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Lu Q, Dawkins-Moultin L, Cho D, Tan NQP, Hopfer S, Li Y, Ramondetta L, Xu Y, Lun D, Chen M. A multilevel intervention to promote HPV vaccination among young adults in Texas: protocol for a randomized controlled trial. BMC Public Health 2024; 24:1506. [PMID: 38840086 PMCID: PMC11151657 DOI: 10.1186/s12889-024-18828-9] [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: 12/19/2023] [Accepted: 05/10/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infections can cause cancers of the cervix, vagina, vulva, penis, anus, and oropharynx. The most recently approved HPV vaccine, Gardasil-9, protects against HPV infection and can prevent HPV-associated invasive cancers. However, Gardasil-9 is one of the most underused vaccines in the US today. Young adults are at risk for HPV infection, but many are not vaccinated. This study uses a randomized controlled trial (RCT) to test an innovative multilevel intervention to increase HPV vaccination rates among young adults. In this paper, we describe the research protocol. METHODS The study uses a two by three factorial design. A total of 1200 young adults in Texas, age 18-26 years, who have not been previously fully vaccinated against HPV will be randomly assigned to one of six conditions to receive: (1) standard CDC information about HPV vaccination (control); (2) video narratives about HPV vaccination; (3) written narratives about HPV vaccination; or (4-6) enhanced access to HPV vaccine combined with (4) standard CDC information, (5) video narratives, or (6) written narratives. The two primary outcomes are the rate of HPV vaccination initiation by 3-month follow-up and rate of HPV vaccination completion by 9-month follow-ups. We will determine the impact of the individual level intervention (i.e., persuasive narratives through video or written format), the systemic level intervention (i.e., enhanced access to HPV vaccines), and the combination of both levels, on HPV vaccination initiation and completion. We will also use purposive sampling to select participants to take part in semi-structured interviews/focus groups to better understand the mechanisms of the intervention. DISCUSSION Recruitment and data collection began in March 2022. We expect to complete data collection by March 2026. We expect that narratives, enhanced access, and the combination of both will improve HPV vaccination initiation and completion rates among young adults. If proven successful, these individual- and system-level interventions can be easily disseminated in regions with low HPV vaccination rates to improve HPV vaccination, and ultimately decrease HPV-related cancer burden. TRIAL REGISTRATION NCT05057312.
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Affiliation(s)
- Qian Lu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St. Unit 1440, Houston, TX, 77030-3906, USA.
| | - Lenna Dawkins-Moultin
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St. Unit 1440, Houston, TX, 77030-3906, USA
| | - Dalnim Cho
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St. Unit 1440, Houston, TX, 77030-3906, USA
| | - Naomi Q P Tan
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Rutgers Cancer Institute of New Jersey, and Division of Medical Oncology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | | | - Yisheng Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lois Ramondetta
- Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yusi Xu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St. Unit 1440, Houston, TX, 77030-3906, USA
| | - Di Lun
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St. Unit 1440, Houston, TX, 77030-3906, USA
| | - Minxing Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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2
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Nouwens SPH, Veldwijk J, Pilli L, Swait JD, Coast J, de Bekker-Grob EW. A socially interdependent choice framework for social influences in healthcare decision-making: a study protocol. BMJ Open 2024; 14:e079768. [PMID: 38458790 DOI: 10.1136/bmjopen-2023-079768] [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] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVES Current choice models in healthcare (and beyond) can provide suboptimal predictions of healthcare users' decisions. One reason for such inaccuracy is that standard microeconomic theory assumes that decisions of healthcare users are made in a social vacuum. Healthcare choices, however, can in fact be (entirely) socially determined. To achieve more accurate choice predictions within healthcare and therefore better policy decisions, the social influences that affect healthcare user decision-making need to be identified and explicitly integrated into choice models. The purpose of this study is to develop a socially interdependent choice framework of healthcare user decision-making. DESIGN A mixed-methods approach will be used. A systematic literature review will be conducted that identifies the social influences on healthcare user decision-making. Based on the outcomes of a systematic literature review, an interview guide will be developed that assesses which, and how, social influences affect healthcare user decision-making in four different medical fields. This guide will be used during two exploratory focus groups to assess the engagement of participants and clarity of questions and probes. The refined interview guide will be used to conduct the semistructured interviews with healthcare professionals and users. These interviews will explore in detail which, and how, social influences affect healthcare user decision-making. Focus group and interview transcripts will be analysed iteratively using a constant comparative approach based on a mix of inductive and deductive coding. Based on the outcomes, a social influence independent choice framework for healthcare user decision-making will be drafted. Finally, the Delphi technique will be employed to achieve consensus about the final version of this choice framework. ETHICS AND DISSEMINATION This study was approved by the Erasmus School of Health Policy and Management Research Ethics Review Committee (ESHPM, Rotterdam, The Netherlands; reference ETH2122-0666).
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Affiliation(s)
- Sven P H Nouwens
- Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands
- Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics, Rotterdam, The Netherlands
| | - Jorien Veldwijk
- Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands
- Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics, Rotterdam, The Netherlands
| | - Luis Pilli
- Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands
- Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics, Rotterdam, The Netherlands
| | - Joffre D Swait
- Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands
- Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics, Rotterdam, The Netherlands
| | - Joanna Coast
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Esther W de Bekker-Grob
- Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands
- Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics, Rotterdam, The Netherlands
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3
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Yahia A, Cole E, Rayford A, Fava J. A community-based, interdisciplinary approach to improving HPV vaccine uptake at a large urban public university. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:500-508. [PMID: 35271416 DOI: 10.1080/07448481.2022.2044823] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 10/30/2021] [Accepted: 02/06/2022] [Indexed: 06/14/2023]
Abstract
The purpose of this project was to pilot and determine the outcomes of a multi-faceted, interdisciplinary human papillomavirus awareness and vaccination campaign within a university community. Students, faculty, and staff of a large urban Midwest-based public university. METHODS This consisted of five key interventions: promotion and outreach, volunteer training, patient education, access, and documentation. Perceived knowledge and attitudes toward HPV and the HPV vaccine, and HPV vaccine uptake were measured as outcome variables. The project resulted in statistically significant increases in perceived knowledge regarding HPV and the HPV vaccine, willingness to receive HPV vaccination, and likeliness to recommend HPV vaccination (p < 0.001). The project also resulted in a 76.6% increase in the number of HPV vaccines administered at the university's Campus Health Center. A novel HPV awareness and vaccination campaign led to increases in knowledge regarding HPV and HPV vaccines, and substantially increased HPV vaccinations administered at a large, urban public university.
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Affiliation(s)
- Adalah Yahia
- Department of Pharmacy Practice, Wayne State University, Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, Michigan, USA
| | - Evan Cole
- Department of Pharmacy Practice, Wayne State University, Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, Michigan, USA
| | - Ann Rayford
- Nursing Practice Corporation - Campus Health Center, Detroit, Michigan, USA
| | - Joseph Fava
- Department of Pharmacy Practice, Wayne State University, Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, Michigan, USA
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4
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Brandt HM, Footman A, Adsul P, Ramanadhan S, Kepka D. Implementing interventions to start HPV vaccination at age 9: Using the evidence we have. Hum Vaccin Immunother 2023; 19:2180250. [PMID: 36803261 PMCID: PMC10026886 DOI: 10.1080/21645515.2023.2180250] [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: 02/22/2023] Open
Abstract
Human papillomavirus (HPV) vaccination is routinely recommended for adolescents aged 11 or 12 years but can begin at age 9. On-time HPV vaccination by the thirteenth birthday has proven to be effective in preventing HPV cancer and pre-cancer. However, HPV coverage rates continue to lag behind other routinely recommended vaccinations for adolescents. A promising approach to improving coverage is to start HPV vaccination at age 9. This approach has been endorsed by the American Academy of Pediatrics and the American Cancer Society. Benefits of this approach include increased time to complete vaccination series by the thirteenth birthday, additional spacing of recommended vaccines, and a more concentrated focus on cancer prevention messaging. While promising, little is known about how and if existing evidence-based interventions and approaches can be used to promote starting HPV vaccination at age 9. Implementation science frameworks offer scientific direction in how to adapt current and develop new interventions to promote starting HPV vaccination at age 9 and accelerate dissemination and prevent HPV cancers.
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Affiliation(s)
- Heather M Brandt
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Alison Footman
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Deanna Kepka
- Huntsman Cancer Institute and College of Nursing, University of Utah, Salt Lake City, UT, USA
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5
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Muraleetharan V, Brault MA. Friends as Informal Educators: The Role of Peer Relationships in Promotion of Sexual Health Services among College Students. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2023; 44:29-41. [PMID: 34284679 PMCID: PMC10730011 DOI: 10.1177/0272684x211034661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This ethnographic study of one United States university's sexual health resources explores the role of peer relationships in sexual health promotion to understand how these relationships shaped students' interactions with campus sexual health resources. Through analysis of seventeen semi-structured interviews with students, five policy interviews with providers and university personnel, and participant-observation of peer health educator training, the authors examine how trust in peer relationships can serve as a form of social capital to influence sexual health information sharing. The article introduces the term "peer administrator" to describe student actors who sit at the intersection of friend and official resource and explores the importance of these mentoring relationships for sexual health promotion. The analysis also considers how more individualistic models of public health promotion limit the impact of peer relationships and concludes with a discussion of how universities might imagine new forms of sexual health promotion among students.
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Affiliation(s)
- Veena Muraleetharan
- Department of Anthropology, Yale University, New Haven, Connecticut, United States
| | - Marie A. Brault
- Social & Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States
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6
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Fasce A, Schmid P, Holford DL, Bates L, Gurevych I, Lewandowsky S. A taxonomy of anti-vaccination arguments from a systematic literature review and text modelling. Nat Hum Behav 2023; 7:1462-1480. [PMID: 37460761 DOI: 10.1038/s41562-023-01644-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/25/2023] [Indexed: 09/23/2023]
Abstract
The proliferation of anti-vaccination arguments is a threat to the success of many immunization programmes. Effective rebuttal of contrarian arguments requires an approach that goes beyond addressing flaws in the arguments, by also considering the attitude roots-that is, the underlying psychological attributes driving a person's belief-of opposition to vaccines. Here, through a pre-registered systematic literature review of 152 scientific articles and thematic analysis of anti-vaccination arguments, we developed a hierarchical taxonomy that relates common arguments and themes to 11 attitude roots that explain why an individual might express opposition to vaccination. We further validated our taxonomy on coronavirus disease 2019 anti-vaccination misinformation, through a combination of human coding and machine learning using natural language processing algorithms. Overall, the taxonomy serves as a theoretical framework to link expressed opposition of vaccines to their underlying psychological processes. This enables future work to develop targeted rebuttals and other interventions that address the underlying motives of anti-vaccination arguments.
