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Enskär I, Fransson E, Enskär K, Nevéus T, Grandahl M. School children's perceptions about being offered the HPV vaccination - A focus group study. Acta Paediatr 2024; 113:1672-1678. [PMID: 38551330 DOI: 10.1111/apa.17225] [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: 11/28/2023] [Revised: 03/06/2024] [Accepted: 03/21/2024] [Indexed: 06/12/2024]
Abstract
AIM There is limited knowledge about the perceptions of HPV vaccination in middle-school children. This qualitative study aimed to explore their views. METHODS We conducted focus group interviews with children, 10-11 years of age, who had been offered HPV vaccination through the school health services in mid-north Sweden in spring of 2023. Data were analysed with qualitative content analysis. RESULTS This study included six focus group interviews with 49 children (boys n = 29; girls n = 20), mean of 11 years of age. Participating children expressed the need to feel safe to be of utmost importance and the means to do so was to be prepared and informed by someone the child trusted. The school nurse was perceived as the expert, best suited to provide factual information, support and motivation, both to children and their parents. CONCLUSION We confirm that healthcare providers' recommendations are crucial for HPV vaccine acceptance also from the child's perspective. Improved information about HPV vaccination to children is necessary. Children's right to participate on their own terms is not fulfilled today. Vaccine promotion, both to children and parents, should be actively managed by the school nurse.
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Affiliation(s)
- Ida Enskär
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Emma Fransson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden
| | - Karin Enskär
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Tryggve Nevéus
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Maria Grandahl
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Alharthi TS, Alqahtani RK, Alghamdi M, Munshi AA, Alzahrani KA, Alenezi AQ, Almurakshi MM, Aljarbou AZ. Awareness and Attitudes Among Parents of Females Aged 9-26 in Saudi Arabia Regarding Human Papillomavirus Vaccination. Cureus 2024; 16:e62470. [PMID: 39022512 PMCID: PMC11251933 DOI: 10.7759/cureus.62470] [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] [Accepted: 06/16/2024] [Indexed: 07/20/2024] Open
Abstract
Background Most cases of cervical cancer are caused by the human papillomavirus (HPV) infection, which can be prevented by vaccination. The HPV vaccine received approval in Saudi Arabia in 2010. Objectives This study aimed to examine the awareness and attitudes toward the HPV vaccine among parents of females aged 9-26 in Saudi Arabia and explore factors contributing to hesitancy or acceptance. Methods Conducted from November 2022 to June 2023 in Saudi Arabia, this cross-sectional study surveyed parents of females aged 9-26 using a self-administered questionnaire. Data collected included parental demographics, maternal vaccination status, awareness of the HPV vaccine, and attitudes toward it. Results Out of 551 participants, 445 (82.4%) were mothers. Most participants (331; 69.1%) had attained a university education, and approximately half (315; 57.2%) were employed. A total of 339 (61.5%) were aware of the HPV vaccine, 256 (46.5%) knew of its connection to cervical cancer, and 296 (53.7%) understood its preventive role. Among them, 230 participants demonstrated a good level of awareness, while 321 had a poor level. The majority (377; 68.4%) intended to vaccinate their daughters. Reasons for hesitancy among those unwilling included lack of awareness (234; 42.5%), insufficient information (206; 37.4%), fear of vaccines and needles (203; 36.8%), and conflicting medical opinions (165; 29.9%). Conclusion The current level of awareness regarding HPV vaccines within the general population is deemed satisfactory, with the majority expressing intent to vaccinate their daughters. Ongoing efforts are warranted to enhance awareness further, particularly by leveraging social media platforms and the expertise of trusted physicians and healthcare authorities. These endeavors are crucial for mitigating the preventable impact of HPV infection. Additionally, it is imperative to sustain immunization programs for HPV vaccines, ensuring streamlined vaccine administration.
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Affiliation(s)
| | - Renad K Alqahtani
- Department of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Manar Alghamdi
- Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | | | - Khalid A Alzahrani
- Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | | | - Muhjah M Almurakshi
- Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Alanoud Z Aljarbou
- Department of Pediatric Infectious Diseases, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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Pergialiotis V, Papageorgiou D, Douligeris A, Mortaki A, Vlachos DE, Thomakos N, Rodolakis A, Haidopoulos D. Awareness, knowledge and attitudes of human papillomavirus infection, screening and vaccination: a survey study in Greece. Arch Gynecol Obstet 2024; 309:2031-2040. [PMID: 38459177 PMCID: PMC11018653 DOI: 10.1007/s00404-024-07398-1] [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: 10/10/2023] [Accepted: 01/25/2024] [Indexed: 03/10/2024]
Abstract
PURPOSE To evaluate the awareness and existing knowledge of a portion of the Greek population about prevention, screening, and HPV vaccination. METHODS A questionnaire designed in Google forms has been distributed through social media between June 2021 and December 2021 in men and women aged > 16 years old. Statistical analysis was performed using the SPSS 20.0 program. Inferential analysis was performed to evaluate differences in responses among men and women. RESULTS We enrolled 2685 participants. Of those, 2285 were women, 386 were men, while 14 respondents chose not to respond to this question. Various age groups were detected with those aged between 26 and 30 years old being the predominant one. Participants with a higher education constituted 36.5% of the population. Most respondents were married (59.8%). In socioeconomic terms 75.5% of participants were employed whereas, monthly income ranged between 1000 and 1500 euros in the predominant group (36.8%). Only 40% of females and 3.9% of males were vaccinated against HPV. Adolescent immunization, acceptability rates reached 92.7% among female and 82.1% among male responders. Although, only a small proportion of the participants were not aware of the existence of HPV, 24.1% of males and 23.4% of females had the impression that condom use may provide absolute immunity to HPV and only 51.6% of males and 60.4% of females were aware about the high prevalence of HPV in the general population. Logistic regression analysis indicated that male participants as well as those aged > 50 years and those choosing to reject vaccination had decreased knowledge of the basic pathophysiology of HPV infection, as well as knowledge related to the existence and use of HPV DNA as a screening tool and the existence and efficacy of HPV vaccination. CONCLUSION Our results indicate that although awareness of the existence of HPV infection is high in Greek general population, the actual perception of the pathophysiology of transmission and importance of HPV testing and vaccination is low. Targeting specific population groups is essential to help increase HPV coverage and screening.
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Affiliation(s)
- Vasilios Pergialiotis
- 1st Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias Avenue 80, Athens, Greece
| | - Dimitrios Papageorgiou
- 1st Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias Avenue 80, Athens, Greece
| | - Athanasios Douligeris
- 1st Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias Avenue 80, Athens, Greece.
| | - Anastasia Mortaki
- 1st Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias Avenue 80, Athens, Greece
| | - Dimitrios Efthymios Vlachos
- 1st Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias Avenue 80, Athens, Greece
| | - Nikolaos Thomakos
- 1st Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias Avenue 80, Athens, Greece
| | - Alexandros Rodolakis
- 1st Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias Avenue 80, Athens, Greece
| | - Dimitrios Haidopoulos
- 1st Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias Avenue 80, Athens, Greece
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Rodrigues IO, Duarte I, Costa CG, Pimentel AL, Chaves S, Gomes AP, Santos L, Santos JI, Moreira AC, Lobão A, Nazaré I, Santos P. Knowledge about cervical cancer in young Portuguese women: a cross-sectional study. Front Public Health 2024; 12:1357606. [PMID: 38560438 PMCID: PMC10978639 DOI: 10.3389/fpubh.2024.1357606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Health literacy is crucial to adherence to medical interventions in therapeutics, prevention, and diagnosis. The basis for literacy is knowledge. To accomplish the goals for the elimination of cervical cancer, one of the most prevalent and preventable cancers, we must understand the determinants of non-adherence and address them specifically to ensure patients' active participation. Aim To determine women's knowledge regarding the manifestations of cervical cancer and its prevention. Materials and methods We conducted a cross-sectional study in an urban population from northern Portugal. Women aged 18 to 30 years were randomly assigned to answer the Cervical Cancer Awareness Measure questionnaire, including questions of knowledge about the causes and symptoms of cervical cancer, prospecting for individual and social-related determinants. Results The total number of participants was 270, with a mean age of 24.7 years. Knowledge about symptoms scored 5.4 ± 2.6, with a maximum of 12 points, and knowledge about the causes scored 5.7 ± 1.9, with a maximum of 11 points. The correlation between both was 0.334. High education, high socio-economic status, self-perception of one's capacity to recognize symptoms, and knowledge about the HPV vaccine were associated with better knowledge. Discussion Portuguese women present low knowledge about cervical cancer, potentially affecting their health through exposure to risk situations and non-adherence to routine screening.
