1
|
Tsui J, Shin M, Sloan K, Martinez B, Palinkas LA, Baezconde-Garbanati L, Cantor JC, Hudson SV, Crabtree BF. Understanding Clinic and Community Member Experiences with Implementation of Evidence-Based Strategies for HPV Vaccination in Safety-Net Primary Care Settings. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:147-162. [PMID: 37368117 PMCID: PMC11133176 DOI: 10.1007/s11121-023-01568-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 06/28/2023]
Abstract
HPV vaccination rates remain below target levels among adolescents in the United States, which is particularly concerning in safety-net populations with persistent disparities in HPV-associated cancer burden. Perspectives on evidence-based strategies (EBS) for HPV vaccination among key implementation participants, internal and external to clinics, can provide a better understanding of why these disparities persist. We conducted virtual interviews and focus groups, guided by the Practice Change Model, with clinic members (providers, clinic leaders, and clinic staff) and community members (advocates, parents, policy-level, and payers) in Los Angeles and New Jersey to understand common and divergent perspectives on and experiences with HPV vaccination in safety-net primary care settings. Fifty-eight interviews and seven focus groups were conducted (n = 65 total). Clinic members (clinic leaders n = 7, providers n = 12, and clinic staff n = 6) revealed conflicting HPV vaccine messaging, lack of shared motivation to reduce missed opportunities and improve workflows, and non-operability between clinic electronic health records and state immunization registries created barriers for implementing effective strategies. Community members (advocates n = 8, policy n = 11, payers n = 8, and parents n = 13) described lack of HPV vaccine prioritization among payers, a reliance on advocates to lead national agenda setting and facilitate local implementation, and opportunities to support and engage schools in HPV vaccine messaging and adolescents in HPV vaccine decision-making. Participants indicated the COVID-19 pandemic complicated prioritization of HPV vaccination but also created opportunities for change. These findings highlight design and selection criteria for identifying and implementing EBS (changing the intervention itself, or practice-level resources versus external motivators) that bring internal and external clinic partners together for targeted approaches that account for local needs in improving HPV vaccine uptake within safety-net settings.
Collapse
Affiliation(s)
- Jennifer Tsui
- University of Southern California, Los Angeles, CA, USA.
| | | | - Kylie Sloan
- University of Southern California, Los Angeles, CA, USA
| | | | | | | | - Joel C Cantor
- Rutgers the State University of New Jersey, New Brunswick, NJ, USA
| | - Shawna V Hudson
- Rutgers the State University of New Jersey, New Brunswick, NJ, USA
| | | |
Collapse
|
2
|
Kong WY, Queen TL, Gottfredson O'Shea N, Heisler-MacKinnon J, Liu A, Ozawa S, Brewer NT, Gilkey MB. Impact of visit characteristics on intention to recommend HPV vaccine: An experiment with US health care professionals. Prev Med 2024; 179:107841. [PMID: 38160884 PMCID: PMC10872220 DOI: 10.1016/j.ypmed.2023.107841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Presumptive recommendations that assume parents want to vaccinate can increase human papillomavirus (HPV) vaccine uptake. We sought to examine how visit characteristics affect health care professionals' (HCPs) intention to use this evidence-based recommendation style. METHODS In 2022, we conducted an online experiment with 2527 HCPs who had a role in adolescent vaccination in the United States. Participants read 1 of 8 randomly assigned vignettes about a well-child visit. Using a 2 × 2 × 2 between-subjects factorial design, the vignettes varied the following visit characteristics: patient age (9 vs. 12-year-old), prior parental vaccine refusal (yes vs. no), and time pressure on the HCP (low vs. high). HCPs reported on their intention to use a presumptive HPV vaccine recommendation, as well as on related attitudes, subjective norms, and self-efficacy. Analyses used 3-way analysis of variance and parallel mediation. RESULTS Participants were pediatricians (26%), family/general medicine physicians (22%), advanced practitioners (24%), and nursing staff (28%). Overall, about two-thirds of HCPs (64%) intended to use a presumptive recommendation. Intentions were higher for older children (b = 0.23) and parents without prior vaccine refusal (b = 0.39, both p < 0.001). Time pressure had no main effect or interactions. HCPs' attitudes and self-efficacy partially mediated effects of patient age and prior vaccine refusal (range of b = 0.04-0.28, all p < 0.05). CONCLUSION To better support visits with younger children and parents who have refused vaccines, HCPs may need more training for making presumptive recommendations for HPV vaccine. Reinforcing positive attitudes and self-efficacy can help HCPs adopt this evidence-based recommendation style.
