vaccine misconceptions among adolescents. METHODS A systematic review of literature between 2007 and 2021 was conducted using five databases: CINAHL, MEDLINE, PsycInfo, Scopus and ASSIA. Studies that examined healthcare professional's promotional strategies in improving the HPV vaccine uptake in adolescents were included. Two researchers independently reviewed study selection, data extraction, and study methodological quality. Results were analysed and synthesised using narrative synthesis. RESULTS Twelve studies met the inclusion criteria. Studies reported on effective approaches used by healthcare professionals to improve vaccine uptake including the use of multi-settings to target hard-to-reach vulnerable adolescents; consistently recommending the vaccine; and initiating the vaccine before the age of eleven. In addressing vaccine misconceptions, open-communication, motivational approaches, and sexual health education were effective strategies used. CONCLUSION This review found that healthcare professionals need to be better informed and educated on HPV vaccine to reduce their own vaccine hesitancy. Uptake of HPV vaccine can be improved by adopting better communication, engagement, supportive information resources, and training for healthcare professionals.
Collapse
Affiliation(s)
- Margaret Efua Sackey
- Department of Nursing and Midwifery, University of Limerick, Limerick V94 T9PX, Ireland.
| | - Kathleen Markey
- Department of Nursing and Midwifery, University of Limerick, Limerick V94 T9PX, Ireland
| | - Annmarie Grealish
- Department of Nursing and Midwifery, University of Limerick, Limerick V94 T9PX, Ireland; King's College London, London, UK
| |
Collapse
|
4
|
Burli A, Hancock S, Zhao YT, Paul D, Cordisco M. HPV Vaccination Status and Resolution of Warts in Pediatric Patients. Indian J Dermatol 2021; 66:604-608. [PMID: 35283520 PMCID: PMC8906332 DOI: 10.4103/ijd.ijd_30_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Warts are a common dermatologic complaint with an increased incidence within the pediatric population. Warts are caused by multiple strains of the human papillomavirus (HPV). There is little research on how a patient's HPV immunization status affects the response to treatment of warts in pediatric patients. Aims: The purpose of this study is to investigate the relationship between HPV vaccination status and wart resolution. Materials and Methods: This is a retrospective chart review that investigates the relationship between response to routine treatment of warts and a subject's HPV vaccination status. Results: There was no significant relationship found between HPV vaccination status and resolution of warts (p = 0.797). However, there was a significant positive correlation between having the HPV vaccine and number of visits for the treatment of warts (r = 0.180, P = 0.024). Conclusion: This study did not show a significant correlation between HPV vaccination status and wart resolution, although it demonstrated a significant positive relationship between those immunized with the HPV vaccine and an increased number of treatment visits. Possible explanations for this unexpected correlation include the variation in HPV vaccine formulation, vaccination status, and frequency of office visits, since vaccinated patients are more likely to be compliant with office visits.
Collapse
Affiliation(s)
- Anuk Burli
- Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Sarah Hancock
- Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Yu Tina Zhao
- Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Deborah Paul
- Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Maria Cordisco
- Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| |
Collapse
|
5
|
Xu X, Wang Y, Liu Y, Yu Y, Yang C, Zhang Y, Hong Y, Wang Y, Zhang X, Bian R, Cao X, Xu L, Hu S, Zhao F. A nationwide post-marketing survey of knowledge, attitudes and recommendations towards human papillomavirus vaccines among healthcare providers in China. Prev Med 2021; 146:106484. [PMID: 33647350 DOI: 10.1016/j.ypmed.2021.106484] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/22/2021] [Accepted: 02/22/2021] [Indexed: 02/03/2023]
Abstract
Since licensure of human papillomavirus (HPV) vaccine in mainland China, little research has been conducted about healthcare providers' (HCPs) understanding and recommendation of HPV vaccine. A multi-stage convenience sample of Chinese HCPs (N = 5270) were surveyed, involving obstetrician-gynecologists, HCPs from Division of Expanded Program on Immunization (DEPI), Community Health Center (CHC) and other non-HPV closely related professions. Binary logistic regression was conducted to explore factors associated with knowledge and recommendation behaviors. Overall, HCPs showed basic HPV/HPV vaccine knowledge with median (interquartile range) score at 9.5 (7.5-11.6) out of 16 and relatively high recommendation behavior (74.8%). Identified knowledge gaps among HCPs included risk factors of HPV infection, best time to vaccinate, prophylactic functions of HPV vaccine and especially classification of low-risk and high-risk types. Profession-specific analysis in individual knowledge item showed HCPs from CHC were suboptimal on HPV while obstetrician-gynecologists were less competent on HPV vaccine knowledge. Obstetrician-gynecologists also recommended vaccination less frequently than HCPs from DEPI and CHC. Besides being key predictors of recommendation practice (2.74, 95% CI: 2.34-3.21), knowledge shared independent determinants with recommendation behavior on age and ethnicity and additionally associated with education and title by itself. Findings highlight overall and profession-specific gaps on HPV and HPV vaccine knowledge and recommendation practice. Future education and training efforts should be profession-niche-targeting and focus much on HCPs with lower title or education background and from minorities.
