Uptake of human papillomavirus (HPV) vaccination in Hong Kong: Facilitators and barriers among adolescent girls and their parents

Parental willingness of HPV vaccination in Mainland China: A meta-analysis

This meta-analysis aimed to systematically review and analyze parental awareness of human papillomavirus (HPV) and its vaccine, as well as parental willingness of the HPV vaccine in China. The literature search selected studies that met the following criteria: study published between 2009 and 2023, study design involving parents with at least one child aged ≤ 18 years, sample sizes exceeding 300, availability of data on parental willingness of the HPV vaccine or sufficient information to calculate effect sizes, and studies published in either English or Chinese. Studies that did not meet one of the above points were excluded. From an initial pool of 660 papers, 33 studies were included, encompassing a total sample size of 92,802. The analysis revealed that the pooled awareness rates of HPV and the HPV vaccine among Chinese parents were 45.0% (95% CI: 36.1-54.0%) and 41.4% (95%CI: 30.7-52.5%), respectively. The overall parental willingness for vaccinating children against HPV was 61.0% (95% CI: 53.5-68.3%). Both parental awareness and willingness of the HPV vaccine in China were found to remain low when compared to other countries.

Exploring the Barriers and Facilitators Influencing Human Papillomavirus Vaccination Decisions Among South Asian and Chinese Mothers: a Qualitative Study

Human papillomavirus (HPV) vaccines are safe and effective in preventing HPV infection and HPV-related cancers. However, the HPV vaccine uptake rate is lower among the ethnic minority population than in the majority population. This qualitative study explored the barriers and facilitators influencing South Asian minority and Chinese mothers' decisions to vaccinate their daughters against HPV in Hong Kong. South Asian and Chinese mothers with at least one daughter aged 9 to 17 years were recruited to this study. Twenty-two semi-structured focus group interviews were conducted, and the transcripts were analysed via content analysis. Two barriers and three facilitating factors were common among South Asian and Chinese mothers: inadequate knowledge of cervical cancer, HPV or the HPV vaccine and high perceived barriers to HPV vaccination due to vaccine cost, the receipt of reliable information from schools or the government, high perceived benefits of HPV vaccination to health, and the presence of vaccination programme arranged by school or government. Despite these commonalities, South Asian mothers experienced more barriers to making the decision to vaccinate than Chinese mothers. Particularly, obtaining family support was an important factor for South Asian mothers. The vaccination decision was considered a joint decision between the mother and father, and the father's agreement was of particular importance to Pakistani mothers. This study identified the factors that hindered and facilitated South Asian and Chinese mothers' decisions to vaccinate their daughters against HPV. The comparison between groups improves our understanding of the distinct needs of South Asian in Hong Kong.

Cervical screening among Chinese females in the era of HPV vaccination: a population-based survey on screening uptake and regular screening following an 18-year organized screening program

OBJECTIVE

China has a substantial disease burden of cervical cancer. To further understand preventive measures for reducing cervical cancer in China, this study aimed to correlate screening attendance and regular screening with human papillomavirus (HPV) vaccination among Chinese females.

METHODS

This prospective questionnaire-based survey recruited Chinese females aged 25 or above in Hong Kong by random digit dialing telephone interviews in 2022. The survey studied women's practice of cervical screening and adherence to regular screening. Variables including HPV vaccination status and attendance of physical check-ups were involved in the questionnaire. Screening uptake and screening adherence were the main outcomes, which were measured as the proportion of women who reported having attended a cervical screening and screened regularly, respectively.

RESULTS

Out of 906 valid respondents, the reported cervical screening uptake was over 70% among females aged 30 or above and particularly over 80% among women aged 35-59; however, the uptake was only 46% among those aged 25-29. Adherence to regular screening was 50%-60% across ages 25-59 years and dropped to approximately 40% for women older than 60 years. Both screening uptake and adherence were associated with HPV vaccination, with adjusted odds ratios of 2.37 and 2.23, respectively. A large proportion of regularly screened women may be overscreened for screening more frequently than recommended.

CONCLUSION

Responded Chinese females showed good cervical screening uptake but were moderately adherent to regular screening. Policymakers should emphasize the importance of regular screening and the recommended screening frequency by HPV vaccination status for better healthcare resource use.

Uptake of Human Papilloma Virus Vaccination and Associated Factors Among Female Students Attending Secondary Schools in South West Shoa, Oromia, Ethiopia, 2022

BACKGROUND

Human papillomavirus (HPV) vaccination is one of the key preventative measures for cervical cancer, provided that effective vaccine uptake is employed. However, HPV vaccine uptake is low in settings with limited resources such as low- and middle-income countries.

OBJECTIVES

To assesses the uptake of HPV vaccine and associated factors among female students attending secondary schools in South West Shoa Zone, Oromia, Ethiopia, 2022.

METHODS

A cross-sectional study was conducted in secondary schools of South West Shoa Zone between November 1st to November 30th 2022. A multi-stage sampling technique was employed among 634 female students attending secondary schools. Data were collected by self-administered structured questionnaires, entered into Epi-info version 7.2.2.6, and exported to SPSS version 25 for statistical analysis. Bivariable analyses were considered for Multivariable analysis. Adjusted odds ratio (AOR) along with 95% confidence levels were estimated to assess the strength of the association, and a P value <0.05 was considered to indicate statistical significance.

