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Odebunmi OO, Spees LP, Biddell CB, Yemeke T, Yanguela J, Higgins C, Gilkey MB, Ozawa S, Wheeler SB. Benefits, challenges, and strategies related to using presumptive recommendations for HPV vaccination: A qualitative study with rural and non-rural-serving primary care professionals. Hum Vaccin Immunother 2024; 20:2347018. [PMID: 38708779 PMCID: PMC11085946 DOI: 10.1080/21645515.2024.2347018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024] Open
Abstract
HPV vaccination coverage remains far below the national target of 80% among US adolescents, particularly in rural areas, which have vaccine uptake rates that are 10% points lower than non-rural areas on average. Primary care professionals (PCPs) can increase coverage by using presumptive recommendations to introduce HPV vaccination in a way that assumes parents want to vaccinate. Through semi-structured interviews, we explored PCPs' experiences and perceptions of using presumptive recommendations in rural- and non-rural-serving primary care clinics in North Carolina. Thematic analysis revealed that most PCPs in rural and non-rural contexts used presumptive recommendations and felt the strategy was an effective and concise way to introduce the topic of HPV vaccination to parents. At the same time, some PCPs raised concerns about presumptive recommendations potentially straining relationships with certain parents, including those who had previously declined HPV vaccine or who distrust medical authority due to their past experiences with the healthcare system. PCPs dealt with these challenges by using a more open-ended approach when introducing HPV vaccination to parents. In conclusion, our findings suggest that PCPs in both rural and non-rural settings see value in using presumptive recommendations to introduce HPV vaccination, but to adequately address concerns and ensure increased HPV vaccine uptake, PCPs can use simple and culturally sensitive language to ensure fully informed consent and to maintain parental trust. And to further strengthen HPV vaccine discussions, PCPs can utilize other effective HPV communication techniques, like the Announcement Approach, in discussing HPV vaccinations with hesitant parents.
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Affiliation(s)
- Olufeyisayo O. Odebunmi
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa P. Spees
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Caitlin B. Biddell
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tatenda Yemeke
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Juan Yanguela
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Colleen Higgins
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melissa B. Gilkey
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sachiko Ozawa
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie B. Wheeler
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Waters AR, Weir C, Kramer HS, van Thiel Berghuijs KM, Wu Y, Kepka D, Kirchhoff AC. Implementation barriers and considerations for recommending and administering the human papillomavirus (HPV) vaccination in oncology settings. J Cancer Surviv 2024; 18:1481-1491. [PMID: 37147553 PMCID: PMC10629381 DOI: 10.1007/s11764-023-01391-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 04/25/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Survivors of childhood and adolescent cancer experience low human papillomavirus (HPV) vaccination rates-a crucial form of cancer prevention. Oncology provider recommendations may increase young survivors HPV vaccine intent, but HPV vaccination is not typically provided in the oncology setting. Thus, we explored the implementation barriers of providing the HPV vaccine in oncology. METHODS We interviewed oncology providers in a variety of specialty areas about their perceptions of the HPV vaccine and to explore barriers to recommending and administering the vaccine in their clinics. Interviews were audio recorded, quality checked, and thematically analyzed. Emergent themes were then mapped onto the Capability, Opportunity, Motivation, and Behavior (COM-B) Model and the Theoretical Domains Framework. RESULTS A total of N=24 oncology providers were interviewed. Most provided direct clinical care (87.5%) and most commonly specialized in pediatric oncology (20.8%), medical oncology (16.7%), bone marrow transplant (16.7%), and nurse coordination (16.7%). Two themes emerged within each COM-B domain. Capability: 1) educational barriers to HPV vaccination and 2) complicated post treatment HPV vaccination guidelines. MOTIVATION 1) perceived importance of HPV vaccine and 2) concern about blurred scope of practice. OPPORTUNITY 1) hospital administration and time concern barriers and 2) clinical workflow integration concerns. CONCLUSION Implementing HPV vaccination in the oncology setting has the potential to increase HPV vaccination rates among young survivors. Multi-level barriers to providing the HPV vaccine in the oncology setting were identified by participants. Leveraging existing implementation strategies may be an effective way to mitigate provider identified barriers and increase vaccination rates.
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Affiliation(s)
- Austin R Waters
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA.
- Department of Health Policy & Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Heidi S Kramer
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | | | - Yelena Wu
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Deanna Kepka
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA
- University of Utah College of Nursing, Salt Lake City, UT, USA
| | - Anne C Kirchhoff
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA
- University of Utah Department of Pediatrics, Salt Lake City, UT, USA
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Foley S, Flowers A, Hall T, Jansen MT, Burcin M. "That Was an Eye Opener for Me": Mixed-Methods Outcomes Educating Texas Community Health Workers on HPV Vaccination Using Project ECHO ®. Vaccines (Basel) 2024; 12:806. [PMID: 39066444 PMCID: PMC11281520 DOI: 10.3390/vaccines12070806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/11/2024] [Accepted: 07/14/2024] [Indexed: 07/28/2024] Open
Abstract
Human papillomavirus (HPV) is known to cause six different types of cancer. HPV vaccination can prevent over 90% of these cancers. Community health workers (CHWs) have the potential to drive HPV vaccination demand through education and navigation by addressing vaccine hesitancy and dis/misinformation and by reaching non-English speaking, vulnerable, or rural populations. Despite their possible reach, there is limited research on HPV vaccination education programs for CHWs. In 2020-2021, the American Cancer Society (ACS) HPV Cancer Free Texas (HPVCFT) Project implemented the eight-session Mission: HPVCFT Vaccination ECHO-CHW Program ten times. This manuscript details the program's implementation processes and outcomes. The program used the Project ECHO model and was offered in both English and Spanish. One hundred and forty-six Texan CHWs completed pre- and post-training surveys. The participants demonstrated significant HPV vaccination knowledge increases and desirable shifts in their foundational HPV vaccination beliefs, including the belief that the HPV vaccine is for cancer prevention. The participants also reported increased confidence in communicating about the HPV vaccine in the community. Improving knowledge, beliefs, and confidence in HPV vaccination is the first step in addressing concerns and increasing uptake. Future research and interventions are needed to better understand how CHWs can be more systematically linked to vaccination opportunities or provided with clearer paths for directing patients to providers that vaccinate.
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Affiliation(s)
- Shaylen Foley
- Interventions and Implementation Department, American Cancer Society, 3380 Chastain Meadows Pkwy NW, Suite 20, Kennesaw, GA 30144, USA; (A.F.); (M.B.)
| | - Ashleigh Flowers
- Interventions and Implementation Department, American Cancer Society, 3380 Chastain Meadows Pkwy NW, Suite 20, Kennesaw, GA 30144, USA; (A.F.); (M.B.)
| | - Tralisa Hall
- Interventions and Implementation Department, American Cancer Society, 3380 Chastain Meadows Pkwy NW, Suite 20, Kennesaw, GA 30144, USA; (A.F.); (M.B.)
| | | | - Michelle Burcin
- Interventions and Implementation Department, American Cancer Society, 3380 Chastain Meadows Pkwy NW, Suite 20, Kennesaw, GA 30144, USA; (A.F.); (M.B.)
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Higgins DM, O’Leary ST. A World without Measles and Rubella: Addressing the Challenge of Vaccine Hesitancy. Vaccines (Basel) 2024; 12:694. [PMID: 38932423 PMCID: PMC11209163 DOI: 10.3390/vaccines12060694] [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: 04/19/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
The worldwide elimination of measles and rubella is feasible, but not without overcoming the substantial challenge of vaccine hesitancy. This challenge is complicated by the spread of misinformation and disinformation fueled by rapidly progressing technologies and evolving forms of online communication. The recent COVID-19 pandemic has only added further complexity to this challenge. However, considerable progress has been made in understanding the scope of the problem and the complex factors that influence vaccine hesitancy. Our understanding of evidence-based strategies for addressing vaccine hesitancy has grown significantly, including evidence for effective communication and behavioral interventions. In this article, we review measles and rubella vaccines and vaccine hesitancy. We then provide an overview of evidence-based strategies for addressing vaccine hesitancy, including communication strategies and behavioral interventions. This article is relevant to healthcare professionals, health system leaders, public health professionals, policymakers, community leaders, and any individuals who have a role in addressing vaccine hesitancy in their communities. Finally, we review future directions and major areas of research need.
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Affiliation(s)
| | - Sean T. O’Leary
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO 80045, USA;
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Chandeying N, Thongseiratch T. Clinician Communication Training to Increase Human Papillomavirus Vaccination Uptake: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2024; 12:611. [PMID: 38932340 PMCID: PMC11209355 DOI: 10.3390/vaccines12060611] [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: 04/21/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
The battle against Human Papillomavirus (HPV)-related cancers is hindered by suboptimal vaccination rates, despite the proven efficacy and availability of vaccines. This systematic review and meta-analysis addressed this issue by evaluating the impact of clinician communication training on increasing HPV vaccination uptake among adolescents. From an initial pool of 3213 records, six randomized controlled trials involving 245,195 participants across the United States were rigorously selected and analyzed. Our findings indicated that clinician communication training could enhance vaccination uptake rates by an average of 5.2%. Specifically, presumptive communication strategies, which proactively assume a patient's acceptance of vaccination, achieved a significant 9.1% increase in uptake, markedly outperforming the 2.3% increase observed with more passive conversational techniques. Moreover, interventions that incorporated audit and feedback processes were particularly impactful, boosting vaccination rates by 9.4%. The most striking results emerged from combining presumptive communication with audit and feedback, which propelled the effectiveness to an 11.4% increase in vaccination rates. These outcomes highlight the pivotal role of deliberate, targeted clinician-patient communication in improving health interventions. This study offers actionable insights for healthcare providers and policymakers to refine communication strategies, thus potentially maximizing HPV vaccination rates and mitigating the spread of HPV-related conditions.
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Affiliation(s)
- Nutthaporn Chandeying
- Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand;
| | - Therdpong Thongseiratch
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
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Nowak GJ, Bradshaw AS, Head KJ. Contributions and Impact of Health Communication Research to Vaccination Efforts and Acceptance. HEALTH COMMUNICATION 2024:1-7. [PMID: 38818795 DOI: 10.1080/10410236.2024.2361584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Vaccines (a medical product) and vaccination recommendations (expert advice on who should receive, when, and how often) have grown in importance and prominence in the past 15 years, including because of a recent COVID-19 pandemic. This essay highlights contributions from vaccine and vaccination-related health communication research since 2010. This research has had significant impacts - that is, visible and discernible positive effects - on the ways health communication is undertaken broadly (e.g. at the campaign level) and at the health care provider-patient level (e.g. conversations with parents and patients regarding vaccine benefits, risks, and safety). As this essay illustrates, health communication research has resulted in greater use of formative research to guide vaccination campaign and education efforts, better identification and understanding of the factors behind vaccination delay and declination, and greater recognition that communication efforts can fail to achieve desired outcomes or generate unintended consequences. Health communication research has also documented the powerful influence of healthcare provider communication on parent and patient understanding and compliance with immunization recommendations. Importantly, this research has also shown the characteristics of provider-patient communication matter much. Healthcare providers must have or establish a high degree of trust, be well-versed in vaccine efficacy and safety, and be adept at using their personal experiences, information tailoring/personalization, and evidence-based communication strategies to increase the likelihood of success.
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Affiliation(s)
- Glen J Nowak
- Center for Health & Risk Communication, Grady College of Journalism & Mass Communication, University of Georgia
| | - Amanda S Bradshaw
- Integrated Marketing Communications, School of Journalism and New Media, The University of Mississippi
| | - Katharine J Head
- Department of Communication Studies and Health Communication, School of Liberal Arts, Indiana University Indianapolis
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Meachum C. Improving clinician communication to increase adolescent HPV vaccination rates. JAAPA 2024; 37:17-23. [PMID: 38349075 DOI: 10.1097/01.jaa.0001005624.18611.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
ABSTRACT Despite the proven effectiveness of human papillomavirus (HPV) vaccination, this vaccine is underused in the United States and is associated with many disparities and barriers to acceptance. Adolescent HPV vaccination rates failed to meet the Healthy People 2020 goal of 80% vaccine coverage when nearly all other routine adolescent vaccines met or were near this goal. When introducing the HPV vaccine series, many clinicians use a conversational approach, although years of research show that an announcement approach is more effective at increasing HPV vaccination rates. This article reviews current HPV vaccine communication practices used by clinicians and recommends evidence-based best practices to improve adolescent HPV vaccination rates in the United States.
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Affiliation(s)
- Chelsey Meachum
- Chelsey Meachum is a senior medical editor at Hippo Education, LLC, a remote medical education company based in Woodland Hills, Calif., and previously practiced in women's health. The author has disclosed no potential conflicts of interest, financial or otherwise
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O'Leary ST, Opel DJ, Cataldi JR, Hackell JM. Strategies for Improving Vaccine Communication and Uptake. Pediatrics 2024; 153:e2023065483. [PMID: 38404211 DOI: 10.1542/peds.2023-065483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/27/2024] Open
Abstract
Vaccines have led to a significant decrease in rates of vaccine-preventable diseases and have made a significant impact on the health of children. However, some parents express concerns about vaccine safety and the necessity of vaccines. The concerns of parents range from hesitancy about some immunizations to refusal of all vaccines. This clinical report provides information about the scope and impact of the problem, the facts surrounding common vaccination concerns, and the latest evidence regarding effective communication techniques for the vaccine conversation. After reading this clinical report, readers can expect to: Understand concepts and underlying determinants of vaccine uptake and vaccine hesitancy.Understand the relationship between vaccine hesitancy and costs of preventable medical care.Recognize and address specific concerns (eg, vaccine safety) with caregivers when hesitancy is present.