Collapse
Affiliation(s)
- Wei Yi Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America.
| | - Tara L Queen
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Nisha Gottfredson O'Shea
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America; RTI International, Research Triangle Park, North Carolina, United States of America
| | - Jennifer Heisler-MacKinnon
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Amy Liu
- School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Sachiko Ozawa
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, North Carolina, United States of America; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, United States of America
| |
Collapse
|
3
|
Štrbac M, Vuković V, Pustahija T, Nikolić N, Rajčević S, Ilić S, Dugandžija T, Patić A, Ristić M, Petrović V. Motives and attitudes of parents toward HPV vaccination: Results from the initial period of HPV vaccine rollout in Serbia. PLoS One 2023; 18:e0287295. [PMID: 37410715 PMCID: PMC10325070 DOI: 10.1371/journal.pone.0287295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/03/2023] [Indexed: 07/08/2023] Open
Abstract
Human papillomavirus (HPV) infection is one of the most common viral infections in sexually active population worldwide, and is the main cause of cervical cancer, which is the fourth most common cancer among women. Serbia ranks third in incidence and mortality rate of cervical cancer in Europe. We conducted a cross-sectional study considering parents' motivation for the HPV vaccination of their children. Statistical analysis included descriptive statistics and a logistic regression model. We found that the strongest motive was "Recommendation from paediatrician" (20.2%), followed by the attitude that HPV vaccine protects against cancers in different localization (15.4%), the motive "It is better to vaccinate a child than expose them to potential risk of HPV infection" (13.3%) and "Feeling anxiety due to a possible infection and cancer in the child" (13.1%). For those parents that vaccinated their child for some other strongest motive, reasons like "Vaccine is free of charge", "Recommendation from friends and family" and motive "My child received all obligatory vaccines, so I want to receive this one as well", were significantly more frequently selected. In the group where paediatricians' recommendation was not a motive for accepting the HPV vaccine, the largest percentage of parents (89.6%) selected motive "HPV vaccine protects against cancers in different localization" and the motive "It is better to vaccinate a child than expose them to potential risk of HPV infection" (78.1%). Paediatrician's recommendation is very important for parents' decision to vaccinate, however, other motives also influenced and had significance in making the parents' decision to vaccinate their children against HPV. Encouraging trust in public health authorities in Serbia, highlighting the advantages of the HPV vaccine and further encouraging healthcare workers to give stronger recommendations can increase the HPV vaccine uptake. Finally, we provided the basis to create more targeted messages that will empower parents to vaccinate their children.