RESULTS

The proportion of HPV vaccine uptake was 31.65% (95% CI, 25-38). Having adequate knowledge AOR = 8.51 (95% CI = 4.57-15.84), living in rural area AOR = 0.25 (95% CI = 0.15-0.42), having older sibling AOR = 4.07(95% = 2.50-6.63), mother's educational level (Diploma and above) AOR = 4.08 (95% CI = 1.75-9.49), and secondary education AOR = 3.98 (95% CI = 1.87-8.48) were significantly associated with HPV vaccine uptake among female students attending secondary schools in South West Shoa Zone, Oromia, Ethiopia.

CONCLUSIONS

The study revealed that HPV vaccine uptake was very low among female students attending secondary schools in South West Shoa Zone, Oromia, Ethiopia. Adequate knowledge, having older sibling, living in rural area, and having mothers with higher educational level were significantly associated with HPV vaccine uptake. All concerned bodies should work jointly to enhance the uptake of HPV vaccination among female students.

Parents' willingness to vaccinate their daughters with human papillomavirus vaccine and associated factors in Debretabor town, Northwest Ethiopia: A community-based cross-sectional study

The Human Papilloma Virus (HPV) is the primary causative agent of cervical cancer. Vaccination against the HPV infection is an effective prevention measure for HPV-related diseases. This study aimed to assess parents' willingness to vaccinate their daughters with Human Papillomavirus vaccine and associated factors in Debre Tabor town. A community-based cross-sectional study was conducted among parents of daughters in Debre Tabor town, and a cluster sampling technique was used to select 738 study participants. A structured and interviewer-administered questionnaire was used to collect the data. Data were entered into EPI data version 4.6 and exported to SPSS version 26 for analysis. Multivariable logistic regression was done and a p-value of ≤ 0.05 was used to declare the level of significance. In this study, parents' willingness for HPV vaccination was found to be 79.10% (95% CI: 76.00, 82.00). Parents having media exposure, had good knowledge of HPV infection, and HPV vaccine, positive attitude, and positive perceived behavioral control toward the HPV vaccine had statistically significant association with willingness for the HPV vaccination of their daughters. Parents' willingness to HPV vaccination for their daughters was higher compared with a previous study done in the setting. Parental knowledge and their beliefs on HPV vaccination, and media exposure play an important role in the HPV vaccination of adolescents. Strengthening community-based education and effective promotion through multimedia on HPV infection and its prevention, addressing parental safety concerns and promoting their positive beliefs about the vaccine are important to increase parents' willingness.

Acceptance of influenza vaccination and associated factors among teachers in China: A cross-sectional study based on health belief model

Teachers played an important role on the transmission of influenza in schools and communities. The study aims to investigate the influenza vaccination coverage and the factors determining flu vaccination acceptance among teachers in Hangzhou, China. A total of 1039 junior high school teachers in Hangzhou were recruited. The self-made questionnaire was used to investigate the influenza vaccine coverage among teachers and the influencing factors of influenza vaccination acceptance. Univariate analysis using the chi-square test and multivariable analysis using binary logistic regression were conducted to determine the relative predictors. The Influenza vaccine coverage among teachers was 5.9% (62/1039). 52.9% of teachers had the intention to receive influenza vaccine, 25.3% (247/977)/21.8% (213/977) of participants was hesitant/did not have the intention to get influenza vaccine. The top three sources for teachers to gain knowledge about influenza were website (72%), TV/radio (66.1%) and social media (58%). Whether get influenza vaccination before, knowledge about influenza and influenza vaccine, the beliefs for the likelihood of catching flu, the severity of getting flu, the effectiveness of influenza vaccine, the possibility of side effects after vaccination, and the troublesome of vaccination, doctors' recommendation, as well as the situation of vaccination among other teachers were the associated factors of influenza vaccination acceptance. The influenza vaccination coverage was low but the intentions were relatively high among junior high school teachers. Future research should focus on the relationship between vaccination acceptance and behavior to increase influenza vaccination rates.

Factors Associated with PCV13 Vaccine Hesitancy in Parents under an Innovative Immunization Strategy: a Cross-Sectional Study - Weifang City, Shandong Province, China, 2021

What is already known on this topic?

Pneumococcal diseases (PDs) are serious threats to child health. Although vaccination is one of the most effective ways to prevent these diseases, the pneumococcal vaccination coverage rate is still relatively low in China.

What is added by this report?

This study investigated the factors associated with 13-valent pneumococcal conjugate vaccine (PCV13) vaccine hesitancy in parents under an innovative immunization strategy. This study found that 29.7% of the participants hesitated to vaccinate their children against PCV13 and the main reasons for vaccine hesitancy were individual and group influences.

What are the implications for public health practice?

This study can provide scientific evidence for further improving children's PCV13 vaccination rate and improving the prevention and control strategy for PDs.

Prevalence of pain and fear as barriers to vaccination in children - Systematic review and meta-analysis

BACKGROUND

Injection-related pain and fear are common adverse reactions in children undergoing vaccination and influence vaccine acceptance. Despite the large body of literature on sources of vaccine non-compliance, there is no estimate of the prevalence of pain and fear as contributing factors. The objective was to estimate the prevalence of injection pain or fear of needles as barriers to childhood (i.e., 0-18 years) vaccination.