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Affiliation(s)
- Angelo Fasce
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Philipp Schmid
- Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany
- Department of Implementation Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Dawn L Holford
- School of Psychological Science, University of Bristol, Bristol, UK
- Department of Psychology, University of Essex, Colchester, UK
| | - Luke Bates
- Ubiquitous Knowledge Processing Lab/Department of Computer Science and Hessian Center for AI (hessian.AI), Technical University of Darmstadt, Darmstadt, Germany
| | - Iryna Gurevych
- Ubiquitous Knowledge Processing Lab/Department of Computer Science and Hessian Center for AI (hessian.AI), Technical University of Darmstadt, Darmstadt, Germany
| | - Stephan Lewandowsky
- School of Psychological Science, University of Bristol, Bristol, UK
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
- Department of Psychology, University of Potsdam, Potsdam, Germany
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7
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Shin Y, Miller-Day M, Pettigrew J, Hecht ML. Does Narrative Quality Matter During Implementation of a School-Based Prevention Intervention? A Test of Narrative Engagement Theory. JOURNAL OF HEALTH COMMUNICATION 2023; 28:526-538. [PMID: 37401175 PMCID: PMC10527670 DOI: 10.1080/10810730.2023.2231886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Narratives play a powerful role in sharing meaning and making sense of experiences. Specifically, health narratives convey storylines, characters, and messages about health-related behaviors and provide audiences with models for healthy behaviors, prompting audiences' health-related reflections and decision-making. Narrative engagement theory (NET) explains how personal narratives can be integrated into interventions to promote health. This study utilizes NET to test direct and indirect effects of teachers' narrative quality on adolescent outcomes during a school-based substance use prevention intervention that includes narrative pedagogy and an implementation strategy. Observational coding of teacher narratives in video-recorded lessons along with self-report student surveys (N = 1,683) were subjected to path analysis. Findings showed significant direct effects of narrative quality on student engagement, norms (i.e. personal, best-friend injunctive, and descriptive norms), and substance use behavior. The analysis also yielded support for indirect effects of narrative quality on adolescent substance use behavior via student engagement, personal norms, and descriptive norms. Findings highlight important issues related to teacher-student interaction during implementation and contributes implications for adolescent substance use prevention research.
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Affiliation(s)
- YoungJu Shin
- Department of Organizational Sciences and Communication, George Washington University
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8
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Foster S, Carvallo M, Song H, Lee J, Lee J. When culture and health collide: feminine honor endorsement and attitudes toward catch-up HPV vaccinations in college women. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1454-1462. [PMID: 34398700 DOI: 10.1080/07448481.2021.1935970] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/22/2021] [Accepted: 05/02/2021] [Indexed: 06/13/2023]
Abstract
Sexual promiscuity stigma constitutes a significant barrier which prevents young women from receiving catch-up human papillomavirus (HPV) vaccinations. Our objective was to explore how this stigma may be particularly detrimental to women in cultures of honor, where women are expected to maintain a reputation of sexual purity. Participants were a sample of 182 young women who had not previously received an HPV vaccination. We measured feminine honor endorsement, HPV sexual promiscuity stigma, HPV vaccination shame, HPV vaccination intentions, and a set of covariates. Analyses revealed that the significant association between feminine honor endorsement and HPV vaccination intentions is fully explained by HPV sexual purity stigma and HPV vaccination shame. These findings indicate that honor-endorsing women are significantly impacted by sexual purity stigma, minimizing intentions to receive HPV vaccinations. These findings also highlight the need for the inclusion of cultural factors in the study of HPV vaccine uptake.
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Affiliation(s)
| | | | - Hairong Song
- Psychology, University of Oklahoma, Norman, Oklahoma, USA
| | - Joyce Lee
- Psychology, University of Oklahoma, Norman, Oklahoma, USA
| | - Jongwon Lee
- College of Nursing, University of New Mexico, Albuquerque, New Mexico, USA
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9
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Manrique de Lara A, Colmenares-Roa T, Pascual-Ramos V, Moctezuma-Rios JF, Contreras-Yañez I, Guaracha-Basañez GA, Álvarez-Hernández E, Meza-López Y Olguín G, Peláez-Ballestas I. Sociocultural and moral narratives influencing the decision to vaccinate among rheumatic disease patients: a qualitative study. Clin Rheumatol 2023:10.1007/s10067-023-06609-5. [PMID: 37129776 PMCID: PMC10152007 DOI: 10.1007/s10067-023-06609-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/16/2023] [Accepted: 04/21/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION/OBJECTIVES Vaccination is a process that involves individual, social, and ethical aspects, beyond public governance of vaccines or vaccination as a public health concern. The aim of this study is to describe the sociocultural and moral narratives that influence the decision to vaccinate in general and to vaccinate against COVID-19 specifically, among patients at the rheumatology units of two hospitals. METHODS Qualitative study involving individual semi-structured interviews following an interview guide. We conducted a thematic analysis using the ATLAS.ti software, with further triangulation to verify concordance and aid in the interpretation of the data from a medical anthropology framework and using a narrative ethics approach to gain insight into the participants' underlying moral values. RESULTS We interviewed 37 patients in total, along with 3 rheumatologists. Five core themes emerged from the analysis to understand the decision to vaccinate: (1) information about vaccines and disease, (2) perceived risk-benefit of vaccination, (3) the physician-patient relationship, (4) governance of vaccination programs, (5) attitudes towards vaccines. Individual and family experiences with vaccination are diverse depending on the type of vaccine. The COVID-19 vaccine, as a new medical technology, is met with more controversy leading to hesitancy. CONCLUSIONS The decision to vaccinate among Mexican rheumatic disease patients can sometimes involve doubt and distrust, especially for those with a lupus diagnosis, but ultimately there is acceptance in most cases. Though patients make and value autonomous decisions, there is a collective process involving sociocultural and ethical aspects. Key points • The complexity of vaccine decision-making is better identified through a narrative, qualitative approach like the one used in this study, as opposed to solely quantitative approaches • Sociocultural and moral perspectives of vaccination shape decision-making and, therefore, highlight the importance of including patients in the development of effective clinical practice guidelines as well as ethically justified public policy • Sociohistorical context and personal experiences of immunization influence vaccine decision-making much more than access to biomedical information about vaccines, showing that approaches based on the information deficit model are inadequate to fight vaccine hesitancy.
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Affiliation(s)
| | | | - Virgina Pascual-Ramos
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Mexico City, México
| | | | - Irazú Contreras-Yañez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Mexico City, México
| | | | | | | | - Ingris Peláez-Ballestas
- Hospital General de Mexico "Dr. Eduardo Liceaga", Mexico City, México.
- Rheumatology Unit, Hospital General de Mexico "Dr. Eduardo Liceaga", Mexico City, México.
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10
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Garcia S, Hopfer S, Amaro H, Tanjasiri S. HPV vaccine delay and refusal among unvaccinated Mexican American young adult women: a qualitative investigation of Mexican-born and US-born HPV vaccine decision narratives. J Behav Med 2023; 46:88-99. [PMID: 35610490 PMCID: PMC9130004 DOI: 10.1007/s10865-022-00326-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/29/2022] [Indexed: 12/23/2022]
Abstract
Low HPV vaccination rates among Latina young adults perpetuate HPV-associated cancer disparities. Using qualitative methods, this study explored individual, interpersonal, and community factors that influence HPV vaccine delay and refusal among Mexican- and U.S.-born Mexican American young adult women. Participants (N = 30) between 18 and 26 years old were purposively sampled from two federally qualified health centers in Orange County, California. The National Institute on Minority Health and Health Disparities research framework and narrative engagement theory guided semi-structured phone interviews coded inductively and deductively. Participants primarily attributed vaccine status to individual and interpersonal reasons. Emerging themes included low HPV vaccine knowledge, insufficient provider communication, negative perceptions about HPV and the vaccine, motherhood responsibilities, mother's communication about HPV, cultural family norms, health care access, and misinformation. Compared to U.S.-born Latinas, Mexican-born participants more frequently expressed avoiding health care discussions with family. HPV vaccine recommendations for young Mexican American women should include socioculturally tailored messages that may improve HPV vaccination acceptance and uptake.
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Affiliation(s)
- Samantha Garcia
- Department of Health, Society, and Behavior, Program in Public Health, University of California, 653 E. Peltason Drive, AIRB, Room 2020D, Irvine, CA 92697-3957 USA
| | - Suellen Hopfer
- Department of Health, Society, and Behavior, Program in Public Health, University of California, 653 E. Peltason Drive, AIRB, Room 2020D, Irvine, CA 92697-3957 USA
| | - Hortensia Amaro
- Herbert Wertheim College of Medicine and Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC4 Room 419, Miami, FL 33199 USA
| | - Sora Tanjasiri
- Department of Epidemiology and Biostatistics, Program in Public Health, University of California, 653 E. Peltason Drive, AIRB, Room 3072, Irvine, CA 92697-3957 USA
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Nicholas J, Mills B, Hansen S, Bright SJ, Scott J, Ridout I, Watson J, Boyd H, Brook L, Hopper L. Sideffect GamePlan: Development of an alcohol and other drug serious game for high school students using a systematic and iterative user-centred game design framework. COMPUTERS IN HUMAN BEHAVIOR 2023. [DOI: 10.1016/j.chb.2023.107774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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12
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Ka Lai Lee D, Jiang CL. Culture-centric narratives of influenza vaccination among high-risk groups in Hong Kong. Health Promot Int 2023; 38:6974793. [PMID: 36617294 DOI: 10.1093/heapro/daac184] [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: 01/09/2023] Open
Abstract
Despite the effectiveness of influenza vaccination, the vaccine coverage rate among high-risk groups in Hong Kong is less than optimal. Guided by the Health Belief Model (HBM) and culture-centric narrative approach, we examined the role of cultural specificities in implicit assumptions held by at-risk individuals when the individuals decided whether to receive the vaccine. Data were collected from 29 in-depth interviews with people from high-risk groups in Hong Kong. From their decision narratives, it is evident that the local socio-cultural characteristics and collectivistic ideology are useful in understanding the perceptions of influenza severity, susceptibility to infection, perceived barriers and benefits, and self-efficacy of accepting or rejecting the vaccine among the high-risk individuals. Implications of vaccination message designs are discussed.
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Affiliation(s)
| | - Crystal Li Jiang
- Department of Media and Communication, City University of Hong Kong, China
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13
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Malone MA, Gower AL, Reiter PL, Kiss DE, McRee AL. "What does it matter?" Young sexual minority men discuss their conversations with sexual partners about HPV vaccination. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:489-495. [PMID: 33830878 PMCID: PMC9404533 DOI: 10.1080/07448481.2021.1895806] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 12/27/2020] [Accepted: 02/21/2021] [Indexed: 05/14/2023]
Abstract
Objective: Human papillomavirus vaccination coverage is suboptimal, especially among males. Social networks influence young adults' health behaviors and could be leveraged to promote vaccination. We sought to describe how young sexual minority men communicate about human papillomavirus (HPV) vaccination with their sexual partners. Participants: National (U.S.) sample of sexual minority men ages 18-26 (n = 42) from January 2019. Methods: We conducted four online focus groups and identified salient themes using inductive content analysis. Results: Across groups, participants described that HPV vaccination is not a focus of their conversations with sexual partners. Other key themes related to HPV vaccine communication included: varying discissions based on relationship type, and valuing conversations with partners about safer sex. Conclusions: Findings provide novel insight into how young sexual minority men communicate with their sexual partners about HPV vaccination and identify potential areas for interventions to promote communication. Future research is needed to investigate associations between partner communication and HPV vaccine uptake.