Collapse
Affiliation(s)
- Mirjana Štrbac
- Institute of Public Health of Vojvodina, Novi Sad, Serbia
| | - Vladimir Vuković
- Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Tatjana Pustahija
- Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Nataša Nikolić
- Institute of Public Health of Vojvodina, Novi Sad, Serbia
| | - Smiljana Rajčević
- Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Svetlana Ilić
- Institute of Public Health of Vojvodina, Novi Sad, Serbia
| | - Tihomir Dugandžija
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Aleksandra Patić
- Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Mioljub Ristić
- Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Vladimir Petrović
- Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| |
Collapse
|
4
|
Staras SAS, Salloum RG, Osegueda E, Bylund CL, Chi X, Mohan V, Sage E, Huo T, Young A, Thompson LA. North-Central Florida Clinicians' Human Papillomavirus Vaccine Recommendation Priorities and Practices for 11- to 12-Year-Olds: A Discrete Choice Experiment. J Adolesc Health 2023; 73:172-180. [PMID: 37029049 DOI: 10.1016/j.jadohealth.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 01/20/2023] [Accepted: 02/01/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE Within the United States, human papillomavirus (HPV) vaccination rates remain low. We examined HPV vaccine recommendation practices among Florida clinicians by assessing variability in: (1) recommendation priorities by patient characteristics and (2) concordance with best practices. METHODS In 2018 and 2019, we conducted a cross-sectional survey incorporating a discrete choice experiment among primary care clinicians (MD/DO, APRN, and PA). We used linear mixed-effects models to determine the importance of patient characteristics (age, sex, time in practice, and chronic condition) and parental concerns. We compared clinician endorsement of predetermined constructs with reported vaccine recommendation statements. RESULTS Among 540 surveys distributed, 272 were returned and 105 reported providing preventive care to 11- to 12-year-olds (43% response rate). Among completing clinicians, 21/99 (21%) did not offer the HPV vaccine. Among clinicians offering the vaccine (n = 78), 35%-37% of each decision to recommend the vaccine was based on the child's age (15 vs. 11 years). For closed-ended questions, most clinicians endorsed best practices including emphasizing cancer prevention (94% for girls and 85% for boys; p = .06), vaccine efficacy (60% both sexes), safety (58% girls and 56% boys), importance at 11-12 years (64% both sexes), and bundling vaccines (35% girls and 31% boys). When clinicians reported their typical recommendation, fewer clinicians incorporated best practices (59% cancer prevention, 5% safety, 8% the importance at 11-12 years, and 8% bundling vaccines). DISCUSSION HPV vaccination recommendation strategies among Florida clinicians somewhat aligned with best practices. Alignment was higher when clinicians were explicitly asked to endorse constructs versus provide recommendations.
Collapse
Affiliation(s)
- Stephanie A S Staras
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida; The Institute for Child Health Policy, University of Florida, Gainesville, Florida.
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Eduardo Osegueda
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida; Health Services Research, Management & Policy, College of Public Health & Health Professions, University of Florida, Gainesville, Florida
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Xiaofei Chi
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Vikasni Mohan
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Emily Sage
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Tianyao Huo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Alyson Young
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Lindsay A Thompson
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida; The Institute for Child Health Policy, University of Florida, Gainesville, Florida; Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
| |
Collapse
|
5
|
Xu MA, Choi J, Capasso A, DiClemente R. Patient-Provider Health Communication Strategies: Enhancing HPV Vaccine Uptake among Adolescents of Color. Healthcare (Basel) 2023; 11:1702. [PMID: 37372820 DOI: 10.3390/healthcare11121702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Cervical cancer remains a public health issue in the United States, particularly among stigmatized racial and ethnic populations. The human papillomavirus (HPV) vaccine has been clinically proven to prevent cervical cancers, and other HPV-associated cancers, among men and women. However, HPV vaccine uptake is suboptimal; only 55% of adolescents complete the two-dose series by age 15. Past research has shown that provider HPV vaccine communication for people of marginalized races/ethnicities is subpar. This article focuses on provider communication strategies to promote HPV vaccine uptake effectively and equitably. The authors reviewed the literature on evidence-based patient-provider HPV vaccine communication techniques to create a set of communication language providers could use and avoid using to enhance HPV vaccine acceptance and uptake among adolescents of marginalized racial and ethnic groups. Evidence has shown that information and the manner of dissemination are critical for influencing HPV vaccine uptake. These communication strategies must be suited to the context of the targeted population, and the message content can be broadly categorized into source, content, and modality. Strategies to improve patient-provider communication among adolescents of color using source, modality, and content include the following: (1) Source: increase provider self-efficacy to provide the recommendation, building rapport between providers and parents; (2) Content: persistent, forceful language with minimal acquiescence should be employed, reframing the conversation focus from sex to cancer; and (3) Modality: use multiple vaccine reminder modalities, and work with the community to culturally adapt the vaccination language. Utilizing effective behavior-change communication adapted for adolescents of color can reduce missed opportunities for HPV prevention, potentially decreasing racial and ethnic disparities in HPV-related morbidity and mortality.