METHODS

Four databases were searched from inception for relevant English and French articles until August 2021. In addition, the references of recent systematic reviews and all articles included in the review were hand searched. Article screening and data extractions were performed in duplicate. Studies were included if they reported on injection-related pain or fear of needles in children (0-18 years) using a checklist/closed-ended question(s). Results were stratified by respondent (parents or children), type of pediatric population (general or under-vaccinated), and relative importance of barrier (pain or needle fear as primary reason or any reason for under-vaccination). Prevalence rates of pain or needle fear were combined using a random effects model. Quality of included studies was assessed using the Joanna Briggs Institute critical appraisal checklist for prevalence data. Quality across studies was assessed using GRADE.

RESULTS

There were 26 studies with 45 prevalence estimates published between 1995 and 2021. For parent reports (of children) and children self-reported reasons for non-compliance, prevalence rates of pain or needle fear ranged from 5 to 13% in a general population and 8 to 28% in an under-vaccinated population, with a substantial variation in the prevalence estimates. There was no difference between category of respondent or relative importance on pain or needle fear prevalence rate. A regression model demonstrated an overall prevalence rate of pain or needle fear as an obstacle to vaccination of 8% in the general population and 18.3% in the under-vaccinated population. All evidence was very low in quality.

CONCLUSION

This is the first review to systematically quantify the prevalence and therefore, importance, of pain and needle fear as obstacles to vaccination in children around the world. Pain from injection or fear of needles were demonstrated to be sufficiently prevalent as barriers to vaccination in children to warrant attention. Addressing pain and fear has the potential to significantly improve vaccination acceptance.

Barriers and Facilitators of Romanian HPV (Human Papillomavirus) Vaccination

BACKGROUND

Many countries had initial success with HPV vaccination campaigns worldwide. The HPV vaccine coverage during the COVID-19 pandemic dropped consistently. The aim of our research is to assess the barriers and facilitators of the current Romanian HPV vaccination campaign.

METHODS

An analytical cross-sectional observational survey was conducted in the Romanian general population; a self-administered questionnaire was used.

RESULTS

1122 responders were interviewed; 666 (59.36%) were parents, and 67 (5.97%) HPV vaccinated themselves. A multinominal logistic regression carried out in the parents' category showed that women with university studies and informed from medical sources have greater chances to HPV vaccinate. Reticence regarding vaccination comes from the high cost of the vaccine and a lack of information. Only 118 (10.51%) vaccinated against HPV. From the logistic regression analysis, gender (ORa 0.461 = 95% CI: (0.196; 1.083)), geographic area of residence (ORa = 0.517; 95% CI: (0.331; 0.807)), and the inclusion of the HPV vaccine in the National Vaccination Program (ORa = 2.4; 95% CI: (1.361; 4.235)) were the factors found most associated with HPV vaccination.

CONCLUSIONS

In the general population, the inclusion of HPV vaccination in the National Vaccination Program would be the most important facilitator of HPV vaccination in Romania. In parents that did not vaccinate their children, one important barrier to HPV vaccination was the high cost of the HPV vaccine and the lack of proper information. The acceptability of HPV vaccination in Romania is low; therefore, public health educational programs are needed.

HPV Vaccination Intentions of Female Students in Chinese Universities: A Systematic Literature Review and Meta-Analysis

OBJECTIVE

To systematically evaluate the human papillomavirus (HPV) vaccination intentions among female university students in China and establish a basis for improving HPV vaccination coverage.

METHODS

We searched CNKI, EBSCO, JSTOR, MESH or Emtree, Weipu Information Chinese Journal Service Platform, Wanfang Data, China Biomedical Literature Database, PubMed, Embase, Web for the Web of Science, and the Cochrane Library to identify peer-reviewed published research on intentions by female college students in China to receive the HPV vaccination.

RESULTS

A preliminary search of 408 papers resulted in the inclusion of 12 studies, all cross-sectional, of moderate or high quality, with a sample size of 12,600. The HPV vaccination intention rate among Chinese female university students was 16.67% (95% CI: 12.38% to 21.24%). The vaccination intention rates of medical students, non-medical students, and Tibetan students were 30.37% (95% CI: 28.80-34.12%), 15.53% (95% CI: 11.2-20.22%), and 14.12% (95 % CI: 10.59-18.04%), respectively. The vaccination intention rates of the participants with parental education of junior high school and below, high school, and bachelor's degree and above were 15.36% (95 % CI: 11.59 to 17.54%), 17.18% (95 % CI: 12.33% to 19.61%), and 19.81% (95 % CI: 15.61% to 22.25%), respectively. The intention rates of vaccination among residents of first-tier, second-tier, and third-tier cities were 17.64% (95% CI: 12.76-21.63%), 15.39% (95% CI: 11.74-19.82%), and 13.87% (95% CI: 9.36-15.65%), respectively. The results of the meta-analysis were relatively stable with little publication bias.

CONCLUSION

The intention rate of HPV vaccination among female university students in China is low and varies among different populations. There is a need to increase HPV vaccination promotion efforts to improve the intention of female university students to receive the vaccine.