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Affiliation(s)
- Molly A. Malone
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Amy L. Gower
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Paul L. Reiter
- Division of Health Behavior and Health Promotion, The Ohio State University, Columbus, OH, USA
| | - Dale E. Kiss
- Division of Health Behavior and Health Promotion, The Ohio State University, Columbus, OH, USA
| | - Annie-Laurie McRee
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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Harper K, Short MB, Bistricky S, Kusters IS. 1-2-3! Catch-Up for HPV: A Theoretically Informed Pilot Intervention to Increase HPV Vaccine Uptake among Young Adults. AMERICAN JOURNAL OF HEALTH EDUCATION 2023. [DOI: 10.1080/19325037.2022.2163005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
| | | | - Steven Bistricky
- University of Houston-Clear Lake
- University of Colorado at Colorado Springs, Colorado Springs
- Lyda Hill Institute for Human Resilience, Colorado Springs
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Dasch S, Wachinger J, Bärnighausen T, Chen S, McMahon SA. Deliberation, context, emotion and trust - understanding the dynamics of adults' COVID-19 vaccination decisions in Germany. BMC Public Health 2023; 23:136. [PMID: 36658504 PMCID: PMC9850339 DOI: 10.1186/s12889-022-14587-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 11/10/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Willingness to vaccinate against coronavirus disease 2019 (COVID-19), which is vital to successful vaccination campaigns, is wavering and suboptimal. In Germany, quantitative research highlighted concerns regarding the safety and efficacy of COVID-19 vaccines as barriers to uptake, but qualitative insights regarding individuals' decisions about COVID-19 vaccines and how personal perceptions reflect or refute existing behavioral theories are lacking. METHODS To identify how individuals make COVID-19 vaccination decisions within real-life contexts, we conducted 33 semi-structured, in-depth qualitative interviews with individuals in Germany between March and April 2021 using maximum variation sampling, focusing on perceptions of COVID-19 vaccines. Analysis, informed by a framework approach, began in the field via debriefings and was amplified upon the conclusion of data collection. RESULTS Four interconnected themes (deliberation, context, emotion, trust) shaped respondents' decisions about vaccination. Personal deliberation regarding benefits and risks of vaccines and perceptions of the broader social and political context sparked a spectrum of emotions that underpinned vaccination decisions. Trust in science and researchers emerged as a powerful protective factor facilitating the decision to get vaccinated even amidst a rapidly changing context and disconcerting information. CONCLUSIONS Our findings add to ongoing debates about the breadth of vaccination decisions by highlighting how respondents are influenced by their perceptions of the political context and the emotional heft of their decisions. The role of cognitive evaluation, context, and emotions mirrors other decision-making frameworks, particularly the Risk as Feelings Theory. We extend on the elements of this theory by highlighting trust as a protective factor when making decisions particularly in highly uncertain contexts. Success of vaccination campaigns, more important than ever as new variants of COVID-19 emerge, is interwoven with an ability to bolster trust in science. Communicating public-health decisions and information about vaccines transparently without instilling fear offers promising chances to strengthen public trust in COVID-19 vaccines. TRIAL REGISTRATION German Clinical Trials Register ( DRKS00024505 ).
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Affiliation(s)
- Selina Dasch
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany.
| | - Jonas Wachinger
- grid.5253.10000 0001 0328 4908Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Till Bärnighausen
- grid.5253.10000 0001 0328 4908Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany ,grid.38142.3c000000041936754XDepartment of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA ,grid.506261.60000 0001 0706 7839Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Simiao Chen
- grid.5253.10000 0001 0328 4908Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany ,grid.506261.60000 0001 0706 7839Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shannon A. McMahon
- grid.5253.10000 0001 0328 4908Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany ,grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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16
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Yin X, Zhang M, Wang F, Huang Y, Niu Y, Ge P, Yu W, Wu Y. A national cross-sectional study on the influencing factors of low HPV vaccination coverage in mainland China. Front Public Health 2023; 10:1064802. [PMID: 36726621 PMCID: PMC9884683 DOI: 10.3389/fpubh.2022.1064802] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023] Open
Abstract
Background HPV vaccine can block the infection of high-risk human papillomavirus and is an important measure to effectively reduce the incidence of cervical cancer and precancerous lesions. However, the HPV vaccination rate is still low in China. There are many factors. Therefore, it is important to study the influencing factors to provide basis for promoting the formulation of vaccination strategies. Methods This study used a multi-stage sampling method to conduct a face-to-face questionnaire survey on women in different regions of China. The new general self-efficacy scale was used to measure the self-efficacy of the respondents. The short form of family health scale measured their family health. The t-test and binary Logistic regression analysis were used to screen the influencing factors of HPV vaccination. Restricted cubic spline model was used to analyze the influence trend of self-efficacy and family health on HPV vaccination rate. Results (1) The HPV vaccination rate was low, especially in the ≤18 group. The place of residence, capita household income/month, individual self-efficacy and family health had a significant impact on HPV vaccination. (2) The restricted cubic spline model showed that self-efficacy positively promoted HPV vaccination, the correlation strength was statistically significant (χ2 =27.64, P<0.001) and non-linear (χ2 = 12.49, P = 0.0004); The poor family health hindered HPV vaccination, and the association strength was statistically significant (χ2 = 47.81, P < 0.001) and non-linear (χ2 = 9.96, P = 0.0016). Conclusion It is necessary to strengthen the health education of HPV vaccination knowledge in the population to eliminate the hesitancy of vaccination. Free HPV vaccination strategies should be developed and encourage people of appropriate age to receive as early as possible. Self-efficacy and family health should be enhanced to increase HPV vaccination rate, so as to achieve the goal of reducing the incidence of cervical cancer and protecting women's health.
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Affiliation(s)
- Xiangju Yin
- School of Emergency Management, Henan Polytechnic University, Jiaozuo, China
| | - Mengrui Zhang
- School of Resource and Environment, Henan Polytechnic University, Jiaozuo, China
| | - Fei Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Yue Huang
- School of Emergency Management, Henan Polytechnic University, Jiaozuo, China
| | - Yuyao Niu
- Department of English, Faculty of Arts and Humanities, University of Macau, Macau, China
| | - Pu Ge
- Department of English, Faculty of Arts and Humanities, University of Macau, Macau, China
| | - Wenli Yu
- School of Foreign Languages, Weifang University of Science and Technology, Weifang, China
| | - Yibo Wu
- School of Public Health, Peking University, Beijing, China
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17
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McCulloh RJ, Darden PM, Snowden J, Ounpraseuth S, Lee J, Clarke M, Newcomer SR, Fu L, Hubberd D, Baldner J, Garza M, Kerns E. Improving pediatric COVID-19 vaccine uptake using an mHealth tool (MoVeUp): study protocol for a randomized, controlled trial. Trials 2022; 23:911. [PMID: 36307830 PMCID: PMC9616622 DOI: 10.1186/s13063-022-06819-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) vaccines demonstrate excellent effectiveness against infection, severe disease, and death. However, pediatric COVID-19 vaccination rates lag among individuals from rural and other medically underserved communities. The research objective of the current protocol is to determine the effectiveness of a vaccine communication mobile health (mHealth) application (app) on parental decisions to vaccinate their children against COVID-19. METHODS Custodial parents/caregivers with ≥ 1 child eligible for COVID-19 vaccination who have not yet received the vaccine will be randomized to download one of two mHealth apps. The intervention app will address logistical and motivational barriers to pediatric COVID-19 vaccination. Participants will receive eight weekly push notifications followed by two monthly push notifications (cues to action) regarding vaccinating their child. Through branching logic, users will access customized content based on their locality, degree of rurality-urbanicity, primary language (English/Spanish), race/ethnicity, and child's age to address COVID-19 vaccine knowledge and confidence gaps. The control app will provide push notifications and information on general pediatric health and infection prevention and mitigation strategies based on recommendations from the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC). The primary outcome is the proportion of children who complete COVID-19 vaccination series. Secondary outcomes include the proportion of children who receive ≥ 1 dose of COVID-19 vaccine and changes in parent/caregiver scores from baseline to immediately post-intervention on the modified WHO SAGE Vaccine Hesitancy Scale adapted for the COVID-19 vaccine. DISCUSSION The COVID-19 pandemic inflicts disproportionate harm on individuals from underserved communities, including those in rural settings. Maximizing vaccine uptake in these communities will decrease infection rates, severe illness, and death. Given that most US families from these communities use smart phones, mHealth interventions hold the promise of broad uptake. Bundling multiple mHealth vaccine uptake interventions into a single app may maximize the impact of deploying such a tool to increase COVID-19 vaccination. The new knowledge to be gained from this study will directly inform future efforts to increase COVID-19 vaccination rates across diverse settings and provide an evidentiary base for app-based vaccine communication tools that can be adapted to future vaccine-deployment efforts. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov NCT05386355 . Registered on May 23, 2022.
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Affiliation(s)
- Russell J McCulloh
- Children's Hospital & Medical Center, 8200 Dodge St., Omaha, NE, 68114, USA.
| | - Paul M Darden
- University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Jessica Snowden
- University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Songthip Ounpraseuth
- University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Jeannette Lee
- University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Martina Clarke
- College of Information Science & Technology, University of Nebraska Omaha, 172 Peter Kiewit Institute, 1110 South 67th Street, Omaha, NE, 68182, USA
| | - Sophia R Newcomer
- School of Public Health and Community Health Sciences, University of Montana, Skaggs Building Room 177, 32 Campus Drive, Missoula, MT, 59812, USA
| | - Linda Fu
- Office of the Director, National Institutes of Health, 11601 Landsdown Sreet, Rockville, MD, 20852, USA
| | - DeAnn Hubberd
- University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Jaime Baldner
- University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Maryam Garza
- University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Ellen Kerns
- University of Nebraska Medical Center, 42nd and Emile St., Omaha, NE, 68131, USA
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18
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McCulloh RJ, Darden P, Snowden J, Ounpraseuth S, Lee J, Clarke M, Newcomer SR, Fu L, Hubberd D, Baldner J, Garza M, Kerns E. Improving pediatric COVID-19 vaccine uptake using an mHealth tool (MoVeUP): a randomized, controlled trial. RESEARCH SQUARE 2022:rs.3.rs-2070396. [PMID: 36238712 PMCID: PMC9558439 DOI: 10.21203/rs.3.rs-2070396/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: Coronavirus disease 2019 (COVID-19) vaccines demonstrate excellent effectiveness against infection, severe disease, and death. However, pediatric COVID-19 vaccination rates lag among individuals from rural and other medically underserved communities. The research objective of the current protocol is to determine the effectiveness of a vaccine communication mobile health (mHealth) application (app) on parental decisions to vaccinate their children against COVID-19. Methods: Custodial parents/caregivers with ≥1 child eligible for COVID-19 vaccination who have not yet received the vaccine will be randomized to download one of two mHealth apps. The intervention app will address logistical and motivational barriers to pediatric COVID-19 vaccination. Participants will receive eight weekly push notifications followed by two monthly push notifications (cues to action) regarding vaccinating their child. Through branching logic, users will access customized content based on their locality, degree of rurality-urbanicity, primary language (English/Spanish), race/ethnicity, and child's age to address COVID-19 vaccine knowledge and confidence gaps. The control app will provide push notifications and information on general pediatric health and infection prevention and mitigation strategies based on recommendations from the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC). The primary outcome is the proportion of children who complete COVID-19 vaccination series. Secondary outcomes include the proportion of children who receive ≥1 dose of COVID-19 vaccine and changes in parent/caregiver scores from baseline to immediately post-intervention on the modified WHO SAGE Vaccine Hesitancy Scale adapted for the COVID-19 vaccine. Discussion: The COVID-19 pandemic inflicts disproportionate harm on individuals from underserved communities, including those in rural settings. Maximizing vaccine uptake in these communities will decrease infection rates, severe illness, and death. Given that most US families from these communities use smart phones, mHealth interventions hold the promise of broad uptake. Bundling multiple mHealth vaccine-uptake interventions into a single app may maximize the impact of deploying such a tool to increase COVID-19 vaccination. The new knowledge to be gained from this study will directly inform future efforts to increase COVID-19 vaccination rates across diverse settings and provide an evidentiary base for app-based vaccine communication tools that can be adapted to future vaccine-deployment efforts. Clinical Trials Registration: Name of the registry: clinicaltrials.gov Trial registration number: NCT05386355 Date of registration: May 23, 2022 URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT05386355.