Collapse
Affiliation(s)
- Xiaoqian Xu
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yueyun Wang
- Department of Healthcare, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yawen Liu
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, China
| | - Yanqin Yu
- School of Public Health, Baotou Medical College, Baotou, Inner Mongolia, China
| | - Chunxia Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health/West China Forth University Hospital, Sichuan University, Chengdu, China
| | - Yanyang Zhang
- Institute for Expanded Program on Immunization, Henan Provincial Center for Disease Control and Prevention, Zhengzhou, China
| | - Ying Hong
- Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yan Wang
- Department of Cancer Institute, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | | | - Rui Bian
- MRL Global Medical Affairs, MSD China, Shanghai, China
| | - Xian Cao
- MRL Global Medical Affairs, MSD China, Shanghai, China
| | - Lili Xu
- MRL Global Medical Affairs, MSD China, Shanghai, China
| | - Shangying Hu
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fanghui Zhao
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
6
|
Bouza B, Hammig B, Schaefer Whitby P. Physicians’ Experiences of Recommending the HPV Vaccine to Females with an Intellectual Disability. SEXUALITY AND DISABILITY 2021. [DOI: 10.1007/s11195-021-09688-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
7
|
Costa ADS, Gomes JM, Germani ACCG, da Silva MR, Santos EFDS, Soares Júnior JM, Baracat EC, Sorpreso ICE. Knowledge gaps and acquisition about HPV and its vaccine among Brazilian medical students. PLoS One 2020; 15:e0230058. [PMID: 32191725 PMCID: PMC7082043 DOI: 10.1371/journal.pone.0230058] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/20/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To analyze factors associated with knowledge gaps and acquisition about HPV and its vaccine among medical students. Method Cross-sectional and analytical study conducted at the University of São Paulo Medicine School, in 2016. A convenience sample of students completed a data collection instrument containing questions on knowledge about HPV and its vaccine, and vaccine acceptability. The level of knowledge and acceptability established as a "good level" was 80% of correct answers on the questionnaire. Internal validity was calculated with Cronbach's alpha value (α) = 0.74. Bivariate and multiple analyzes were performed using the Stata® program (Stata Corp, College Station, USA) 14.0. Results To evaluate the internal consistency of the instrument applied, the Cronbach's alpha equation was used, obtaining the alpha value (α) = 0.74 for this population. This value attests that the consistency of the answers obtained with this questionnaire is considered substantial and acceptable. Among the 518 medical students who completed the survey, the majority were men 312 (60.4%) with a mean age of 23 (± 2.8) years old; 199 (38.3%) of the students were in the final years of graduation (5th and 6th years). Students in the first, second and third year of study had a 51% higher risk of a knowledge gap when compared to students in the final years of graduation [PR 1.51 (1.3:1.8); p <0.001]. Men were at 22% higher risk of unsatisfactory knowledge than women are [PR 1.22 (1.07: 1.39). There was no knowledge acquisition during medical school in the following questions (p <0.05), indication of vaccine for individuals with HIV and contraindication in pregnant patients. Conclusion Male medical students, in the first year of medical school, and those who were not vaccinated had significant knowledge gaps about HPV. The novelty of the study includes the finding of non- acquisition of knowledge during the medical school graduation on safety and vaccination schedule and vaccine administration in specific populations.
Collapse
Affiliation(s)
- Annielson de Souza Costa
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jéssica Menezes Gomes
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Matheus Reis da Silva
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - José Maria Soares Júnior
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Edmund Chada Baracat
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Isabel Cristina Esposito Sorpreso
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
- * E-mail:
| |
Collapse
|
8
|
Franco M, Mazzucca S, Padek M, Brownson RC. Going beyond the individual: how state-level characteristics relate to HPV vaccine rates in the United States. BMC Public Health 2019; 19:246. [PMID: 30819149 PMCID: PMC6393974 DOI: 10.1186/s12889-019-6566-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 02/20/2019] [Indexed: 01/25/2023] Open
Abstract
Background The human papillomavirus (HPV) vaccine is an underutilized cancer control practice in the United States. Although individual contextual factors are known to impact HPV vaccine coverage rates, the impact of macro-level elements are still unclear. The aim of this analysis was to use HPV vaccination rates to explore the underuse of an evidence-based cancer control intervention and explore broader-level correlates influencing completion rates. Methods A comprehensive database was developed using individual-level date from the National Immunization Survey (NIS)-Teen (2016) and state-level data collected from publically available sources to analyze HPV vaccine completion. Multi-level logistic models were fit to identify significant correlates. Level-1 (individual) and level-2 (state) correlates were fitted to a random intercept model. Deviance and AIC assessed model fit and sampling weights were applied. Results The analysis included 20,495 adolescents from 50 U.S. states and the District of Columbia. Teen age, gender, race/ethnicity, and maternal education were significant individual predictors of HPV completion rates. Significant state-level predictors included sex education policy, religiosity, and HPV vaccine mandate. States with the lowest HPV coverage rates were found to be conservative and highly religious. Little variation in vaccine exemptions and enacted sex and abstinence education polices were observed between states with high and low HPV vaccine coverage suggesting various contextual and situational factors impact HPV vaccine completion rates. Conclusions Given that gender, religiosity, political ideology, and education policies are predictors of HPV vaccine completion, the interaction and underlying mechanism of these factors can be used to address the underutilization of the HPV vaccine.
Collapse
Affiliation(s)
- Melissa Franco
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Stephanie Mazzucca
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Margaret Padek
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.,Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, 63103, USA
| |
Collapse
|
9
|
Importance of a team approach to recommending the human papillomavirus vaccination. J Am Assoc Nurse Pract 2019; 30:368-372. [PMID: 29979294 DOI: 10.1097/jxx.0000000000000064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Few studies have examined human papillomavirus (HPV) vaccine communication in the context of the health care team. METHODS In 2016, the investigators conducted a national, online survey of U.S. parents who reported having discussed HPV vaccination with their adolescent's health care team. Multivariable logistic regression assessed associations between HPV vaccine initiation (≥1 dose) and having: 1) discussed HPV vaccination with multiple team members and 2) received congruent recommendations about HPV vaccination. CONCLUSIONS Of the 795 parents in the sample, about half (52%) reported discussing HPV vaccination with multiple team members, including nurse practitioners, nurses, and physicians. Most reported receiving congruent recommendations for (76%) or against (12%) HPV vaccination; few (12%) received mixed recommendations. Parents who discussed HPV vaccination with multiple team members had greater odds of series initiation (odds ratio [OR] = 2.34, 95% CI: 1.61-3.40), whereas those who received mixed versus congruent recommendations for HPV vaccination had lower odds of vaccination (OR = 0.56, 95% CI: 0.33-0.95). IMPLICATIONS FOR PRACTICE Findings suggest that a coordinated team approach to recommendations may encourage HPV vaccination. Nurse practitioners are well positioned to facilitate coordination efforts within their clinical practices.