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Affiliation(s)
- Sean T O'Leary
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, Colorado
| | - Douglas J Opel
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Jessica R Cataldi
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, Colorado
| | - Jesse M Hackell
- Department of Pediatrics, New York Medical College, Valhalla, New York
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Kong WY, Queen TL, Gottfredson O'Shea N, Heisler-MacKinnon J, Liu A, Ozawa S, Brewer NT, Gilkey MB. Impact of visit characteristics on intention to recommend HPV vaccine: An experiment with US health care professionals. Prev Med 2024; 179:107841. [PMID: 38160884 PMCID: PMC10872220 DOI: 10.1016/j.ypmed.2023.107841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Presumptive recommendations that assume parents want to vaccinate can increase human papillomavirus (HPV) vaccine uptake. We sought to examine how visit characteristics affect health care professionals' (HCPs) intention to use this evidence-based recommendation style. METHODS In 2022, we conducted an online experiment with 2527 HCPs who had a role in adolescent vaccination in the United States. Participants read 1 of 8 randomly assigned vignettes about a well-child visit. Using a 2 × 2 × 2 between-subjects factorial design, the vignettes varied the following visit characteristics: patient age (9 vs. 12-year-old), prior parental vaccine refusal (yes vs. no), and time pressure on the HCP (low vs. high). HCPs reported on their intention to use a presumptive HPV vaccine recommendation, as well as on related attitudes, subjective norms, and self-efficacy. Analyses used 3-way analysis of variance and parallel mediation. RESULTS Participants were pediatricians (26%), family/general medicine physicians (22%), advanced practitioners (24%), and nursing staff (28%). Overall, about two-thirds of HCPs (64%) intended to use a presumptive recommendation. Intentions were higher for older children (b = 0.23) and parents without prior vaccine refusal (b = 0.39, both p < 0.001). Time pressure had no main effect or interactions. HCPs' attitudes and self-efficacy partially mediated effects of patient age and prior vaccine refusal (range of b = 0.04-0.28, all p < 0.05). CONCLUSION To better support visits with younger children and parents who have refused vaccines, HCPs may need more training for making presumptive recommendations for HPV vaccine. Reinforcing positive attitudes and self-efficacy can help HCPs adopt this evidence-based recommendation style.
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Affiliation(s)
- Wei Yi Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America.
| | - Tara L Queen
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Nisha Gottfredson O'Shea
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America; RTI International, Research Triangle Park, North Carolina, United States of America
| | - Jennifer Heisler-MacKinnon
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Amy Liu
- School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Sachiko Ozawa
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, North Carolina, United States of America; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, United States of America
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Malik AA, Ahmed N, Shafiq M, Elharake JA, James E, Nyhan K, Paintsil E, Melchinger HC, Team YBI, Malik FA, Omer SB. Behavioral interventions for vaccination uptake: A systematic review and meta-analysis. Health Policy 2023; 137:104894. [PMID: 37714082 PMCID: PMC10885629 DOI: 10.1016/j.healthpol.2023.104894] [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: 02/08/2023] [Revised: 06/22/2023] [Accepted: 08/15/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Human behavior and more specifically behavioral insight-based approaches to vaccine uptake have often been overlooked. While there have been a few narrative reviews indexed in Medline on behavioral interventions to increase vaccine uptake, to our knowledge, none have been systematic reviews and meta-analyses covering not just high but also low-and-middle income countries. METHODS We included 613 studies from the Medline database in our systematic review and meta-analysis categorizing different behavioral interventions in 9 domains: education campaigns, on-site vaccination, incentives, free vaccination, institutional recommendation, provider recommendation, reminder and recall, message framing, and vaccine champion. Additionally, considering that there is variability in the acceptance of vaccines among different populations, we assessed studies from both high-income countries (HICs) and low- to middle-income countries (LMICs), separately. FINDINGS Our results showed that behavioral interventions can considerably improve vaccine uptake in most settings. All domains that we examined improved vaccine uptake with the highest effect size associated with provider recommendation (OR: 3.4 (95%CI: 2.5-4.6); Domain: motivation) and on-site vaccination (OR: 2.9 (95%CI: 2.3-3.7); Domain: practical issues). While the number of studies conducted in LMICs was smaller, the quality of studies was similar with those conducted in HICs. Nevertheless, there were variations in the observed effect sizes. INTERPRETATION Our findings indicate that "provider recommendation" and "on-site vaccination" along with other behavioral interventions can be employed to increase vaccination rates globally.
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Affiliation(s)
- Amyn A Malik
- Yale Institute for Global Health, New Haven, CT 06510, USA; Analysis Group, Inc, Boston, MA 02199, USA
| | - Noureen Ahmed
- UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA
| | - Mehr Shafiq
- Yale Institute for Global Health, New Haven, CT 06510, USA; Columbia University School of Public Health, New York, NY 10032, USA
| | - Jad A Elharake
- Yale Institute for Global Health, New Haven, CT 06510, USA; UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA; The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Erin James
- Yale Institute for Global Health, New Haven, CT 06510, USA
| | - Kate Nyhan
- Yale University, New Haven, CT 06510, USA
| | - Elliott Paintsil
- Yale Institute for Global Health, New Haven, CT 06510, USA; Columbia University Institute of Human Nutrition, New York, NY 10032, USA
| | | | | | - Fauzia A Malik
- UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA
| | - Saad B Omer
- UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA.
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Dimitrova V, Stoitsova S, Nenova G, Martinova M, Yakimova M, Rangelova V, Georgieva I, Georgiev I, Krumova S, Minkova A, Vladimirova N, Nikolaeva-Glomb L. Bulgarian General Practitioners' Communication Styles about Child Vaccinations, Mainly Focused on Parental Decision Making in the Context of a Mandatory Immunization Schedule. Healthcare (Basel) 2023; 11:2566. [PMID: 37761763 PMCID: PMC10531209 DOI: 10.3390/healthcare11182566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
The communication practices of general practitioners in relation with vaccines have not been a topic of wide scientific interest. In this article, we outline them in the context of Bulgaria. A representative, cross-sectional, quantitative, face-to-face survey was conducted among 358 Bulgarian general practitioners in 2022 using simple random sampling. We conducted an exploratory factor analysis using questions about the role of the GPs, which measure models of communication. Based on the factor analysis, we distinguished four communication styles. They were called: active communicator, restrictive communicator, informing communicator, and strained communicator. One-way ANOVA and the T-test were carried out to explore the connections between factor scores (communication styles) and other variables. One of the most important results in the study was that the informing physician (emphasizing the choice of the parents) was the most common model in Bulgaria. This is somewhat contradictory, because of the mandatory status of most vaccines. We found connections between the communication styles and other variables-such as the type of settlement, having a hesitant parent in the practice, recommendations of non-mandatory vaccines, and experience with vaccine-preventable diseases. On the basis of the factor analysis and analysis of relationships with other variables, we reached the conclusion that in Bulgaria, hesitant parents are not sufficiently involved in active, effective communication about vaccines by GPs.
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Affiliation(s)
- Veronika Dimitrova
- Department of Sociology, Sofia University, 1000 Sofia, Bulgaria; (G.N.); (M.Y.)
| | - Savina Stoitsova
- Department of Epidemiology, National Centre of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria; (S.S.); (I.G.); (A.M.); (N.V.)
| | - Gergana Nenova
- Department of Sociology, Sofia University, 1000 Sofia, Bulgaria; (G.N.); (M.Y.)
| | - Maria Martinova
- Communities and Identities Department, Institute of Sociology and Philosophy at the Bulgarian Academy of Sciences, 1000 Sofia, Bulgaria;
| | - Milena Yakimova
- Department of Sociology, Sofia University, 1000 Sofia, Bulgaria; (G.N.); (M.Y.)
| | - Vanya Rangelova
- Department of Epidemiology and Disaster Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
| | - Irina Georgieva
- Department of Virology, National Centre of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria; (I.G.); (S.K.); (L.N.-G.)
| | - Ivo Georgiev
- Department of Epidemiology, National Centre of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria; (S.S.); (I.G.); (A.M.); (N.V.)
| | - Stefka Krumova
- Department of Virology, National Centre of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria; (I.G.); (S.K.); (L.N.-G.)
| | - Antoaneta Minkova
- Department of Epidemiology, National Centre of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria; (S.S.); (I.G.); (A.M.); (N.V.)
| | - Nadezhda Vladimirova
- Department of Epidemiology, National Centre of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria; (S.S.); (I.G.); (A.M.); (N.V.)
| | - Lubomira Nikolaeva-Glomb
- Department of Virology, National Centre of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria; (I.G.); (S.K.); (L.N.-G.)
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Vielot NA, Lane RM, Loefstedt K, Cunningham JL, Everson J, Tiller E, Johnson Patel SE, Smith JS. Acceptability and readiness to promote human papillomavirus vaccination at ages 9-10 years: a feasibility study among North Carolina clinics. Pilot Feasibility Stud 2023; 9:153. [PMID: 37653458 PMCID: PMC10470204 DOI: 10.1186/s40814-023-01379-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 07/18/2023] [Indexed: 09/02/2023] Open
Abstract
While 9-valent human papillomavirus (HPV) vaccination is approved by the US Food and Drug Administration for use in adolescents as young as age 9, providers typically recommend it at ages 11-12. Studies suggest that recommending HPV vaccination at 9 or 10 years of age could increase up-to-date vaccination by age 13, which could especially benefit rural populations with reduced access to primary health care and lower HPV vaccination coverage than urban areas. This study aimed to assess the feasibility of the age-9 recommendation of HPV vaccination in rural clinics. We conducted in-depth interviews with providers and staff from two primary care clinics in central North Carolina to understand attitudes toward recommending HPV vaccination to 9- and 10-year-olds. All interviewees agreed that HPV vaccination was important for cancer prevention and should be recommended before the onset of sexual activity, agreeing that HPV vaccination could be initiated before age 11 to improve timeliness and completion of the vaccination series. However, opinions were mixed on whether HPV vaccination should be initiated as young as 9 years old. Two key informants recruited from two university-affiliated clinics described their experiences recommending HPV vaccination to 9- and 10-year-olds, including a modified vaccination schedule that promotes HPV vaccination during routine well-child visits, prior to pubertal onset, and alongside other recommended adolescent vaccines. Age-9 recommendation and administration of HPV vaccination is possible with minimal changes to current clinical practices and could increase the convenience and acceptability of HPV vaccination in under-vaccinated settings.
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Affiliation(s)
- Nadja A Vielot
- Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, North Carolina, 27599, USA.
| | - Robyn M Lane
- Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, North Carolina, 27599, USA
| | - Kaitlyn Loefstedt
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Jason Everson
- Piedmont Health Services, Inc, Chapel Hill, North Carolina, USA
| | - Eli Tiller
- Piedmont Health Services, Inc, Chapel Hill, North Carolina, USA
| | | | - Jennifer S Smith
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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13
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Brewer NT, Kahn BZ, Kritikos KI, Heisler-MacKinnon JA, Young JD, Gilkey MB. How to make effective HPV vaccine recommendations starting at age 9. Hum Vaccin Immunother 2023; 19:2216117. [PMID: 37246871 PMCID: PMC10305488 DOI: 10.1080/21645515.2023.2216117] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/17/2023] [Indexed: 05/30/2023] Open
Abstract
This article provides best and promising practices for recommending HPV vaccination at age 9 as a way to ensure high uptake. An effective method for recommending HPV vaccination is the Announcement Approach, which consists of 3 evidence-based steps. The first step, Announce, involves noting that the child is 9 years old, saying they are due for a vaccine that prevents 6 HPV cancers, and saying you'll vaccinate today. This adapted version of the Announce step simplifies the bundled approach used at ages 11-12 that emphasizes the prevention of meningitis and whooping cough in addition to HPV cancers. For hesitant parents, the second step, Connect and Counsel, involves finding common ground with the parent and communicating the value of starting HPV vaccination at the first opportunity. Finally, for parents who decline, the third step is to Try Again at a later visit. Using the Announcement Approach at age 9 stands to increase HPV vaccine uptake, save time, and lead to high family and provider satisfaction.