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Affiliation(s)
| | - Inês Duarte
- USF Barão do Corvo, ULS Gaia, Vila Nova de Gaia, Portugal
| | | | | | - Sílvia Chaves
- USF Barão do Corvo, ULS Gaia, Vila Nova de Gaia, Portugal
| | | | - Lina Santos
- USF Barão do Corvo, ULS Gaia, Vila Nova de Gaia, Portugal
| | | | | | - Andrea Lobão
- USF Barão do Corvo, ULS Gaia, Vila Nova de Gaia, Portugal
| | - Isabel Nazaré
- USF Barão do Corvo, ULS Gaia, Vila Nova de Gaia, Portugal
| | - Paulo Santos
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- Faculty of Medicine, Center for Health Technology and Services Research – CINTESIS@RISE, University of Porto, Porto, Portugal
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Wang H, Xu Y, Zhang H, Chen N. Determinants of HPV vaccine uptake intentions in Chinese clinical interns: an extended theory of planned behavior approach. Front Public Health 2024; 12:1345530. [PMID: 38435300 PMCID: PMC10904661 DOI: 10.3389/fpubh.2024.1345530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
Background This study aims to utilize the extended Theory of Planned Behavior (TPB) model to examine the intentions of clinical interns in China towards Human papillomaviruses (HPV) vaccination. It also fills a significant gap in the literature concerning vaccine acceptance in this specific population. Methods This cross-sectional study was carried out with clinical interns in Shandong Province, China, with a total of 1,619 participants. Data were collected through self-reported questionnaires, including demographic characteristics, TPB variables, and HPV-related health knowledge. Hierarchical regression analysis was employed to identify key factors influencing vaccination intentions, and Structural Equation Modeling (SEM) was used to analyze the interrelationships between these factors. Results This study initially identified key predictors affecting clinical interns' intentions to receive the HPV vaccine through hierarchical regression analysis. The preliminary model, which accounted for demographic factors, revealed foundational impacts of household income and HPV-related clinical experience on intentions. After integrating TPB variables-attitude, subjective norm, perceived behavioral control, and HPV-related health knowledge-the model's explanatory power was enhanced to 37.30%. SEM analysis focused on the interplay among TPB constructs and extended variables, confirming their significance in forming vaccination intentions, with subjective norm having the most substantial impact (β = 0.375, p < 0.001). The extended TPB model explained over half of the variance in vaccination intentions, substantiating the hypotheses and revealing the psychological determinants behind clinical interns' decision-making for HPV vaccination. Conclusion The extended TPB model from this study effectively explains the vaccination intentions among clinical interns for HPV, offering theoretical support for public health strategies and educational interventions targeting this group. These findings are of significant importance for public health practice and future health promotion strategies.
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Affiliation(s)
- Huizi Wang
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial QianFoshan Hospital, Jinan, China
| | - Yuedong Xu
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial QianFoshan Hospital, Jinan, China
| | - Hui Zhang
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial QianFoshan Hospital, Jinan, China
| | - Ning Chen
- Center of Digestive Endoscopy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Achimaș-Cadariu T, Pașca A, Jiboc NM, Puia A, Dumitrașcu DL. Vaccine Hesitancy among European Parents-Psychological and Social Factors Influencing the Decision to Vaccinate against HPV: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2024; 12:127. [PMID: 38400111 PMCID: PMC10891840 DOI: 10.3390/vaccines12020127] [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: 12/12/2023] [Revised: 01/21/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Due to low adherence to HPV vaccination programs, the European region struggles with vaccination rates lower than 30% among the targeted population. The present report investigated various socio-demographic and psychological factors influencing European parents' hesitancy towards vaccinating their children. METHODS As of September 2023, four databases were searched. After applying inclusion criteria, all articles comparing psychological and socio-demographic factors in parents who vaccinate or do not vaccinate their children were included. RESULTS Twenty-five primary publications met the criteria, totaling 385,460 responders, of which 311,803 want to or have already vaccinated their child, and 73,555 do not wish to do so. Immigrant and employment status, religion, age of parents and the child's gender seemed to influence their decision to vaccinate their child. Previous experience with vaccines, perceived safety and efficacy and the mother's previous abnormal CCS results also impacted their decision. The caregivers' education, gender, civil status, number of children, family history of neoplasia or mother's CCS attendance did not influence their hesitancy to vaccine. CONCLUSION Multiple demographic, social, economic and psychological barriers involved in the parents' hesitancy to vaccinate their children against the HPV virus were highlighted. Specific at-risk categories that need to be targeted with information, education and vaccination campaigns were identified.
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Affiliation(s)
- Teodora Achimaș-Cadariu
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (T.A.-C.); (A.P.); (D.L.D.)
| | - Andrei Pașca
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (T.A.-C.); (A.P.); (D.L.D.)
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
| | | | - Aida Puia
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (T.A.-C.); (A.P.); (D.L.D.)
| | - Dan Lucian Dumitrașcu
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (T.A.-C.); (A.P.); (D.L.D.)
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Hussein I, Vänskä S, Sivelä J, Leino T, Nohynek H. Factors associated with parental Human Papillomavirus (HPV) vaccination intention of daughter: A national survey in Finland. Vaccine 2024; 42:701-712. [PMID: 38172018 DOI: 10.1016/j.vaccine.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccines are offered free of charge in Finland to 10-12-year-old children. Nationally about 80% of girls are vaccinated, with regional differences in first dose coverage varying from 62% to 82% in girls born in 2011. This study examined the factors associated with HPV vaccination intention. Furthermore, we assessed the realisation of HPV vaccination among the daughters of the participating parents. METHODS A web-based survey was conducted for randomly selected parents of girls (N = 6 465) aged 10 to 14 years of age. Data was collected in February and March 2022 in five Finnish high and low coverage municipalities. The national vaccination register was employed to assess realisation of vaccination. RESULTS Participation rate was 13.7% (n = 883 parents). Almost all parents were aware of the association between HPV and cervical cancer, but only one fifth was aware of other diseases associated with HPV. Adherence to the national vaccination programme, parents' mother tongue, and trusting in official information were associated with positive vaccination intention. The most often reported reason for non-vaccination was fear of adverse effects (22%). Overall, parental attitudes towards HPV vaccination were positive, with 83% of parents indicating their daughter had received or will receive the vaccination. Vaccination realisation was subsequently examined and 88% of the daughters were vaccinated. CONCLUSIONS Despite low knowledge of HPV-related diseases overall, majority of parents held a positive intention to vaccinate their daughter. Realisation of intention was high in our study, higher than the national uptake. Foreign-origin parents had lower intention to vaccinate their daughters. As information on HPV and its vaccine is available in 11 languages, there is a need to re-think accessibility. In-depth interviews are needed to better explore the reasons behind non-vaccination.
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Affiliation(s)
- Idil Hussein
- Infectious Disease Control and Vaccinations, Department of Health Security, Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland; Doctoral Programme in Population Health, Faculty of Medicine, University of Helsinki, Finland.
| | - Simopekka Vänskä
- Infectious Disease Control and Vaccinations, Department of Health Security, Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland
| | - Jonas Sivelä
- Infectious Disease Control and Vaccinations, Department of Health Security, Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland
| | - Tuija Leino
- Infectious Disease Control and Vaccinations, Department of Health Security, Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland
| | - Hanna Nohynek
- Infectious Disease Control and Vaccinations, Department of Health Security, Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland
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Walker KK, Clare A, Kumar A, Gaviria-Agudelo C. A scoping review of the use of parent-adolescent dyads in HPV vaccination research. PATIENT EDUCATION AND COUNSELING 2024; 118:108007. [PMID: 37847989 DOI: 10.1016/j.pec.2023.108007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/13/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE Parental vaccine hesitancy is a significant contributor to low adolescent HPV vaccination. Shared HPV vaccination decision-making among adolescents and parents is an important determinant of vaccination uptake. We performed a scoping review to identify studies that used parent-adolescent dyads in HPV vaccination research. METHODS We searched peer-reviewed articles in PubMed, Embase, and PsychInfo from 2012 to 2023. Randomized or observational studies with parent-adolescent dyads related to HPV vaccination were eligible for inclusion. Articles were coded for the main themes related to use of parent-adolescent dyads in HPV vaccination research. RESULTS Fifteen articles met the inclusion criteria and were categorized into two main themes: qualitative decision-making and quantitative vaccination intentions. Dyad members reported substantially different roles, barriers, and facilitators of HPV vaccine decisions and intentions. Dyad members disagreed on who made the final decision. Provider recommendation style and content were important to parental confidence in the vaccine decision. CONCLUSION The recent evidence for parent-adolescent HPV vaccination dyad research is sparse but indicates that factors that account for dyad vaccination decisions and intentions often differ between dyad members. PRACTICE IMPLICATIONS Studies in this review support ongoing research with parent-adolescent dyads to target HPV vaccine interventions at individual dyad members to increase HPV vaccination.
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Affiliation(s)
- Kimberly K Walker
- Zimmerman School of Advertising and Mass Communications, University of South Florida, Tampa, FL, USA.
| | - Alyssa Clare
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
| | - Ambuj Kumar
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
| | - Claudia Gaviria-Agudelo
- Pediatric Infectious Diseases, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
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Roy DN, Tanvir MRS, Pallab MF, Ferdiousi N, Islam E, Azam MS. Potential determinants of childhood COVID-19 vaccine confidence among the primary school's stakeholders in Bangladesh: A cross-sectional study to assess the effects of education. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:420. [PMID: 38333173 PMCID: PMC10852184 DOI: 10.4103/jehp.jehp_1153_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 07/24/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Rapid corona virus disease 2019 (COVID-19) vaccination drives aimed to immunize primary school-aged youth have a potential for health safety and supportive academic attainment. This study aimed to identify the potential factors influencing childhood COVID-19 vaccine confidence among the primary school's stakeholders in Bangladesh and assess the effects of health education on vaccine confidence and receptivity. MATERIALS AND METHODS This cross-sectional study used a bilingual, multi-item, closed-ended, anonymous questionnaire adopted from the extant literature studies on the topic. Data were collected purposively by the face-to-face interview approach. In total, 627 primary school's stakeholders participated in this study. The binary logistic regressions and Chi-square tests were employed to investigate and rationalize the study-outlined objectives where <0.05 was considered statistically significant. RESULTS The pooled childhood vaccine confidence and receptivity against COVID-19 was 91% (95% CI 89-93) among the primary school's stakeholders. The regression analysis revealed that of eight potential determinants of vaccine confidence, "safety" and "effectiveness" had a highly significant (P = 0.006, P = 0.001, respectively) and positive association and "efficacy" had a significant (P = 0.03) and positive association, while "rumor" had a highly significant (P = 0.000) and negative association with childhood vaccine confidence. The analysis also showed that"health education" had a significant (P = 0.04) and positive association with childhood vaccine confidence and receptivity against COVID-19. Although the odds ratio for receiving childhood vaccine was found to be 0.6, the result was insignificant (P > 0.05) in the Chi-squared test. Hence, there was no vaccine-hesitant risky recipient group identified in implementing upcoming childhood COVID-19 vaccination programs. CONCLUSIONS This study confirms the importance of a positive perception of vaccine safety, efficacy, effectiveness, and health education for vaccine confidence under any circumstances. Childhood COVID-19 vaccine confidence is Improved if vaccination data become more available to the guardians and school community. Public health education would be considered a preferred approach for building trust and fostering childhood vaccine confidence against COVID-19 in Bangladesh.