Collapse
|
10
|
Kasting ML, Christy SM, Sutton SK, Lake P, Malo TL, Roetzheim RG, Schechtman T, Zimet GD, Walkosz BJ, Salmon D, Kahn JA, Giuliano AR, Vadaparampil ST. Florida physicians' reported use of AFIX-based strategies for human papillomavirus vaccination. Prev Med 2018; 116:143-149. [PMID: 30219689 PMCID: PMC6260815 DOI: 10.1016/j.ypmed.2018.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/27/2018] [Accepted: 09/11/2018] [Indexed: 11/24/2022]
Abstract
HPV vaccination rates in Florida are low. To increase rates, the CDC recommends clinics adhere to components of their evidence-based quality improvement program, AFIX (Assessment, Feedback, Incentives, and eXchange of information). We explored factors associated with engaging in HPV-specific AFIX-related activities. In 2016, we conducted a cross-sectional survey of a representative sample of 770 pediatric and family medicine physicians in Florida and assessed vaccination practices, clinic characteristics, and HPV-related knowledge. Data were analyzed in 2017. The primary outcome was whether physicians' clinics engaged in ≥1 AFIX activity. We stratified by physician specialty and developed multivariable models using a backward selection approach. Of the participants in the analytic sample (n = 340), 52% were male, 60% were White of any ethnicity, and 55% were non-Hispanic. Pediatricians and family medicine physicians differed on: years practicing medicine (p < 0.001), HPV-related knowledge (p < 0.001), and VFC provider status (p < 0.001), among others. Only 39% of physicians reported engaging in ≥1 AFIX activity. In the stratified multivariable model for pediatricians, AFIX activity was significantly associated with HPV-related knowledge (aOR = 1.33;95%CI = 1.08-1.63) and provider use of vaccine reminder prompts (aOR = 3.61;95%CI = 1.02-12.77). For family medicine physicians, HPV-related knowledge was significant (aOR = 1.57;95%CI = 1.20-2.05) as was majority race of patient population (non-Hispanic White vs. Other: aOR = 3.02;95%CI = 1.08-8.43), daily patient load (<20 vs. 20-24: aOR = 9.05;95%CI = 2.72-30.10), and vaccine administration to male patients (aOR = 2.98;95%CI = 1.11-8.02). Fewer than half of Florida pediatric and family medicine physicians engaged in any AFIX activities. Future interventions to increase AFIX engagement should focus on implementing and evaluating AFIX activities in groups identified as having low engagement in AFIX activities.
Collapse
Affiliation(s)
- Monica L Kasting
- Moffitt Cancer Center & Research Institute, Division of Population Science, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, United States; Moffitt Cancer Center & Research Institute, Center for Immunization and Infection Research in Cancer, 12902 Magnolia Drive, Tampa, FL 33612, United States.
| | - Shannon M Christy
- Moffitt Cancer Center & Research Institute, Division of Population Science, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, United States; University of Tennessee Health Science Center, College of Medicine, 66. N. Pauline St., Suite 322, Memphis, TN 38163, United States; University of South Florida, Morsani College of Medicine, 13330 USF Laurel Drive, Tampa, FL 33612, United States.
| | - Steven K Sutton
- University of South Florida, Morsani College of Medicine, 13330 USF Laurel Drive, Tampa, FL 33612, United States; Moffitt Cancer Center & Research Institute, Division of Quantitative Sciences, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, United States.
| | - Paige Lake
- Moffitt Cancer Center & Research Institute, Division of Population Science, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, United States.
| | - Teri L Malo
- University of North Carolina, Lineberger Comprehensive Cancer Center, 101 East Weaver Street, Ste 203, Campus Box 7293, Carrboro, NC 27510, United States.
| | - Richard G Roetzheim
- Moffitt Cancer Center & Research Institute, Division of Population Science, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, United States; University of South Florida, Morsani College of Medicine, 13330 USF Laurel Drive, Tampa, FL 33612, United States.
| | - Tommy Schechtman
- Pediatric Partners, 3401 PGA Blvd, Suite 300, Palm Beach Gardens, FL 33410, United States.
| | - Gregory D Zimet
- Indiana University School of Medicine, Department of Pediatrics, 410 W. 10th Street, HS 1001, Indianapolis, IN 46202, United States.
| | - Barbara J Walkosz
- Klein Buendel, Inc., 1667 Cole Blvd. Ste. 225, Golden, CO 80401, United States.
| | - Daniel Salmon
- Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe Street Room W5035, Baltimore, MD 21205, United States.
| | - Jessica A Kahn
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4000, Cincinnati, OH 45229, United States; University of Cincinnati, College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, United States.
| | - Anna R Giuliano
- Moffitt Cancer Center & Research Institute, Division of Population Science, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, United States; Moffitt Cancer Center & Research Institute, Center for Immunization and Infection Research in Cancer, 12902 Magnolia Drive, Tampa, FL 33612, United States.
| | - Susan T Vadaparampil
- Moffitt Cancer Center & Research Institute, Division of Population Science, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, United States; Moffitt Cancer Center & Research Institute, Center for Immunization and Infection Research in Cancer, 12902 Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, Morsani College of Medicine, 13330 USF Laurel Drive, Tampa, FL 33612, United States.