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Affiliation(s)
- Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Benjamin Z Kahn
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Katherine I Kritikos
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer A Heisler-MacKinnon
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Jessica D Young
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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14
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Escoffery C, Petagna C, Agnone C, Perez S, Saber LB, Ryan G, Dhir M, Sekar S, Yeager KA, Biddell CB, Madhivanan P, Lee S, English AS, Savas L, Daly E, Vu T, Fernandez ME. A systematic review of interventions to promote HPV vaccination globally. BMC Public Health 2023; 23:1262. [PMID: 37386430 PMCID: PMC10308645 DOI: 10.1186/s12889-023-15876-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 05/11/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Despite the human papillomavirus (HPV) vaccine being a safe, effective cancer prevention method, its uptake is suboptimal in the United States (U.S.). Previous research has found a variety of intervention strategies (environmental and behavioral) to increase its uptake. The purpose of the study is to systematically review the literature on interventions that promote HPV vaccination from 2015 to 2020. METHODS We updated a systematic review of interventions to promote HPV vaccine uptake globally. We ran keyword searches in six bibliographic databases. Target audience, design, level of intervention, components and outcomes were abstracted from the full-text articles in Excel databases. RESULTS Of the 79 articles, most were conducted in the U.S. (72.2%) and in clinical (40.5%) or school settings (32.9%), and were directed at a single level (76.3%) of the socio-ecological model. Related to the intervention type, most were informational (n = 25, 31.6%) or patient-targeted decision support (n = 23, 29.1%). About 24% were multi-level interventions, with 16 (88.9%) combining two levels. Twenty-seven (33.8%) reported using theory in intervention development. Of those reporting HPV vaccine outcomes, post-intervention vaccine initiation ranged from 5% to 99.2%, while series completion ranged from 6.8% to 93.0%. Facilitators to implementation were the use of patient navigators and user-friendly resources, while barriers included costs, time to implement and difficulties of integrating interventions into the organizational workflow. CONCLUSIONS There is a strong need to expand the implementation of HPV-vaccine promotion interventions beyond education alone and at a single level of intervention. Development and evaluation of effective strategies and multi-level interventions may increase the uptake of the HPV vaccine among adolescents and young adults.
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Affiliation(s)
- Cam Escoffery
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA.
| | - Courtney Petagna
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Christine Agnone
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Stephen Perez
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Lindsay B Saber
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Grace Ryan
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Meena Dhir
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Swathi Sekar
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Caitlin B Biddell
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, Durham, NC, USA
| | - Purnima Madhivanan
- Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA
| | - Stephanie Lee
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Amanda S English
- Institute for Health Disparities, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Lara Savas
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Eliza Daly
- Prevention Research Center, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Thuy Vu
- Health Promotion Research Center, School of Public Health, University of Washington, Seattle, WA, USA
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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15
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Xu MA, Choi J, Capasso A, DiClemente R. Patient-Provider Health Communication Strategies: Enhancing HPV Vaccine Uptake among Adolescents of Color. Healthcare (Basel) 2023; 11:1702. [PMID: 37372820 DOI: 10.3390/healthcare11121702] [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: 04/24/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Cervical cancer remains a public health issue in the United States, particularly among stigmatized racial and ethnic populations. The human papillomavirus (HPV) vaccine has been clinically proven to prevent cervical cancers, and other HPV-associated cancers, among men and women. However, HPV vaccine uptake is suboptimal; only 55% of adolescents complete the two-dose series by age 15. Past research has shown that provider HPV vaccine communication for people of marginalized races/ethnicities is subpar. This article focuses on provider communication strategies to promote HPV vaccine uptake effectively and equitably. The authors reviewed the literature on evidence-based patient-provider HPV vaccine communication techniques to create a set of communication language providers could use and avoid using to enhance HPV vaccine acceptance and uptake among adolescents of marginalized racial and ethnic groups. Evidence has shown that information and the manner of dissemination are critical for influencing HPV vaccine uptake. These communication strategies must be suited to the context of the targeted population, and the message content can be broadly categorized into source, content, and modality. Strategies to improve patient-provider communication among adolescents of color using source, modality, and content include the following: (1) Source: increase provider self-efficacy to provide the recommendation, building rapport between providers and parents; (2) Content: persistent, forceful language with minimal acquiescence should be employed, reframing the conversation focus from sex to cancer; and (3) Modality: use multiple vaccine reminder modalities, and work with the community to culturally adapt the vaccination language. Utilizing effective behavior-change communication adapted for adolescents of color can reduce missed opportunities for HPV prevention, potentially decreasing racial and ethnic disparities in HPV-related morbidity and mortality.
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Affiliation(s)
- Mia Ann Xu
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | - Jasmin Choi
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | | | - Ralph DiClemente
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
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16
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Opel DJ. Clinician Communication to Address Vaccine Hesitancy. Pediatr Clin North Am 2023; 70:309-319. [PMID: 36841598 DOI: 10.1016/j.pcl.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
There are several factors that influence childhood vaccine uptake. Pediatric clinicians play a particularly influential role in parent vaccine decision-making. It is critical therefore that pediatric clinicians have a "communication toolbox"--a set of effective, evidence-based communication strategies to facilitate uptake of childhood vaccines--that they can use in conversations with parents about vaccines. In this article, recent advances in our understanding of what constitutes effective clinician vaccine communication with parents are discussed.
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Affiliation(s)
- Douglas J Opel
- Department of Pediatrics, University of Washington School of Medicine, Center for Clinical and Translational Research, Seattle Children's Research Institute, M/S: JMB-6, 1900 Ninth Avenue, Seattle, WA 98101, USA.
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17
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Penick E, Grabert BK, Stockton E, Prentice-Dunn H, Ward M, Kirk T, Gilkey MB. Feasibility and sustainability of a nurse-led intervention to integrate HPV vaccination into medical processing for active-duty Soldiers. Hum Vaccin Immunother 2022; 18:2153536. [PMID: 36539433 PMCID: PMC9891672 DOI: 10.1080/21645515.2022.2153536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
To increase Soldiers' access to HPV vaccination, we evaluated the feasibility and sustainability of a nurse-led intervention to integrate HPV vaccination into medical processing procedures for Soldiers. We partnered with nursing staff to introduce HPV vaccine into existing vaccination services at a nurse-led clinic that serves Soldiers at Fort Bragg, North Carolina. In addition to stocking the vaccine, the intervention included training nursing staff (n = 11) strategies for recommending HPV vaccination for Soldiers ages 18-26. We conducted surveys of nursing staff to assess their perspectives on feasibility. Nursing staff tracked HPV vaccine uptake among Soldiers for 4 weeks post-training to assess adoption and again for 2 weeks at 4-month follow-up to assess sustainability. We assessed delivery cost as the cost of personnel time, vaccine doses, and other materials during the initial 4-week intervention period. Nursing staff agreed that recommending HPV vaccination fit in with medical processing procedures (mean = 4.6 of 5.0). Of the 516 Soldiers offered HPV vaccine in the 4 weeks following the training, 198 (38%) accepted and received the vaccine. Soldier ages 18-20 more often accepted HPV vaccination than older Soldier ages 21-26 (46% versus 32%, p < .01). Vaccine uptake was similar at follow-up, with 98 of 230 eligible Soldiers (43%) receiving HPV vaccine. The total delivery cost was $12,737, with an average cost per vaccine dose delivered of $64. Our findings suggest that training nursing staff to recommend and administer HPV vaccinations to Soldiers is feasible and warrants wider-scale testing as a strategy to protect soldiers from HPV-attributable cancers.
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Affiliation(s)
- Emily Penick
- Department of Obstetrics & Gynecology, Womack Army Medical Center, Fort Bragg, NC, USA,CONTACT Emily Penick Department of Obstetrics & Gynecology, Womack Army Medical Center, Fort Bragg, NC28310, USA
| | - Brigid K. Grabert
- Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA,Department of Health Behaviors, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Emma Stockton
- Department of Health Behaviors, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hannah Prentice-Dunn
- Department of Health Behaviors, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marion Ward
- Department of Obstetrics & Gynecology, Womack Army Medical Center, Fort Bragg, NC, USA
| | - Trinita Kirk
- Medical One Stop, Womack Army Medical Center, Fort Bragg, NC, USA
| | - Melissa B. Gilkey
- Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA,Department of Health Behaviors, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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18
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Garbutt J, Wang R, Graham S, McKay V, Haire-Joshu D, Barker A, Liu L. Provider and Practice Factors Associated With On-Time HPV Vaccination in Primary Care. Acad Pediatr 2022; 23:800-807. [PMID: 36592791 DOI: 10.1016/j.acap.2022.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND In 2018, only one third of girls and boys completed the 2-dose series of the human papillomavirus vaccine by their 13th birthday, the target for on-time vaccination. The study objective was to identify key patient, provider and practice-level factors associated with on-time vaccination in the primary care setting. METHODS We examined data from 20 primary care pediatric practices (89 providers) in St. Louis including: the percentage of eligible patients with on-time vaccination assessed from medical records; providers' knowledge, attitudes and behaviors regarding on-time vaccination assessed with a survey; and practice-level strategies used to optimize vaccine delivery assessed with a 19-item vaccine delivery system score (VDSS). Factors that increased on-time vaccination were identified using logistic regression, controlling for clustering within providers. RESULTS Completion of on-time vaccination occurred in 1347/3125 (43.10%) of patients (95% confidence interval [CI], 41.36%-44.86%) and varied among practices (7.39%-64.24%) and among providers (2.63%-82.50%). Independent predictors for higher completion of on-time vaccination included more frequent use by providers of the announcement style for vaccine recommendation (odds ratio [OR] 1.18, 95% CI, 1.04, 1.35), higher provider self-efficacy to deliver the vaccine according to guideline recommendations if parents were hesitant (OR 1.21, 95% CI, 1.05, 1.40), and higher VDSS (OR 1.20, 95% CI, 1.10, 1.31). CONCLUSIONS Provider and practice-level factors were identified that may represent modifiable targets for improvement in on-time vaccine uptake. Future research is needed to test interventions built on these findings.
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Affiliation(s)
- Jane Garbutt
- Department of Medicine and Department of Pediatrics, Washington University School of Medicine (J Garbutt), St. Louis, Mo.
| | - Ruoyun Wang
- Department of Pediatrics, Washington University School of Medicine (R Wang and S Graham), St. Louis, Mo
| | - Sharon Graham
- Department of Pediatrics, Washington University School of Medicine (R Wang and S Graham), St. Louis, Mo
| | - Virginia McKay
- Brown School, Washington University (V McKay, D Haire-Joshu, and A Barker), St. Louis, Mo
| | - Debra Haire-Joshu
- Brown School, Washington University (V McKay, D Haire-Joshu, and A Barker), St. Louis, Mo
| | - Abigail Barker
- Brown School, Washington University (V McKay, D Haire-Joshu, and A Barker), St. Louis, Mo
| | - Lei Liu
- Division of Biostatistics, Washington University School of Medicine (L Liu), St. Louis, Mo
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19
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Osaghae I, Darkoh C, Chido-Amajuoyi OG, Chan W, Padgett Wermuth P, Pande M, Cunningham SA, Shete S. HPV Vaccination Training of Healthcare Providers and Perceived Self-Efficacy in HPV Vaccine-Hesitancy Counseling. Vaccines (Basel) 2022; 10:vaccines10122025. [PMID: 36560435 PMCID: PMC9781563 DOI: 10.3390/vaccines10122025] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
HPV vaccine hesitancy is a key barrier to HPV vaccination. Using a population-based survey of HCPs practicing in Texas we determined the association between formal training of HCPs and perceived self-efficacy in counseling HPV vaccine-hesitant parents and adult patients. A total of 1283 HCPs completed the survey, with 879 providing vaccination services to pediatric patients and 1018 providing vaccination services to adult patients. Among HCPs included in this study, 405 of 577 (70%) and 315 of 505 (62%) perceived they were very/completely confident in counseling HPV vaccine-hesitant parents and adult patients, respectively. Compared to HCPs who received no training, those who received formal training in HPV vaccination promotion or counseling had 2.56 (AOR: 2.56; 95% CI:1.69-3.86) and 2.84 times higher odds (AOR: 2.84; 95% CI:1.87-4.33) of perceiving that they were very/completely confident in counseling HPV vaccine-hesitant parents and adult patients, respectively. Additionally, increasing years of practice and volume of patients seen were positively associated with being very/completely confident in counseling HPV vaccine-hesitant parents and adult patients. On the other hand, nurses were less likely than physicians to be very/completely confident in counseling HPV vaccine-hesitant parents. To increase HPV vaccination uptake, HCPs should receive tailored training to improve their self-efficacy in addressing HPV vaccine-hesitancy.
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Affiliation(s)
- Ikponmwosa Osaghae
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Charles Darkoh
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
| | | | - Wenyaw Chan
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, TX 75207, USA
| | - Paige Padgett Wermuth
- Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX 77030, USA
| | - Mala Pande
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sonia A. Cunningham
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sanjay Shete
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-(713)-745-2483; Fax: +1-(713)-563-4243
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20
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Aguolu OG, Malik AA, Ahmed N, Omer SB. Overcoming Vaccine Hesitancy for Future COVID-19 and HIV Vaccines: Lessons from Measles and HPV Vaccines. Curr HIV/AIDS Rep 2022; 19:328-343. [PMID: 36114951 PMCID: PMC9483354 DOI: 10.1007/s11904-022-00622-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The discovery of vaccines significantly reduced morbidity and mortality of infectious diseases and led to the elimination and eradication of some. Development of safe and effective vaccines is a critical step to the control of infectious diseases; however, there is the need to address vaccine hesitancy because of its potential impact on vaccine uptake. METHODS We conducted a narrative review of studies on interventions to address measles and human papillomavirus vaccine hesitancy. We discussed how lessons learned from these studies could be applied towards COVID-19 and future human immunodeficiency virus vaccines. RESULTS We found that there are several successful approaches to improving vaccine acceptance. Interventions should be context specific and build on the challenges highlighted in various settings. CONCLUSION Strategies could be used alone or in combination with others. The most successful interventions directly targeted the population for vaccination. Use of financial incentives could be a potential tool to improve vaccine uptake.