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Affiliation(s)
- Debendra Nath Roy
- Department of Pharmacy, Jashore University of Science and Technology, Jashore, Bangladesh
- Institute of Education and Research, University of Rajshahi, Rajshahi, Bangladesh
| | | | - Maruf Faisal Pallab
- Department of Pharmacy, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Nowrin Ferdiousi
- Department of Pharmacy, Dhaka International University, Dhaka, Bangladesh
| | - Ekramul Islam
- Department of Pharmacy, University of Rajshahi, Bangladesh
| | - Md. Shah Azam
- Department of Marketing, University of Rajshahi, Rajshahi, Bangladesh
- Office of the Vice Chancellor, Rabindra University, Shahjadpur, Bangladesh
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Sorrentino M, Mercogliano M, Esposito F, Lamberti AM, Buonocore G, Riganti C, Triassi M, Palladino R. Identification of organizational barriers to HPV vaccination uptake in medical students in southern Italy: a cross-sectional study. Front Public Health 2023; 11:1272630. [PMID: 38045958 PMCID: PMC10691465 DOI: 10.3389/fpubh.2023.1272630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Despite proven efficacy, HPV vaccination coverage is still suboptimal. Factors influencing vaccination uptake are education attainment, socio-economic position, and knowledge about HPV. This study aimed to assess HPV vaccination uptake and its correlates among medical students and identify logistic-organizational barriers, knowledge, and attitudes with regard towards HPV vaccination to improve current public health vaccination strategies. Medical students, with their acquired biological knowledge, were selected as a low-risk groups for HPV vaccination uptake. This cross-sectional study was conducted using a validated questionnaire. Methods Students in their the first 3 years of study students were preferentially invited. Eventually, the invitation was extended to every medical student. Logistic multivariable regression was used to assess determinants of HPV vaccination uptake. Additional analysis explored determinants of knowledge of and attitude toward HPV vaccination. Finally, a sensitive analysis was conducted to further assess the effect of knowledge and attitude on the HPV vaccination rate. Results A total of 882 medical students participated, with 74.5% enrolled in the first 3 years of their training. HPV vaccination uptake was 55.5%, ranging from 78.5% for females to 16.5% for males. Male sex and increasing age were consistently associated with a lower vaccination uptake (males sex: OR 0.03, CI 0.02-0.05; age: OR 0.77, CI 0.68-0.88), whereasilst progress in their academic career was associated with a to higher likelihood of being vaccinated (6th year: OR 3.45, CI 1.24-9.57). These associations were confirmed when considering the knowledge of and attitude towards HPV. Additionally also, an active outreach from healthcare institutions was associated with a higher likelihood of receiving HPV vaccination (OR 1.70, CI 1.09-2.65. Conclusion HPV vaccination in medical students was higher than in the general population; however, it was still suboptimal. An active and up-to-date call strategy and extending the free-of-charge offer are essential measures for to improvinge vaccination uptake. The findings support the need to improve public health strategies and increase awareness and knowledge ofregarding HPV vaccination.
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Affiliation(s)
- Michele Sorrentino
- Department of Public Health, University “Federico II” of Naples, Naples, Italy
| | | | - Federica Esposito
- Department of Public Health, University “Federico II” of Naples, Naples, Italy
| | | | - Gaetano Buonocore
- Clinical Directorate, niversity Hospital “Federico II” of Naples, Naples, Italy
| | - Carla Riganti
- Clinical Directorate, niversity Hospital “Federico II” of Naples, Naples, Italy
| | - Maria Triassi
- Department of Public Health, University “Federico II” of Naples, Naples, Italy
- Interdepartmental Research Center in Healthcare Management and Innovation in Healthcare (CIRMIS), Naples, Italy
| | - Raffaele Palladino
- Department of Public Health, University “Federico II” of Naples, Naples, Italy
- Interdepartmental Research Center in Healthcare Management and Innovation in Healthcare (CIRMIS), Naples, Italy
- Department of Primary Care and Public Health, School of Public Health, Imperial College, London, United Kingdom
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Moffroid H, Doglioni DO, Chyderiotis S, Sicsic J, Barret AS, Raude J, Bruel S, Gauchet A, Michel M, Gagneux-Brunon A, Thilly N, Mueller JE. Can physicians and schools mitigate social inequalities in human papillomavirus vaccine awareness, uptake and vaccination intention among adolescents? A cross-sectional study, France, 2021 to 2022. Euro Surveill 2023; 28:2300166. [PMID: 37971661 PMCID: PMC10655205 DOI: 10.2807/1560-7917.es.2023.28.46.2300166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/27/2023] [Indexed: 11/19/2023] Open
Abstract
BackgroundIn France, human papillomavirus (HPV) vaccination coverage varies across socioeconomic levels.AimWe aimed at assessing HPV vaccine awareness, uptake and vaccination intention among adolescents in France.MethodsIn a cluster-randomised study, 13-15-year-old students in 61 French middle schools completed a web-based questionnaire. We used multivariable logistic regression to evaluate determinants of HPV vaccine awareness, self-reported uptake and vaccination intention among unvaccinated students and interaction terms to explore effects of visits to family physician and remembering school lessons on vaccination. The French deprivation index of school municipalities served as proxy for socioeconomic levels.ResultsAmong 6,992 participants, awareness was significantly associated with parental education (odds ratio (OR) = 0.82; 95% confidence interval (CI): 0.71-0.95), language spoken at home (OR = 0.59; 95% CI: 0.52-0.66) and deprivation level (OR = 0.57; 95% CI: 0.44-0.71), regardless of physician visit or school lessons. Vaccine uptake was associated with parental education without a recent physician visit (OR = 0.31; 95% CI: 0.16-0.59, vs OR = 0.64; 95% CI: 0.52-0.78 with a visit, interaction p = 0.045). Vaccination intention among unvaccinated was associated with deprivation level (moderate-low vs low) among students not remembering school lessons on vaccination (OR = 0.17; 95% CI: 0.05-0.62, vs OR = 0.93; 95% CI: 0.51-1.67 remembering school lessons, interaction p = 0.022). Parental education was associated with vaccination intention among students reporting a physician visit (OR = 0.41; 95% CI: 0.26-0.64 vs OR = 1.05; 95% CI: 0.50-2.20 without a visit, interaction p = 0.034).ConclusionOur results suggest that healthcare and school could promote vaccination and mitigate social inequalities in HPV vaccination coverage.
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Affiliation(s)
- Hadrien Moffroid
- Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, 75015 Paris, France
- University of Melbourne, Melbourne, Australia
| | - Damien Oudin Doglioni
- Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, 75015 Paris, France
| | - Sandra Chyderiotis
- Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, 75015 Paris, France
| | | | | | - Jocelyn Raude
- Université Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U1309 - 35000 Rennes, France
| | - Sebastien Bruel
- Department of General Practice, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, Université de Lyon, Saint-Etienne, France
- Health, Systemic, Process UR 4129 Research Unit, University Claude Bernard, University of Lyon, Lyon, France
| | - Aurelie Gauchet
- Université Savoie Mont Blanc, Université Grenoble Alpes LIP/PC2S, Grenoble, France
| | - Morgane Michel
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'épidémiologie clinique, Paris, France
- Université Paris Cité, ECEVE, UMR1123, Inserm, Paris, France
| | - Amandine Gagneux-Brunon
- CHU de Saint-Etienne - Service d'infectiologie
- Centre International de Recherche en Infectiologie, Team GIMAP, Université de Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, Nancy, France
- Université de Lorraine, CHRU-Nancy, Département Méthodologie, Promotion, Investigation, Nancy, France
| | - Judith E Mueller
- Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, 75015 Paris, France
- Université Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U1309 - 35000 Rennes, France
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Iova CF, Badau D, Daina MD, Șuteu CL, Daina LG. Evaluation of the Knowledge and Attitude of Adolescents Regarding the HPV Infection, HPV Vaccination and Cervical Cancer in a Region from the Northwest of Romania. Patient Prefer Adherence 2023; 17:2249-2262. [PMID: 37706209 PMCID: PMC10497041 DOI: 10.2147/ppa.s421875] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/22/2023] [Indexed: 09/15/2023] Open
Abstract
Purpose In Romania, after reaching the age of 18, teenage girls can make an informed decision about vaccination. The aim of the study was to evaluate both knowledge and attitudes related to HPV infection, HPV vaccination, cervical cancer, as well as intentions, reservations, reasons that could influence the decision related to vaccination. Patients and Methods We applied an anonymized questionnaire to 690 teenage girls in the 18-19 age group, recruited from 15 high schools in Bihor County. Based on the answers to the question corresponding to item 14 of subscale 3, 2 groups were identified: the group with a hesitant behavior called the non-vaccine group (GNV) and the group with a positive behavior called the pro-vaccine group (GPV). The statistical analysis was processed by using IBM-SPSS 22. Results The analysis revealed significant differences between the groups in terms of the level of knowledge and attitudes related to vaccination, the adolescent girls in the GPV being more aware of the role and importance of HPV vaccination and more open to the idea of vaccination. For the GNV, the behavior can be explained by the fact that even if they have heard about the HPV infection being transmitted through unprotected sex and they think that vaccination in general is necessary to prevent certain diseases, they do not know if HPV vaccination would be effective in protecting them in the future. Adolescents from GPV declare they would accept HPV vaccination if it would be offered to them or they are already vaccinated. Conclusion Alongside interventions targeting parents and health-care professionals, it is necessary to improve the level of knowledge of adolescents about HPV infection, HPV vaccination and cervical cancer, by organizing information campaigns in schools, campaigns in which professionals in the field should be involved, but also by implementing education programs addressed to them.