| |
Collapse
|
11
|
Rosen BL, Shepard A, Kahn JA. US Health Care Clinicians' Knowledge, Attitudes, and Practices Regarding Human Papillomavirus Vaccination: A Qualitative Systematic Review. Acad Pediatr 2018; 18:S53-S65. [PMID: 29502639 PMCID: PMC7305794 DOI: 10.1016/j.acap.2017.10.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 10/20/2017] [Accepted: 10/21/2017] [Indexed: 11/26/2022]
Abstract
Clinicians' recommendation for the human papillomavirus (HPV) vaccine appears to be an important driver of parental decisions about vaccination. Our aim was to synthesize the best available evidence exploring the perceptions and experiences regarding HPV vaccination, from the perspective of the US clinician. We conducted a comprehensive literature search of Academic Search Complete, CINAHL Plus, Communication & Mass Media Complete, Consumer Health Complete (EBSCOhost), ERIC, Health and Psychosocial Instruments, MEDLINE with full text, and PsycINFO databases. We identified 60 eligible articles: 48 quantitative and 12 qualitative. We extracted the following information: study purpose, use of theory, location, inclusion criteria, and health care provider classification. Results were organized into 5 categories: 1) clinicians' knowledge and beliefs about HPV and the HPV vaccine, 2) clinicians' attitudes and beliefs about recommending HPV vaccines, 3) clinicians' intention to recommend HPV vaccines, 4) clinicians' professional practices regarding HPV vaccination, and 5) patient HPV vaccination rates. Although clinicians were generally supportive of HPV vaccination, there was a discrepancy between clinicians' intentions, recommendation practices, and patient vaccination rates. Studies reported that clinicians tended not to provide strong, consistent recommendations, and were more likely to recommend HPV vaccines to girls versus boys and to older versus younger adolescents. Analyses revealed a number of facilitating factors and barriers to HPV vaccination at the clinician, parent/patient, and systems levels, including clinician knowledge, clinician beliefs, and office procedures that promote vaccination. This review provides an evidence base for multilevel interventions to improve clinician HPV vaccine recommendations and vaccination rates.
Collapse
Affiliation(s)
- Brittany L Rosen
- University of Cincinnati, School of Human Services, Cincinnati, Ohio.
| | - Allie Shepard
- University of Cincinnati, School of Human Services, Cincinnati, Ohio
| | - Jessica A Kahn
- Cincinnati Children's Hospital Medical Center, Division of Adolescent and Transition Medicine, Cincinnati, Ohio; University of Cincinnati, College of Medicine, Cincinnati, Ohio
| |
Collapse
|
12
|
Kasting ML, Scherr CL, Ali KN, Lake P, Malo TL, Johns T, Roetzheim RG, Quinn GP, Vadaparampil ST. Human Papillomavirus Vaccination Training Experience Among Family Medicine Residents and Faculty. Fam Med 2017; 49:714-722. [PMID: 29045989 PMCID: PMC5801740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Residency training is a pivotal time to establish skills for career-long practices, particularly for challenging skills such as human papillomavirus (HPV) vaccine recommendation. Training experience and preferences related to delivering HPV vaccine recommendations were examined for family medicine (FM) residents and faculty. METHODS Residents (n=28) and faculty (n=19) were identified through a national FM residency directory and recruited from training programs in Florida. Participants completed a phone interview assessing key aspects of HPV vaccine recommendation training. Interviews were audio recorded, transcribed verbatim, and analyzed using content analysis. A brief follow-up survey assessing training, practices, and demographics was emailed after the interview. RESULTS Residents' training experience with HPV vaccine recommendation varied from none to extensive, and was often self-directed. Variation in training was seen between and within programs. Faculty often noted HPV vaccination training was not standardized and residents lacked instruction about effective communication. Most programs relied on preceptors for training residents but training from preceptors varied widely and was often not standardized within the program. CONCLUSIONS This study identified a lack of consistent and standardized training for delivering HPV vaccine recommendations. A training curriculum that uses multiple modalities and reflects resident and faculty preferences is needed.
Collapse
Affiliation(s)
- Monica L. Kasting
- Division of Population Science, Moffitt Cancer Center, Tampa, FL
- Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL
| | - Courtney L. Scherr
- Department of Communication Studies, Northwestern University, Evanston, IL
| | - Karla N. Ali
- U.S Department of Veterans Affairs, VA St. Louis Health Care System-John Cochran, St. Louis, MO
| | - Paige Lake
- Division of Population Science, Moffitt Cancer Center, Tampa, FL
| | - Teri L. Malo
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Tracy Johns
- University of South Florida Morsani College of Medicine, Department of Family Medicine, Tampa, FL
- Eaddy Family Medicine Research Center, BayCare Health System, Clearwater, FL
| | - Richard G. Roetzheim
- Division of Population Science, Moffitt Cancer Center, Tampa, FL
- University of South Florida Morsani College of Medicine, Department of Family Medicine, Tampa, FL
| | - Gwendolyn P. Quinn
- Division of Population Science, Moffitt Cancer Center, Tampa, FL
- University of South Florida Morsani College of Medicine, Department of Oncologic Sciences, Tampa, FL
| | - Susan T. Vadaparampil
- Division of Population Science, Moffitt Cancer Center, Tampa, FL
- Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL
- University of South Florida Morsani College of Medicine, Department of Family Medicine, Tampa, FL
| |
Collapse
|
13
|
Tan TQ, Gerbie MV. Perception, Awareness, and Acceptance of Human Papillomavirus Disease and Vaccine Among Parents of Boys Aged 9 to 18 Years. Clin Pediatr (Phila) 2017; 56:737-743. [PMID: 28589764 DOI: 10.1177/0009922816682788] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Male human papillomavirus (HPV) vaccination rates remain very low. The study objective was to gain an understanding of the perceptions of HPV disease and acceptance/barriers to HPV vaccine by parents of boys aged 9 to 18 years. An anonymous, written survey was administered from January 1, 2011 to September 30, 2013 in private pediatric offices (PPOs) and public health clinics (PHCs) in Chicago, Illinois. A total of 230 PPO parents (PPOPs) and 286 PHC parents (PHCPs) completed the survey. Despite significant differences ( P < .0001) in education level, socioeconomic status, and HPV disease and vaccine knowledge/awareness between the PPOP and PHCP, there was no difference between PPOP and PHCP who would vaccinate their sons with HPV vaccine. For both groups, health care provider recommendation was the primary influence for vaccination. The major barrier to vaccination was lack of information on HPV disease/vaccine. Health care providers need to proactively discuss and use HPV vaccine in male patients.