Evaluating the psychometric properties of the Chinese version of the modified Carolina Human Papillomavirus immunisation attitudes and beliefs scale among Chinese adolescent girls

Human Papillomavirus (HPV) vaccine uptake among adolescents is influenced by their views and perceptions of the vaccination. The modified Carolina HPV Immunisation Attitudes and Beliefs Scale (CHIAS) is a well-established instrument to measure adolescents’ views of HPV vaccination. However, there is currently no Chinese version available to inform HPV vaccination promotion efforts among Chinese adolescents. This study aimed to translate and validate the Chinese version of the modified CHIAS (CHIAS-C). A cross-sectional descriptive study was carried out with 212 female adolescents recruited from secondary schools. Internal consistency, convergent validity, and construct validity were examined. Cronbach’s alpha of the five domains ranged from 0.60 to 0.89, suggesting acceptable internal consistency. Both positive and negative correlations were found between CHIAS-C domains and HPV vaccination intention, indicating convergent validity. Factorial validity was established through confirmatory factor analysis. Our findings suggest that adolescents had generally positive perceptions of HPV vaccination and were likely to accept vaccination if given more relevant information. It was found that most adolescents had neither attended any school talks about HPV nor spoken about the vaccination with healthcare providers. This illustrates that adolescents experience a lack of communication and education about HPV vaccination, both of which can be enhanced in order to persuade adolescents to receive the vaccination. The results suggest that the CHIAS-C is a reliable and valid tool to measure adolescents’ views of HPV vaccination. The translated scale may therefore be used in future adolescent research and to inform the development of interventions to increase HPV vaccine uptake.

Women's Preference for Cervical Cancer Screening Methods in Iran: A Contingent Valuation Survey

Background: Cervical cancer is the fifth most deadly cancer in women in Iran. The present study aimed to investigate the monetary value of cervical cancer screening benefits from a social perspective. Methods: A cross-sectional study was conducted among 480 women aged 30 to 59 years in Mazandaran province, Iran, from 2020-21. The willingness to pay (WTP) for screening tests- Pap smear and simultaneous tests- was investigated using a researcher-made questionnaire based on the contingent valuation method (CVM) in 2 separate sample groups. The first group received basic information regarding cervical cancer (Scenario 1), while the second received complementary information in addition to basic knowledge (Scenario 2). Multivariate regression was applied to examine factors affecting WTP and the difference between the mean WTP in 2 scenarios was analyzed by a t-test. Results: The mean WTP of Pap smear and simultaneous tests was estimated at US$135.08 and US$160.19, respectively. There were significant and negative relationships between age and household size with the WTP of the Pap smear test. The number of people with income, household expenses, a chronic illness, and suggested base price indicated significant and positive effects on WTP of the Pap smear test. The number of people with income and household expenses showed significant and positive relationships with the WTP of simultaneous tests. There was no significant difference between the mean WTP of each group and the demand for screening tests was not elastic. Conclusion: The mean WTP of screening tests is notable when compared to their cost, demonstrating the need of concentrating on screening programs.

Healthcare professional's promotional strategies in improving Human papillomavirus (HPV) vaccination uptake in adolescents: A systematic review

PURPOSE

Human papillomavirus (HPV) vaccination coverage remains suboptimal with a global vaccination rate ranging from 12 to 90%. This review examined the approaches used by healthcare professionals in improving the uptake of HPV vaccine and reducing vaccine misconceptions among adolescents.

METHODS

A systematic review of literature between 2007 and 2021 was conducted using five databases: CINAHL, MEDLINE, PsycInfo, Scopus and ASSIA. Studies that examined healthcare professional's promotional strategies in improving the HPV vaccine uptake in adolescents were included. Two researchers independently reviewed study selection, data extraction, and study methodological quality. Results were analysed and synthesised using narrative synthesis.

RESULTS

Twelve studies met the inclusion criteria. Studies reported on effective approaches used by healthcare professionals to improve vaccine uptake including the use of multi-settings to target hard-to-reach vulnerable adolescents; consistently recommending the vaccine; and initiating the vaccine before the age of eleven. In addressing vaccine misconceptions, open-communication, motivational approaches, and sexual health education were effective strategies used.

CONCLUSION

This review found that healthcare professionals need to be better informed and educated on HPV vaccine to reduce their own vaccine hesitancy. Uptake of HPV vaccine can be improved by adopting better communication, engagement, supportive information resources, and training for healthcare professionals.

Does group education affect mothers' knowledge and attitudes towards the HPV vaccine?

In this study the authors' investigated the effect of group education on human papillomavirus (HPV) on level of knowledge and health beliefs for HPV infection and vaccine. The study was semi-experimental with a pre- and post-test education model. In total, 110 mothers of secondary school students, 55 in education group, and 55 in control group participated. The groups were educated on different content and three evaluations (pre-education, post-education, and six months following the education) were made. HPV knowledge and belief scores of the education group increased compared to pre-education and control group scores (p < 0.001). Perceived barriers to vaccination were similar in both groups (p > 0.05). Group education increases awareness about HPV infection and vaccine.

Multistakeholder knowledge levels and perspectives of human papillomavirus and its vaccination: An exploratory qualitative study

OBJECTIVE

This qualitative study was an integral part in the development of a multidisciplinary team-led school-based human papillomavirus vaccination health-promotion programme (MDL-SHPVP) aiming to increase HPV vaccine uptake in Hong Kong. Study findings will inform the design of the MDL-SHPVP by drawing on interview data regarding the expectations and needs of key stakeholders and potential programme users.

METHODS

Eight mother-daughter dyads, four secondary school teachers, two school principals, three social workers and one school nurse were interviewed. All interviews were audio-recorded and transcribed verbatim for thematic analysis.

RESULTS

Most participants had misconceptions about HPV and the vaccine. Alhough there was no immediate perceived need for the vaccination, most participants had favourable attitudes towards HPV inoculation and vaccines in general. Factors affecting vaccine uptake included perceptions about risk of infection, vaccine availability, and cost. Participants were largely open to suggested MDL-SHPVP components (videos, digital game, and group discussions).