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Affiliation(s)
- Camelia Florina Iova
- Faculty of Medicine and Pharmacy, Doctoral School, University of Oradea, Oradea, 410081, Romania
- Department of Epidemiological Surveillance and Disease Control, Directorate of Public Health of Oradea, Oradea, 410042, Romania
| | - Dana Badau
- Petru Maior Faculty of Sciences and Letters, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, 540142, Romania
- Interdisciplinary Doctoral School, Transilvania University, Brasov, 500068, Romania
| | | | - Corina Lacramioara Șuteu
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, 410081, Romania
- Department of Quality Management in Health, Emergency Clinical County Hospital of Oradea, Oradea, Romania
| | - Lucia Georgeta Daina
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, 410081, Romania
- Department of Quality Management in Health, Emergency Clinical County Hospital of Oradea, Oradea, Romania
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Nellessen T, Ebner B, Pyrgidis N, Ledderose S, Kretschmer A, Marcon J, Teupser D, Mayr D, Faihs V, Stief CG, French LE, Herlemann A, Reinholz M. Characterization of Human Papilloma Virus in Prostate Cancer Patients Undergoing Radical Prostatectomy-A Prospective Study of 140 Patients. Viruses 2023; 15:1264. [PMID: 37376564 DOI: 10.3390/v15061264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/21/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION The association between human papilloma virus (HPV) and the pathogenesis of prostate cancer (PCa) is still controversial. Existing studies often lack information about clinical risk factors, are limited by their retrospective design or only use a single detection method for HPV. MATERIAL AND METHODS A total of 140 patients undergoing radical prostatectomy (RP) for PCa at the Department of Urology, Ludwig Maximilian University of Munich, Germany, were prospectively enrolled. Knowledge of HPV and sociodemographic parameters were assessed with questionnaires. The following methods were used for HPV detection: RP specimens were tested for HPV DNA by PCR. If HPV DNA was detected, an LCD-Array hybridization technique was used for HPV subtyping, and immunohistochemical staining for p16 was performed as a surrogate marker for HPV infection. Serological titers of HPV-16 L1 antibodies were measured using an HPV-16-specific immunoassay. RESULTS HPV DNA was detected in 9.3% (13/140) of RP specimens, with HPV-16 being the most predominantly detected subtype (5/13 = 39%). HPV-16 L1 antibody levels were below the limit of detection in 98% of patients (137/140). We found no significant difference between HPV PCR-positive (HPV+) and -negative (HPV-) patients in terms of HPV-16 antibody levels, history of HPV-associated diseases, level of education or marital status. Seventy-five percent of all PCa patients had never heard of HPV before. An acinar adenocarcinoma of the prostate was the most frequently detected histologic type in both HPV+ (100%) and HPV- (98%) patients (p = 0.86). HPV+ patients had fewer positive biopsy cores (3.5 vs. 5.8; p = 0.01) and a lower maximal tumor infiltration rate per core (37% vs. 57%; p = 0.03) compared to HPV- patients. However, when analyzing the whole prostate and the lymph nodes after RP, there were no significant differences in TNM stage, Gleason score or tumor volume between both groups. In a subgroup analysis of all high-risk HPV patients (n = 6), we found no significant differences in sociodemographic, clinical or histopathological parameters compared to HPV- or low-risk HPV+ patients. CONCLUSION In our prospective study, we were not able to prove a clinically significant impact of HPV status on tumor characteristics in RP specimens. Most men with PCa had never heard of HPV, despite its proven causal association with other tumor entities.
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Affiliation(s)
- Tobias Nellessen
- Department of Urology, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
- Department of Dermatology and Allergy, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
| | - Benedikt Ebner
- Department of Urology, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
| | - Nikolaos Pyrgidis
- Department of Urology, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
| | - Stephan Ledderose
- Institute of Pathology, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
| | - Alexander Kretschmer
- Department of Urology, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
| | - Julian Marcon
- Department of Urology, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
| | - Daniel Teupser
- Institute of Laboratory Medicine, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
| | - Doris Mayr
- Institute of Pathology, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
| | - Valentina Faihs
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, 80802 Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
| | - Lars E French
- Department of Dermatology and Allergy, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
| | - Annika Herlemann
- Department of Urology, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
| | - Markus Reinholz
- Department of Dermatology and Allergy, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
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Kutz JM, Rausche P, Gheit T, Puradiredja DI, Fusco D. Barriers and facilitators of HPV vaccination in sub-saharan Africa: a systematic review. BMC Public Health 2023; 23:974. [PMID: 37237329 PMCID: PMC10214362 DOI: 10.1186/s12889-023-15842-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Human Papilloma Virus (HPV) is the most common sexually transmitted infection worldwide. Globally, both men and women have a 50% risk of being infected at least once in their life. HPV prevalence is among the highest in sub-Saharan Africa (SSA), at an average of 24%. HPV causes different types of cancers, including cervical cancer (CC), which is the leading cause of cancer deaths among women in SSA. HPV-vaccination has been proven to be effective in reducing HPV induced cancers. SSA countries are delayed in reaching the WHO's target of fully vaccinating 90% of girls within the age of 15 by 2030. Our systematic review aims to identify barriers and facilitators of HPV-vaccination in SSA to inform national implementation strategies in the region. METHODS This is a mixed method systematic review based on the PRISMA statement and The Joanna Briggs Institute Reviewers' Manual. Search strategies were adapted to each selected database: PubMed/MEDLINE, Livivo, Google Scholar, Science Direct, and African Journals Online for papers published in English, Italian, German, French and Spanish between 1 December 2011 and 31 December 2021. Zotero and Rayyan were the software used for data management. The appraisal was conducted by three independent reviewers. RESULTS A total of 20 articles were selected for appraisal from an initial 536 articles. Barriers included: limited health system capacities, socio-economic status, stigma, fear and costs of vaccines, negative experience with vaccinations, COVID-19 pandemic, lack of correct information, health education (HE) and consent. Additionally, we found that boys are scarcely considered for HPV-vaccination by parents and stakeholders. Facilitators included: information and knowledge, policy implementation, positive experience with vaccinations, HE, stakeholders' engagement, women's empowerment, community engagement, seasonality, and target-oriented vaccination campaigns. CONCLUSIONS This review synthesizes barriers and facilitators of HPV-vaccinations in SSA. Addressing these can contribute to the implementation of more effective HPV immunization programs targeted at eliminating CC in line with the WHO 90/70/90 strategy. REGISTRATION AND FUNDING Protocol ID: CRD42022338609 registered in the International Prospective Register of Systematic Reviews (PROSPERO). Partial funds: German Centre for Infection research (DZIF) project NAMASTE: 8,008,803,819.
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Affiliation(s)
- Jean-Marc Kutz
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Pia Rausche
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Tarik Gheit
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Dewi Ismajani Puradiredja
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
| | - Daniela Fusco
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany.
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany.
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Setiawan D, Annisa AN, Lianawati, Hutubessy RCW, Ting Yeung KH. The Cost Analysis of Human Papillomavirus Vaccination Program in Indonesia. Value Health Reg Issues 2023; 35:102-108. [PMID: 36934486 DOI: 10.1016/j.vhri.2023.01.005] [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: 07/28/2022] [Revised: 12/05/2022] [Accepted: 01/20/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVES This study aimed to analyze and describe the cost of HPV vaccination program in Indonesia. METHODS This study identified the cost-related HPV vaccination program implemented in Makassar, Manado, and Surabaya cities, Indonesia, according to the previous activities performed. Cost information was collected and analyzed in each specific activity for each cost components, using the HPV vaccination module of the World Health Organization Cervical Cancer Prevention and Control Costing tool. RESULTS According to the Cervical Cancer Prevention and Control Costing tool, the recurrent costs, both financial and economic costs, dominated the HPV vaccination program costs in Surabaya (US dollars [USD] 264 618; USD 268 724), Makassar (USD 166 852; USD 293 300), and Manado (USD 270 815; USD 270 946), with a total cost of USD 702 285 for financial cost and USD 832 970 for economic cost. Vaccine procurement drives the recurrent cost. CONCLUSIONS The implementation of demonstration program in Surabaya, Makassar, and Manado cities was considerably succeed. Any prediction related to the cost of implementation of HPV vaccination in Indonesia can be calculated and used to advocate regional or national government.
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Affiliation(s)
- Didik Setiawan
- Faculty of Pharmacy, Universitas Muhammadiyah Purwokerto, Purwokerto, Central of Java, Indonesia; Center for Health Economics Studies, Universitas Muhammadiyah Purwokerto, Purwokerto, Central of Java, Indonesia.
| | - Andi Nurul Annisa
- Center for Health Economics Studies, Universitas Muhammadiyah Purwokerto, Purwokerto, Central of Java, Indonesia
| | - Lianawati
- Center for Health Economics Studies, Universitas Muhammadiyah Purwokerto, Purwokerto, Central of Java, Indonesia
| | - Raymond C W Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Switzerland
| | - Karene Hoi Ting Yeung
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Switzerland
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Tobaiqy MA, Mehdar SA, Altayeb TI, Saad TM, Alqutub ST. Parental knowledge, views, and perceptions of human papilloma virus infection and vaccination-cross-sectional descriptive study. J Family Med Prim Care 2023; 12:556-560. [PMID: 37122659 PMCID: PMC10131950 DOI: 10.4103/jfmpc.jfmpc_1673_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/28/2022] [Accepted: 12/27/2022] [Indexed: 05/02/2023] Open
Abstract
Human papillomavirus (HPV) is a highly contagious virus that is linked to cervical cancer and is a major public health issue. Saudi Arabia national efforts aimed to have females aged 9-25 years to receive the available vaccine. Objectives This study aims to explore parental knowledge, views, and perceptions around HPV in Saudi Arabia. Methods A cross-sectional online questionnaire was used through direct interview to collect information from a group of parents attending King Abdul-Aziz University Hospital in Jeddah, Saudi Arabia. The questionnaire comprised items including demographics, knowledge, views, and perceptions of HPV infection and vaccination. Results Of the 500 parents who participated in this study, only 54 (11%) had heard about HPV being associated with cervical cancer. The majority of the participants reported being from the middle social class (n = 472, 94.4%). The vast majority (n = 483, 96.8%) had never heard of the HPV vaccine and (n = 470, 94%) were unwilling to vaccinate their daughters. The primary reported reason behind refusing the vaccine was the lack of information on the importance of HPV vaccination (n = 426, 85.2%). The majority (n = 419, 83.8%) believed that there was insufficient information regarding vaccine safety and efficacy. Participants suggested ways to increase vaccination acceptance like social media awareness (n = 369, 73.8%), educational seminars in schools (n = 254, 50.8%), and a governmental platform (n = 218, 43.6%) providing information on HPV infection and promoting vaccination. Conclusion Parents in the present study demonstrated a substantial lack of knowledge about HPV infection and vaccination, which may necessitate the establishment of national awareness campaigns.