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Affiliation(s)
- Obianuju G. Aguolu
- Yale Institute for Global Health, Yale University, New Haven, CT USA
- Section of Infectious Diseases, Department of Medicine, Yale School of Medicine, Yale University, New Haven, CT USA
| | - Amyn A. Malik
- Yale Institute for Global Health, Yale University, New Haven, CT USA
- Section of Infectious Diseases, Department of Medicine, Yale School of Medicine, Yale University, New Haven, CT USA
| | - Noureen Ahmed
- Yale Institute for Global Health, Yale University, New Haven, CT USA
- Yale School of Public Health, Yale University, New Haven, CT USA
| | - Saad B. Omer
- Yale Institute for Global Health, Yale University, New Haven, CT USA
- Section of Infectious Diseases, Department of Medicine, Yale School of Medicine, Yale University, New Haven, CT USA
- Yale School of Public Health, Yale University, New Haven, CT USA
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21
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Cox JE, Bogart LM, Elliott MN, Starmer AJ, Meleedy-Rey P, Goggin K, Banerjee T, Samuels RC, Hahn PD, Epee-Bounya A, Allende-Richter S, Fu CM, Schuster MA. Improving HPV Vaccination Rates in a Racially and Ethnically Diverse Pediatric Population. Pediatrics 2022; 150:189547. [PMID: 36127315 DOI: 10.1542/peds.2021-054186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Nationally, 54.2% of youth are fully vaccinated for human papilloma virus (HPV) with persistent gender and racial/ethnic disparities. We used a quality improvement approach to improve completion of the HPV vaccine series by age 13 years. As a secondary aim, we examined racial/ethnic and gender differences in vaccine uptake. METHODS The study setting included 2 pediatric, academic, primary care practices in Massachusetts. We designed a multilevel patient-, provider-, and systems-level intervention addressing parental hesitancy, provider communication, and clinical operations. Rates of HPV series completion by age 13 were monitored using a control p chart. Bivariate and multivariate analyses evaluated vaccine completion differences on the basis of clinic size, gender, and race/ethnicity. RESULTS Between July 1, 2014, and September 30, 2021, control p charts showed special cause variation with HPV vaccine initiation by age 9 years, increasing from 1% to 52%, and vaccine completion by 13 years, increasing from 37% to 77%. Compared with White and Black children, Hispanic children were more likely to initiate the HPV vaccine at age 9 (adjusted odds ratio [95% confidence interval] = (1.4-2.6)] and complete the series by age 13 (adjusted odds ratio [95% confidence interval] = 2.3 (1.7-3.0). CONCLUSIONS A multilevel intervention was associated with sustained HPV vaccine series completion by age 13 years. Hispanic children were more likely to be vaccinated. Qualitative family input was critical to intervention design. Provider communication training addressed vaccine hesitancy. Initiation of the vaccine at age 9 and clinicwide vaccine protocols were key to sustaining improvements.
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Affiliation(s)
- Joanne E Cox
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laura M Bogart
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,RAND Corporation, Santa Monica, California
| | | | - Amy J Starmer
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Kathy Goggin
- Schools of Medicine and Pharmacy, Health Services and Outcome Research, Children's Mercy Hospital and University of Missouri, Kansas City, Missouri
| | - Taruna Banerjee
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Organizational Quality and Patient Safety, Cambridge Health Alliance, Cambridge Massachusetts
| | - Ronald C Samuels
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of General Pediatrics, Children's Hospital at Montefiore, Bronx, New York
| | - Phillip D Hahn
- Patient Safety and Quality, Boston Children's Hospital, Boston, Massachusetts
| | - Alexandra Epee-Bounya
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sophie Allende-Richter
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chong-Min Fu
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark A Schuster
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,RAND Corporation, Santa Monica, California
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22
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Landier W, Bhatia S, Richman JS, Campos Gonzalez PD, Cherven B, Chollette V, Aye J, Castellino SM, Gramatges MM, Lindemulder S, Russell TB, Turcotte LM, Colditz GA, Gilkey MB, Klosky JL. Implementation of a provider-focused intervention for maximizing human papillomavirus (HPV) vaccine uptake in young cancer survivors receiving follow-up care in pediatric oncology practices: protocol for a cluster-randomized trial of the HPV PROTECT intervention. BMC Pediatr 2022; 22:541. [PMID: 36096775 PMCID: PMC9466329 DOI: 10.1186/s12887-022-03562-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/21/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Childhood cancer survivors are at high risk for developing new cancers (such as cervical and anal cancer) caused by persistent infection with the human papillomavirus (HPV). HPV vaccination is effective in preventing the infections that lead to these cancers, but HPV vaccine uptake is low among young cancer survivors. Lack of a healthcare provider recommendation is the most common reason that cancer survivors fail to initiate the HPV vaccine. Strategies that are most successful in increasing HPV vaccine uptake in the general population focus on enhancing healthcare provider skills to effectively recommend the vaccine, and reducing barriers faced by the young people and their parents in receiving the vaccine. This study will evaluate the effectiveness and implementation of an evidence-based healthcare provider-focused intervention (HPV PROTECT) adapted for use in pediatric oncology clinics, to increase HPV vaccine uptake among cancer survivors 9 to 17 years of age. METHODS This study uses a hybrid type 1 effectiveness-implementation approach. We will test the effectiveness of the HPV PROTECT intervention using a stepped-wedge cluster-randomized trial across a multi-state sample of pediatric oncology clinics. We will evaluate implementation (provider perspectives regarding intervention feasibility, acceptability and appropriateness in the pediatric oncology setting, provider fidelity to intervention components and change in provider HPV vaccine-related knowledge and practices [e.g., providing vaccine recommendations, identifying and reducing barriers to vaccination]) using a mixed methods approach. DISCUSSION This multisite trial will address important gaps in knowledge relevant to the prevention of HPV-related malignancies in young cancer survivors by testing the effectiveness of an evidence-based provider-directed intervention, adapted for the pediatric oncology setting, to increase HPV vaccine initiation in young cancer survivors receiving care in pediatric oncology clinics, and by procuring information regarding intervention delivery to inform future implementation efforts. If proven effective, HPV PROTECT will be readily disseminable for testing in the larger pediatric oncology community to increase HPV vaccine uptake in cancer survivors, facilitating protection against HPV-related morbidities for this vulnerable population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04469569, prospectively registered on July 14, 2020.
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Affiliation(s)
- Wendy Landier
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7th Ave. South, Lowder 500, Birmingham, Alabama, 35233, USA.
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Alabama at Birmingham, 1600 7th Ave. South, Lowder 512, Birmingham, Alabama, 35233, USA.
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7th Ave. South, Lowder 500, Birmingham, Alabama, 35233, USA
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Alabama at Birmingham, 1600 7th Ave. South, Lowder 512, Birmingham, Alabama, 35233, USA
| | - Joshua S Richman
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7th Ave. South, Lowder 500, Birmingham, Alabama, 35233, USA
| | - Paula D Campos Gonzalez
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7th Ave. South, Lowder 500, Birmingham, Alabama, 35233, USA
| | - Brooke Cherven
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, 2015 Uppergate Drive, ECC#412, Atlanta, GA, 30322, USA
| | - Veronica Chollette
- Healthcare Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr., Room 3E344, MSC 9762, Rockville, MD, 20850, USA
| | - Jamie Aye
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Alabama at Birmingham, 1600 7th Ave. South, Lowder 512, Birmingham, Alabama, 35233, USA
| | - Sharon M Castellino
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, 2015 Uppergate Drive, ECC#412, Atlanta, GA, 30322, USA
| | - Maria M Gramatges
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Baylor College of Medicine, 1102 Bates St., Suite 1200, Houston, TX, 77030, USA
| | - Susan Lindemulder
- Department of Pediatrics, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon, 97239, USA
| | - Thomas B Russell
- Department of Pediatrics, Wake Forest University, Medical Center Boulevard, Winston-Salem, North Carolina, 27157, USA
| | - Lucie M Turcotte
- Department of Pediatrics, University of Minnesota, D-557 Mayo Building, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Graham A Colditz
- Department of Surgery, Washington University at St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 317 Rosenau Hall, CB #7440, 135 Dauer Drive, Chapel Hill, North Carolina, 27599, USA
| | - James L Klosky
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, 2015 Uppergate Drive, ECC#412, Atlanta, GA, 30322, USA
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Skeens M, Sezgin E, Stevens J, Landier W, Pai A, Gerhardt C. An mHealth App to Promote Adherence to Immunosuppressant Medication and Track Symptoms in Children After Hematopoietic Stem Cell Transplant: Protocol for a Mixed Methods Usability Study. JMIR Res Protoc 2022; 11:e39098. [PMID: 35862184 PMCID: PMC9353681 DOI: 10.2196/39098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background In the United States, poor adherence accounts for up to 70% of all medication-related hospital admissions, resulting in $100 billion in health care costs annually. In pediatrics, adherence is largely dependent on caregivers. In a high-risk hematopoietic stem cell transplant (HSCT) population, caregivers are isolated with their child due to infection risk and must manage challenging treatment regimens at home, often with limited time and support. Complex behavioral interventions, typically employed to address adherence, are difficult to deliver and manage in the context of these daily tasks. The most successful adherence interventions, and thus improved clinical outcomes, have included mobile health (mHealth) reminder approaches and a direct measure of adherence. Objective This is a 3-phase project, with this protocol describing phase 2, to determine the usability and feasibility of an mHealth app (BMT4me) designed to promote adherence to immunosuppressant medication and to track symptoms among children who received HSCT. Methods This study uses an iterative convergent mixed methods design to develop and assess the usability and feasibility of an adherence digital health intervention. We will recruit 15 caregivers of pediatric patients receiving HSCT to complete user testing. Qualitative and quantitative data will be integrated to enhance and expand upon study findings. Results Enrollment began in September 2021 and is ongoing. A total of 7 caregivers have enrolled. We anticipate completion by fall 2022. We anticipate high usability scores and a better understanding of unique features within the app that are needed for HSCT families post transplant. To date, usability scores among enrolled participants are greater than 70%. Feedback from qualitative interviews is being used to further adapt the app by adding specific weekly logs, call provider options, and voice to text. Conclusions This protocol describes a mixed methods usability and feasibility study to develop and implement a smartphone app for caregivers of children receiving HSCT. The app was designed to improve immunosuppressant adherence and to track symptoms in the acute phase post discharge. Study findings will inform further refinement of the app and the feasibility of a pilot randomized controlled trial examining efficacy on clinical outcomes. Trial Registration ClinicalTrials.gov NCT04976933; https://clinicaltrials.gov/ct2/show/NCT04976933 International Registered Report Identifier (IRRID) DERR1-10.2196/39098
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Affiliation(s)
- Micah Skeens
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Emre Sezgin
- Nationwide Children's Hospital, Columbus, OH, United States
| | - Jack Stevens
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Wendy Landier
- Division of Pediatric Hematology Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ahna Pai
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Cynthia Gerhardt
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
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Adolescent COVID-19 Vaccine Decision-Making among Parents in Southern California. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074212. [PMID: 35409893 PMCID: PMC8998887 DOI: 10.3390/ijerph19074212] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 01/12/2023]
Abstract
Adolescent COVID-19 vaccination has stalled at 53% in the United States. Vaccinating adolescents remains critical to preventing the continued transmission of COVID-19, the emergence of variants, and rare but serious disease in children, and it is the best preventive measure available to return to in-person schooling. We investigated parent–adolescent COVID-19 vaccine decision-making. Between 24 February and 15 March 2021, we conducted surveys and 12 focus groups with 46 parent–adolescent dyads in Southern California. Parents and adolescents completed a survey prior to participation in a focus group discussion, which focused on exploring COVID-19 vaccine acceptance or uncertainty and was guided by the 5C vaccine hesitancy model. Parents uncertain about vaccinating adolescents expressed low vaccine confidence and high COVID-19 disease risk complacency. Parents who accepted COVID-19 vaccination for adolescents expressed high confidence in health authority vaccine recommendations, high perceived COVID-19 risk, and collective responsibility to vaccinate children. Additionally, unique pandemic-related factors of vaccine acceptance included vaccinating for emotional health, resuming social activities, and vaccine mandates. Among parents, 46% were willing to vaccinate their adolescent, 11% were not, and 43% were unsure. Among adolescents, 63% were willing to vaccinate. Despite vaccine availability, 47% of adolescents remain unvaccinated against COVID-19. Factors associated with vaccine uncertainty and acceptability inform health care practitioner, school, community, and public health messaging to reach parents and adolescents.