CONCLUSION

Findings have highlighted knowledge gaps among potential users and key stakeholders and will be used to inform the design of the MDL-SHPVP to ensure that their needs and expectations are addressed. Study findings may also aid future HPV vaccine promotion efforts and boost HPV vaccine uptake among youth in the city.

Willingness to pay for and acceptance of cervical cancer prevention methods: A systematic review and meta-analysis

Background: The Willingness to pay (WTP) for and acceptance of cervical cancer prevention (CCP) methods have an important role in the control of this type of cancer. Therefore, the aim of this study was to estimate the WTP and acceptance of CCP methods with the contingent valuation method (CVM). Methods: In this systematic review and meta-analysis study, the required information was collected by searching relevant keywords in PubMed, Scopus, Embase, Web of Knowledge, and their Persian equivalent in the Scientific Information Database (SID) and Elmnet databases during January 1, 2000 to June 30, 2020. All studies that reported the WTP and CCP methods with the CVM in English or Persian were included. The reporting quality of studies was assessed by strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Comprehensive meta-analysis (CMA: 2) software was used to conduct the meta-analysis. The content analysis method was used for qualitative data analysis. Results: Finally, 28 articles (with 49610 people) were included in the study. Most of the participants were women (35.7%). The HPV vaccine was the most common method of prevention (75%). The overall acceptance rate was 64% and the overall positive WTP rate was 66%. The average WTP was US$30.44, which accounts for about 0.84% of GDP per capita. The most significant effective factors included income, age, education, high-risk sexual behaviors, and awareness of cervical cancer, belief in the risk of cervical cancer, and belief about the effectiveness of prevention methods. The cost was the most important reason for the unwillingness to pay and accept. Conclusion: Results show that the WTP and acceptance rate of CCP methods are relatively high. It is recommended to reduce the cost of prevention methods, especially the HPV vaccine, and to increase awareness and improve the attitude of people. Also, it is recommended to consider other methods of estimation of WTP and other cancers in future studies.

Human papillomavirus vaccination coverage and knowledge, perceptions and influencing factors among university students in Guangzhou, China

Introduction: HPV vaccines were administered in mainland China from July 2017 at a gradual rate. We aimed to assess the vaccination rate and vaccination influencing factors among college students in mainland China.Methods: From October to December 2018, we conducted face-to-face questionnaires including 5 sections and 22 questions to collect demographic information, HPV infection and transmission knowledge, HPV vaccine knowledge and attitudes among college students in Guangzhou, China. HPV vaccine vaccination status and cervical screening behaviors were self-reported. Knowledge and attitudes differences between the vaccinate and non-vaccinate groups were analyzed using univariable logistic regression. Vaccination-related influencing factors were estimated using multivariable logistic regression.Results: 5307 of 5414 valid questionnaires were collected. The self-reported cervical screening rate and HPV vaccine coverage were 11.82% (9.03%-14.61%) and 3.09% (2.62%-3.56%). In total, 55.57% of the participants were hesitant about vaccination. Urban residence (OR = 2.1, 95%CI: 1.4-3.3), high monthly consumption (OR = 2.6, 95%CI: 1.9-3.6), awareness of vaccination adaptive population (OR = 3.1, 95%CI: 1.9-5.0), awareness of infection-related risk factors (OR = 2.5, 95%CI: 1.1-5.7), and awareness of HPV vaccine effectiveness (OR = 3.2, 95%CI: 2.0-5.2) were significant in multivariable logistic regression.Conclusion: HPV vaccine coverage is quite low among college students in China Guangzhou. Economic affordability, awareness of HPV infection, and belief in the effectiveness of HPV vaccine are influencing factors for vaccination. In the future, establishing a national financial subsidy and strengthening health education is needed to increase the vaccination rate in China.

Knowledge of preconception care and its association with family planning utilization among women in Ethiopia: meta-analysis

Preconception care (PCC) increases the chance of couple's being healthy and having a healthier baby. It is an important strategy to prevent maternal and perinatal complications. The level of knowledge on preconception care increases its uptake. It is also considered as an input for further intervention of reduction in maternal and neonatal mortality enabling progress towards sustainable development goals (SDGs). Therefore, this systematic review and meta-analysis aimed to estimate the pooled knowledge level of PCC and its association with family planning usage among women in Ethiopia. All observational studies regardless of publication status were retrieved. Important search terms were used to search articles in Google scholar, African Journals Online, CINHAL, HINARI, Science Direct, Cochrane Library, EMBASE, and PubMed/Medline. Independent critical appraisal of retrieved studies was done using the Newcastle-Ottawa assessment checklist. The meta-analysis was conducted using STATA version 14 software. The I² statistics were used to test heterogeneity, whereas publication bias was assessed by Begg's and Egger's tests. The results of the meta-analysis were explained in the Odds ratio (OR) with a 95% confidence interval (CI) and presented using forest plots. A total of seven articles were included in the current systematic review and meta-analysis. Based on the data retrieved from the articles, 35.7% of women in Ethiopia had good knowledge about preconception care. The subgroup analysis based on region revealed the lowest (22.34%) and highest (45.06%) percentage of good knowledge on preconception care among women who were living in Amhara and Oromia regions, respectively. Moreover, women who utilized family planning services were three and more times (OR 3.65 (95% CI 2.11, 6.31)) more likely to have a good level of knowledge about preconception care. One-third of Ethiopian women had good knowledge about preconception care. Family planning utilization had a positive impact on women's knowledge of preconception care.