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19
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Leader AE, Miller-Day M, Rey RT, Selvan P, Pezalla AE, Hecht ML. The impact of HPV vaccine narratives on social media: Testing narrative engagement theory with a diverse sample of young adults. Prev Med Rep 2022; 29:101920. [PMID: 36161120 PMCID: PMC9502044 DOI: 10.1016/j.pmedr.2022.101920] [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: 12/09/2021] [Revised: 07/10/2022] [Accepted: 07/18/2022] [Indexed: 11/28/2022] Open
Abstract
Rates of human papillomavirus (HPV) infection are highest in young adults, who can be vaccinated against HPV if they were not vaccinated as adolescents. Since young adults increasingly access health information on social media, we tested the impact of a social media campaign with narrative-based health information on intentions related to HPV vaccination. We also aimed to understand which ads resonated most with young adults and led to higher survey completion rates. We created social media posts featuring videos promoting HPV vaccination. We launched a sponsored ad campaign on Facebook to reach young women, ages 18–26, across the country. Participants were randomly assigned one of 6 videos and then completed a brief survey about video engagement and intentions to: talk with a health care professional, talk with friends or family, and vaccinate against HPV. A descriptive correlational design and a test for moderation were used to explore hypothesized relationships. Across all ads, 1332 link clicks led to 991 completed surveys that were reduced to 607 surveys (95 % ages 18–26, 63 % non-Caucasian; 58 % sexually active). Higher video engagement was associated with stronger intentions to talk with a health care professional (r = 0.44, p =.01), talk with friends/family (r = 0.52, p =.01), and vaccinate against HPV (r = 0.43, p =.01). Young adults were receptive to watching narrative-based health information videos on social media. When promoting HPV vaccination, more engaging information leads to greater intentions to talk about the vaccine and get vaccinated.
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Affiliation(s)
- Amy E. Leader
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, United States
- Corresponding author at: Population Science, Medical Oncology, Thomas Jefferson University, 834 Chestnut Street, Suite 314, Philadelphia, PA 19107, United States.
| | | | - Rikishi T. Rey
- Department of Communication, Clemson University, United States
| | - Preethi Selvan
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, United States
| | - Anne E. Pezalla
- REAL Prevention, LLC, United States
- Department of Psychology, Macalester College, United States
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20
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Cho D, Wang C, Pierce J, Dawkins-Moultin L, Lu Q. Preliminary efficacy of a tailored narrative intervention to increase human papillomavirus vaccination intention among a multi-ethnic sample of female students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022:1-8. [PMID: 35981315 DOI: 10.1080/07448481.2022.2103372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 05/24/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
Objective. We investigated the preliminary efficacy of a tailored human papillomavirus (HPV) vaccination on-line intervention designed to increase HPV vaccination intention. Participants. Female college students (N = 101; 18-26 years), who have not received the HPV vaccine. Methods. Participants were randomized to either a control group to read standard Center for Disease Control information or a narrative intervention group to read two narrative messages about HPV/HPV vaccination that were tailored based on the individual's sexual history and told from the perspectives from a peer and an expert. Participants were assessed at baseline (T1) and immediately after the intervention (T2). Results. The narrative intervention group reported a greater increase from T1 to T2 in vaccination intention compared with control group. Both groups reported increases in knowledge, positive attitude, self-efficacy, social norm, and perceived susceptibility to HPV from T1 to T2. Conclusions. A narrative intervention is promising to effectively increase HPV vaccination intention.
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Affiliation(s)
- Dalnim Cho
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carol Wang
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Jace Pierce
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Lenna Dawkins-Moultin
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Qian Lu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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21
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Hecht ML, BeLue R, Ray A, Hopfer S, Miller-Day M, Mckee F. HPV Vaccine Intent among Adult Women Receiving Care at Community Health Centers. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1186-1193. [PMID: 33400206 DOI: 10.1007/s13187-020-01937-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 06/12/2023]
Abstract
Human papillomavirus (HPV) is a disease that exacts substantial costs in human life and public health expenditures. Fortunately, a vaccine exists that can mitigate these costs. This study reports the development and evaluation of the intervention designed to overcome these barriers by using culturally grounded narratives to promote HPV vaccination. Women's Stories (WS) targets women over the age of 18 and was originally successfully validated for use among college students resulting in NCI recognition. WS was adapted for touch pad delivery in Planned Parenthood clinics where a randomized clinical trial was conducted in 8 clinics in 3 cities. Two hundred seventeen women were randomly assigned to treatment and control, completing pretest and posttest surveys. This study examined data from the immediate posttest. An intent to treat analysis was conducted using a generalized linear mixed modeling approach using a multinomial link and accounting for repeated measures by site. Results demonstrate significant short-term effects on vaccine intentions and vaccine self-efficacy. When compared to control group participants, women in the treatment condition more likely to intend to get the shot today/the day of interview (p < 0.01), as well as in 1 (p < 0.01) and 6 (p < 0.01) months and had greater self-efficacy to receive the HPV vaccination (B = 0.54; p = 0.0002). These results are promising for the potential impact of the intervention in clinical settings as well as providing a model for overcoming lack of awareness and vaccine resistance in other segments of the population.
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Affiliation(s)
- M L Hecht
- REAL Prevention LLC, Clifton, NJ, USA
| | - R BeLue
- Health Management and Policy, Saint Louis University, St Louis, MO, USA.
| | - A Ray
- Public Health, University of Kentucky, Lexington, KY, USA
| | - S Hopfer
- Public Health, UC Irvine, Irvine, CA, USA
| | - M Miller-Day
- Communication Studies, Chapman University, Orange, CA, USA
| | - F Mckee
- St. Andrew Development, Inc., Philadelphia, PA, USA
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22
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Fields EJ, Hopfer S, Warren JR, BeLue R, Lebed J, Hecht ML. Motivators and Barriers to HPV Vaccination: A Qualitative Study of Underserved Women Attending Planned Parenthood. Vaccines (Basel) 2022; 10:vaccines10071126. [PMID: 35891290 PMCID: PMC9317585 DOI: 10.3390/vaccines10071126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 12/10/2022] Open
Abstract
Human papilloma virus (HPV) is the most common sexually transmitted infection in the United States. Disease-associated strains of HPV can cause genital warts and six cancer types. HPV-associated cervical cancer disproportionately impacts medically underserved women including Black and Latina women with respect to incidence, prevalence, and mortality rates. Although safe and effective vaccines are available, HPV vaccination rates remain low among low-income individuals and women of color. The current study examined individual and structural motivators and barriers to HPV vaccination among medically underserved women utilizing a Planned Parenthood health center in Southeast Pennsylvania. Guided by narrative engagement theory (NET), qualitative interviews (N = 24) were used to elicit HPV vaccine decision stories from both vaccinated and unvaccinated women. Using a phronetic iterative data analysis approach, we identified three motivators to vaccinate against HPV: (1) receiving an explicit vaccine recommendation from a healthcare provider (a structural determinant), (2) feeling empowered to take control of one’s health (an individual determinant), and (3) knowing someone infected with HPV (an individual determinant). Among unvaccinated participants, barriers to HPV vaccination included: (1) not receiving an explicit vaccine recommendation from a healthcare provider (a structural determinant), (2) low perceived risk for acquiring HPV or that HPV is not severe (an individual determinant), and (3) lack of maternal support to vaccinate (a structural determinant). Healthcare providers are optimally positioned to fill the gap in prior missed vaccine opportunities and empower women by recommending HPV vaccination.
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Affiliation(s)
- Emilia J. Fields
- Department of Health, Society, and Behavior, Program in Public Health, University of California-Irvine, Irvine, CA 92697, USA;
| | - Suellen Hopfer
- Department of Health, Society, and Behavior, Program in Public Health, University of California-Irvine, Irvine, CA 92697, USA;
- Correspondence: ; Tel.: +1-(949)-824-6996
| | - Jennifer R. Warren
- Department of Communication, Women and Gender Studies, African and African American Studies, George Mason University, Fairfax, VA 22030, USA;
| | - Rhonda BeLue
- Department of Public Health, University of Texas San Antonio, San Antonio, TX 78249, USA;
| | - Joel Lebed
- Planned Parenthood Southeastern Pennsylvania, Philadelphia, PA 19107, USA;
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23
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Aninye IO, Berry-Lawhorn JM, Blumenthal P, Felder T, Jay N, Merrill J, Messman JB, Nielsen S, Perkins R, Rowen T, Saslow D, Trimble CL, Smith-McCune K. Gaps and Opportunities to Improve Prevention of Human Papillomavirus-Related Cancers. J Womens Health (Larchmt) 2021; 30:1667-1672. [PMID: 34871035 PMCID: PMC8721503 DOI: 10.1089/jwh.2021.0507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Human papillomavirus (HPV) infections cause more than 35,900 cancers annually in the United States. Although cervical cancer is the most prevalent HPV-related malignancy in women, the virus is also responsible for a significant percentage of anal, vaginal, and vulvar cancers. A comprehensive approach to mitigating cervical cancer includes HPV vaccination (primary prevention), screening and treatment of precancerous lesions (secondary prevention), and diagnosis and treatment of invasive cancer (tertiary prevention). Although a successful strategy, there are opportunities to innovate and increase access that can also be adapted to address the unique clinical care gaps that exist with the other anogenital cancers. The Society for Women's Health Research held a series of interdisciplinary meetings and events, during which expert researchers, clinicians, patient advocates, and health care policy leaders evaluated the current landscape of HPV-related cancers and their effects on women's health. This report summarizes the discussions of this working group and areas it identified in which to address gaps in primary and secondary prevention approaches to improve access and health outcomes for women with HPV-related anogenital cancers.
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Affiliation(s)
- Irene O Aninye
- Society for Women's Health Research, Washington, District of Columbia, USA
| | - J Michael Berry-Lawhorn
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Paul Blumenthal
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California, USA
| | | | - Naomi Jay
- Anal Neoplasia Clinic, Research, and Education Center, University of California San Francisco, San Francisco, California, USA
| | - Janette Merrill
- Policy Programs, American Society of Clinical Oncology, Alexandria, Virginia, USA
| | - Jenna B Messman
- University Health Center, University of Maryland, College Park, Maryland, USA
| | - Sarah Nielsen
- Human Relations, High Point University, High Point, North Carolina, USA
| | - Rebecca Perkins
- Department of Obstetrics and Gynecology, Boston University, Boston, Massachusetts, USA
| | - Tami Rowen
- Department of Obstetrics, Gynecology, and Gynecologic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Debbie Saslow
- Department of Prevention and Early Detection, American Cancer Society, Atlanta, Georgia, USA
| | - Connie Liu Trimble
- Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Karen Smith-McCune
- Department of Obstetrics, Gynecology, and Gynecologic Surgery, University of California San Francisco, San Francisco, California, USA
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24
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Peterson CE, Silva A, Goben AH, Ongtengco NP, Hu EZ, Khanna D, Nussbaum ER, Jasenof IG, Kim SJ, Dykens JA. Stigma and cervical cancer prevention: A scoping review of the U.S. literature. Prev Med 2021; 153:106849. [PMID: 34662598 DOI: 10.1016/j.ypmed.2021.106849] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/20/2021] [Accepted: 10/11/2021] [Indexed: 01/08/2023]
Abstract
Cervical cancer is preventable through HPV vaccination and screening however, uptake falls below national targets. A scoping review was conducted to describe stigmas related to HPV infection and vaccination and cervical cancer and screening in the US. Results were organized into the domains proposed by Stangl and colleagues' Health Stigma and Discrimination Framework. Common drivers of stigma were fear of social judgement and rejection, self-blame, and shame. Positive facilitators included social norms that provided motivation to receive HPV vaccination and screening. Gender and social norms were notable negative facilitators of stigma. HPV infection and cervical cancer resulted in stigma marking through the belief that both result from incautious behavior-either multiple sexual partners or failing to get screening. Stereotyping and prejudice were stigma practices attributed to HPV infection and cervical cancer through these same behaviors. Stigma experiences related to HPV infection, cervical cancer, and abnormal screening results included altered self-image based on perceived/anticipated stigma, as well as discrimination. This review advances understanding of the multiple dimensions of stigma associated with these outcomes in the US population. Three areas warrant additional consideration. Future studies should 1) assess how stigma dimensions affect uptake of cervical cancer preventions efforts; 2) focus on US women most affected by cervical cancer incidence and mortality to identify potential differences in these dimensions and tailor interventions accordingly; 3) include women from geographic areas of the US with high rates of cervical cancer to adapt interventions that address potential regional variations in resources and need.