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Bernstein TA, Broome M, Millman J, Epstein J, Derouin A. Promoting Strategies to Increase HPV Vaccination in the Pediatric Primary Care Setting. J Pediatr Health Care 2022; 36:e36-e41. [PMID: 35120779 DOI: 10.1016/j.pedhc.2021.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/07/2021] [Accepted: 10/31/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Evaluation of a quality improvement project designed to improve HPV vaccine uptake in a pediatric primary care setting for young adolescents. METHOD Three strategies were implemented in one private pediatric practice to promote HPV vaccine uptake for 11- and 12-year-old adolescents. 1) a standardized vaccine policy change was made to include HPV vaccine with other adolescent vaccines, 2) a pre-visit email was sent to parents of teens to provide factual vaccine information in preparation for the visit, and 3) a provider communication initiative was implemented to ensure all providers communicated consistent messages and delivered an effective cancer prevention recommendation for HPV vaccination. A pre/post design was used to compare vaccine rates. Data was obtained via the electronic health records. RESULTS The post-intervention group demonstrated HPV vaccine rates increased substantially from 17.8% to 63.6%. DISCUSSION Strategically implementing standardized clinical vaccine policies and presumprive provider communication practices has implications for significantly increasing HPV vaccine uptake among teens and may be key to preventing cancer among future generations.
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Affiliation(s)
| | - Marion Broome
- Dean and Vice-Chancellor for Nursing Affairs, School of Nursing, Duke University, Associate Vice-President for Academic Nursing, Duke University School of Nursing, Durham, NC
| | | | - Jessica Epstein
- Pediatrician, Greenwich Pediatric Associates, Old Greenwich, CT
| | - Anne Derouin
- Professor and Assistant Dean, MSN program at Duke University School of Nursing, Durham, NC
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Grabert BK, Kurtzman R, Heisler-MacKinnon J, Leeman J, Bjork A, Kameny M, Liu A, Todd K, Alton Dailey S, Smith K, Brewer NT, Gilkey MB. Implementation of quality improvement coaching versus physician communication training for improving human papillomavirus vaccination in primary care: a randomized implementation trial. Transl Behav Med 2022; 12:ibab071. [PMID: 34244807 PMCID: PMC8919808 DOI: 10.1093/tbm/ibab071] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Many US health departments (HDs) conduct in-person quality improvement (QI) coaching to help primary care clinics improve their HPV vaccine delivery systems and communication. Some HDs additionally conduct remote communication training to help vaccine prescribers recommend HPV vaccination more effectively. Our aim was to compare QI coaching and communication training on key implementation outcomes. In a cluster randomized trial, we offered 855 primary care clinics: 1) QI coaching; 2) communication training; or 3) both interventions combined. In each trial arm, we assessed adoption (proportion of clinics receiving the intervention), contacts per clinic (mean number of contacts needed for one clinic to adopt intervention), reach (median number of participants per clinic), and delivery cost (mean cost per clinic) from the HD perspective. More clinics adopted QI coaching than communication training or the combined intervention (63% vs 16% and 12%, both p < .05). QI coaching required fewer contacts per clinic than communication training or the combined intervention (mean = 4.7 vs 29.0 and 40.4, both p < .05). Communication training and the combined intervention reached more total staff per clinic than QI coaching (median= 5 and 5 vs 2, both p < .05), including more prescribers (2 and 2 vs 0, both p < .05). QI coaching cost $439 per adopting clinic on average, including follow up ($129/clinic), preparation ($73/clinic), and travel ($69/clinic). Communication training cost $1,287 per adopting clinic, with most cost incurred from recruitment ($653/clinic). QI coaching was lower cost and had higher adoption, but communication training achieved higher reach, including to influential vaccine prescribers.
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Affiliation(s)
- Brigid K Grabert
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rachel Kurtzman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer Heisler-MacKinnon
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer Leeman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adam Bjork
- Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
- United States Public Health Service, Commissioned Corps, Rockville, MD, USA
| | - Maddy Kameny
- Delaware Valley Community Health, Philadelphia, PA, USA
| | - Amy Liu
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, USA
| | - Karen Todd
- WakeMed Health and Hospitals, WakeMed Physician Practices, Raleigh, NC, USA
| | - Susan Alton Dailey
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kevin Smith
- Immunization Action & Lead Poisoning Prevention Programs, Westchester County Department of Health, Mt Kisco, NY, USA
| | - Noel T Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melissa B Gilkey
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Bishop JM, Real FJ, McDonald SL, Klein M, DeBlasio D, Kahn JA, Kreps GL, Rosen BL. Evaluation of HPV Vaccine: Same Way, Same Day TM: A Pilot Study. JOURNAL OF HEALTH COMMUNICATION 2021; 26:839-845. [PMID: 34985403 DOI: 10.1080/10810730.2021.2021459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Missed clinical opportunities and the lack of strong and consistent vaccine recommendations are key reasons for low HPV vaccination rates. The purpose of this study was to conduct a pilot evaluation of a web-based training's impact on knowledge, attitudes, and self-efficacy related to providing evidence-based HPV vaccine recommendations. Participants completed three online interactive learning modules and the HPV Vaccine: Same Way, Same Day™ smartphone application (app). Participants completed a pre-training survey, immediate post-training survey, and two-month post-survey. Participants demonstrated a statistically significant increase in knowledge scores from T1 to T2 and T1 to T3. Mean attitudes for recommending HPV vaccination for female patients increased from T1 to T2 and T1 to T3. Mean attitudes for recommending HPV vaccination for male patients increased from T1 to T2 and T1 to T3. Mean self-efficacy scores increased from T1 to T2 and T1 to T3. The HPV Vaccine: Same Way, Same Day™ app is a promising strategy for improving HPV vaccine recommendations among physicians. Future research should explore long-term effects and enroll attending and community physicians to examine its efficacy in other physician populations.
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Affiliation(s)
- James M Bishop
- Department of Health Sciences, James Madison University, Harrisonburg, Virginia, USA
| | - Francis J Real
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Skye L McDonald
- School of Human Services, University of Cincinnati, Cincinnati, Ohio, USA
| | - Melissa Klein
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Dominick DeBlasio
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jessica A Kahn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gary L Kreps
- Department of Communication, George Mason University, Fairfax, Virginia, USA
| | - Brittany L Rosen
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Davies C, Marshall HS, Zimet G, McCaffery K, Brotherton JML, Kang M, Garland S, Kaldor J, McGeechan K, Skinner SR. Effect of a School-Based Educational Intervention About the Human Papillomavirus Vaccine on Psychosocial Outcomes Among Adolescents: Analysis of Secondary Outcomes of a Cluster Randomized Trial. JAMA Netw Open 2021; 4:e2129057. [PMID: 34726749 PMCID: PMC8564580 DOI: 10.1001/jamanetworkopen.2021.29057] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Delivery of vaccination to adolescents via a school-based program provides an opportunity to promote their involvement in health decision-making, service provision, and self-efficacy (belief in one's ability to perform a certain behavior). OBJECTIVE To examine the effect of a human papillomavirus (HPV) vaccination education and logistical intervention on adolescent psychosocial outcomes. DESIGN, SETTING, AND PARTICIPANTS In this cluster randomized trial and process and qualitative evaluation, adolescents aged 12 to 13 years (first year of high school) were recruited at high schools in Western Australia (WA) and South Australia (SA) in 2013 and 2014. Statistical analysis was performed from January 2016 to December 2020. INTERVENTIONS The complex intervention consisted of an adolescent intervention to promote knowledge and psychosocial outcomes, shared decisional support tool, and logistical strategies. MAIN OUTCOMES AND MEASURES Prespecified secondary outcomes were assessed. The HPV Adolescent Vaccination Intervention Questionnaire (HAVIQ) was used to measure changes in adolescent knowledge (6-item subscale), fear and anxiety (6-item subscale), self-efficacy (5-item subscale), and decision-making (8-item subscale). The hypothesis was that the intervention would improve adolescent involvement in vaccine decision-making (measured before dose 1 only), improve vaccine-related self-efficacy, and reduce vaccine-related fear and anxiety (measured before doses 1, 2, and 3). Mean (SD) scores for each subscale were compared between intervention and control students. In the process evaluation, focus groups were conducted. Analyses of the HAVIQ data were conducted from 2016 to 2020. Qualitative analyses of the focus groups were undertaken from 2017 to 2020. RESULTS The trial included 40 schools (21 intervention and 19 control) across sectors with 6967 adolescents (mean [SD] age, 13.70 [0.45] years). There were 3805 students (1689 girls and 2116 boys) in the intervention group and 3162 students (1471 girls and 1691 boys) in the control group. The overall response rate for the HAVIQ was 55%. In WA, where parental consent was required, the response rate was 35% (1676 of 4751 students); in SA, where parental consent was not required, it was 97% (2166 of 2216 students). The mean (SD) score for decision-making in the intervention group before dose 1 was 3.50 (0.42) of 5 points and 3.40 (0.40) in the control group, a small but significant difference of 0.11 point (95% CI, 0.06 to 0.16 point; P < .001). There was a small difference in favor of the intervention group in reduced vaccination-related anxiety (pre-dose 1 difference, -0.11 point [95% CI, -0.19 to -0.02 point]; pre-dose 2 difference, -0.18 point [95% CI, -0.26 to -0.10 point]; pre-dose 3 difference, -0.18 [95% CI, -0.24 to -0.11]) and increased vaccination self-efficacy (pre-dose 1 difference, 4.0 points; [95% CI, 1.0 to 7.0 points]; pre-dose 2 difference, 4.0 points [95% CI, 2.0 to 6.0 points]; pre-dose 3 difference, 3.0 points [95% CI, 1.0 to 5.0 points]). Focus group data from 111 adolescents in 6 intervention and 5 control schools revealed more confidence and less anxiety with each vaccine dose. CONCLUSIONS AND RELEVANCE In this cluster randomized trial, there was a small difference in adolescent decisional involvement and vaccine-related confidence and reduced vaccination-related fear and anxiety that was maintained throughout the vaccine course in the intervention vs control groups. Guidelines for vaccination at school should incorporate advice regarding how this outcome can be achieved. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN12614000404628.
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Affiliation(s)
- Cristyn Davies
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Helen S. Marshall
- Women’s and Children’s Hospital and School of Medicine and Robinson Research Institute, The University of Adelaide, South Australia, Australia
| | - Gregory Zimet
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Julia M. L. Brotherton
- VCS Population Health, VCS Foundation, Victoria, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa Kang
- Specialty of General Practice, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Health, School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Suzanne Garland
- Centre for Women’s Infectious Diseases Research, The Royal Women’s Hospital, Melbourne, Victoria, Australia
- Reproductive and Neonatal Infectious Diseases, Department of Obstetrics and Gynaecology, University of Melbourne, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - John Kaldor
- The Kirby Institute for Infection and Immunity in Society, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Kevin McGeechan
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - S. Rachel Skinner
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Application of theoretical frameworks on human papillomavirus vaccine interventions in the United States: systematic review and meta-analysis. Cancer Causes Control 2021; 33:15-24. [PMID: 34705121 DOI: 10.1007/s10552-021-01509-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/14/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Theoretical frameworks are useful tools to explain the dynamics of behavioral change, develop, and implement intervention studies. The purpose of this systematic review and meta-analysis is to evaluate the application of theoretical frameworks and models to HPV vaccination intervention studies in the United States (US) from January 2006 to December 2019. METHODS A comprehensive search across databases, including PubMed, EMBASE, ERIC, CINAHL, Academic Search Complete, Scopus, Web of Science, and PsycINFO, was conducted. Articles were included in the systematic analysis if at least one theory was used to develop the intervention phase. All intervention studies targeting populations in the US without restrictions of age, income, sex, and ethnicity were included. Articles were included in the meta-analysis if vaccine uptake and/or vaccine completion was addressed. RESULTS The Health Belief Model, Motivational Interviewing, Theory of Planned Behavior, and Information-Motivation-Behavioral Skills were the most used theories. Based on theory integrity, theory rationale, and theory operationalization, most of the studies (60%) were rated high for the application of the theoretical frameworks. Our results suggest a preference for theoretical frameworks targeting individual change rather than community change and the existence of gender disparities in the application of theoretical frameworks. The association between theory and increase of likelihood in vaccine uptake and completion was not supported. CONCLUSION This review spotlights common issues in the application of theoretical frameworks in HPV vaccine interventions in the US. Our results suggest we are still in a developmental phase on several aspects of theory application to HPV vaccination.
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Abstract
PURPOSE OF REVIEW We reviewed the literature about parental vaccine hesitancy, focusing on publications from October 2019 to April 2021 to describe patterns and causes of hesitancy and interventions to address hesitancy. RECENT FINDINGS Recent studies expand understanding of the prevalence of vaccine hesitancy globally and highlight associated individual and contextual factors. Common concerns underlying hesitancy include uncertainty about the need for vaccination and questions about vaccine safety and efficacy. Sociodemographic factors associated with parental vaccine hesitancy vary across locations and contexts. Studies about psychology of hesitancy and how parents respond to interventions highlight the role of cognitive biases, personal values, and vaccination as a social contract or norm. Evidence-based strategies to address vaccine hesitancy include presumptive or announcement approaches to vaccine recommendations, motivational interviewing, and use of immunization delivery strategies like standing orders and reminder/recall programs. A smaller number of studies support use of social media and digital applications to improve vaccination intent. Strengthening school vaccine mandates can improve vaccination rates, but policy decisions must consider local context. SUMMARY Vaccine hesitancy remains a challenge for child health. Future work must include more interventional studies to address hesitancy and regular global surveillance of parental vaccine hesitancy and vaccine content on social media.