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Affiliation(s)
- Mansour A. Tobaiqy
- Department of Pharmacology, Faculty of Medicine, University of Jeddah, Kingdom of Saudi Arabia
| | - Safaa A. Mehdar
- Medical Student, College of Medicine, University of Jeddah, Kingdom of Saudi Arabia
| | - Tasneem I. Altayeb
- Medical Student, College of Medicine, University of Jeddah, Kingdom of Saudi Arabia
| | - Tala M. Saad
- Medical Student, College of Medicine, University of Jeddah, Kingdom of Saudi Arabia
| | - Sulafa T. Alqutub
- Family and Community Medicine Department, Faculty of Medicine, University of Jeddah, Jeddah, Kingdom of Saudi Arabia
- Address for correspondence: Dr. Sulafa T. Alqutub, 5340 Abdulrahman Bin Abi Farad, 23717 - AlBasatin Dist., Jeddah, Kingdom of Saudi Arabia. E-mail:
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Jäger L, Senn O, Rosemann T, Plate A. Assessment of Human Papillomavirus Vaccination in Primary Care Among Swiss University Students. JAMA Netw Open 2023; 6:e233949. [PMID: 36943263 PMCID: PMC10031396 DOI: 10.1001/jamanetworkopen.2023.3949] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
IMPORTANCE Human papillomavirus vaccination coverage rates lie below desired thresholds in Switzerland. Because general practitioners are the main contact for the relatively rare health issues of many Swiss young adults, primary care offers an important opportunity to provide catch-up human papillomavirus vaccination. OBJECTIVE To examine the knowledge, experiences, and attitudes of Swiss university students in the context of receiving human papillomavirus vaccination during primary care visits. DESIGN, SETTING, AND PARTICIPANTS This self-administered, cross-sectional, web-based survey study was conducted among students of 3 universities and 1 educational institution for health professions in the Swiss Canton of Zurich. Specific questions about human papillomavirus vaccination experience were directed to respondents who had received at least 1 dose administered by a general practitioner. Responses were collected during 12-week intervals between November 11, 2020, and April 7, 2021, and data were analyzed from August 3 to August 30, 2022. MAIN OUTCOMES AND MEASURES The primary outcome was whether human papillomavirus vaccination had been administered on the patient's or the general practitioner's initiative. RESULTS The responses of 5524 participants (median [IQR] age, 23 [21-25] years; 3878 women [70.2%]) were analyzed. The survey completion rate was 90.9% (5524 of 6076 students who consented to participate). A total of 2029 respondents (1792 women [46.2%] and 237 men [14.6%]) reported having received at least 1 human papillomavirus vaccination dose, of whom 740 (36.5%) had received at least 1 dose administered by a general practitioner. Among these, 190 respondents (25.7%) reported that vaccine administration had occurred on their request rather than on their general practitioner's initiative. Among all respondents, 4778 (86.5%) wanted to obtain more information about human papillomavirus vaccination at a general practitioner's office, and 2569 (55.3%) rated acute consultations in general practice as inappropriate for addressing human papillomavirus vaccination. CONCLUSIONS AND RELEVANCE The findings of this survey study of Swiss university students suggest that primary care shows a high potential for increasing human papillomavirus vaccination coverage rates in Switzerland. However, there was room for improvement in the proactivity of general practitioners, especially with men, and in the attitudes of students toward the appropriateness of acute consultations in general practice for addressing human papillomavirus vaccination.
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Affiliation(s)
- Levy Jäger
- Institute of Primary Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Andreas Plate
- Institute of Primary Care, University Hospital and University of Zurich, Zurich, Switzerland
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Barriers in the School-Based Pan-Gender HPV Vaccination Program in Sweden: Healthcare Providers' Perspective. Vaccines (Basel) 2023; 11:vaccines11020310. [PMID: 36851188 PMCID: PMC9962905 DOI: 10.3390/vaccines11020310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) vaccines effectively prevent, and can even eliminate, HPV-related cancers. Currently, vaccination rates are suboptimal in the national Swedish school-based vaccination program. School nurses play a key role in all aspects of the vaccination process. Therefore, this study aims to explore school nurses' perceived HPV vaccination challenges. METHODS Seven focus group interviews were conducted with school nurses (n = 35) working in nine socio-demographically diverse municipalities in mid-Sweden. Data were analyzed using qualitative content analysis. RESULTS Participants described difficulties in encountering and handling the diversity of reasons for vaccine hesitancy. Parents known to be skeptical of vaccines in general were seen as most difficult to reach. Uncertainty was expressed concerning the extent of professional responsibility for vaccine promotion. The informants expressed a lack of guidelines for vaccine promotion and described challenges in supporting the child's own wishes. Creating a safe space for the individual child was seen as crucial. Other problems described were the challenges of overcoming children's fear of needles, supporting unvaccinated children, and being confronted with the remaining gender inequities of the pan-gender vaccination program. CONCLUSIONS Our results suggest that school nurses, especially those new to their profession, may benefit from training and guidance22 material on how to address vaccine hesitancy.
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Güneş Ö, Özkaya-Parlakay A, Güney AY, Güder L, Mustafaoğlu Ö, Bayraktar P, Kanık-Yüksek S, Gülhan B. A Survey on Parents' Health Literacy on Childhood Human Papilloma Virus Vaccination. J PEDIAT INF DIS-GER 2023. [DOI: 10.1055/s-0042-1760374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Abstract
Objective The aim of this study is to determine parents' knowledge levels and attitudes about childhood human papillomavirus (HPV) vaccination and reveal the differences between parents who are health care workers and nonhealth care workers. The HPV vaccine can potentially prevent initial HPV infection and HPV-related genital and anal precancerous disorders and cancers.
Methods Questions and attitudes toward childhood HPV vaccination were asked to 564 parents who agreed to participate in the study.
Results In our study, the rate of health care worker parents considering having their children vaccinated against HPV (63.1%) was higher than that of nonhealth care worker parents (11.4%). Only 5% of parents had their children previously vaccinated against HPV; however, there was no difference between parents who were health care workers and those who were not. In addition, this rate was relatively low compared to other paid vaccines (49.8, 35.3, and 18.8%, respectively). Parents who had not previously vaccinated their children against HPV were considering getting their children vaccinated, especially if a pediatrician recommended it.
Conclusion The parents' high level of health literacy may not be effective in deciding to vaccinate their children against HPV. Therefore, adequate information and awareness should be provided to all parents about HPV vaccination as early as possible for all children of appropriate age. Pediatricians should be given important roles in raising the awareness of parents about childhood HPV vaccination by health authorities.
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Affiliation(s)
- Ömer Güneş
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye
| | - Aslınur Özkaya-Parlakay
- Department of Pediatric Infectious Diseases, Yildirim Beyazit University, Ankara City Hospital, Ankara, Türkiye
| | - Ahmet Yasin Güney
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye
| | - Latife Güder
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye
| | - Özlem Mustafaoğlu
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye
| | - Pınar Bayraktar
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye
| | - Saliha Kanık-Yüksek
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye
| | - Belgin Gülhan
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye
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Babi A, Issa T, Issanov A, Akhanova S, Udalova N, Koktova S, Balykov A, Sattarkyzy Z, Imankulova B, Kamzayeva N, Almawi WY, Aimagambetova G. Knowledge and attitudes of mothers toward HPV vaccination: A cross-sectional study in Kazakhstan. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231172355. [PMID: 37184051 DOI: 10.1177/17455057231172355] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Although recommended for all member states of World Health Organization, there is no national human papillomavirus vaccination program in Kazakhstan. Furthermore, there are no studies in Kazakhstan that evaluate the mothers' perception of human papillomavirus vaccines. OBJECTIVES This study aims to assess the knowledge and attitudes toward human papillomavirus vaccination among mothers in Kazakhstan and the factors associated with their attitudes. DESIGN A cross-sectional study was performed during the period of December 2021-February 2022. The STROBE guideline for cross-sectional studies was applied. METHODS Paper-based structured questionnaires were filled out by 191 mothers, 141 of whom had daughters. The attitude score was assessed as per the Likert-type scale. The Chi-square and Fisher's exact tests, with a significance value of < 0.05 were used to analyze the relationships between the characteristics of mothers and their attitude scores. RESULTS The following factors were significantly associated with mothers' attitudes toward human papillomavirus vaccination: a place of residence, family income, number of children, and refusal of vaccination for themselves (p < 0.005). Of all participants, only 45% of all mothers, 41% of mothers with a female, and 46% of mothers with male children had positive attitudes toward human papillomavirus vaccination. The child's gender was not a significant determinant. Overall, the level of knowledge about human papillomavirus vaccination was found to be low. The median total score is 0 out of 12 for women who have negative and neutral attitudes toward human papillomavirus vaccines. Among women who have positive attitudes toward HPV vaccines, the median score is around 3 points. CONCLUSION Before the implementation of the human papillomavirus vaccination program into the Kazakhstani national vaccination calendar, comprehensive and adequate information and education campaigns are required on the national level for parents and the population in general.