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Affiliation(s)
- Caryn E Peterson
- School of Public Health, University of Illinois at Chicago, USA.
| | - Abigail Silva
- Department of Public Health Sciences, Loyola University Chicago, Parkinson School of Health Sciences and Public Health, USA
| | | | | | - Elise Z Hu
- University of Illinois College of Medicine, USA
| | | | | | - Ian G Jasenof
- University of Illinois Health, Mile Square Health Center, USA
| | - Sage J Kim
- School of Public Health, University of Illinois at Chicago, USA
| | - J Andrew Dykens
- University of Illinois College of Medicine, USA; Department of Family Medicine, College of Medicine, Center for Global Health, USA
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25
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Hopfer S, Duong HT, Garcia S, Tanjasiri SP. Health Information Source Characteristics Matter: Adapting the Dissemination of an HPV Vaccine Intervention to Reach Latina and Vietnamese Women. J Prim Prev 2021; 42:511-529. [PMID: 34283351 PMCID: PMC8290389 DOI: 10.1007/s10935-021-00643-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/28/2022]
Abstract
Latina and Vietnamese women are disproportionately burdened by human papillomavirus (HPV)-associated cervical cancer and underutilize the HPV vaccine, which is an effective cancer prevention measure. To inform the adaptation of a National Cancer Institute's evidence-based cancer control program, HPV Vaccine Decision Narratives, and because of the rapidly changing information concerning consumption patterns of young adults, we elicited preferences and characteristics associated with women's interest in various health information sources, specifically for HPV vaccination. We conducted 50 interviews with young Latina and Vietnamese women at two Planned Parenthood health centers in Southern California. Interview questions were guided by the Channel Complementarity Theory and focused on understanding the multiple communication channels women turn to for health, and the characteristics that motivate their use. Our results showed that Latina and Vietnamese women turn to many sources, from online and social media to school health classes, mothers, and doctors. Specific characteristics that motivate women's online use of health information included immediacy and access, convenience and credibility. When receiving HPV vaccine information, privacy, avoiding information overload, interpersonal engagement, and receiving health information from trusted sources was important. Our study advances the prevention literature by elevating the role of platform delivery considerations and emphasizing preferences to effectively reach Latina and Vietnamese women, who are disproportionately burdened by HPV cancers and are less aware of HPV vaccine prevention. These results can be used to further inform the dissemination of this cancer control program. Adaptation of the program should include changes to its delivery, such that trusted sources are used, and dissemination is coordinated to send a consistent message across multiple communication methods.
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Affiliation(s)
- Suellen Hopfer
- Department of Health, Society & Behavior, UCI Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA.
- Anteater Instruction & Research Building (AIRB) Second Floor, Office 2024, 653 E. Peltason, Irvine, CA, 92697, USA.
| | - Huong T Duong
- Department of Health, Society & Behavior, UCI Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
| | - Samantha Garcia
- Department of Health, Society & Behavior, UCI Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
| | - Sora P Tanjasiri
- Department of Epidemiology, University of California, Irvine, CA, USA
- Director of Community Engagement, UCI Chao Family Comprehensive Cancer Center, Orange, CA, USA
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Gesser-Edelsburg A. How to Make Health and Risk Communication on Social Media More "Social" During COVID-19. Risk Manag Healthc Policy 2021; 14:3523-3540. [PMID: 34471393 PMCID: PMC8403670 DOI: 10.2147/rmhp.s317517] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/13/2021] [Indexed: 12/14/2022] Open
Abstract
Social media have changed the way citizens participate in and express opinions about government policy. Social media serve organizations in achieving four main goals: interacting with citizens; fostering citizen participation; furthering open government; and analyzing/monitoring public opinion and activities. We contend that despite the importance of social media, international and local health organizations have been slow to adopt to them, primarily due to the discrepancy between intraorganizational discourse modes and the type of discourse suitable for dialogue with the public. In this perspective paper, we recommend strategies for such public dialogue based on understanding the challenges faced by organizations on the road to becoming more “social” in their social media presence and in their health and risk communication. Subsequently, we propose an integrative approach that combines three complementary paths: (1) putting the “social” back into health organizations’ culture by inserting more “social” content into the internal organizational discourse through consultation with experts from different fields, including those who diverge from the scientific consensus. (2) Using strategies to enable health organizations to respond to the public on social networks, based on health communications research and studies on emerging infectious disease (EID) communication. (3) Engaging the public on social media based on the participatory approach, which considers the public as a partner that understands science and can work with the organizations to develop an open and innovative pandemic realm by using crowdsourcing to solve complex global health problems. For each path, we define the current challenges, among which are (1) overcoming organizational groupthink and hidden profiles, (2) treating all unofficial information as misleading, and (3) insufficient public engagement in solving complex global problems. We then offer recommendations for dealing with each challenge.
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Affiliation(s)
- Anat Gesser-Edelsburg
- School of Public Health and the Health and Risk Communication Research Center, University of Haifa, Haifa, 3498838, Israel
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Groves S, Brooks J. What do young women below national screening age in England think about cervical cancer and cervical screening? A qualitative study. J Clin Nurs 2021; 31:1588-1597. [PMID: 34418192 DOI: 10.1111/jocn.16012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore what women aged below the national screening age in the UK know and think about cervical cancer and cervical screening. BACKGROUND The efficacy of cervical cancer screening is well established. However, cervical screening attendance in the United Kingdom has decreased, with especially low rates at the first screening opportunity at age 25. Research has not yet explored knowledge and beliefs underpinning young women's intention to screen before first screening invitation. DESIGN Qualitative exploratory study. METHODS Qualitative email interviews were undertaken with 16 participants, using questions derived from the Health Belief Model. Data were analysed using template analysis. The COREQ were followed. RESULTS Analysis generated three themes; (1) Learning about cervical cancer and cervical screening: sources of information and (missed) opportunities; (2) Young women know screening is important - but they don't always know why; (3) Screening intentions: a cost/benefit analysis of the available information. CONCLUSIONS Young women had varied knowledge and beliefs about cervical cancer and screening which were underpinned by several sources of information available to them. Most women expressed an intention to attend screening when invited; however, some participants were unsure, with low screening-based knowledge and low perceived susceptibility of cervical cancer identified as key barriers. Social media, familial interactions and interventions within education were highlighted as being suited to interventions aimed at increasing cervical cancer- and screening-based knowledge in young women. RELEVANCE TO CLINICAL PRACTICE Findings suggest that women below screening age could be better informed about cervical cancer and screening. Tailored interventions addressing common concerns and misconceptions around screening may be acceptable to young women and could help to promote screening attendance at first invitation.
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Affiliation(s)
- Samantha Groves
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, England
| | - Joanna Brooks
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, England
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Self-efficacy and HPV Vaccine Attitudes Mediate the Relationship Between Social Norms and Intentions to Receive the HPV Vaccine Among College Students. J Community Health 2021; 45:1187-1195. [PMID: 32418009 DOI: 10.1007/s10900-020-00837-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Human papillomavirus (HPV) has been linked to genital warts and multiple cancers affecting both men and women. Despite college students' high risk for HPV, their vaccination rates remain suboptimal. The current observational study examined the relationship between social norms and HPV vaccine intentions and potential mechanisms underlying this relationship among undergraduates. Participants (N = 190; 66.8% female) completed a survey assessing HPV vaccine social norms, attitudes, self-efficacy, and intentions. Three mediation analyses were conducted to examine whether self-efficacy and attitudes mediated the relationship between social norms (i.e., parents, friends, doctor) and intentions, controlling for demographic and health care covariates. Social norms were indirectly related to intentions through self-efficacy and attitudes in multiple models (ps < .05). Specifically, perceiving greater support for HPV vaccination from one's friends, parents, and doctor was related to greater HPV vaccine self-efficacy, which, in turn, was related to increased vaccine intentions. In addition, perceiving greater parental and doctor support for HPV vaccination was related to more favorable attitudes towards the vaccine, which, in turn, were related to increased vaccine intentions. Findings suggest potential targets for future interventions to promote HPV vaccination among young adults.
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Glenn BA, Nonzee NJ, Tieu L, Pedone B, Cowgill BO, Bastani R. Human papillomavirus (HPV) vaccination in the transition between adolescence and adulthood. Vaccine 2021; 39:3435-3444. [PMID: 33992435 DOI: 10.1016/j.vaccine.2021.04.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/27/2021] [Accepted: 04/09/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Young adulthood is characterized by changes in health care decision-making, insurance coverage, and sexual risk. Although the human papillomavirus (HPV) vaccine is now approved for adults up to age 45, and catch-up vaccination is currently recommended up through age 26, vaccination rates remain low in young adults. This study explored perspectives on HPV vaccination among young adults receiving care at the student health center of a large public university. METHODS We conducted semi-structured interviews (n = 27) and four focus groups with female and male undergraduate and graduate students (n = 18) and semi-structured interviews with health care providers (n = 6). Interviews and focus groups explored perceived risk of HPV infection, benefits of the HPV vaccine, and motivations for and barriers to HPV vaccination. RESULTS Many young adults cited their parents' views and recommendations from medical providers as influential on their decision-making process. Students perceived that cervical cancer prevention was a main benefit of the HPV vaccine and sexual activity was a risk factor for HPV infection. Students often lacked knowledge about the vaccine's benefits for males and expressed some concerns about the safety and side effects of a vaccine perceived as new. Logistical barriers to vaccination included uncertainty over vaccination status and insurance coverage for the vaccine, and concerns about balancing the vaccine schedule with school obligations. Providers' vaccine recommendations were impacted by health system factors, including clinical infrastructure, processes for recommending and documenting vaccination, and office visit priorities. Suggested vaccination promotion strategies included improving the timing and messaging of outreach efforts on campus and bolstering clinical infrastructure. CONCLUSIONS Although college may be an opportune time to reach young adults for HPV vaccination, obstacles including navigating parental influence and independent decision-making, lack of awareness of vaccination status, and numerous logistical and system-level barriers may impede vaccination during this time.