Collapse
Affiliation(s)
- Tina Q Tan
- 1 Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,2 Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Melvin V Gerbie
- 1 Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
14
|
Charlton BM, Reisner SL, Agénor M, Gordon AR, Sarda V, Austin SB. Sexual Orientation Disparities in Human Papillomavirus Vaccination in a Longitudinal Cohort of U.S. Males and Females. LGBT Health 2017; 4:202-209. [PMID: 28467238 DOI: 10.1089/lgbt.2016.0103] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This study sought to examine how human papillomavirus (HPV) vaccination may differ across sexual orientation groups (e.g., bisexuals compared to heterosexuals)-particularly in boys and men, about whom little is known. METHODS Data were from a prospective cohort of 10,663 U.S. females and males enrolled in the Growing Up Today Study followed from 1996 to 2014. Participants were aged 11-24 years when the vaccine was approved for females in 2006 and 14-27 years when approved for males in 2009. In addition to reporting sexual orientation identity/attractions, participants reported sex of lifetime sexual partners. Log-binominal models were used to examine HPV vaccination across sexual orientation groups. RESULTS Among females, 56% received ≥1 dose. In contrast, 8% of males obtained ≥1 dose; HPV vaccination initiation was especially low among completely heterosexual males. After adjusting for potential confounders, completely heterosexual (risk ratio [RR]; 95% confidence interval [CI]: 0.45 [0.30-0.68]) and mostly heterosexual (RR; 95% CI: 0.44 [0.25-0.78]) males were half as likely to have received even a single dose compared to gay males. Compared to lesbians, no differences were observed for completely heterosexual or bisexual females, but mostly heterosexual females were 20% more likely to have received at least one dose. CONCLUSIONS HPV vaccination rates in the U.S. are strikingly low and special attention is needed for boys and men, especially those who do not identify as gay. Vaccinating everyone, regardless of sex/gender and/or sexual orientation, will not only lower that individual's susceptibility but also decrease transmission to partners, females and/or males, to help eradicate HPV through herd immunity.
Collapse
Affiliation(s)
- Brittany M Charlton
- 1 Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston, Massachusetts.,2 Department of Pediatrics, Harvard Medical School , Boston, Massachusetts
| | - Sari L Reisner
- 2 Department of Pediatrics, Harvard Medical School , Boston, Massachusetts.,3 Division of General Pediatrics, Boston Children's Hospital , Boston, Massachusetts.,4 The Fenway Institute , Fenway Health, Boston, Massachusetts.,5 Department of Epidemiology, Harvard T.H. Chan School of Public Health , Boston, Massachusetts
| | - Madina Agénor
- 6 Dana-Farber Cancer Institute , Boston, Massachusetts.,7 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health , Boston, Massachusetts
| | - Allegra R Gordon
- 1 Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston, Massachusetts.,2 Department of Pediatrics, Harvard Medical School , Boston, Massachusetts
| | - Vishnudas Sarda
- 1 Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston, Massachusetts
| | - S Bryn Austin
- 1 Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston, Massachusetts.,2 Department of Pediatrics, Harvard Medical School , Boston, Massachusetts.,7 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health , Boston, Massachusetts.,8 Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital , Boston, Massachusetts
| |
Collapse
|
15
|
Fontenot HB, Fantasia HC, Vetters R, Zimet GD. Increasing HPV vaccination and eliminating barriers: Recommendations from young men who have sex with men. Vaccine 2016; 34:6209-6216. [PMID: 27838067 DOI: 10.1016/j.vaccine.2016.10.075] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/20/2016] [Accepted: 10/28/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is a disparity in HPV vaccination rates in particular among young men who have sex with men (YMSM) and until very recently there has been a dearth of research examining factors related to HPV vaccination for YMSM. The purpose of this study was to elicit YMSM's beliefs about HPV and the HPV vaccine as well as describe perceived barriers and facilitators of vaccine initiation and completion. METHODS A qualitative, descriptive study that utilized a focus group design was conducted among an urban and racially diverse sample of YMSM. Questionnaire data were analyzed using descriptive statistics, and focus group data were analyzed using content analysis. FINDINGS 34 YMSM with a mean age of 20.8years participated. The sample was diverse, with the largest proportion of youth identifying as Black (35.4%). Over 90% reported having an annual exam each year, 61.8% reported obtaining a flu vaccine during the past year, and 58.8% reported initiating the HPV vaccine 3-dose series. Themes identified included low HPV knowledge and awareness, positive vaccine beliefs, perceived stigmas, and HPV vaccine facilitators. Participants identified 3 ways health providers/ researchers could facilitate vaccination: creative use of mobile technology, bundling vaccination with other health services, and increasing HPV and HPV vaccine awareness. CONCLUSIONS Our findings point to some clear avenues to pursue in research and practice to improve HPV vaccination rates among YMSM, including increased use of mobile health strategies, making HPV vaccination a co-occurring part of other health-related services (e.g., HIV testing), and providing information on the relevance of HPV and HPV vaccination to YMSM.