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Affiliation(s)
- Aisha Babi
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Torgyn Issa
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Alpamys Issanov
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Sholpan Akhanova
- Obstetrics and Gynecology Department, "Keruen Medicus" Clinic, Almaty, Kazakhstan
| | - Natalya Udalova
- Obstetrics and Gynecology Department, East-Kazakhstan Regional Hospital, Oskemen, Kazakhstan
| | | | | | - Zhanna Sattarkyzy
- Obstetrics and Gynecology Department, City polyclinic #6, Astana, Kazakhstan
| | - Balkenzhe Imankulova
- Clinical Academic Department of Women's Health, CF University Medical Center, Astana, Kazakhstan
| | - Nazira Kamzayeva
- Clinical Academic Department of Women's Health, CF University Medical Center, Astana, Kazakhstan
| | - Wassim Y Almawi
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana, Kazakhstan
- Faculty of Sciences, El-Manar University, Tunis, Tunisia
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López N, de la Cueva IS, Taborga E, de Alba AF, Cabeza I, Raba RM, Marès J, Company P, Herrera B, Cotarelo M. HPV knowledge and vaccine acceptability: a survey-based study among parents of adolescents (KAPPAS study). Infect Agent Cancer 2022; 17:55. [DOI: 10.1186/s13027-022-00467-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
Human papillomavirus (HPV) infection is recognized as one of the major causes of infection-related cancer worldwide. In Spain, the HPV vaccination program started in 2007 and until 2022, it targeted 12-year-old girls.
Methods
This was a cross-sectional, multicenter survey-based research carried out at 24 pediatric offices to describe HPV knowledge and vaccine acceptability in parents of children aged between 9 and 14 years-old in Spain. Parents were randomly selected from the medical records following specific quotas to ensure representativeness. The survey included five sections that aim to collect information about sociodemographic characteristics, knowledge of HPV, knowledge and acceptability of vaccines in general, HPV vaccination knowledge and HPV vaccine acceptability. Each section was constituted by a number of close questions with different answer options. Specific scores were assigned to each possible answer to these questions. Based on these scores, four composite variables were created to assess HPV knowledge, HPV vaccine knowledge, HPV vaccine acceptability and vaccines knowledge and acceptability in general. A latent class analysis was performed to identify different group of respondents according to their HPV vaccine acceptability.
Results
A total of 1405 valid surveys were included, with 86.19% of the respondents being mothers. The mean score of HPV knowledge was 28.92 out of 40 (maximum value) (95% CI 28.70–29.20) and the mean score of HPV vaccine acceptability was 3.37 out of 5 (maximum value). One third of parents still need more information to take a final decision about HPV vaccination in their children. Parents perceived that females were more likely to become infected than males and tended to associate HPV infection mainly with cervical cancer, showing a. a lack of information about other HPV-related diseases affecting males.
Conclusions
This study results highlight the need for future actions and educational initiatives to raise awareness of HPV consequences in both genders and to contribute to achieving the elimination of HPV-related diseases beyond cervical cancer.
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Galeshi M, Shirafkan H, Yazdani S, Motaghi Z. Reproductive health needs of Human papillomavirus (HPV) positive women: A systematic review. PLoS One 2022; 17:e0266819. [PMID: 36095006 PMCID: PMC9467316 DOI: 10.1371/journal.pone.0266819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/26/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives Human papillomavirus is one of the most important causes of cervical cancer. Participating in an HPV test and receiving an HPV diagnosis can create questions about the needs and preferences. The present systematic review was conducted to determine the reproductive health needs of women with HPV. Methods We searched PubMed, Scopus, Web of Science, Google Scholar and Magiran, SID and Iranmedex. Without language restrictions and time constraints. We also searched the grey literature and carried out forward/backward citation searches. Results In the first, 1056 articles were retrieved, and, after removing them, 13 articles published were entered. The studies were qualitative (N = 9), quantitative (N = 3), and one was unclear. Most qualitative studies collected data using individual interviews (N = 7), two qualitative studies, narratives of HPV patients from a website of patient experiences and questions. Women wanted further information on different HPV viral types, transmission, implications for sexual partners, prevalence, latency and regression of HPV, their management options and the implications of infection for cancer risk and fertility. Women’s experience of searching the Internet for further information about HPV was reported as difficult, anxiety provoking and contributing to the stigma of the infection because information was often located in the context of other sexually transmitted infections, with multiple sexual partners highlighted as a risk factor for infection. Conclusion Surveys showed that the majority of women had unanswered questions about their HPV test results. The information that women thought was helpful in interpreting their test results included having a high-risk type of HPV, and cancer survival statistics for the virus. Women also needed information about sexual transmission, how HPV tested positive in a long-term relationship, and the potential consequences for their partners and the risk of re-infection. Younger women had questions about whether HPV could affect fertility.
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Affiliation(s)
- Mina Galeshi
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hoda Shirafkan
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Shahla Yazdani
- Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Motaghi
- Department of Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
- * E-mail:
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Awareness of human papillomavirus and acceptability of the vaccine among women in Palestine: is it time for policy adjustment? BMC Womens Health 2022; 22:352. [PMID: 35986304 PMCID: PMC9389825 DOI: 10.1186/s12905-022-01930-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 08/11/2022] [Indexed: 11/28/2022] Open
Abstract
Background Progress has been made in the reduction of morbidity and mortality of cervical cancer by the implementation of human papillomavirus (HPV) vaccination programs. This study aimed to assess the awareness of Palestinian women about HPV as well as their knowledge and acceptability of the HPV vaccine and to examine the factors associated with good awareness. Methods This was a national cross-sectional study. Adult women were recruited from hospitals, primary healthcare centers, and public spaces in 11 Palestinian governorates using convenience sampling. A structured questionnaire was used for data collection. For each correctly answered question, one point was given. The total score was calculated and categorized into poor (0–10) and good awareness (11–21). Results The questionnaire was completed by 7223 women out of 8086 who were approached (response rate = 89.3%). A total of 7058 questionnaires were included in the final analysis; 4403 from the West Bank and Jerusalem (WBJ) and 2655 from the Gaza Strip. Women recruited from the Gaza Strip were younger, getting lower monthly incomes, and with fewer chronic diseases than women recruited from the WBJ. Only 33 women (0.5%) displayed good awareness of HPV and its vaccine with 0.7% of women from WBJ and only 0.2% of women from the Gaza Strip. Completing post-secondary education, being employed or a student, and having a higher monthly income were associated with an increase in the likelihood of having good awareness. Among women who had heard of HPV (n = 571, 8.1%), only 46 women (8.1%) reported familiarity with its vaccine. Women from the WBJ were more likely than women from the Gaza Strip to have heard about the HPV vaccine (0.9% vs. 0.2%). Most women agreed to receive the HPV vaccine themselves or for their daughters if it was given without cost or with a co-payment. No differences were found in the likelihood of agreeing to receive the HPV vaccine among women in the WBJ versus the Gaza Strip. Conclusion The overall awareness of HPV and its vaccine was extremely low. Inclusion of the HPV vaccine in the national immunization program could change this, especially as the HPV vaccine appeared to be acceptable.
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Fisher H, Chantler T, Mounier-Jack S, Audrey S. Human papillomavirus vaccine communication materials for young people in English-speaking countries: A content analysis. HEALTH EDUCATION JOURNAL 2022; 81:513-528. [PMID: 35910267 PMCID: PMC9326800 DOI: 10.1177/00178969221092135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To undertake a content analysis of human papillomavirus (HPV) vaccine communication materials available to young people. DESIGN Content analysis. SETTING Majority English-speaking countries. METHODS Between March and April 2020, a web engine was utilised to search for and retrieve relevant communication materials. Content analysis was used to describe how the following key issues were covered: (1) side effects, (2) safety, (3) practicalities related to receiving the HPV vaccine and (4) gender-specific information. RESULTS A total of 44 separate communication materials were retrieved, predominantly videos, webpages and leaflets. There was a focus on mild side effects of the vaccine (43.2%), with less frequent reference being made to moderate or serious side effects (22.7%). Reassurance concerning the safety profile of vaccine was communicated by referencing the widespread use of the HPV vaccine (31.8%). Information regarding formal criteria for entry into the vaccination programme emphasised country-specific eligibility criteria (59.1%), the setting in which vaccination was offered (38.6%) and the number of doses required (38.6%). Content intended to improve young people's experiences of receiving the HPV vaccine was less often provided (22.7%). Gender-specific content usually related to specific HPV-related diseases (52.3%) and/or the availability of cervical cancer screening programmes (52.3%). CONCLUSION A variety of different communication tools were retrieved encompassing a wide variety of formats and content, reflective of different vaccination programmes and the varied priorities of organisations producing the materials. Findings will inform the co-production of a tailored educational package to improve access to information by populations of young people identified as having lower HPV vaccine uptake.
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Affiliation(s)
- Harriet Fisher
- National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tracey Chantler
- National Institute for Health Research Health Protection Research Unit in Vaccinations and Immunisation, London School of Hygiene and Tropical Medicine, London, UK
| | - Sandra Mounier-Jack
- National Institute for Health Research Health Protection Research Unit in Vaccinations and Immunisation, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzanne Audrey
- National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Naoum P, Athanasakis K, Zavras D, Kyriopoulos J, Pavi E. Knowledge, Perceptions and Attitudes Toward HPV Vaccination: A Survey on Parents of Girls Aged 11–18 Years Old in Greece. Front Glob Womens Health 2022; 3:871090. [PMID: 35783121 PMCID: PMC9243232 DOI: 10.3389/fgwh.2022.871090] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/16/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate knowledge, perceptions and practices of parents of girls aged 11–18 years old in Greece toward HPV vaccination, and determine which factors are associated with parents' decision to vaccinate their daughters. Methods A close-end questionnaire was constructed and telephone interviews were conducted upon informed consent. The sample was random, national, stratified by geographic region and representative of the general population of parents of girls aged 11–18. The data collected include: general knowledge, attitudes and perceptions concerning HPV and HPV vaccine, information regarding their daughters' HPV vaccination, and sociodemographic characteristics. Statistical analysis included descriptives and a logistic regression model to investigate which factors are associated with HPV vaccination. Results Overall, 1,000 parents participated in the study, 99.4% of which knew what HPV is and 98.8% knew there is a vaccine available against HPV. Furthermore, 47% of the parents stated that their daughters had been vaccinated against HPV, while further analysis revealed that only 35% had received all the recommended doses. In the logistic regression analysis, the following variables had a statistically significant association with HPV vaccination: perceived ease of contracting HPV (OR = 1.105), level of trust in medical profession regarding information on prevention (OR = 1.205), overall perception regarding importance of children's vaccination (OR = 0.618), internet/social media as a source of parent information regarding HPV (OR = 0.886), participant (parent) age (OR = 1.125), and daughter's treating physician's recommendation for HPV vaccination (OR = 7.319). Conclusions HPV vaccination coverage is still suboptimal. Comprehension of the obstacles toward this goal is important and the role of healthcare professionals is crucial to increase acceptance.