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Affiliation(s)
- Jessica R Cataldi
- Department of Pediatrics, University of Colorado School of Medicine
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Sean T O'Leary
- Department of Pediatrics, University of Colorado School of Medicine
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
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Cernasev A, Veve MP, Hohmeier KC, Summers NA, Kumar S. Importance of pharmacist-patient relationship in people living with HIV and concomitant opioid use disorder. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 3:100052. [PMID: 35480609 PMCID: PMC9030677 DOI: 10.1016/j.rcsop.2021.100052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background PLWHA commonly suffer from chronic pain that is often treated with opioids, leading to subsequent opiate use disorders. As the majority of Americans live in close proximity to a pharmacy, community pharmacists are well equipped to interact with PLWHA. Few data quantify the needs of PLWHA with OUD, or how they utilize community pharmacists. Objectives To characterize the perceptions of Persons Living with HIV/AIDS (PLWHA) and using opioid medications on the interaction with pharmacists. Methods For this study, a qualitative approach was used. A key purpose of interviews is to encourage and inspire the subject to share a significant event of his/her life with the interviewer. Recruitment for face-to-face interviews with PLWHA continued until saturation was achieved. The Theory of Planned Behavior was used to assess the findings from this study. Sixteen interviews were transcribed verbatim and content analysis was performed by two researchers using Dedoose®, a qualitative software. Codes were grouped based on similarities into categories that facilitated the emergence of themes. Results Content analysis revealed two major themes. The first theme presents the subjects' beliefs and opinions about pharmacists' interactions when picking up their opioid prescriptions. Several subjects described encounters with the pharmacists that facilitated a trustful relationship. In the second theme, the analysis showed that the relationship with community pharmacists could be improved by having a more in-depth counseling about opioid medication and abuse. Conclusions These data highlight how PLWHA would like to interact with pharmacists when picking up opioid prescriptions. These results depicted how some subjects are using the pharmacists as a vital resource for medication information. These findings also demonstrated how for some subjects a more detailed counseling session when they receive opioid medications could be crucial in changing their behavior. Thus, community pharmacists are well positioned to reduce the usage of opioid medications and change PLWHA behavior and attitudes toward opioid prescriptions.
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Affiliation(s)
- Alina Cernasev
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Sciences Center, Nashville, TN, USA
- Corresponding author.
| | - Michael P. Veve
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI 48201, USA
| | - Kenneth C. Hohmeier
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Sciences Center, Nashville, TN, USA
| | - Nathan A. Summers
- Division of Infectious Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Santosh Kumar
- Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
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Oster NV, Williams EC, Unger JM, Newcomb PA, deHart MP, Englund JA, Hofstetter AM. A Risk Prediction Model to Identify Newborns at Risk for Missing Early Childhood Vaccinations. J Pediatric Infect Dis Soc 2021; 10:1080-1086. [PMID: 34402910 PMCID: PMC8719613 DOI: 10.1093/jpids/piab073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/02/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Approximately 30% of US children aged 24 months have not received all recommended vaccines. This study aimed to develop a prediction model to identify newborns at high risk for missing early childhood vaccines. METHODS A retrospective cohort included 9080 infants born weighing ≥2000 g at an academic medical center between 2008 and 2013. Electronic medical record data were linked to vaccine data from the Washington State Immunization Information System. Risk models were constructed using derivation and validation samples. K-fold cross-validation identified risk factors for model inclusion based on alpha = 0.01. For each patient in the derivation set, the total number of weighted adverse risk factors was calculated and used to establish groups at low, medium, or high risk for undervaccination. Logistic regression evaluated the likelihood of not completing the 7-vaccine series by age 19 months. The final model was tested using the validation sample. RESULTS Overall, 53.6% failed to complete the 7-vaccine series by 19 months. Six risk factors were identified: race/ethnicity, maternal language, insurance status, birth hospitalization length of stay, medical service, and hepatitis B vaccine receipt. Likelihood of non-completion was greater in the high (77.1%; adjusted odds ratio [AOR] 5.6; 99% confidence interval [CI]: 4.2, 7.4) and medium (52.7%; AOR 1.9; 99% CI: 1.6, 2.2) vs low (38.7%) risk groups in the derivation sample. Similar results were observed in the validation sample. CONCLUSIONS Our prediction model using information readily available in birth hospitalization records consistently identified newborns at high risk for undervaccination. Early identification of high-risk families could be useful for initiating timely, tailored vaccine interventions.
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Affiliation(s)
- Natalia V Oster
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA,Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Administration Puget Sound, Seattle, Washington, USA
| | - Joseph M Unger
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Polly A Newcomb
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA,Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - M Patricia deHart
- Office of Immunization and Child Profile, Washington State Department of Health, Tumwater, Washington, USA
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle, Washington, USA,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Annika M Hofstetter
- Department of Pediatrics, University of Washington, Seattle, Washington, USA,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington, USA,Corresponding Author: Annika M. Hofstetter, MD, PhD, MPH, Seattle Children’s Research Institute, M/S CURE-4, PO Box 5371, Seattle, WA 98145-5005, USA.
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Easing Human Papillomavirus Vaccine Hesitancy: A Communication Experiment With U.S. Parents. Am J Prev Med 2021; 61:88-95. [PMID: 33975768 PMCID: PMC8217248 DOI: 10.1016/j.amepre.2021.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 01/18/2021] [Accepted: 02/16/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The Announcement Approach using presumptive announcements increases human papillomavirus vaccine uptake. This study seeks to understand the impact of the final Announcement Approach steps-easing parents' vaccine concerns and then encouraging them to get human papillomavirus vaccine for their children-on parents' human papillomavirus vaccine hesitancy and confidence in the vaccine's benefits. METHODS In 2017-2018, investigators recruited an online national sample of 1,196 U.S. parents of children aged 9-17 years who had not yet completed the human papillomavirus vaccine series. Following the steps of the Announcement Approach, participants viewed brief videos of a pediatrician announcing that a child was due for human papillomavirus vaccine (shown to all the parents). In the 2 × 2 experiment, parents saw (1) a video of the pediatrician attempting to ease a concern that the parent had raised earlier in the survey (Ease video), (2) a video of the pediatrician encouraging the parent to get their child vaccinated (Encourage video), (3) both videos, or (4) neither of the videos. Data analysis was conducted in spring 2020. RESULTS Seeing the Ease video message led to lower human papillomavirus vaccine hesitancy than not seeing it (mean=2.71, SD=1.29 vs mean=2.97, SD=1.33; p<0.001). The beneficial impact of easing concerns on lower vaccine hesitancy was explained by higher confidence (p<0.05). By contrast, the Encourage video had no impact on human papillomavirus vaccine hesitancy or confidence. CONCLUSIONS Addressing parents' concerns can decrease human papillomavirus vaccine hesitancy and increase confidence. On the basis of these findings, the Announcement Approach retained its emphasis on announcing that children are due for vaccination and easing parent concerns.
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Grabert BK, Heisler-MacKinnon J, Liu A, Margolis MA, Cox ED, Gilkey MB. Prioritizing and implementing HPV vaccination quality improvement programs in healthcare systems: the perspective of quality improvement leaders. Hum Vaccin Immunother 2021; 17:3577-3586. [PMID: 34152924 DOI: 10.1080/21645515.2021.1913965] [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] [Indexed: 10/21/2022] Open
Abstract
Human papillomavirus (HPV) vaccination could prevent most of the ~34,000 HPV-attributable cancers diagnosed annually in the US, but uptake remains suboptimal. Healthcare systems are key partners in implementing HPV vaccination quality improvement (QI) programs. To inform future system-level HPV vaccine initiatives, we sought to understand HPV vaccine QI from the perspective of QI program leaders in healthcare systems. We conducted telephone interviews with a multi-state sample of 17 QI leaders in 15 systems. We analyzed data qualitatively via thematic analysis to describe QI leaders' perspectives on prioritizing and implementing HPV vaccine QI. All QI leaders endorsed HPV vaccination as beneficial, and some had already prioritized increasing uptake to improve adolescent health and meet payor reimbursement standards. Those not prioritizing HPV vaccination cited concerns including the relatively small size of adolescent patient populations, lack of buy-in among providers, and the need to focus on health services perceived as more profitable or urgent. When implementing HPV vaccine QI programs, QI leaders reported key barriers to be the lack of robust data systems and acceptable QI metrics, limited time, and pressures of a fee-for-service clinical environment. Facilitators included automation and standardization in QI efforts and passionate vaccine champions. Almost all QI leaders reported future plans to implement HPV vaccine QI projects. Findings suggest that many healthcare systems are motivated to improve HPV vaccination. However, resistance to guideline-consistent quality metrics, the narrow target of one vaccine in the adolescent patient population, payment structures, and constrained time of providers are key barriers to practice improvements.
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Affiliation(s)
- Brigid K Grabert
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.,Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer Heisler-MacKinnon
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Amy Liu
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, USA
| | - Marjorie A Margolis
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.,Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Elizabeth D Cox
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Melissa B Gilkey
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.,Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
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Reñosa MDC, Wachinger J, Bärnighausen K, Aligato MF, Landicho-Guevarra J, Endoma V, Landicho J, Bravo TA, Demonteverde MP, Guevarra JR, de Claro Iii N, Inobaya M, Adam M, Chase RP, McMahon SA. How can human-centered design build a story-based video intervention that addresses vaccine hesitancy and bolsters vaccine confidence in the Philippines? A mixedmethod protocol for project SALUBONG. BMJ Open 2021; 11:e046814. [PMID: 34108166 PMCID: PMC8190986 DOI: 10.1136/bmjopen-2020-046814] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/26/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Since the onset of a dengue vaccine controversy in late 2017, vaccine confidence has plummeted in the Philippines, leading to measles and polio outbreaks in early 2019. This protocol outlines a human-centered design (HCD) approach to co-create and test an intervention that addresses vaccine hesitancy (VH) via narrative and empathy with and among families and healthcare workers. METHODS AND ANALYSIS: 'Salubong' is a Filipino term that means to welcome someone back into one's life, reinforcing notions of family ties and friendships. We apply this sentiment to vaccines. Following the phases of HCD, guided by a theoretical framework, and drawing from locally held understandings of faith and acceptance, we will conduct in-depth interviews (IDIs) and focus group discussions (FGDs) in rural and urban Filipino communities that witnessed dramatic increases in measles cases in recent years. During qualitative engagements with caretakers, providers, and policymakers, we will collect narratives about family and community perceptions of childhood vaccinations, public health systems and opportunities to restore faith. IDIs and FGDs will continuously inform the development of (and delivery mechanisms for) story-based interventions. Once developed, we will test our co-created interventions among 800 caretakers and administer a VH questionnaire prior to and immediately following the intervention encounter. We will use the feedback gained through the survey and Kano-style questionnaires to further refine the intervention. Considering the data collection challenges posed by the ongoing COVID-19 pandemic, we have developed workarounds to conduct data collection primarily online. We will use systematic online debriefings to facilitate comprehensive participation of the full research team. ETHICS AND DISSEMINATION Ethical approval has been granted by the Institutional Review Board of the Research Institute for Tropical Medicine (number 2019-44) and Ethical Commission of Heidelberg University, Faculty of Medicine (S-833/2019). Study findings will be disseminated in scientific conferences and published in peer-reviewed journals.
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Affiliation(s)
- Mark Donald C Reñosa
- Heidelberg Institute of Global Health, Ruprecht Karls Universität Heidelberg, Heidelberg, Germany
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Jonas Wachinger
- Heidelberg Institute of Global Health, Ruprecht Karls Universität Heidelberg, Heidelberg, Germany
| | - Kate Bärnighausen
- Heidelberg Institute of Global Health, Ruprecht Karls Universität Heidelberg, Heidelberg, Germany
- School of Public Health, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
| | - Mila F Aligato
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Jhoys Landicho-Guevarra
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Vivienne Endoma
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Jeniffer Landicho
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Thea Andrea Bravo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Maria Paz Demonteverde
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Jerric Rhazel Guevarra
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Nicanor de Claro Iii
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Marianette Inobaya
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Maya Adam
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | | | - Shannon A McMahon
- Heidelberg Institute of Global Health, Ruprecht Karls Universität Heidelberg, Heidelberg, Germany
- International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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McFadden SM, Ko LK, Shankar M, Ibrahim A, Berliner D, Lin J, Mohamed FB, Amsalu F, Ali AA, Jang SH, Winer RL. Development and evaluation of an online continuing education course to increase healthcare provider self-efficacy to make strong HPV vaccine recommendations to East African immigrant families. Tumour Virus Res 2021; 11:200214. [PMID: 33647533 PMCID: PMC7944093 DOI: 10.1016/j.tvr.2021.200214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/03/2021] [Accepted: 02/17/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To develop and evaluate an online continuing education (CE) course designed to improve healthcare provider self-efficacy to make strong adolescent HPV vaccine recommendations to East African immigrant families. METHODS Focus groups with providers and East African immigrant mothers informed course development. Providers serving East African immigrant families were recruited to view the course and complete pre-/post-test and two-month follow-up surveys. Pre-/post differences were compared with paired t-tests. RESULTS 202 providers completed the course and pre-/post-test; 158 (78%) completed two-month follow-up. Confidence to make strong HPV vaccine recommendations to East African families increased from 68% pre-test to 98% post-test. Confidence to address common parental concerns also increased: safety, 54% pre-test, 92% post-test; fertility, 55% pre-test, 90% post-test; child too young, 68% pre-test, 92% post-test; and pork gelatin in vaccine manufacturing, 38% pre-test, 90% post-test. Two-month follow-up scores remained high (97% for overall confidence, 94%-97% for addressing parental concerns). All pre-/post-test and pre-test/two-month follow-up comparisons were statistically significant (p < 0.05). CONCLUSIONS The online CE course focused on culturally appropriate strategies for making strong recommendations and addressing specific parental concerns was effective for increasing provider self-efficacy to recommend HPV vaccination to East African families. Similar courses could be tailored to other priority populations.