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Affiliation(s)
- Beth A Glenn
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, 650 Charles Young Drive South Drive, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
| | - Narissa J Nonzee
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, 650 Charles Young Drive South Drive, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
| | - Lina Tieu
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, 650 Charles Young Drive South Drive, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
| | - Bettina Pedone
- UCLA Arthur Ashe Student Health & Wellness Center, University of California, Los Angeles, 221 Westwood Plaza, Los Angeles, CA 90095, USA.
| | - Burt O Cowgill
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, 650 Charles Young Drive South Drive, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
| | - Roshan Bastani
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, 650 Charles Young Drive South Drive, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
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Pierre-Victor D, Stephens D, Gabbidon K, Jean-Baptiste N, Clarke R, Madhivanan P. Conversations about sexual activity within Haitian families: implications for HPV vaccine uptake. ETHNICITY & HEALTH 2021; 26:571-584. [PMID: 30353738 DOI: 10.1080/13557858.2018.1539221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 10/11/2018] [Indexed: 06/08/2023]
Abstract
Objective: Parents play an integral role in young adults' sexual health including human papillomavirus (HPV) vaccine decision-making. The objective of this study was to explore conversations regarding sexual activity in Haitian households and the influence of such conversations on young Haitian women's HPV vaccine discussion with their parents.Methods: From a large university in the southeastern United States, 30 Haitian-American college women (ages 17-26) were recruited for semi-structured in-depth interviews. The interviews were recorded and transcribed verbatim. Interview transcripts were analyzed using thematic analysis.Results: Most participants stated that they either did not have conversations regarding sexual activity or the conversations that they had were described as 'uncomfortable' or 'awkward'. Many participants stated that once parents knew that HPV is sexually transmitted, their discussions about the vaccine would be considered an announcement of their sexual debut or sexual activity. Hence, many decided to not discuss the HPV vaccine with their parents.Conclusion: Findings have important implications for HPV vaccine uptake. Results showed that a lack of conversations about sexual activity within Haitian households led to limited discussions about the HPV vaccine among young Haitian-American college women and their parents. Future HPV vaccine uptake efforts should integrate familial and cultural beliefs about female sexuality, while focusing on cervical cancer prevention.
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Affiliation(s)
- Dudith Pierre-Victor
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Dionne Stephens
- College of Arts and Science, Florida International University, Miami, FL, USA
| | - Kemesha Gabbidon
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | | | - Rachel Clarke
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Purnima Madhivanan
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
- Public Health Research Institute of India, Mysore, India
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Social norms and vaccine uptake: College students' COVID vaccination intentions, attitudes, and estimated peer norms and comparisons with influenza vaccine. Vaccine 2021; 39:2060-2067. [PMID: 33741191 PMCID: PMC7965606 DOI: 10.1016/j.vaccine.2021.03.018] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/09/2021] [Accepted: 03/04/2021] [Indexed: 11/29/2022]
Abstract
Background Vaccination may be critical to curtailing the spread of the SARS-CoV-2 virus responsible for the COVID-19 pandemic, but herd immunity can only be realized with high vaccination coverage. There is a need to identify empirically supported strategies to increase uptake, especially among young adults as this subpopulation has shown relatively poor adherence to physical distancing guidelines. Social norms – estimates of peers’ behavior and attitudes – are robust predictors of health behaviors and norms-based intervention strategies may increase COVID vaccine uptake, once available. This study examined the extent that vaccination intentions and attitudes were associated with estimated social norms as an initial proof-of-concept test. Method In November of 2020, 647 undergraduate students (46.21% response rate) completed online surveys in which they reported intentions to get COVID and influenza vaccines, perceived importance of these vaccines for young adults, and estimated social norms regarding peers’ vaccination behaviors and attitudes. Results Students reported significantly greater intentions to get a COVID vaccine (91.64%) than an influenza vaccine (76.04%), and perceived COVID vaccination as significantly more important than influenza vaccination. The sample generally held strong intentions to receive a COVID vaccine and thought that doing so was of high importance, but participants, on average, perceived that other young adults would be less likely to be vaccinated and would not think vaccination was as important. Multiple regression models indicated that estimated social norms were positively associated with participants’ own intentions and perceived importance of getting a COVID vaccine. Conclusions These significant associations highlight the potential value in developing and testing norms-based intervention strategies, such as personalized normative feedback, to improve uptake of forthcoming COVID vaccines among young adults.
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Gesser-Edelsburg A. Using Narrative Evidence to Convey Health Information on Social Media: The Case of COVID-19. J Med Internet Res 2021; 23:e24948. [PMID: 33674257 PMCID: PMC7962859 DOI: 10.2196/24948] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/09/2020] [Accepted: 03/05/2021] [Indexed: 01/14/2023] Open
Abstract
During disease outbreaks or pandemics, policy makers must convey information to the public for informative purposes (eg, morbidity or mortality rates). They must also motivate members of the public to cooperate with the guidelines, specifically by changing their usual behavior. Policy makers have traditionally adopted a didactic and formalistic stance by conveying dry, statistics-based health information to the public. They have not yet considered the alternative of providing health information in the form of narrative evidence, using stories that address both cognitive and emotional aspects. The aim of this viewpoint paper is to introduce policy makers to the advantages of using narrative evidence to provide health information during a disease outbreak or pandemic such as COVID-19. Throughout human history, authorities have tended to employ apocalyptic narratives during disease outbreaks or pandemics. This viewpoint paper proposes an alternative coping narrative that includes the following components: segmentation; barrier reduction; role models; empathy and support; strengthening self-efficacy, community efficacy, and coping tools; preventing stigmatization of at-risk populations; and communicating uncertainty. It also discusses five conditions for using narrative evidence to produce an effective communication campaign on social media: (1) identifying narratives that reveal the needs, personal experiences, and questions of different subgroups to tailor messaging to produce targeted behavioral change; (2) providing separate and distinct treatment of each information unit or theory that arises on social networks; (3) identifying positive deviants who found creative solutions for stress during the COVID-19 crisis not found by other members of the community; (4) creating different stories of coping; and (5) maintaining a dialogue with population subgroups (eg, skeptical and hesitant groups). The paper concludes by proposing criteria for evaluating the effectiveness of a narrative.
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Affiliation(s)
- Anat Gesser-Edelsburg
- School of Public Health, University of Haifa, Haifa, Israel.,Health and Risk Communication Research Center, University of Haifa, Haifa, Israel
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Quinn DA, Lewin A. Family factors associated with emerging adults' human papillomavirus vaccine behavior. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2020; 68:528-535. [PMID: 30908148 DOI: 10.1080/07448481.2019.1583240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/23/2019] [Accepted: 02/07/2019] [Indexed: 06/09/2023]
Abstract
Objective: The current study examined the role of family influences on the vaccine behavior of emerging adults. Participants: In Spring 2017, we conducted anonymous online surveys of undergraduate students (n = 608) at a large, public university in the mid-Atlantic. Methods: Logistic regression was used to examine associations between family factors and students' awareness of the HPV vaccine, vaccine receipt, and vaccine intentions. Family factors included sex communication, religiosity, parental monitoring, family structure, and parents' birthplace. Results: More comprehensive family sex communication is associated with less uncertainty regarding HPV vaccine receipt and greater likelihood of being already vaccinated. More frequent family religiosity and more parental monitoring are associated with greater likelihood of having decided against vaccination rather than already being vaccinated. Significant gender and racial disparities exist. Conclusion: Further research, policy, and programmatic intervention are needed to reduce disparities and to improve emerging adults' compliance with HPV vaccine recommendations.
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Affiliation(s)
- Deirdre A Quinn
- Center for Health Equity Research & Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Amy Lewin
- Department of Family Science, University of Maryland School of Public Health, College Park, MD, USA
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Kteily-Hawa R, Hari S, Soor JK, Wong JPH, Chikermane V, Chambers LA, Vahabi M. Paradigm shifts in sexual health: Quantitative analysis of story and fact-based health education interventions. THE CANADIAN JOURNAL OF HUMAN SEXUALITY 2020. [DOI: 10.3138/cjhs.2018-0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There is a pressing need for sex education interventions that combat stigma and increase HIV knowledge and comfort in talking about sex among Canadian South Asians. A community-based research study in the Greater Toronto Area in Ontario, Canada assessed (1) the impact of fact-based versus story-based interventions on two outcomes: knowledge of HIV/STIs and HIV-related stigma; and (2) the potential of parasocial contact to reduce HIV-related stigma. This is a peer-facilitated, mixed method intervention involving a partnership between the Alliance for South Asian AIDS Prevention (ASAAP), an organization serving South Asian and Middle Eastern people living with and affected by HIV, knowledge users, and a team of academic researchers. Eight South Asian women peer leaders were trained to help carry out the interventions. A convenience sample of 78, ages 18–60 were recruited. Participants were randomly allocated to traditional fact sheets (n = 40), and stories (n = 38). Analysis of Covariance (ANCOVA) was conducted to investigate the differences in the two outcome variables (HIV/STI knowledge and stigma) between the two study groups after the intervention controlling for differences in measures before the intervention. Adjusted mean for the HIV/STI knowledge after the intervention was significantly higher in the story-sharing group (M = 8.02, SE = .28) vs fact-based group (M = 7.13, SE = .27), F(1, 75) = 5.10, p = .027, with the small effect size, partial Π2 = .06. Similarly, a significant difference was found in the mean post-intervention stigma scores between the story-sharing group and the fact-based group, F(1, 41) = 5.03, p = .030, with moderate effect size, partial Π2 = .11. Specifically, the mean stigma scores in the story-sharing group (M = 45.75, SE = 2.72) were significantly lower than the fact-based group (M = 54.80, SE = 2.85). Story-based interventions facilitated through parasocial contact with peer leaders offer powerful potential across populations and showed promise by increasing HIV/STI knowledge, reducing HIV-related stigma, and fostering capacity building, agency and empowerment.
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Affiliation(s)
- Roula Kteily-Hawa
- Faculty of Education and Social Work, Thompson Rivers University, Kamloops, BC
- Ontario HIV Treatment Network, Toronto, ON
| | - Shriya Hari
- Alliance for South Asian AIDS Prevention, Toronto, ON
| | | | - Josephine Pui-Hing Wong
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | | | | | - Mandana Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON
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Ng TW, Cowling BJ, So HC, Ip DK, Liao Q. Testing an integrative theory of health behavioural change for predicting seasonal influenza vaccination uptake among healthcare workers. Vaccine 2020; 38:690-698. [DOI: 10.1016/j.vaccine.2019.10.041] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/27/2019] [Accepted: 10/15/2019] [Indexed: 11/27/2022]
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Amith M, Roberts K, Tao C. Conceiving an application ontology to model patient human papillomavirus vaccine counseling for dialogue management. BMC Bioinformatics 2019; 20:706. [PMID: 31865902 PMCID: PMC6927108 DOI: 10.1186/s12859-019-3193-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background In the United States and parts of the world, the human papillomavirus vaccine uptake is below the prescribed coverage rate for the population. Some research have noted that dialogue that communicates the risks and benefits, as well as patient concerns, can improve the uptake levels. In this paper, we introduce an application ontology for health information dialogue called Patient Health Information Dialogue Ontology for patient-level human papillomavirus vaccine counseling and potentially for any health-related counseling. Results The ontology’s class level hierarchy is segmented into 4 basic levels - Discussion, Goal, Utterance, and Speech Task. The ontology also defines core low-level utterance interaction for communicating human papillomavirus health information. We discuss the design of the ontology and the execution of the utterance interaction. Conclusion With an ontology that represents patient-centric dialogue to communicate health information, we have an application-driven model that formalizes the structure for the communication of health information, and a reusable scaffold that can be integrated for software agents. Our next step will to be develop the software engine that will utilize the ontology and automate the dialogue interaction of a software agent.
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Affiliation(s)
- Muhammad Amith
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin Road, Suite 600, Houston, TX, 77030, USA
| | - Kirk Roberts
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin Road, Suite 600, Houston, TX, 77030, USA
| | - Cui Tao
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin Road, Suite 600, Houston, TX, 77030, USA.