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HPV Vaccination: An Underused Strategy for the Prevention of Cancer. Curr Oncol 2022; 29:3780-3792. [PMID: 35621693 PMCID: PMC9140027 DOI: 10.3390/curroncol29050303] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/28/2022] [Accepted: 05/13/2022] [Indexed: 01/08/2023] Open
Abstract
Human papillomavirus (HPV) vaccination prevents cervical, head and neck, and anogenital cancers. However, global HPV vaccine coverage falls short of global targets and has seen unexpected and dramatic declines in some countries. This paper synthesizes the impact of HPV on the global burden of cancer and the potential benefit of HPV vaccination. Approximately 5% of the world’s cancers are specifically attributed to HPV. While the greatest global burden of HPV is cervical cancers in low- and middle-income countries, HPV-associated head and neck cancers are increasing in high-income countries and have surpassed cervical cancer as the primary HPV-associated cancer in some countries. Therefore, it is also critical to improve gender-neutral HPV vaccination. Understanding the modifiable drivers of vaccine acceptance and uptake is important for increasing HPV vaccination. The Behavioural and Social Drivers of Vaccination framework is broadly applied to identify key factors associated with HPV vaccination including domains concerning practical issues, motivation, social processes, and thinking and feeling. Among the behavioural strategies available to reduce the incidence and mortality of cancer, increasing HPV vaccination stands out as having unrealized potential to prevent disease, financial cost, and psychological distress. An understanding of the shifting burden of HPV and the factors associated with vaccination can be leveraged to regularly measure these factors, develop interventions to promote vaccine uptake, and improve global HPV vaccine coverage. Future research in diverse contexts is necessary to investigate the barriers and facilitators of global HPV vaccination.
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Fan KMH, Sprague S, Zhang P, Ariyawardana A, Johnson NW. Rates of oropharyngeal cancer continue to rise steeply amongst Australian men. Oral Dis 2022. [PMID: 35359030 DOI: 10.1111/odi.14202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/15/2022] [Accepted: 03/23/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To analyse trends in incidence of oropharyngeal cancers (OPC) across Australia from 1982 to 2017 with implications for prevention. METHODS Data were obtained from the Australian Cancer Database (ACD) compiled at the Australian Institute of Health and Welfare (AIHW). Joinpoint analyses are presented. RESULTS AND DISCUSSION A striking increase of age-standardised incidence rate (ASIR) of OPC by over 1.5 times: the most significant rise was between 2007 and 2017 with an annual percentage change (APC) of +5.24% (p<0.001). Slow but gradual growth of ASIR was observed among women with a statistically significant APC of +1.02% (p<0.001). Statistically significant bimodal increasing trends of APC were also observed in total ASIR of OPC. These rising trends are widely attributed to increased oral sex practices. Highest number of incident cases were found in patients aged 55 to 69 years old attributable to continued alcohol and tobacco exposure. Most common subsites affected were base of tongue (BOT) and "oropharynx" from 1982 to 2017. CONCLUSION OPC is rising rapidly across Australia, particularly in men. Whilst the national proportion of cases driven by HPV is not known, it is evident that vaccination is yet to have an impact.
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Affiliation(s)
- Ka Ming Henry Fan
- School of Medicine & Dentistry, Griffith University Queensland, Australia
| | - Samuel Sprague
- School of Medicine & Dentistry, Griffith University Queensland, Australia
| | - Ping Zhang
- Menzies Health Institute Queensland, Griffith University Queensland, Australia
| | - Anura Ariyawardana
- School of Medicine & Dentistry, Griffith University Queensland, Australia.,Queensland Health, Australia
| | - Newell W Johnson
- School of Medicine & Dentistry, Griffith University Queensland, Australia.,Menzies Health Institute Queensland, Griffith University Queensland, Australia.,Faculty of Dentistry Oral and Craniofacial Sciences, King's College London
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Ortega-Ortega M, Hanly P, Pearce A, Soerjomataram I, Sharp L. Paid and unpaid productivity losses due to premature mortality from cancer in Europe in 2018. Int J Cancer 2022; 150:580-593. [PMID: 34569617 DOI: 10.1002/ijc.33826] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/15/2021] [Accepted: 09/06/2021] [Indexed: 12/24/2022]
Abstract
When someone dies prematurely from cancer this represents a loss of productivity for society. This loss can be valued and provides a measure of the cancer burden. We estimated paid and unpaid productivity lost due to cancer-related premature mortality in 31 European countries in 2018. Lost productivity was estimated for all cancers combined and 23 cancer sites, overall, by region and country. Deaths aged 15 to 64 were abstracted from GLOBOCAN 2018. Unpaid time lost (housework, caring, volunteering) was derived from Eurostat. Paid and unpaid productivity losses were valued using the human capital approach. In total, 347,149 premature cancer deaths occurred (60% male). The total value of cancer-related lost productivity was €104.6 billion. Of this, €52.9 billion (50.6%) was due to lost paid work, and €51.7 billion (49.4%) to unpaid work. Females accounted for 36.7% of paid work costs but half (51.1%) of the unpaid work costs. Costs were highest in Western Europe (€52.0 billion). The most costly cancer was lung (€21.7 billion), followed by breast (€10.6 billion). The average loss per premature death was highest for Hodgkin's lymphoma (€506 345), melanoma (€450 694), brain cancer (€428 449) and leukaemia (€378 750). Cancer-related lost productivity costs are significant. Almost half are due to unpaid work losses, indicating the importance of considering both paid and unpaid labour in assessing the cancer economic burden. The high cost per premature death of some less common cancers illustrates the potential benefits that could accrue from investment in prevention and control of these cancers.
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Affiliation(s)
- Marta Ortega-Ortega
- Department of Applied and Public Economics, and Political Economy, Complutense University of Madrid, Madrid, Spain
| | - Paul Hanly
- School of Business, National College of Ireland, Dublin 1, Ireland
| | - Alison Pearce
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | | | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle Upon Tyne, UK
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López N, Salamanca de la Cueva I, Vergés E, Suárez Vicent E, Sánchez A, López AB, Panizo-Santos MB, Garcés-Sánchez M, Montesdeoca A, Rivera AJ, Cotarelo Suárez M. Factors influencing HPV knowledge and vaccine acceptability in parents of adolescent children: results from a survey-based study (KAPPAS study). Hum Vaccin Immunother 2022; 18:2024065. [PMID: 35103571 PMCID: PMC8993091 DOI: 10.1080/21645515.2021.2024065] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Human Papillomavirus (HPV) is one of the most common sexually transmitted infections associated with a wide range of diseases and cancers that may affect both genders. Since 2007, the Spanish National Immunization Program includes HPV vaccination, and currently it only targets 12-year-old girls. The objective of our study is to assess differences in the knowledge of HPV and HPV vaccine acceptability according to different factors, and to identify the role of different sources of information. A cross-sectional, multicenter survey research was carried out in twenty-four pediatric offices in Spain, and included parents of children aged 9 to 14 years old. 1,405 valid survey-responses were considered for the analysis. Parental awareness of HPV and HPV vaccine, as well as vaccine acceptability, are still strongly associated with child gender (girls) and age (12–14 years old). HPV knowledge and HPV vaccine acceptability are related to parental gender, HPV vaccination status and having at least one daughter. Parents who consulted a healthcare source to obtain further information about HPV had greater HPV and HPV vaccine knowledge and acceptability. HPV and HPV vaccine awareness and acceptability are strongly associated with child gender and age, which correlates with the current immunization program.
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Affiliation(s)
- Noelia López
- Medical Affairs Department, MSD Spain, Madrid, Spain
| | | | | | | | | | | | | | | | - Abián Montesdeoca
- Primary Care Pediatrician in Guanarteme Healthcare Center, Las Palmas and Member of the Vaccine Advisory Committee of the Spanish Association of Pediatrics
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Extension de la vaccination contre les HPV aux garçons : enquête auprès de familles et de médecins généralistes. Bull Cancer 2022; 109:445-456. [DOI: 10.1016/j.bulcan.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 11/15/2022]
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Galanis P, Vraka I, Siskou O, Konstantakopoulou O, Katsiroumpa A, Moisoglou I, Kaitelidou D. Predictors of Real-World Parents’ Acceptance to Vaccinate Their Children Against the COVID-19. Acta Med Litu 2022; 29:33-43. [PMID: 36061935 PMCID: PMC9428642 DOI: 10.15388/amed.2021.29.1.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 01/23/2023] Open
Abstract
Background: As the COVID-19 pandemic continues to threaten public health, the vaccination of children against the disease appears to be a key factor to control the pandemic. Our aim was to investigate the prevalence of parents who have vaccinated their children against the COVID-19 and the factors influencing this decision. Materials and Methods: We conducted a web-based cross-sectional study in Greece during the first week of September 2021. The study questionnaire was distributed through social media and a convenience sample was obtained. Only parents with children aged 12–17 years old could participate in the study. We collected socio-demographic data of parents and we measured their attitudes towards vaccination and COVID-19 pandemic. Results: Study population included 656 parents. Regarding vaccination, 27.1% of parents had their children vaccinated against the COVID-19, while almost all children had a complete vaccination history (98.9%). The most important reasons for decline of COVID-19 vaccination were doubts about the safety and effectiveness of COVID-19 vaccines (45.3%) and fear of side effects (36.6%). Regarding the information about the COVID-19 vaccines, parents showed more trust in family doctors than in scientists and the government. We found that increased parents’ age, increased trust in COVID-19 vaccines, and positive attitude of parents towards vaccination had a positive effect on children’s vaccination. Conclusions: Understanding the factors influencing parents’ decision to vaccinate their children against the COVID-19 is crucial to increase the COVID-19 vaccination coverage rate. Implementation of public health policies is necessary to spread knowledge about COVID-19 vaccines and to regain vaccine confidence.