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Affiliation(s)
- SarahAnn M McFadden
- University of Washington School of Nursing, 1959 NE Pacific St, Box 357260, Seattle, WA, 98195, USA.
| | - Linda K Ko
- Division of Public Health Services, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M3-B232, Seattle, WA, 98102, USA; Department of Health Services, University of Washington School of Public Health, 3980 15th, Ave NE, Box 351621, Seattle, WA, 98195, USA.
| | - Megha Shankar
- Department of Medicine, University of Washington, 1959 NE Pacific St, Box 356421, Seattle, WA, 98195, USA.
| | - Anisa Ibrahim
- Department of Pediatrics, University of Washington, 1959 NE Pacific St, Box 356320, Seattle, WA, 98104, USA; Somali Health Board, 7050 32nd, AVE S, Seattle, WA, 98118, USA.
| | - Debra Berliner
- Public Health - Seattle & King County, Communicable Disease, Epidemiology, and Immunization Program, 401 5th(,) Ave., Seattle, WA, 98104, USA.
| | - John Lin
- Department of Epidemiology, University of Washington School of Public Health, 3980 15th, Ave NE, Box 351619, Seattle, WA, 98195, USA.
| | - Farah B Mohamed
- Somali Health Board, 7050 32nd, AVE S, Seattle, WA, 98118, USA; Department of Epidemiology, University of Washington School of Public Health, 3980 15th, Ave NE, Box 351619, Seattle, WA, 98195, USA.
| | - Fanaye Amsalu
- Department of Epidemiology, University of Washington School of Public Health, 3980 15th, Ave NE, Box 351619, Seattle, WA, 98195, USA.
| | - Ahmed A Ali
- Somali Health Board, 7050 32nd, AVE S, Seattle, WA, 98118, USA.
| | - Sou Hyun Jang
- Department of Sociology, Sungkyunkwan University, 25-2 Sungkyunkwan-ro, Jongno-gu, Seoul, 03063, South Korea.
| | - Rachel L Winer
- Department of Epidemiology, University of Washington School of Public Health, 3980 15th, Ave NE, Box 351619, Seattle, WA, 98195, USA.
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HPV vaccine communication training in healthcare systems: Evaluating a train-the-trainer model. Vaccine 2021; 39:3731-3736. [PMID: 34078555 DOI: 10.1016/j.vaccine.2021.05.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Large healthcare systems provide an opportunity to disseminate evidence-based interventions to primary care. We evaluated the impact of a train-the-trainer model in two large systems to disseminate the Announcement Approach Training, which teaches providers to communicate about HPV vaccination more effectively. METHODS In collaboration with the American Cancer Society, we partnered with two midwestern healthcare systems that served over 77,000 patients ages 11 through 17. Both systems hosted a 2-hour train-the-trainer workshop. Providers from one system then conducted in-person 1-hour CME-eligible trainings, using our standard slide set and script (available at hpvIQ.org). The other system did not implement trainings, providing a natural experiment. RESULTS The train-the-trainer workshop included physicians, nurses and other clinical staff (n = 11/13 for intervention/comparison systems). The intervention system delivered 18 trainings to 234 physicians, nurses, and other clinic staff. From baseline to 6-month follow-up, the intervention system had an increase in HPV vaccine uptake that was larger than that of the comparison system for adolescents ages 11 through 12 (1.9%, p = .002) and ages 13 through 17 (1.5%, p = .015). Attending the training was associated with increased intentions to routinely recommend HPV vaccine when patients turn 11 or 12 (mean 4.19 (SD = 0.95) vs. 4.43 (SD = 0.83) as well as increased positive vaccine attitudes, self-efficacy, and norms (all p < .001). Participant satisfaction with the trainings was high (90%-94%). CONCLUSION The train-the-trainer model was effective in increasing provider motivation to recommend HPV vaccination and led to a small increase in vaccine uptake. Dissemination through large healthcare systems is promising but faces some challenges.
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Rand CM, Humiston SG. Provider Focused Interventions to Improve Child and Adolescent Vaccination Rates. Acad Pediatr 2021; 21:S34-S39. [PMID: 33958090 DOI: 10.1016/j.acap.2021.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Cynthia M Rand
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry (CM Rand), Rochester, NY.
| | - Sharon G Humiston
- Department of Pediatrics, University of Missouri Kansas City School of Medicine and Children's Mercy Kansas City (SG Humiston), Mo
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Limaye RJ, Opel DJ, Dempsey A, Ellingson M, Spina C, Omer SB, Dudley MZ, Salmon DA, Leary SO. Communicating With Vaccine-Hesitant Parents: A Narrative Review. Acad Pediatr 2021; 21:S24-S29. [PMID: 33958087 DOI: 10.1016/j.acap.2021.01.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/21/2021] [Accepted: 01/29/2021] [Indexed: 01/04/2023]
Abstract
Although vaccines are considered one of the most effective medical interventions to prevent vaccine preventable disease and associated morbidity and mortality, a number of recent outbreaks are threatening the gains made by vaccines. Vaccine hesitancy is a key driver of vaccine refusal and has been associated with vaccine preventable outbreaks. While parents seek information from many sources to inform their vaccine decision-making process, they continue to view their child's pediatric provider as a trusted source of vaccine information. The communication that occurs between a provider and parent with regards to vaccination is critical in reducing concerns and nudging parents toward vaccine acceptance. However, vaccine-hesitant parents raise issues in this encounter that many providers feel ill-equipped to answer, due to lack of training on evidence-based communication strategies. We focus on promising approaches related to patient-provider communication within the context of vaccination. We found empirical evidence that the use of a presumptive format to recommend vaccines, motivational interviewing, and tailoring information to increase message salience are approaches that can positively affect vaccine acceptance. As providers continue to serve as important influencers in the vaccine decision-making process, it is evident that there is a need to continue to identify evidence-based, and practically implementable approaches to mitigate parental vaccine hesitancy. Providers play a key role in improving coverage rates, and therefore it is paramount to seek ways to improve how providers communicate about vaccines.
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Affiliation(s)
- Rupali J Limaye
- Johns Hopkins Bloomberg School of Public Health (RJ Limaye, MZ Dudley, and DA Salmon), Baltimore, Md.
| | | | - Amanda Dempsey
- University of Colorado Denver (A Dempsey, C Spina, and SO Leary), Denver, Colo
| | | | - Christine Spina
- University of Colorado Denver (A Dempsey, C Spina, and SO Leary), Denver, Colo
| | - Saad B Omer
- Yale School of Medicine (M Ellingson and SB Omer), New Haven, Conn
| | - Matthew Z Dudley
- Johns Hopkins Bloomberg School of Public Health (RJ Limaye, MZ Dudley, and DA Salmon), Baltimore, Md
| | - Daniel A Salmon
- Johns Hopkins Bloomberg School of Public Health (RJ Limaye, MZ Dudley, and DA Salmon), Baltimore, Md
| | - Sean O Leary
- University of Colorado Denver (A Dempsey, C Spina, and SO Leary), Denver, Colo
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Koskan A, Vizcaino M, Brennhofer SA, Lee CD, Roberto AJ. Human papillomavirus vaccine administration behaviors and influences among Arizona pharmacists and pharmacy interns. Hum Vaccin Immunother 2021; 17:3090-3095. [PMID: 33886423 DOI: 10.1080/21645515.2021.1905469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
This study assessed 27 Arizona community pharmacists' and pharmacy interns' human papillomavirus (HPV) vaccine administration behaviors and influences. We recruited community pharmacists and pharmacy interns from a statewide pharmacy conference to complete a 40-item cross-sectional survey. Informed by the Theory of Planned Behavior, the survey assessed pharmacists' HPV vaccine-related behaviors, intentions, attitudes, subjective norms, and perceived behavioral control to vaccinate against HPV. We analyzed all data using descriptive statistics and correlations. Overall, most pharmacists held positive attitudes about the HPV vaccine. However, the majority rarely administered the HPV vaccine. Intentions to vaccinate and subjective norms positively correlated with vaccine administration behavior. Pharmacists' positive attitudes about the vaccine, subjective norm to vaccinate, and behavioral control or self-efficacy to recommend the vaccine impacted their intentions to vaccinate against HPV. Most surveyed pharmacists believed that the most substantial HPV vaccine administration barriers include parental consent and parental stigma against the vaccine. The most common pharmacy-related barrier was the lack of a tracking and reminder system to encourage patients to return for additional HPV vaccine doses. This work highlights the need to increase public awareness that pharmacists can administer vaccines to adolescents. Study authors recommend offering communication training to increase pharmacists' perceived behavioral control to recommend the HPV vaccine.
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Affiliation(s)
- Alexis Koskan
- Arizona State University College of Health Solutions, Phoenix, AZ, USA
| | | | | | - Chong D Lee
- Arizona State University College of Health Solutions, Phoenix, AZ, USA
| | - Anthony J Roberto
- Hugh Downs School of Human Communication, Arizona State University, Tempe, AZ, USA
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Gülpınar G, Keleş Ş, Yalım NY. Perspectives of community pharmacists on conscientious objection to provide pharmacy services: A theory informed qualitative study. J Am Pharm Assoc (2003) 2021; 61:373-381.e1. [PMID: 33895101 DOI: 10.1016/j.japh.2021.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/25/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND In recent years, pharmacists have been opting out of certain pharmacy services, particularly, providing contraceptives, for moral reasons. No research has been conducted on the perceptions of community pharmacists toward conscience objection in a secular state with a mostly Muslim population. OBJECTIVE This study aimed to provide an in-depth understanding of the factors related to the beliefs of community pharmacists on conscientious objection to provide pharmacy services contrary to their personal beliefs based on the theory of planned behavior. METHODS Semistructured interviews were conducted with a purposive sampling of community pharmacists. A hybrid deductive and inductive qualitative analysis approach was used on the data that were recorded and transcribed verbatim. Constructs related to attitude, subjective norm, and perceived behavioral control were explored. RESULTS In total, 25 community pharmacists were interviewed. Factors affecting pharmacists' decision to provide pharmacy services when their personal beliefs included the desire to maintain moral integrity, beliefs about consequences for health care service, profit, patient pressure, precedence of professional values, and care for religious sources. CONCLUSION Most of the community pharmacists were against the behavior of conscientiously objecting to provide pharmacy services in Turkey because of possible negative consequences on health care. The pharmacists who were willing to act based on their personal beliefs were expecting from various third parties to fulfill certain responsibilities to facilitate to adopt the behavior. This novel study highlights the urgent need for more research and training for community pharmacists serving patients in different socioeconomic contexts in both developed and developing countries.
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Finney Rutten LJ, Zhu X, Leppin AL, Ridgeway JL, Swift MD, Griffin JM, St Sauver JL, Virk A, Jacobson RM. Evidence-Based Strategies for Clinical Organizations to Address COVID-19 Vaccine Hesitancy. Mayo Clin Proc 2021; 96:699-707. [PMID: 33673921 PMCID: PMC7772995 DOI: 10.1016/j.mayocp.2020.12.024] [Citation(s) in RCA: 182] [Impact Index Per Article: 60.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/28/2020] [Indexed: 12/24/2022]
Abstract
The success of vaccination programs is contingent upon irrefutable scientific safety data combined with high rates of public acceptance and population coverage. Vaccine hesitancy, characterized by lack of confidence in vaccination and/or complacency about vaccination that may lead to delay or refusal of vaccination despite the availability of services, threatens to undermine the success of coronavirus disease 2019 (COVID-19) vaccination programs. The rapid pace of vaccine development, misinformation in popular and social media, the polarized sociopolitical environment, and the inherent complexities of large-scale vaccination efforts may undermine vaccination confidence and increase complacency about COVID-19 vaccination. Although the experience of recent lethal surges of COVID-19 infections has underscored the value of COVID-19 vaccines, ensuring population uptake of COVID-19 vaccination will require application of multilevel, evidence-based strategies to influence behavior change and address vaccine hesitancy. Recent survey research evaluating public attitudes in the United States toward the COVID-19 vaccine reveals substantial vaccine hesitancy. Building upon efforts at the policy and community level to ensure population access to COVID-19 vaccination, a strong health care system response is critical to address vaccine hesitancy. Drawing on the evidence base in social, behavioral, communication, and implementation science, we review, summarize, and encourage use of interpersonal, individual-level, and organizational interventions within clinical organizations to address this critical gap and improve population adoption of COVID-19 vaccination.