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Ma Z, Nan X. Positive Facts, Negative Stories: Message Framing as a Moderator of Narrative Persuasion in Antismoking Communication. HEALTH COMMUNICATION 2019; 34:1454-1460. [PMID: 30040484 DOI: 10.1080/10410236.2018.1499702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study examines the moderating role of message framing in narrative persuasion in the context of promoting smoking cessation. A controlled experiment involving 101 college smokers revealed a significant interaction effect between message framing (gain-framing vs. loss-framing) and evidence type (narrative vs. nonnarrative) on smoking-related risk perceptions. For the gain-framed message, the nonnarrative version produced significantly greater perceived susceptibility to smoking-related diseases than did the narrative version. For the loss-framed message, evidence type did not make a difference in perceived susceptibility. On perceived severity of smoking-related diseases, the interaction was such that for the loss-framed message, the narrative version resulted in significantly greater perceived severity than did the nonnarrative version. In contrast, for the gain-framed message, evidence type did not make a difference in perceived severity. In addition, our results revealed that the interaction between message framing and evidence type had an indirect effect on attitudes toward quitting smoking through perceived severity of smoking-related diseases. Theoretical and practical implications are discussed.
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Affiliation(s)
- Zexin Ma
- Department of Communication and Journalism, Oakland University
| | - Xiaoli Nan
- Department of Communication, University of Maryland, College Park
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Tien HK, Chung W. Exploration of Effective Persuasive Strategies Used in Resisting Product Advertising: A Case Study of Adult Health Check-Ups. HEALTH COMMUNICATION 2019; 34:1242-1249. [PMID: 29746177 DOI: 10.1080/10410236.2018.1473706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This research addressed adults' health check-ups through the lens of Role Transportation Theory. This theory is applied to narrative advertising that lures adults into seeking health check-ups by causing audiences to empathize with the advertisement's character. This study explored the persuasive mechanism behind narrative advertising and reinforced the Protection Motivation Theory model. We added two key perturbation variables: optimistic bias and truth avoidance. To complete the verification hypothesis, we performed two experiments. In Experiment 1, we recruited 77 respondents online for testing. We used analyses of variance to verify the effectiveness of narrative and informative advertising. Then, in Experiment 2, we recruited 228 respondents to perform offline physical experiments and conducted a path analysis through structural equation modelling. The findings showed that narrative advertising positively impacted participants' disease prevention intentions. The use of Role Transportation Theory in advertising enables the audience to be emotionally connected with the character, which enhances persuasiveness. In Experiment 2, we found that the degree of role transference can interfere with optimistic bias, improve perceived health risk, and promote behavioral intentions for health check-ups. Furthermore, truth avoidance can interfere with perceived health risks, which, in turn, reduce behavioral intentions for health check-ups.
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Affiliation(s)
- Han-Kuang Tien
- Advertising Department, School of Continuing Education, Chinese Culture University
| | - Wen Chung
- Program of Marketing, Business College at Chinese Culture University
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Cartmell KB, Mzik CR, Sundstrom BL, Luque JS, White A, Young-Pierce J. HPV Vaccination Communication Messages, Messengers, and Messaging Strategies. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:1014-1023. [PMID: 30054900 PMCID: PMC9673969 DOI: 10.1007/s13187-018-1405-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Human papillomavirus (HPV) causes over 39,000 cancers annually in the US. The HPV vaccine is safe and effective but underutilized to prevent cancer. In the US, only 37% of adolescents ages 13-17 have received the full vaccine series. Ineffective messages and misinformation about the vaccine have negatively impacted its uptake in the US. It was initially only approved for girls and early marketing focused on cervical cancer prevention and prevention of HPV as a sexually transmitted infection. Understanding effective messages and methods of dissemination is critical to address suboptimal vaccine uptake. Qualitative interviews were conducted with 34 participants to identify best practices for HPV vaccination messaging in SC. Participants included state leaders representing public health, medical associations, K-12 public schools, universities, insurers, and cancer advocacy organizations. Recommended HPV vaccine messages included focusing on cancer prevention rather than sexual transmission, routinizing the vaccine, and highlighting risks/costs of HPV. Targeting messages to specific demographics and utilizing multiple media platforms to disseminate consistent, scientifically accurate messages were recommended. Strategies such as appealing to parents' moral responsibility to protect their children against cancer and addressing the ubiquity of HPV and sharing growing evidence that HPV may be transmitted independent of sexual activity were also recommended. Suggested HPV vaccine messengers included trusted peers, medical professionals, and health associations. Culture-centered narratives to raise the voices of cancer survivors and parents were also recommended. This study provides an array of HPV vaccination messages and dissemination strategies for optimizing HPV vaccination rates.
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Affiliation(s)
- Kathleen B Cartmell
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, Charleston, SC, 29425, USA.
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.
| | - Carlie R Mzik
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | | | - John S Luque
- Institute of Public Health, Florida A&M University, Tallahassee, FL, USA
| | - Ashley White
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
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Facilitators and barriers of human papillomavirus vaccine uptake in young females 18-26 years old in Singapore: A qualitative study. Vaccine 2019; 37:6030-6038. [PMID: 31473002 DOI: 10.1016/j.vaccine.2019.08.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Around 70% of cervical cancers are caused by Types 16 and 18 of human papillomavirus (HPV). Vaccines against HPV have been shown to be safe and effective in preventing HPV and cervical cancer. OBJECTIVE To explore the facilitators and barriers of HPV vaccination in young females aged 18-26 years in Singapore, and to describe their recommended strategies to improve the uptake of HPV vaccination. DESIGN Qualitative, descriptive design guided by the socio-ecological model. PARTICIPANTS Young women studying in National University of Singapore (NUS), aged 18-26 (N = 40). Purposive sampling was used to recruit participants from various socio-economic levels and faculties, both vaccinated against HPV and unvaccinated. METHODS In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted with the participants. IDIs and FGDs were transcribed and coded using NVIVO software. Thematic data analysis was performed using an inductive approach. RESULTS Barriers to HPV vaccination included lack of awareness, lack of perceived risk for cervical cancer, cost, lack of parental support, inconvenience of getting the vaccination, stigma associated with connection with sexual activity, and concern regarding safety. Facilitators include parental encouragement, protection of one's health, lack of logistical barriers, and perceived safety and efficacy of the vaccine. Participants recommended increasing awareness of HPV vaccination and cervical cancer, reducing cost of vaccination and making the vaccine compulsory to increase vaccine uptake. CONCLUSION Barriers and facilitators exist at different levels to influence vaccine uptake. Public education on cervical cancer and the vaccine should be stepped up to increase public awareness. A school-based national vaccination programme was proposed by the target group to increase the rate of uptake of HPV vaccination in Singapore.
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Vu M, Bednarczyk RA, Escoffery C, Getachew B, Berg CJ. Human papillomavirus vaccination among diverse college students in the state of Georgia: who receives recommendation, who initiates and what are the reasons? HEALTH EDUCATION RESEARCH 2019; 34:415-434. [PMID: 31081024 PMCID: PMC6646951 DOI: 10.1093/her/cyz014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 05/12/2019] [Indexed: 05/30/2023]
Abstract
Young adulthood is a critical time for catch-up HPV vaccination. We assessed predictors of vaccine recommendation and initiation among college students. We analysed cross-sectional surveys from 2397 students using multivariable logistic regressions. Guided by the Socio-ecological and Health Belief Models, measures included socio-demographic characteristics, intrapersonal measures (e.g. vaccine beliefs), interpersonal measures (e.g. doctor's recommendation) and institutional-level measures (e.g. college settings). The sample included students from private, public, technical and historically black colleges/universities. Of the sample, 64.5% were White; additionally, 48.3% of women (n = 750/1552) and 18.8% of men (n = 159/845) received a doctor's recommendation. Among women, predictors included older age, US-born, higher parental education and attending private schools. Among men, predictors included younger age, being homosexual and attending private schools. HPV vaccine series initiation was low-43.3% of women (n = 672) and 16.7% of men (n = 141). Doctor's recommendation predicted initiation for both sexes. Younger women, women attending technical colleges and men of 'multiple/other' race had lower odds of initiation. Common initiation barriers for both sexes included a lack of doctor recommendation and sexual inactivity. These barriers and the associations between nativity, race and socio-economic status with vaccine recommendation and initiation should be further investigated. Interventions should improve patient-provider communication around HPV vaccine.
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Affiliation(s)
- Milkie Vu
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health
- Winship Cancer Institute
- Emory Vaccine Center, Emory University, 1518 Clifton Rd NE, Atlanta, GA, USA
| | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health
- Winship Cancer Institute
| | - Betelihem Getachew
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health
| | - Carla J Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health
- Winship Cancer Institute
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Interventions to increase uptake of the human papillomavirus vaccine in unvaccinated college students: A systematic literature review. Prev Med Rep 2019; 14:100884. [PMID: 31193049 PMCID: PMC6513780 DOI: 10.1016/j.pmedr.2019.100884] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/13/2019] [Accepted: 04/28/2019] [Indexed: 11/21/2022] Open
Abstract
Objective The purpose of this systematic review is to summarize the best available evidence on interventions that could be implemented in the college environment to increase HPV vaccination uptake in college students who were not previously vaccinated. Methods Pubmed, CINAHL, PsycINFO, Cochrane, and EBSCO were searched in December 2017 to identify all literature meeting the following criteria: human subjects, English language, HPV, HPV vaccination, and college. PRISMA recommendations were followed. We focused only on manuscripts that reported vaccine uptake, excluding studies that only reported vaccine intentions. We identified 2989 articles; 101 relevant after screening; nine eligible for final qualitative review. Results Vaccine uptake rates ranged from 5% to 53%. Theory-based variables (e.g., perceived susceptibility and self-efficacy) were associated with vaccine uptake in most studies. A study exposing participants to a narrative video about HPV vaccination led by a combination of peers and medical experts produced the greatest difference in HPV vaccination initiation compared to a control group (21.8% vs 11.8%) of all the studies reviewed. Conclusions Few interventions resulted in substantial HPV vaccine uptake. A combination of peer and provider encouragement may be the most effective method to increase vaccine uptake in this population.
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Information Targeting Increases the Weight of Stigma: Leveraging Relevance Backfires When People Feel Judged. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2019. [DOI: 10.1016/j.jesp.2018.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Fu LY, Haimowitz R, Thompson D. Community members trusted by African American parents for vaccine advice. Hum Vaccin Immunother 2019; 15:1715-1722. [PMID: 30779691 DOI: 10.1080/21645515.2019.1581553] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Exposure to pro-vaccination messages from nonmedical peers and others perceived to share a similar value system for society (referred to as worldview outlook) improves vaccination attitudes. Nonetheless, a minority of African American parents have friends and family members who provide them with vaccine advice. The aims of the current study were to identify the presumed worldview outlook of eight types of community figures as perceived by African American parents, and determine parents' trust in these figures for vaccine advice, and whether trust varied according to the figures' racial concordance. A cross-sectional survey was administered to 110 African American parents in 2015. Parents perceived the community figures to represent a spectrum of worldview outlooks. Although levels of trust in the community figures differed overall (p < .001), it was high in the school nurse, pediatrician, mother, father, disease survivor, and vaccine scientist. All trusted figures except the father were perceived to hold a communitarian outlook. Parents shown race-concordant figures had higher levels of trust in them than those who were shown race-discordant equivalents (p < .01). These findings suggest that vaccination campaigns geared toward African American parents may be strengthened by including other nonmedical, African American spokespersons who convey their community contributions in messages.