Improvement of Parent's awareness, knowledge, perception, and acceptability of human papillomavirus vaccination after a structured-educational intervention

Background

Regardless of the disease burden of human papillomavirus (HPV), the vaccine has not been included in the Indonesia National Immunization Program. Since 2017 there was a demonstration program of the HPV vaccination in Yogyakarta Province. This vaccine was given free to female primary school students in the 5th and 6th grades (11–13 years old). This study aimed to assess whether a structured-educational intervention focus on HPV increases the parental awareness, knowledge, and perceptions toward HPV and the vaccine acceptability.

Methods

We conducted a pre-post structured-educational intervention study from July to August 2017 before the implementation of the HPV vaccination demonstration program, in Kulon Progo District, Yogyakarta Province, Indonesia. Parents of female primary school students grades 5th and 6th were selected using a school-based proportional random sampling. A pediatric resident provided a structured-educational intervention, which consists of the burden and risk of HPV disease, as well as the benefit and safety of the vaccine. Parents were required to complete validated self-administered questionnaires before and after the structured-educational intervention.

Results

A total of 506 parents participated. Before receiving the structured-educational intervention, parents’ awareness of HPV infection and the vaccines were low. Only 49.2% of parents had heard HPV infection, and 48.8% had heard about the vaccine. After the structured-educational intervention, there were significant improvements in parent’s awareness, knowledge, and perceptions of HPV infection, cervical cancer, and HPV vaccination (all p < 0.001). HPV vaccine’s acceptability increased from 74.3 to 87.4% (p < 0.001). There was a significant correlation between increasing HPV vaccine acceptability with the improvement of awareness, knowledge, and perception toward HPV infection, cervical cancer and HPV vaccination (r = 0.32 to 0.53, p < 0.001). After the structured-educational intervention, better knowledge and positive perceptions of HPV vaccination were predictive of HPV vaccine’s acceptability with OR 1.90 (95%CI:1.40–2.57) and OR 1.31(95%CI,1.05–1.63), respectively.

Conclusions

A structured-educational intervention may improve parental awareness, knowledge, and perceptions toward HPV and the acceptability of the vaccine. Further study, a randomized control trial with longer follow-up are needed to evaluate the long-term and actual effectiveness of improving parents’ knowledge, perceptions and HPV vaccine acceptability.

Effects of a multidisciplinary team-led school-based human papillomavirus vaccination health-promotion programme on improving vaccine acceptance and uptake among female adolescents: A cluster randomized controlled trial

INTRODUCTION

Evidence has consistently shown the high efficacy of human papillomavirus (HPV) vaccines in preventing cervical cancers. However, the HPV vaccine uptake rate in Hong Kong is very low. We will develop and evaluate an innovative, theory-based multidisciplinary team-led school-based HPV vaccination health-promotion program (MDL-SHPVP), engaging female adolescents, parents/guardians, and secondary school personnel in multicomponent educational strategies and interactive discussions.

METHODS AND ANALYSIS

A cluster randomized controlled trial is proposed. We will recruit 2520 female adolescents and their parents/guardians from 18 secondary day schools. The MDL-SHPVP is underpinned by the Health Belief Model and Precaution Adoption Process Model. Multicomponent interventions will be offered, including education sessions with small group dialogues with a registered nurse and trained healthcare and lay volunteers, and educational computer games. A team of volunteers will be established to raise HPV, cervical cancer, and HPV vaccine awareness. Outcomes include adolescents' uptake of the HPV vaccine, adolescents' intention to receive HPV vaccination, vaccine acceptance among parents/guardians, and parents'/guardians' and adolescents' HPV knowledge, attitudes, and beliefs. Data will be collected at baseline, 1 month, and 1 year after intervention. The generalized estimating equations analysis will be used for comparing the outcomes between the 2 groups.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee (Ref. no.: 2019.055). We will disseminate the study findings via peer-reviewed publications and presentations at relevant events and international and local conferences.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT04438291.

Multidimensional social and cultural norms influencing HPV vaccine hesitancy in Asia

HPV vaccine hesitancy in Asia is unique compared to Western countries due to multidimensional social-cultural norms that influence beliefs regarding vaccination. Reviews on HPV vaccine hesitancy in Asia lack of in-depth discussion regarding the traditional and social-cultural norms dimensions. This paper puts forward opinions in which culture, normative beliefs, and religion influence HPV vaccine hesitancy in Asian countries. Issues surrounding HPV hesitancy among parents, young adult women, adult women, men and the sexual and gender minority people in Asian countries were highlighted. The shortage of HPV vaccine supply would soon be reduced as some Asian countries are on the way to producing the HPV vaccine which production is currently dominated by Western European countries. The culture of favoring imported Western products among many in Asia and in addition to long-existing fake vaccine crisis pose a challenge for the newly emerging HPV vaccine produced in Asia. Some recommendations, research gaps, and future research needs were discussed.

Sexual behaviors and intention for cervical screening among HPV-vaccinated young Chinese females

BACKGROUND AND OBJECTIVES

Human papillomavirus (HPV) vaccination and cervical screening prevent cervical cancer effectively. However, there are concerns whether vaccination leads to high-risk sexual behaviors and less intention for cervical screening. We aimed to evaluate the influence of HPV vaccination on high-risk sexual behaviors, and intention for cervical screening among young Chinese females. We also reported the latest HPV vaccination uptake in Hong Kong.