Collapse
Affiliation(s)
- Holly B Fontenot
- Boston College, W.F. Connell School of Nursing, Chestnut Hill, MA 02467, United States; The Fenway Institute, 1340 Boylston St., Boston, MA 02215, United States; Fenway Health/Sidney Borum Jr. Health Center, 75 Kneeland St., Boston, MA 02111, United States.
| | - Heidi C Fantasia
- University of Massachusetts Lowell, College of Health Sciences, School of Nursing, 113 Wilder Street, Lowell, MA 01854, United States.
| | - Ralph Vetters
- Fenway Health/Sidney Borum Jr. Health Center, 75 Kneeland St., Boston, MA 02111, United States.
| | - Gregory D Zimet
- Indiana University School of Medicine, Department of Pediatrics, Section of Adolescent Medicine, 410 West 10th St., Indianapolis, IN 46202, United States.
| |
Collapse
|
16
|
Vadaparampil ST, Malo TL, Sutton SK, Ali KN, Kahn JA, Casler A, Salmon D, Walkosz B, Roetzheim RG, Zimet GD, Giuliano AR. Missing the Target for Routine Human Papillomavirus Vaccination: Consistent and Strong Physician Recommendations Are Lacking for 11- to 12-Year-Old Males. Cancer Epidemiol Biomarkers Prev 2016; 25:1435-1446. [PMID: 27486020 DOI: 10.1158/1055-9965.epi-15-1294] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 07/25/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Rates of routine human papillomavirus (HPV) vaccination of adolescent males in the United States are low. Leading health organizations advocate consistent and strong physician recommendations to improve HPV vaccine dissemination. This study describes the prevalence and correlates of consistent and strong physician recommendations for HPV vaccination of adolescent males. METHODS We surveyed pediatric and family medicine physicians in Florida about their HPV vaccine recommendations for male vaccine-eligible age groups (11-12, 13-17, 18-21 years). Descriptive statistics compared consistency and strength of HPV recommendations across age groups. Multivariable logistic regression examined factors associated with consistent and strong recommendations for 11- to 12-year-olds. RESULTS We received 367 completed surveys (51% response rate). Physicians most often consistently and strongly recommended HPV vaccine to males ages 13 to 17 (39%) compared with ages 11 to 12 (31%) and 18 to 21 (31%). Consistent and strong recommendation for 11- to 12-year-old males was more likely to be delivered by Vaccine for Children providers and less likely among physicians who reported more personal barriers to vaccination, particularly concerns about vaccine safety, concerns about adding vaccines to the vaccine schedule, and difficulty in remembering to discuss HPV vaccination. CONCLUSIONS Physicians' current consistency and strength of HPV vaccine recommendations do not align with national recommendations. Interventions to improve HPV vaccine recommendations must also consider the influence of physicians' personal barriers to HPV vaccine delivery. IMPACT As one of the first studies to examine both consistency and strength of physicians' HPV vaccine recommendations for males, our findings can inform future interventions focused on facilitating physicians' recommendations. Cancer Epidemiol Biomarkers Prev; 25(10); 1435-46. ©2016 AACR.
Collapse
Affiliation(s)
- Susan T Vadaparampil
- Division of Population Science, Moffitt Cancer Center, Tampa, Florida. Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida. Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, Florida.
| | - Teri L Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Steven K Sutton
- Division of Population Science, Moffitt Cancer Center, Tampa, Florida. Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, Florida
| | - Karla N Ali
- Division of Population Science, Moffitt Cancer Center, Tampa, Florida
| | - Jessica A Kahn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohia
| | - Alix Casler
- Department of Pediatrics, Orlando Health Physician Associates, Orlando, Florida
| | - Daniel Salmon
- Department of International Health and Health Behavior Society, John Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Richard G Roetzheim
- Division of Population Science, Moffitt Cancer Center, Tampa, Florida. Department of Family Medicine, College of Medicine, University of South Florida, Tampa, Florida
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Anna R Giuliano
- Division of Population Science, Moffitt Cancer Center, Tampa, Florida. Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida. Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, Florida
| |
Collapse
|
17
|
Gilkey MB, McRee AL. Provider communication about HPV vaccination: A systematic review. Hum Vaccin Immunother 2016; 12:1454-68. [PMID: 26838681 PMCID: PMC4964733 DOI: 10.1080/21645515.2015.1129090] [Citation(s) in RCA: 212] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/19/2015] [Accepted: 12/03/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Improving HPV vaccination coverage in the US will require healthcare providers to recommend the vaccine more effectively. To inform quality improvement efforts, we systematically reviewed studies of provider communication about HPV vaccination. METHODS We searched MEDLINE, CINAHL, EMBASE, and POPLINE in August 2015 to identify studies of provider communication about HPV vaccination. RESULTS We identified 101 qualitative and quantitative studies. Providers less often recommended HPV vaccine if they were uncomfortable discussing sex, perceived parents as hesitant, or believed patients to be low risk. Patients less often received recommendations if they were younger, male, or from racial/ethnic minorities. Despite parents' preference for unambiguous recommendations, providers often sent mixed messages by failing to endorse HPV vaccine strongly, differentiating it from other vaccines, and presenting it as an "optional" vaccine that could be delayed. CONCLUSION Interventions are needed to help providers deliver effective recommendations in the complex communication environment surrounding HPV vaccination.
Collapse
Affiliation(s)
- Melissa B. Gilkey
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, MA
| | | |
Collapse
|
18
|
Berenson AB, Rahman M, Hirth JM, Rupp RE, Sarpong KO. A brief educational intervention increases providers' human papillomavirus vaccine knowledge. Hum Vaccin Immunother 2016; 11:1331-6. [PMID: 25945895 DOI: 10.1080/21645515.2015.1022691] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Recommendation by a healthcare provider is critical to increase human papillomavirus (HPV) vaccine uptake in the US. However, current deficits in providers' knowledge of HPV and its vaccine are not fully understood and interventions to amend knowledge gaps are untested. To determine whether attending a structured presentation could increase provider knowledge of the HPV vaccine, we assessed knowledge levels of physicians, non-physician healthcare workers, and medical students before and after attending a 30-minute lecture held between October 2012 and June 2014. Paired t-test and McNemar's test were used to compare knowledge scores and the proportion of correct responses for each question, respectively. Multiple linear regression analyses were performed to examine correlates of baseline knowledge and change in knowledge scores post-intervention. A total of 427 participants, including 75 physicians, 208 medical students, and 144 nurses or other healthcare workers, attended one of 16 presentations and responded to both pre-test and post-test surveys. Baseline knowledge was low among all groups, with scores higher among older participants and physicians/medical students. On average, knowledge scores significantly improved from 8 to 15 after the presentation (maximum possible score 16) (P < .001), irrespective of specialty, race/ethnicity, gender, and age. Although lower at baseline, knowledge scores of younger participants and non-physician healthcare workers (e.g., nurses, physician assistants (PAs), nursing students) improved the most of all groups. We conclude that a brief, structured presentation increased HPV knowledge among a variety of healthcare workers, even when their baseline knowledge was low.