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Runngren E, Eriksson M, Blomberg K. Parents' reasoning about HPV vaccination in Sweden. Scand J Caring Sci 2021; 36:1113-1122. [PMID: 34672006 DOI: 10.1111/scs.13041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/10/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of this study was to describe parents' reasoning in making decisions about vaccinating their daughters against human papilloma virus (HPV), a part of the Swedish vaccination programme. METHOD Twenty parents whose daughter had been offered HPV vaccination participated. Semi-structured individual interviews were conducted and analysed using thematic analysis. RESULTS The findings reveal that the decision-making process is complex. The parents trusted the vaccination programme and saw it as beneficial to society. They also described using different resources to decide about HPV vaccination, but they did not include their daughters in making the decision. DISCUSSION Parents need better vaccine and health literacy to be able to decide, based on evidence and in consultation with their daughters, on HPV vaccination. School nurses can play an important role in evidence-based decision-making about HPV vaccination and introducing children to this health-promoting intervention.
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Affiliation(s)
- Eva Runngren
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Students' Knowledge about Cervical Cancer Prevention in Poland. MEDICINA-LITHUANIA 2021; 57:medicina57101045. [PMID: 34684082 PMCID: PMC8539101 DOI: 10.3390/medicina57101045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 02/04/2023]
Abstract
Background and Objectives: In Poland, the rates of morbidity and mortality due to cervical cancer are amongst the highest in Europe. A significant percentage of newly diagnosed cases of cervical cancer are at an advanced stage. Unfortunately, only about 20% of Polish women take part in cervical cancer screening. The aim of the study was to assess students’ knowledge of cervical cancer risk factors and prevention. Materials and Methods: The study was provided to Polish students from various universities and faculties between May 2020 and November 2020. The questionnaire was designed specifically for this study and was validated. The chi-square test was used to compare the responses between subgroups. Results: The study was carried out on a group of 995 students (80.6% women, 19% men, 0.4% no data), (average age 21.9 years). Most students knew that the main risk factor for cervical cancer is human papillomavirus (HPV) infection (82% of all responders; 86% of medical students; 73% of non-medical students; p < 0.001). Only 40% of students knew that in Poland the Population Prevention and Early Diagnosis Program is carried out on women aged 25–59 years every three years. Most students correctly indicated that cervical cancer screening in Poland is performed using cervical cytology and were familiar with the basis of cytology. Only 57% of students knew that there are no specific early symptoms of cervical cancer. A total of 78% of all respondents knew that HPV vaccination reduces the risk of cervical cancer. Medical students and students who are sexually active demonstrated a better knowledge of cervical cancer. Conclusions: The Polish students had some knowledge of cervical cancer risk factors and primary and secondary prevention. Significantly better knowledge was demonstrated by medical students. Some efforts should be made to ensure that young people, who are not associated with medicine are better educated about cervical cancer in order to reduce the overall incidence and improve early detection rates.
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Dereje N, Ashenafi A, Abera A, Melaku E, Yirgashewa K, Yitna M, Shewaye S, Fasil T, Yoseph Y. Knowledge and acceptance of HPV vaccination and its associated factors among parents of daughters in Addis Ababa, Ethiopia: a community-based cross-sectional study. Infect Agent Cancer 2021; 16:58. [PMID: 34479576 PMCID: PMC8418033 DOI: 10.1186/s13027-021-00399-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Cervical cancer is one of the most diagnosed and deadly cancers in women globally. Though vaccination is an effective way to reduce cervical cancer, people’s knowledge and acceptance of the vaccination remains a challenge in low and middle-income countries. Therefore, the aim of this study was to assess the level of knowledge and acceptance of Human Papilloma Virus (HPV) vaccination and its associated factors among parents of daughters in Addis Ababa, Ethiopia. Methods A community-based cross-sectional study was conducted among parents or guardians whose daughters are in the age group of 9–17 years and residing in Akaki-Kalty sub-city in Addis Ababa. A multistage sampling technique was used to select the study participants (n = 430). Face-to-face interview was conducted by using a structured questionnaire. Factors associated with the acceptance of HPV vaccination was identified by multivariable binary logistic regression and expressed by adjusted odds ratio (aOR), and respective 95% confidence interval. Results Complete response was obtained from 422 (98.1%) of the participants and their mean age was 39.0 years (SD ± 9.9). Out of the study participants, 41.7% and 72.0% had poor knowledge on cervical cancer and HPV, respectively. More than a quarter (27.0%) of the participants has never heard about HPV vaccine. One-third (36.5%) of the participants had negative attitude towards the HPV vaccine. Overall, 94.3% of the study participants were willing to vaccinate their daughters for HPV. Vaccine acceptability was associated with higher monthly income (aOR = 2.48, 95% CI 1.08–6.34), good knowledge on HPV (aOR = 2.32, 95% CI 1.56–4.87) and the vaccine (aOR = 2.24, 95% CI 1.12–8.60), and positive attitude towards the vaccine (aOR = 5.03, 95% CI 1.63—9.56). Conclusions The overall HPV vaccine acceptance was high. However, two out of five and one-thirds of the parents had poor knowledge on cervical cancer and negative attitude towards the HPV vaccine, respectively. Higher monthly income, good knowledge on HPV and the vaccine, and positive attitude towards the vaccine were associated with acceptance of HPV vaccination. To ensure sustainable acceptance of HPV vaccination, it is crucial to increase the community awareness in a sustainable manner.
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Affiliation(s)
- Nebiyu Dereje
- Department of Public Health, Myungsung Medical College, P.O Box 14972, Addis Ababa, Ethiopia.
| | - Abigia Ashenafi
- Department of Medicine, Myungsung Medical College, Addis Ababa, Ethiopia
| | - Anteneh Abera
- Department of Medicine, Myungsung Medical College, Addis Ababa, Ethiopia
| | - Efrata Melaku
- Department of Medicine, Myungsung Medical College, Addis Ababa, Ethiopia
| | - Kaleb Yirgashewa
- Department of Medicine, Myungsung Medical College, Addis Ababa, Ethiopia
| | - Meron Yitna
- Department of Medicine, Myungsung Medical College, Addis Ababa, Ethiopia
| | - Sarona Shewaye
- Department of Medicine, Myungsung Medical College, Addis Ababa, Ethiopia
| | - Tsedenia Fasil
- Department of Medicine, Myungsung Medical College, Addis Ababa, Ethiopia
| | - Yadel Yoseph
- Department of Medicine, Myungsung Medical College, Addis Ababa, Ethiopia
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YILMAZ B, HAT BN, YÜREKLİ Y, OSKAY Ü. Genç Erişkinlerin Human Papilloma Virüs (HPV) ve HPV Aşısına İlişkin Bilgi ve Görüşleri: Kesitsel Bir Çalışma. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.30934/kusbed.874847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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The Acceptance of Key Public Health Interventions by the Polish Population Is Related to Health Literacy, But Not eHealth Literacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155459. [PMID: 32751180 PMCID: PMC7432801 DOI: 10.3390/ijerph17155459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 12/16/2022]
Abstract
Background: Public health and health promotion rely on many different interventions, which range from health education and communication, through community mobilisation and changes to environmental conditions, to legal and fiscal actions. The introduction of the increased tax on sugar-sweetened beverages (SSB), popularly called sugar tax (ST), and a mandatory programme of vaccinations are the strategies inciting the most vivid discussions in Polish society. The study was intended to assess the determinants of the attitudes of Polish society regarding the ST and to vaccinations. Methods: For the analysis, the data originating from the survey of a representative adult sample of Polish society (n = 1000) was used. The survey was based on computer-assisted telephone interviewing (CATI). The assessment of the relationships between the selected variables and the opinions about the introduction of the ST and the safety and effectiveness of vaccinations were carried out using the chi2 test and univariate logistic regression models. Results: The acceptance of the ST and vaccination showed a significant relationship to the level of health literacy (HL) but not to eHealth literacy (eHL). Respondents having a higher rather than lower HL; older rather than younger; married rather than singles; retired, or on a disability pension, rather than vocationally active and nonusers of the Internet rather than users were more likely to show an acceptance for both interventions. Those more frequently using health care services and those with chronic diseases showed a greater belief in the safety and effectiveness of vaccinations. Conclusions: The relationship between the opinions of the two public health interventions analysed and the sociodemographic variables demonstrated similar patterns. Interestingly, the opinions were associated only with HL and not with eHL and users of the Internet were more sceptical about the interventions.
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López N, Garcés-Sánchez M, Panizo MB, de la Cueva IS, Artés MT, Ramos B, Cotarelo M. Correction to: HPV knowledge and vaccine acceptance among European adolescents and their parents: a systematic literature review. Public Health Rev 2020; 41:20. [PMID: 32699653 PMCID: PMC7372881 DOI: 10.1186/s40985-020-00130-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Noelia López
- Medical Affairs Department, Merck Sharp & Dohme Spain, Madrid, Spain
| | | | | | | | | | - Beatriz Ramos
- Medical Affairs Department, Merck Sharp & Dohme Spain, Madrid, Spain
| | - Manuel Cotarelo
- Medical Affairs Department, Merck Sharp & Dohme Spain, Madrid, Spain
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