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Affiliation(s)
- Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN
| | - Xuan Zhu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN
| | - Aaron L Leppin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN
| | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN
| | - Melanie D Swift
- Department of Health Sciences Research, Division of Infectious Diseases, Mayo Clinic, Rochester, MN
| | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN
| | - Jennifer L St Sauver
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Epidemiology, Mayo Clinic, Rochester, MN
| | - Abinash Virk
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN
| | - Robert M Jacobson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN; Department of Medicine, and Division of Community Pediatric and Adolescent Medicine and Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
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Attwell K, Betsch C, Dubé E, Sivelä J, Gagneur A, Suggs LS, Picot V, Thomson A. Increasing vaccine acceptance using evidence-based approaches and policies: Insights from research on behavioural and social determinants presented at the 7th Annual Vaccine Acceptance Meeting. Int J Infect Dis 2021; 105:188-193. [PMID: 33578012 DOI: 10.1016/j.ijid.2021.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In 2019, the World Health Organization (WHO) flagged vaccine hesitancy as one of the top 10 threats to global health. The drivers of and barriers to under-vaccination include logistics (access to and awareness of affordable vaccines), as well as a complex mix of psychological, social, political, and cultural factors. INCREASING VACCINE UPTAKE There is a need for effective strategies to increase vaccine uptake in various settings, based on the best available evidence. Fortunately, the field of vaccine acceptance research is growing rapidly with the development, implementation, and evaluation of diverse measurement tools, as well as interventions to address the challenging range of drivers of and barriers to vaccine acceptance. ANNUAL VACCINE ACCEPTANCE MEETINGS Since 2011, the Mérieux Foundation has hosted Annual Vaccine Acceptance Meetings in Annecy, France that have fostered an informal community of practice on vaccination confidence and vaccine uptake. Mutual learning and sharing of knowledge has resulted directly in multiple initiatives and research projects. This article reports the discussions from the 7th Annual Vaccine Acceptance Meeting held September 23-25, 2019. During this meeting, participants discussed emergent vaccine acceptance challenges and evidence-informed ways of addressing them in a programme that included sessions on vaccine mandates, vaccine acceptance and demand, training on vaccine acceptance, and frameworks for resilience of vaccination programmes.
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Affiliation(s)
- Katie Attwell
- School of Social Science, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia.
| | - Cornelia Betsch
- University of Erfurt, Nordhäuser Str. 63, 99089, Erfurt, Germany.
| | - Eve Dubé
- Centre de Recherche du CHU de Québec-Université Laval, 2400 D'Estimauville, Quebec, QC, G1E 7G9, Canada.
| | - Jonas Sivelä
- Infectious Disease Control and Vaccinations, Finnish Institute for Health and Welfare (THL), Mannerheimintie 166, Helsinki, Finland.
| | - Arnaud Gagneur
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada.
| | - L Suzanne Suggs
- BeCHANGE Research Group, Institute of Public Health, Faculty of Communication Sciences, Università della Svizzera Italiana, via G. Buffi 13, Lugano, Switzerland; Swiss School of Public Health (SSPH+), Zurich, Switzerland; Institute for Global Health Innovation, Imperial College London, London, UK.
| | - Valentina Picot
- Scientific Conferences and Public Health Initiatives, Fondation Mérieux, 17 Rue Bourgelat, 69002, Lyon, France.
| | - Angus Thomson
- Sanofi Pasteur, 14 Espace Henry Vallee, 69007, Lyon, France.
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Escriva-Boulley G, Mandrik O, Préau M, Herrero R, Villain P. Cognitions and behaviours of general practitioners in France regarding HPV vaccination: A theory-based systematic review. Prev Med 2021; 143:106323. [PMID: 33171178 PMCID: PMC7840585 DOI: 10.1016/j.ypmed.2020.106323] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 01/11/2023]
Abstract
Human papillomavirus (HPV) vaccination is safe and efficacious to prevent persistent HPV infection, precancerous anogenital lesions and cervical cancer. However, in countries where vaccination programmes are implemented outside of schools, such as France, reaching high HPV vaccination coverage of the target population is challenging. Many studies have been performed in France to assess cognitions of general practitioners (GPs) regarding HPV vaccination. However, the evidence is not consistent about which cognitions are key. To provide a comprehensive overview, we performed a systematic review of studies conducted in France on GPs' cognitions regarding HPV vaccination and used the reasoned action approach to extract and synthesize data. The systematic search was performed up to July 2020 in Medline via PubMed, PsycINFO, PsycARTICLES, Embase, CINAHL Plus, Web of Science, Pascal and Francis databases. Grey literature was searched for in the French Public Health Database, Cairn. Info, yahoo.fr, and Google Scholar. Twenty-five scientific publications were selected based on eligibility criteria and assessed for quality. Our qualitative synthesis highlights that although 73% of GPs report recommending HPV vaccination, up to 50% would not recommend it because of concerns, including changes in patients' health behaviours and doubts about safety and/or efficacy. GPs' injunctive norms, i.e. trust in institutional information, were shown to be associated positively with GPs' willingness to recommend HPV vaccination. Parents' fears, girls' age, and potential connection with sexuality do not seem to affect GPs' recommendations. These results will inform the development of a professional educational intervention targeting GPs in France.
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Affiliation(s)
| | - Olena Mandrik
- The University of Sheffield, School of Health and Related Research (ScHARR), Health Economic and Decision Science (HEDS), Sheffield S1 4DA, United Kingdom
| | - Marie Préau
- Laboratoire GRePS (EA 4163), Université Lyon 2, 69676 Bron, France
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones, Biomédicas, San Jose, Costa Rica
| | - Patricia Villain
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, World Health Organization (IARC - WHO), 69372 Lyon, France.
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Affiliation(s)
- Shilpi Chabra
- Divisions of Neonatology and
- Seattle Children's Hospital, Seattle, Washington
| | - Annika M Hofstetter
- General Pediatrics, Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington; and
- Seattle Children's Hospital, Seattle, Washington
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Abstract
PURPOSE OF REVIEW To offer healthcare providers current, evidence-based approaches for addressing vaccine hesitancy to increase vaccine coverage and reduce the frequency of vaccine-preventable disease outbreaks. RECENT FINDINGS Vaccine hesitancy is a growing problem with profound societal, economic, and medical consequences. Understanding the complexity of vaccine hesitancy can inform approaches to increasing vaccine uptake on both the individual and population levels. Notably, pediatricians play a critical role in increasing vaccine uptake due to their relationships with families. This doctor-patient relationship establishes trust and allows evidence-based intervention strategies to be effective in the office. Understanding potential solutions outside the office, such as media campaigns and policy changes, also provide insight into vaccine hesitancy and potential directions for future research. While pediatricians' attempts in the clinic to increase coverage remain crucial, vaccine hesitancy remains a formidable public health problem that requires attention on both the micro and macro levels to be addressed successfully. SUMMARY Providers have an opportunity to increase both confidence in and uptake of vaccines. Public health interventions would effectively complement strategies in the clinic to increase overall coverage.
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Opel DJ, Henrikson NB, Lepere K, Robinson JD. Progress in Evidence-Based Communication About Childhood Vaccines. Acad Pediatr 2020; 20:729-730. [PMID: 32058106 PMCID: PMC7864538 DOI: 10.1016/j.acap.2020.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/13/2020] [Accepted: 02/06/2020] [Indexed: 12/27/2022]
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Implementation of the Standards for adult immunization practice: A survey of U.S. Health care providers. Vaccine 2020; 38:5305-5312. [PMID: 32586760 DOI: 10.1016/j.vaccine.2020.05.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 01/10/2023]
Abstract
The revised Standards for Adult Immunization Practice ("Standards"), published in 2014, recommend routine vaccination assessment, strong provider recommendation, vaccine administration or referral, and documentation of vaccines administered into immunization information systems (IIS). We assessed clinician and pharmacist implementation of the Standards in the United States from 2016 to 2018. Participating clinicians (family and internal medicine physicians, obstetricians-gynecologists, specialty physicians, physician assistants, and nurse practitioners) and pharmacists responded using an internet panel survey. Weighted proportion of clinicians and pharmacists reporting full implementation of each component of the Standards were calculated. Adjusted prevalence ratio (APR) estimates of practice characteristics associated with self-reported implementation of the Standards are also presented. Across all medical specialties, the percentages of clinicians and pharmacists implementing the vaccine assessment and recommendation components of the Standards were >80.0%. However, due to low IIS documentation, full implementation of the Standards was low overall, ranging from 30.4% for specialty medicine to 45.8% in family medicine clinicians. The presence of an immunization champion (APR, 1.40 [95% confidence interval {CI}, 1.26 to 1.54]), use of standing orders (APR, 1.41 [95% CI, 1.27 to 1.57]), and use of a patient reminder-recall system (APR, 1.39 [95% CI, 1.26 to 1.54]) were positively associated with adherence to the Standards by clinicians. Similar results were observed for pharmacists. Nonetheless, vaccination improvement strategies, i.e., having standing orders in place, empowering an immunization champion, and using patient recall-reminder systems were underutilized in clinical settings; full implementation of the Standards was inconsistent across all health care provider practices.
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Jacobson RM, St Sauver JL, Griffin JM, MacLaughlin KL, Finney Rutten LJ. How health care providers should address vaccine hesitancy in the clinical setting: Evidence for presumptive language in making a strong recommendation. Hum Vaccin Immunother 2020; 16:2131-2135. [PMID: 32242766 PMCID: PMC7553710 DOI: 10.1080/21645515.2020.1735226] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Vaccine hesitancy occurs throughout the world and can result in poor vaccine uptake and vaccine-preventable disease-outbreaks. Vaccine hesitancy dates back to the days of Edward Jenner and the smallpox vaccine. It persists despite the preponderance of evidence supporting vaccine safety and effectiveness. Studies show even among parents of well-vaccinated children that 15–35% of those parents are vaccine-hesitant. Studies have failed to show the efficacy of educational interventions, and, indeed, a number of studies of educational interventions show a contrarian effect leaving the vaccine-hesitant more entrenched in their views. Still dozens of studies support health care provider recommendation as a major factor in achieving high rates of vaccine uptake. Furthermore, studies find those recommendations perceived as stronger are more effective than those perceived as weaker. What makes for a stronger recommendation? Several observational studies indicate that presumptive, announcement language as contrasted with participatory, conversational language makes for a stronger more effective recommendation. Several trials now demonstrate that health care providers and practices can implement this language and obtain higher vaccination uptake. The authors recommend the practice be adopted as a routine practice in the clinical setting for all vaccinations
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Affiliation(s)
- Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic , Rochester, MN, USA.,Department of Health Sciences Research, Mayo Clinic , Rochester, MN, USA
| | | | - Joan M Griffin
- Department of Health Sciences Research, Mayo Clinic , Rochester, MN, USA
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Allen-Leigh B, Rivera-Rivera L, Yunes-Díaz E, Portillo-Romero AJ, Brown B, León-Maldonado L, Vargas-Guadarrama G, Salmerón J, Lazcano-Ponce EC. Uptake of the HPV vaccine among people with and without HIV, cisgender and transgender women and men who have sex with men and with women at two sexual health clinics in Mexico City. Hum Vaccin Immunother 2019; 16:981-990. [PMID: 31657665 DOI: 10.1080/21645515.2019.1675456] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Our aim was to better understand Human Papillomavirus (HPV) vaccine acceptance among Mexican adults including people with and without HIV, cisgender men who have sex with men (MSM) or with women (MSW), cisgender and transgender women. A computer-assisted, self-administered questionnaire was completed by healthcare users and participants recruited through community organizations, and the first dose of the quadrivalent HPV vaccine was offered at no cost at a large sexual health clinic in Mexico City, from May to December 2018. Socio-demographic characteristics and factors associated with HPV vaccine acceptance were analyzed using logistic regression.The sample of 1915 participants included 1341 cisgender men (70.9%, 1247 MSM and 94 MSW), 396 (20.7%) cisgender women and 178 (9.3%) transwomen; 615 people (32.1%) were HIV positive. Uptake of the HPV vaccine was higher in men and transwomen (91.5% and 87%, respectively) than among cisgender women (81.8%; p < .001). Cisgender women (OR 0.43, 95%CI 0.30-0.61, p < .05) were less likely to accept HPV vaccination than men. Married/partnered people were less likely to accept HPV vaccination compared to those who were single (OR 0.70, 95%CI 0.51-0.97). People living with HIV were not significantly more likely to accept HPV vaccination (OR 1.7; 95%CI 0.86-1.61).HPV vaccine acceptance was high among adult Mexican study participants; it may be higher than among other Mexican adults given most of these individuals are engaged in care. Modifications will be needed in national and international recommendations on HPV vaccination in adults if healthcare personnel are to recommend the vaccine to the population groups studied.
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Affiliation(s)
- Betania Allen-Leigh
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Leonor Rivera-Rivera
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Elsa Yunes-Díaz
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | - Brandon Brown
- School of Medicine, University of California at Riverside, Riverside, California, USA
| | - Leith León-Maldonado
- Cátedra CONACYT-Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico.,Academic Unit in Epidemiological Research. Center for Research in Policies, Population, and Health, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Galileo Vargas-Guadarrama
- Center for the Prevention and Comprehensive Care of HIV/AIDS in Mexico City, Condesa Clinic, Mexico City, Mexico
| | - Jorge Salmerón
- Academic Unit in Epidemiological Research. Center for Research in Policies, Population, and Health, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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