Collapse
Affiliation(s)
- Abbey B Berenson
- a Center for Interdisciplinary Research in Women's Health; The University of Texas Medical Branch ; Galveston , TX , USA
| | | | | | | | | |
Collapse
|
19
|
Dempsey AF, Zimet GD. Interventions to Improve Adolescent Vaccination: What May Work and What Still Needs to Be Tested. Am J Prev Med 2015; 49:S445-54. [PMID: 26272849 DOI: 10.1016/j.amepre.2015.04.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 02/03/2023]
Abstract
Since the development of the "adolescent platform" of vaccination in 1997, hundreds of studies have been conducted, identifying barriers to and facilitators of adolescent vaccination. More recent research has focused on developing and evaluating interventions to increase uptake of adolescent vaccines. This review describes a selection of recent intervention studies for increasing adolescent vaccination, divided into three categories: those with promising results that may warrant more widespread implementation, those with mixed results requiring more research, and those with proven effectiveness in other domains that have not yet been tested with regard to adolescent vaccination.
Collapse
Affiliation(s)
- Amanda F Dempsey
- Adult and Child Center for Outcomes Research and Dissemination Science program, University of Colorado Denver, Aurora, Colorado.
| | - Gregory D Zimet
- Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|
20
|
|
21
|
Zimet GD. “A Day Late and a Dollar Short”: Physicians and HPV Vaccination. Cancer Epidemiol Biomarkers Prev 2015; 24:1643-4. [DOI: 10.1158/1055-9965.epi-15-0879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 08/19/2015] [Indexed: 11/16/2022] Open
|
22
|
Gilkey MB, Malo TL, Shah PD, Hall ME, Brewer NT. Quality of physician communication about human papillomavirus vaccine: findings from a national survey. Cancer Epidemiol Biomarkers Prev 2015; 24:1673-9. [PMID: 26494764 DOI: 10.1158/1055-9965.epi-15-0326] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/23/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Improving the quality of physicians' recommendations for human papillomavirus (HPV) vaccination is critical to addressing low coverage. Thus, we sought to describe HPV vaccine communication practices among primary care physicians. METHODS Pediatricians and family physicians (n = 776) completed our national online survey in 2014. We assessed the quality of their HPV vaccine recommendations on strength of endorsement (i.e., saying the vaccine is important), timeliness (recommending it by ages 11-12), consistency (recommending it routinely vs. using a risk-based approach), and urgency (recommending same-day vaccination). RESULTS A sizeable minority of physicians reported that they do not strongly endorse HPV vaccine (27%) or deliver timely recommendations for girls (26%) or boys (39%). Many physicians (59%) used a risk-based approach to recommending HPV vaccine, and only half (51%) usually recommended same-day vaccination. Overall recommendation quality was lower among physicians who were uncomfortable talking about HPV vaccine or who believed parents did not value it. Quality was higher among physicians who began discussions by saying the child was due for HPV vaccine versus giving information or eliciting questions. CONCLUSION Many physicians in our national sample reported recommending HPV vaccine inconsistently, behind schedule, or without urgency. These practices likely contribute to under-immunization among adolescents, and may convey ambivalence to parents. IMPACT As one of the first studies to assess multiple aspects of recommendation quality, these findings can inform the many state and national initiatives that aim to improve communication about HPV vaccine so as to address the persistent underuse of a powerful tool for cancer prevention.
Collapse
Affiliation(s)
- Melissa B Gilkey
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
| | - Teri L Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina. Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Parth D Shah
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Megan E Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Noel T Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina. Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| |
Collapse
|
23
|
Gerend MA, Shepherd MA, Lustria MLA, Shepherd JE. Predictors of provider recommendation for HPV vaccine among young adult men and women: findings from a cross-sectional survey. Sex Transm Infect 2015; 92:104-7. [PMID: 26297720 DOI: 10.1136/sextrans-2015-052088] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 08/05/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Although physician recommendation is one of the strongest predictors of human papillomavirus (HPV) vaccination, it is unclear for whom physicians are recommending the vaccine. To help guide intervention efforts, this study investigated predictors of participant-reported physician recommendation for HPV vaccine among young adults in the USA. METHODS Women and men (N=223) aged 18-26 years were recruited online through Craigslist, a popular classified advertisements website. Ads were posted in the 25 largest US cities from September 2013 to March 2014. Participants completed a survey that assessed demographic and sociopolitical characteristics, sexual history, HPV vaccination history, and whether they had ever received a recommendation for HPV vaccine from a physician or healthcare provider. RESULTS Fifty-three per cent reported receiving a recommendation for HPV vaccine and 45% had received ≥1 dose of HPV vaccine. Participants who received a recommendation were over 35 times more likely to receive ≥1 dose of HPV vaccine relative to participants without a recommendation. Bivariable and multivariable correlates of provider recommendation were identified. Results from the multivariable model indicated that younger (aged 18-21 years), female, White participants with health insurance (ie, employer-sponsored or some other type such as military-sponsored) were more likely to report receiving a recommendation for HPV vaccine. CONCLUSIONS Results suggest that physician recommendation practices for HPV vaccination vary by characteristics of the patient. Findings underscore the key role of the healthcare provider in promoting HPV vaccination and have important implications for future HPV vaccine interventions with young adults.