METHODS

A population-based survey was conducted between September 2016 and January 2017. Subjects were school-age girls from twenty-five secondary schools (in-school) and community females between 18 and 27 years (out-school). Demographics, vaccine-related attitudes, intention for cervical screening and participants' sexual behaviors were examined.

RESULTS

We surveyed 2260 females from in-school (n = 1664) and out-school (n = 596) settings. 11.5% in-school and 23.5% out-school participants received at least one dose of HPV vaccine. Vaccination was not associated with age (in-school Odds Ratio [OR] 0.99, p = 0.87; out-school OR 1, p = 0.94), ethnicity (in-school OR 0.82, p = 0.72; out-school OR 0, p = 0.98), maternal education (in-school OR for secondary school 1.19, p = 0.43; for post-secondary school 1.28, p = 0.48), underage sex (in-school OR 1.22, p = 0.80; out-school OR 0.63, p = 0.67), earlier sexual exposure (in-school β 0.01, p = 0.99; out-school β 0.13, p = 0.68), multiple sex partners (in-school OR 3.27, p = 0.22; out-school OR 1.16, p = 0.43), and unprotected sex (in-school OR 1.14, p = 0.78; out-school OR 0.60, p = 0.10). Out-school females with higher personal education level was associated with higher vaccine uptake (post-secondary OR 3.4, p < 0.001; bachelor's degree or above OR 3.71, p < 0.001). More vaccinated females intended for cervical screening (in-school 23.6% vs. 21.1%; out-school 53.6% vs. 43.6%). Costs and knowledge were important factors for non-vaccination and non-intention for cervical screening.

CONCLUSIONS

HPV vaccination was not associated with earlier and high risk sexual behavior among Chinese young females. Vaccinated Chinese young females had a higher intention for cervical screening.

Schoolteachers' experiences of implementing school-based vaccination programs against human papillomavirus in a Chinese community: a qualitative study

Background

Cervical cancer was the fourth most common cancer among women worldwide in 2012 and was the eighth most common cancer in 2014 and the eighth greatest cause of female cancer deaths in Hong Kong in 2015. Human papillomavirus (HPV) vaccination has been clinically documented to have a high efficacy in reducing HPV-related cervical intraepithelial neoplasia incidence. Therefore, receiving vaccination is a crucial public health measure to reduce disease burden. Significant others, such as schools and schoolteachers, have prominent influence in shaping adolescents’ health perceptions and behavior. Therefore, the perspective of schools and schoolteachers regarding vaccination can significantly influence students’ acceptance and accessibility of the vaccine. However, few studies have analyzed the perceptions of schoolteachers toward HPV vaccination, and even fewer have concerned how schoolteachers’ perceptions influence their schools’ motivation in implementing school-based HPV vaccination programs. This study was thus conducted to fill this literature gap.

Methods

With a Chinese community as the field site of this study, a qualitative approach of five focus group interviews was conducted with 35 schoolteachers from five primary and eight secondary schools in Hong Kong between July 2014 and January 2015. Thematic content analysis was used for data analysis.

Results

Perceptual, institutional, student and parental, and collaborator barriers interacted to discourage the sampled schoolteachers from organizing school-based HPV vaccination programs. Lack of knowledge regarding HPV vaccination, perception of HPV vaccination as inappropriate given the students’ age, violation of traditional cultural values, lack of perceived needs and perceived risk, opposition from schools, low priority of HPV vaccination over other health education topics, lack of government support, lack of interest from parents and students, and lack of confidence in implementing organizations, all were the mentioned barriers.

Conclusions

The sampled schoolteachers were demotivated to organize school-based HPV vaccination programs because of their perceptions and various social and cultural factors. As significant influencers of adolescent students, schoolteachers and schools should receive more support and information on organizing school-based HPV vaccination programs in the future.

Social and cultural construction processes involved in HPV vaccine hesitancy among Chinese women: a qualitative study

Background

HPV vaccine is a prophylactic vaccine to prevent HPV infections. Recommended by the World Health Organization, this vaccine is clinically proven to be one of the most effective preventive measures against the prevalence of cervical cancer and other HPV-associated cancers and chronic genital conditions. However, its uptake rate among women in Hong Kong is insignificant—only approximately 2.9% adolescent girls and 9.7% female university students received HPV vaccination in 2014. With the notion of Critical Medical Anthropology, we aimed to identify if different influential factors, ranging from individual, societal, and cultural, are involved in the decision-making process of whether to receive HPV vaccination.

Methods

We adopted a qualitative approach and conducted in-depth individual semistructured interviews with 40 women in Hong Kong between May and August 2017.

Results

We noted that the following factors intertwined to influence the decision-making process: perceptions of HPV and HPV vaccine; perceived worthiness of HPV vaccines, which was in turn influenced by vaccine cost, marriage plans, and experiences of sexual activities; history of experiencing gynecological conditions, stigma associated with HPV vaccination, acquisition of information on HPV vaccines, distrust on HPV vaccines, and absence of preventive care in the healthcare practice.

Conclusions

HPV vaccination is promoted in a manner that is “feminized” and “moralized” under the patriarchal value system, further imposing the burden of disease on women, and leading to health inequality of women in pursuing the vaccination as a preventive health behaviour as a result. We believe that this ultimately results in an incomplete understanding of HPV, consequently influencing the decision-making process. The “mixed-economy” medical system adopting capitalist logic also molds a weak doctor–patient relationship, leading to distrust in private practice medical system, which affects the accessibility of information regarding HPV vaccination for participants to make the decision.