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Affiliation(s)
- Linda Y Fu
- a Department of Pediatrics, Children's National Health System , Washington , DC , USA
| | - Rachel Haimowitz
- a Department of Pediatrics, Children's National Health System , Washington , DC , USA
| | - Danielle Thompson
- a Department of Pediatrics, Children's National Health System , Washington , DC , USA
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Lefevre H, Samain S, Ibrahim N, Fourmaux C, Tonelli A, Rouget S, Mimoun E, Tournemire RD, Devernay M, Moro MR, Lachal J. HPV vaccination and sexual health in France: Empowering girls to decide. Vaccine 2019; 37:1792-1798. [PMID: 30808568 DOI: 10.1016/j.vaccine.2019.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/30/2019] [Accepted: 02/05/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Vaccination coverage against HPV in France is among the lowest in the industrialized world, although the public authorities have recently become aware of this issue. Few studies have looked at teenaged girls' representations of this vaccination, even though they are the most concerned by it. This qualitative study explored the experiences and representations of HPV vaccination by adolescent girls seeing doctors at least occasionally. STUDY DESIGN We used a written essay question to explore this issue among 101 adolescent girls at six urban medical centers and a semi-structured interview to discuss it in further depth with five of them. The analysis was lexicometric (ALCESTE®) and phenomenological (Interpretative Phenomenological Analysis). RESULTS These results are organized around four superordinate themes: the teenage girls' factual knowledge about this vaccine, their motives for and obstacles to vaccination, their involvement in this decision, and finally the need for information about and solutions to this issue. CONCLUSIONS Teenage girls know little about this vaccine and are more sensitive to the emotional discourse that surrounds it than to rational knowledge about it. The requirement for parental authorization for this vaccine reinforces the girls' lack of investment. Vaccination programs should integrate the HPV vaccine more thoroughly into general prevention concerning sexual health and should send a strong signal by offering minors anonymous vaccination free of charge, as is already the case in France for requests for contraception, the morning-after pill, elective abortion, and screening and treatment of sexually transmitted infections.
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Affiliation(s)
- Hervé Lefevre
- AP-HP, Cochin Hospital, Maison de Solenn, Paris, France; CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805 Villejuif, France; French Clinical Research Group in Adolescent Medicine and Health, France.
| | - Stéphanie Samain
- AP-HP, Cochin Hospital, Maison de Solenn, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Nour Ibrahim
- AP-HP, Cochin Hospital, Maison de Solenn, Paris, France; CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805 Villejuif, France; French Clinical Research Group in Adolescent Medicine and Health, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - Christine Fourmaux
- French Clinical Research Group in Adolescent Medicine and Health, France; Unité de médecine de l'adolescent CHI Créteil, France.
| | - Anne Tonelli
- French Clinical Research Group in Adolescent Medicine and Health, France; Service de médecine interne pour adolescence, clinque E.Rist, Paris, France.
| | - Sébastien Rouget
- French Clinical Research Group in Adolescent Medicine and Health, France; Service de pédiatrie Centre Hospitalier Sud-Francilien, Corbeil, France.
| | - Emmanuelle Mimoun
- French Clinical Research Group in Adolescent Medicine and Health, France; CH Marchant, Toulouse, France.
| | - Renaud De Tournemire
- French Clinical Research Group in Adolescent Medicine and Health, France; Unité de Médecine pour Adolescents CHI Poissy St Germain en Laye, France.
| | - Marie Devernay
- French Clinical Research Group in Adolescent Medicine and Health, France; AP-HP, Trousseau Hospital, unité pour adolescents, Paris France.
| | - Marie Rose Moro
- AP-HP, Cochin Hospital, Maison de Solenn, Paris, France; CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805 Villejuif, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - Jonathan Lachal
- AP-HP, Cochin Hospital, Maison de Solenn, Paris, France; CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805 Villejuif, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
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Hopfer S, Ray AE, Hecht ML, Miller-Day M, Belue R, Zimet G, Evans WD, McKee FX. Taking an HPV vaccine research-tested intervention to scale in a clinical setting. Transl Behav Med 2019; 8:745-752. [PMID: 29425333 DOI: 10.1093/tbm/ibx066] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Research tested interventions are seldom ready for wide spread use. Successful intervention adaptation to clinical settings demands an iterative process with target audience feedback. We describe the adaptation process of implementing an NCI research tested HPV vaccine intervention, Women's Stories, to a community clinic context (Planned Parenthood). Five phases are described for the adaptation of content and the development of a health kiosk intervention delivery system: (a) informant interviews with the target audience of young adult, predominantly African-American women, (b) translating HPV vaccine decision narratives into prevention messages, (c) health kiosk interface design, (d) conducting a usability study of the health kiosk intervention product, and (e) conducting a waiting room observational study. Lessons learned and challenges in adapting prevention interventions to clinical settings are discussed.
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Affiliation(s)
- Suellen Hopfer
- Program in Public Health, University of California, Irvine, CA, USA
| | | | | | - Michelle Miller-Day
- REAL Prevention, Clifton, NJ, USA.,Communication Studies and Health and Strategic Communication, Chapman University, Orange, CA, USA
| | - Rhonda Belue
- Health Management and Policy, Saint Louis University, St. Louis, MO, USA
| | - Gregory Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - W Douglas Evans
- The George Washington University, Milken Institute School of Public Health, Washington DC, USA
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Bednarczyk RA. Addressing HPV vaccine myths: practical information for healthcare providers. Hum Vaccin Immunother 2019; 15:1628-1638. [PMID: 30676241 DOI: 10.1080/21645515.2019.1565267] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Human papillomavirus (HPV) vaccine uptake consistently lags behind that of other adolescent vaccines. In 2017, uptake of a single HPV vaccine dose and HPV vaccine series completion was 66% and 49%, respectively, compared to uptake of tetanus, diphtheria, and acellular pertussis vaccine (89%) and quadrivalent meningococcal conjugate vaccine (85%). Reasons for not vaccinating adolescents again HPV are varied, and in many cases, are rooted in commonly spread myths and misperceptions about the vaccine. In this review, we address five key myths - HPV vaccination is not effective at preventing cancer; Pap smears are sufficient to prevent cervical cancer; HPV vaccination is not safe; HPV vaccination is not needed since most infections are naturally cleared by the immune system; 11-12 years of age is too young to vaccinate. For each myth, we summarize the scientific evidence refuting the myth and provide speaking prompts for healthcare professionals to communicate about HPV vaccination.
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Affiliation(s)
- Robert A Bednarczyk
- a Hubert Department of Global Health, Rollins School of Public Health, Emory University , Atlanta GA , USA.,b Department of Epidemiology, Rollins School of Public Health, Emory University , Atlanta GA , USA.,c Cancer Prevention and Control Program, Winship Cancer Institute, Emory University , Atlanta GA , USA.,d Emory Vaccine Center, Emory University , Atlanta GA , USA
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Hopfer S, Wright ME, Pellman H, Wasserman R, Fiks AG. HPV vaccine recommendation profiles among a national network of pediatric practitioners: understanding contributors to parental vaccine hesitancy and acceptance. Hum Vaccin Immunother 2019; 15:1776-1783. [PMID: 30570419 PMCID: PMC6746469 DOI: 10.1080/21645515.2018.1560771] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/28/2018] [Accepted: 12/11/2018] [Indexed: 12/15/2022] Open
Abstract
Background: Practitioner communication is one of the most important influences and predictors of HPV vaccination uptake. The objective of this study was to conduct a latent class analysis characterizing pediatric practitioner HPV recommendation patterns. Methods: Pediatric practitioners of the American Academy of Pediatrics' (AAP) Pediatric Research in Office Settings (PROS) national network completed an online survey where they were presented with 5 hypothetical vignettes of well child visits and responded to questions. Questions asked about their use of communication strategies, assessments about the adolescent patient becoming sexually active in the next 2 years for decision-making about HPV vaccine recommendation, and peer norms. Latent class analysis characterized practitioner subgroups based on their response patterns to 10 survey questions. Multinomial logistic regression examined practitioner characteristics associated with each profile. Results: Among 470 respondents, we identified three distinct practitioner HPV vaccine recommendation profiles: (1) Engagers (52%) followed national age-based guidelines, strongly recommended HPV vaccination, and perceived peers as strongly recommending; (2) Protocol Followers (20%) also strongly recommended HPV vaccination, but were less likely to engage families in a discussion about benefits; and (3) Ambivalent HPV Vaccine Recommenders (28%) delayed or did not recommend HPV vaccination and were more likely to use judgment about whether adolescents will become sexually active in the next two years. Practicing in a suburban setting was associated with twice the odds of being an Ambivalent Recommender relative to being an Engager (OR = 2.2; 95% CI:1.1-4.1). Conclusions: Findings underscore the importance of continued efforts to bolster practitioner adoption of evidence-based approaches to HPV vaccine recommendation especially among Ambivalent Recommenders.
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Affiliation(s)
- Suellen Hopfer
- Department of Population Health and Disease Prevention, Irvine, CA, USA
- Institute for Clinical & Translational Science, USA
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
| | - Margaret E. Wright
- Pediatric Research in Office Settings (PROS), Itasca, IL, USA
- American Academy of Pediatrics (AAP), Itasca, IL, USA
| | - Harry Pellman
- University of California, Irvine, CA, USA
- Edinger Medical Group, University of California, Fountain Valley, CA, USA
| | - Richard Wasserman
- Department of Pediatrics, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Alexander G. Fiks
- Pediatric Research in Office Settings (PROS), Itasca, IL, USA
- The Center for Clinical Effectiveness, USA
- Policy Lab, USA
- Pediatric Research Consortium, USA
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, USA
- Department of Pediatrics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Hernandez R. Understanding Sorority Women's Privacy Management About Condom Use. QUALITATIVE HEALTH RESEARCH 2018; 28:1342-1353. [PMID: 29642774 DOI: 10.1177/1049732318766506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Sorority women are at risk for engaging in unsafe sexual behavior. Fortunately, the positive influence of peer communication about condom use can mitigate the risk these women face. To better understand this communication, this article investigates sorority women's communication about condom use through focus groups, using the lens of the theory of Communication Privacy Management. The results revealed the criteria for privacy rules sorority women use to negotiate privacy and engage in comfortable communication with other women in the sorority. The analysis also revealed an external privacy boundary; the women sought to maintain a good reputation for their social group, and followed explicit and implicit privacy management rules to do so. The implications for this study include better understanding of the personal and collective boundaries of privacy management, and improvements in sorority and college student sexual health programs.
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Affiliation(s)
- Rachael Hernandez
- 1 Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
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Pierre-Victor D, Stephens DP, Omondi A, Clarke R, Jean-Baptiste N, Madhivanan P. Barriers to HPV Vaccination Among Unvaccinated, Haitian American College Women. Health Equity 2018; 2:90-97. [PMID: 29904749 PMCID: PMC5994833 DOI: 10.1089/heq.2017.0028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Haitian women residing in the United States are disproportionately affected by cervical cancer. Human papillomavirus (HPV) vaccine has been licensed in the United States since 2006. Vaccination rates are less than optimal overall, and the rates are particularly low among young black women. We investigated barriers to HPV vaccination in a sample of Haitian American college women. Methods: Thirty self-identified Haitian American women, aged 17-26 years, were recruited from a large university campus in southeastern United States (n=30). They completed in-depth face-to-face interviews. The research team analyzed the transcripts using thematic analysis. Results: More than half of the participants (n=18) had not yet initiated the HPV vaccine series. Most of the unvaccinated participants stated that they had received a provider recommendation for the vaccine. Lack of provider recommendation, negative vaccine perception and attitudes, and side effect concerns constituted barriers to vaccination. Conclusions: Haitian American college women at high risk of cervical cancer have cited several barriers to HPV vaccination, with the most prominent being lack of physician recommendation. Healthcare providers should continue recommending the vaccine to college women as many of them may not have received a recommendation. When recommending the HPV vaccine, discussions should be framed with the intent to positively influence HPV vaccine perceptions and ultimately vaccine attitudes.
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