Collapse
Affiliation(s)
- Mary A Gerend
- Department of Behavioral Sciences & Social Medicine, Florida State University College of Medicine, Tallahassee, Florida, USA Departments of Medical Social Sciences and Psychology, Northwestern University, Chicago, Illinois, USA
| | - Melissa A Shepherd
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Mia Liza A Lustria
- College of Communication & Information, Florida State University, Tallahassee, Florida, USA
| | - Janet E Shepherd
- Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, Florida, USA
| |
Collapse
|
24
|
Berenson AB. An update on barriers to adolescent human papillomavirus vaccination in the USA. Expert Rev Vaccines 2015; 14:1377-84. [PMID: 26292763 DOI: 10.1586/14760584.2015.1078240] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Human papillomavirus is the most common sexually transmitted infection in the USA. It is the primary cause of almost all cervical cancers as well as several other cancers that affect both men and women. Adolescents of both genders can now prevent transmission of the most common oncogenic strains of human papillomavirus by obtaining a safe, three-dose vaccine series. However, despite its potential to save lives and reduce severe morbidity, many US adolescents have not been vaccinated. This is in contrast to other countries where high rates of vaccination are already reducing rates of cervical intra-epithelial neoplasia and genital warts. This article describes barriers recently reported among families in the USA and concludes with suggestions for improving uptake.
Collapse
Affiliation(s)
- Abbey B Berenson
- a The University of Texas Medical Branch at Galveston, Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, 301 University Boulevard, Mail Route 0587, Galveston, TX 77555-0587, USA
| |
Collapse
|
25
|
Alexander AB, Best C, Stupiansky N, Zimet GD. A model of health care provider decision making about HPV vaccination in adolescent males. Vaccine 2015; 33:4081-6. [PMID: 26143612 DOI: 10.1016/j.vaccine.2015.06.085] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 06/16/2015] [Accepted: 06/22/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In the U.S., HPV vaccination of adolescent males remains low, despite the recommendation for routine vaccination. Although research has highlighted that health care provider (HCP) recommendation is very influential in HPV vaccine uptake, research on this topic in the male population is lacking. Accordingly, we used a qualitative approach to identify HCP knowledge, attitudes, and behaviors regarding adolescent male HPV vaccination, one year, after routine vaccination of adolescent males was recommended. METHOD A total of 20 U.S. pediatric HCPs participated in 20-30 min interviews about knowledge, attitudes, and practices regarding male HPV vaccination. Interviews were audio-recorded, transcribed and, analyzed using inductive content analysis. RESULTS The providers had been in practice for 1-35 years, 75% were female, and 75% were White. Opinions on HPV vaccination were shaped by knowledge/perception of the risks and benefits of vaccination. Although all providers frequently offered HPV vaccine to male patients, the strength and content of the offer varied greatly. Vaccination opinions determined what issues were emphasized in the vaccine offer (e.g., stressing herd immunity, discussing prevention of genital warts), while adolescent age influenced if and how they pitched their vaccine offer (e.g., HPV as a STI). Most providers agreed with the ACIP recommendations, however, several expressed that providers' preexisting opinions might remain unchanged despite the recommendations. Consistent with the literature on determinants of HPV vaccination, providers believed that their own recommendation was a major factor in a family's decision to vaccinate. Barriers to vaccination included the "newness" and sexual nature of the vaccine, lack of insurance coverage, and the vaccine not being mandated. CONCLUSIONS Providers' opinions about, and approaches to offering, HPV vaccination to males were highly variable. Interventions designed to improve male HPV vaccination should focus on helping providers to routinely recommend the vaccine to all of their eligible patients, both males and females.
Collapse
Affiliation(s)
- Andreia B Alexander
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, 410 West 10th Street, HS 1001, Indianapolis, IN 46202, United States.
| | - Candace Best
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, 410 West 10th Street, HS 1001, Indianapolis, IN 46202, United States.
| | - Nathan Stupiansky
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, 410 West 10th Street, HS 1001, Indianapolis, IN 46202, United States.
| | - Gregory D Zimet
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, 410 West 10th Street, HS 1001, Indianapolis, IN 46202, United States.
| |
Collapse
|
26
|
Donahue KL, Hendrix KS, Sturm LA, Zimet GD. Human papillomavirus vaccine initiation among 9–13-year-olds in the United States. Prev Med Rep 2015; 2:892-898. [PMID: 26594616 PMCID: PMC4652326 DOI: 10.1016/j.pmedr.2015.10.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The quadrivalent and 9-valent human papillomavirus (HPV) vaccines are licensed for administration among 9–26-year-old males and females, with routine vaccination recommended for 11–12-year-olds. Despite the availability of the vaccine at younger ages, few studies have explored vaccine uptake prior to age 13, and national HPV vaccination surveillance data is limited to 13–17-year-olds. Our objective was to examine rates and predictors of HPV vaccine initiation among 9–13-year-olds in the United States. A national sample of mothers of 9–13-year-olds in the United States (N = 2446) completed a 2014 Web-based survey assessing socio-demographic characteristics, child's HPV vaccination history, provider communication regarding the vaccine, and other attitudes and behaviors pertaining to vaccination and healthcare utilization. The main outcome measure was child's initiation of the HPV vaccine (i.e., receipt of one or more doses). Approximately 35% of the full sample and 27.5% of the 9–10-year-olds had initiated HPV vaccination. Females were more likely than males to have initiated HPV vaccination by the age of 13 but not by younger ages. Strength of health provider recommendation regarding HPV vaccination was a particularly salient predictor of vaccine initiation. Approximately a third of children may be initiating the HPV vaccine series before or during the targeted age range for routine administration of the vaccine. Because coverage remains below national targets, further research aimed at increasing vaccination during early adolescence is needed. Improving providers' communication with parents about the HPV vaccine may be one potential mechanism for increasing vaccine coverage. Approximately 35% of 9–13-year-olds had initiated the HPV vaccine series. A quarter of 9–10-year-olds had initiated the HPV vaccine series. At age 13, females were more likely than males to have initiated HPV vaccination. No gender difference in HPV vaccine initiation was found prior to age 13. Provider recommendation was a particularly salient predictor of HPV vaccination
Collapse
|