Knowledge, Attitudes, and Behaviors of Parents towards Recommended Adult Vaccinations: An Explanatory Survey in the Geographic Area of Naples, Italy

The purposes of this study were to explore the knowledge, attitudes, and behaviors towards the recommended vaccinations for adults between 19–64 years of age and the associated factors among parents. The survey was conducted from October to December 2018 among a sample of parents randomly selected from five preschools and primary, secondary, and high schools in the geographic area of Naples, Italy. The mean age of participants was 45.2 years (range 19–71). Only 16% of the parents knew all vaccinations recommended to adults between 19–64 years of age. Those being healthcare professionals, having a chronic condition, having received information about vaccinations from physicians, and having a lower educational level were more likely to know the vaccinations recommended to adults between 19–64 years of age. Female participants, those who had received information about vaccinations from physicians, and those who had a lower number of children were more likely to have a positive attitude toward the usefulness of the administration of vaccinations recommended to adults between 19–64 years of age. Among unvaccinated respondents, more than half reported a positive attitude toward willingness to receive a recommended vaccination. This positive attitude was significantly higher among those who considered vaccinations as being useful and among who had received information from physicians. Only 16.9% self-reported to have received at least one vaccination recommended to adults between 19–64 years of age. Those who were healthcare professionals, who had at least one chronic condition, and who considered the administration of the vaccinations as being useful were more likely to have received at least one recommended vaccination. Greater efforts by policy makers and healthcare providers are needed to increase parents’ knowledge on recommended vaccines, and it is also crucial that healthcare providers have a high knowledge and favorable attitudes in order to increase vaccine coverage.

Rotavirus Infection and Vaccination: Knowledge, Beliefs, and Behaviors among Parents in Italy

This study was designed to investigate the knowledge, beliefs, and behaviors about rotavirus infection and its vaccination in a sample of parents in Naples, Italy. The survey was conducted between June and December 2018 among parents of children aged 3 months to 3 years. A total of 40.7% of the study subjects declared that they had heard about rotavirus infection and 60.8% and 59.2% were aware about the vaccination and of its availability in Italy. Parents with a child aged <1 year and those who reported the physicians as source of information were more likely to have heard about rotavirus infection and to know that the vaccination is available in Italy. More than half (56.4%) were worried that their children could have a rotavirus gastroenteritis and this was most likely to occur in those who have heard about rotavirus infection. Only 15.3% declared that they had immunized their children against rotavirus infection. Parents who considered it dangerous for their children to contract the rotavirus gastroenteritis, those who considered the rotavirus vaccine useful, and those who had received information by physicians were more likely to have vaccinated their children against the infection. More than half of the parents who did not immunize their children expressed their willingness to vaccinate them. Developing and implementing additional public education programs are needed for better knowledge toward rotavirus infection and vaccination and a high coverage among parents.

The Acceptability of HPV Vaccines and Perceptions of Vaccination against HPV among Physicians and Nurses in Hong Kong

Background: Human papillomavirus (HPV) is one of the most common sexually transmitted infections nationwide. Methods: This is the first cross-sectional survey assessing physicians’ and nurses’ knowledge of HPV and recording their attitudes to HPV vaccination in Hong Kong. Survey questions were derived from the Health Belief Model. Results: 1152 clinicians (170 physicians and 982 nurses) aged 21 and 60 participated in this study. A multiple stepwise regression model was used to examine associations between cognitive factors (clinicians’ attitudes) and subjects’ intention to HPV vaccine uptake. Results showed that only 30.2% of physicians and 21.2% nurses found vaccinating for HPV acceptable. Conclusions: Perceived self-efficacy was the only significant background and cognitive variable associated with physicians’ and nurses’ accepting HPV vaccines. Further, when nurses found HPV vaccination acceptable, cues to action was featured as a significant background variable in their choice.

Knowledge and attitudes toward HPV infection and vaccination among immigrants and refugees in Italy

BACKGROUND

The objectives of the present cross-sectional study were to investigate the level of knowledge and attitudes regarding Human papillomavirus (HPV) infection and its vaccination and to understand the impact of different determinants among immigrants and refugees in Italy.

METHODS

Between September 2016 and March 2018, a total of 519 potential participants were randomly recruited. The information was collected through a questionnaire administered by two researchers.

RESULTS

Only 15.9% reported that they had heard of HPV infection before completing the survey and 83.8% of them were aware that the infection could be transmitted through sexual intercourses, 32.3% that it can lead to cervical cancer, 22% to warts, 16.2% to penile cancer, 13.2% to oral cancer, 39.7% that cervical cancer is a very severe disease, 47.1% that receiving the vaccine could protect against the infection, and 44.1% that a vaccine against HPV is available in Italy. Females, those who originated from Eastern Europe, Asia and South America, those who lived in a house compared to those who lived in a street, and those who had 1-10 years and 11 or more years of education compared to those illiterate were more likely to have heard about the HPV infection before completing the survey. Only 3 participants (0.7%) received the HPV vaccination. Out of the unvaccinated who had heard of HPV, 50.7% and 59% of those between the ages of 12 and 26 and of those who had at least one child aged 12-26 years, were willing to receive vaccination for themselves as well as their children.

CONCLUSION

The results underscored the necessity to develop health education and promotion aimed at improving the knowledge and vaccination practice in immigrants and refugees.