Collapse
Affiliation(s)
- Mia Ann Xu
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | - Jasmin Choi
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | | | - Ralph DiClemente
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| |
Collapse
|
6
|
Molokwu J, Mendez M, Bracamontes C. The Effect of Clinical Decision Prompts in Improving Human Papillomavirus Vaccination Rates in a Multispecialty Practice in a Predominantly Hispanic Population: Quasi-Experimental Study. JMIR Cancer 2023; 9:e42890. [PMID: 36920453 PMCID: PMC10131873 DOI: 10.2196/42890] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/05/2023] [Accepted: 01/26/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The human papillomavirus (HPV) is implicated in the causal pathway of cancers of the vulva, vagina, penis, cervix, anus, and oropharyngeal region. It is the most common sexually transmitted infection in the United States. Despite the documented safety and effectiveness of the HPV vaccine, rates lag behind those of other vaccines given at the same age. OBJECTIVE Provider recommendation is identified as a robust predictor of HPV vaccine uptake, and physician-prompting is shown to increase the provision of preventive care services in general. Theoretically, providing reminders to providers should increase opportunities for providing HPV vaccine recommendations and therefore affect vaccination rates. The objective of our study was to assess the effectiveness of an electronic medical record (EMR) prompt in improving HPV vaccination rates in an academic clinic setting caring for a predominantly Hispanic border population. METHODS We used a quasi-experimental design with a retrospective chart audit to evaluate the effect of a clinical decision prompt (CDP) on improving HPV immunization rates in different specialty settings. We introduced an EMR prompt to remind providers to recommend the HPV vaccine when seeing appropriate patients in an obstetrics and gynecology (OBGYN), pediatrics (PD), and family medicine (FM) clinic in a large multispecialty academic group located along the Texas-Mexico border. We assessed HPV vaccination rates in all the departments involved before and after introducing the prompts. Participants included male and female patients between the ages of 9 and 26 years, presenting at the clinics between January 2014 and December 2015. RESULTS We reviewed over 2800 charts in all 3 clinics. After adjusting for age, ethnicity, race, type of insurance, preferred language, and clinic, the odds of immunization were 92% (P<.001) higher in patients after the prompt implementation of the EMR. In addition, there was an overall statistically significant increase in the overall HPV vaccination completion rates after implementing the CDP (31.96% vs 21.22%; P<.001). Again, OBGYN saw the most significant improvement in vaccination completion rates, with rates at follow-up 66.02% higher than baseline rates (P=.04). PD and FM had somewhat similar but no less impressive improvements (57.7% and 58.36%; P<.001). CONCLUSIONS Implementing an EMR CDP improved our overall odds of HPV vaccination completion by 92%. We theorize that the decision prompts remind health care providers to discuss or recommend the HPV vaccination during clinical service delivery. CDPs in the EMR help increase HPV vaccination rates in multiple specialties and are a low-cost intervention for improving vaccination rates.
Collapse
Affiliation(s)
- Jennifer Molokwu
- Department of Family And Community Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States
| | - Melissa Mendez
- Department of Obstetrics and Gynecology, Hospital Corporation of America Las Palmas Del Sol Healthcare, El Paso, TX, United States
| | - Christina Bracamontes
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States
| |
Collapse
|
7
|
Niccolai LM, Johnson NP, Torres A, Sullivan EL, Hansen CE. Messaging of Different Disease Outcomes for Human Papillomavirus Vaccination: A Systematic Review. J Adolesc Health 2023; 72:334-343. [PMID: 36529616 DOI: 10.1016/j.jadohealth.2022.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 08/12/2022] [Accepted: 10/13/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The purpose of this systematic review was to assess how messaging for human papillomavirus (HPV) vaccination to prevent different health outcomes (sexually transmitted infection, anogenital warts ([AGW], and/or cancer) influences intentions or initiation for the vaccine series. METHODS We searched PubMed, MEDLINE, and Embase databases for all previously published articles with an evaluation, discussion, or comparison of messages containing content about HPV infections, AGW, precancers, or cancer through June 3, 2021. Results about messages were summarized by study population and design. RESULTS We identified 25 studies evaluating or comparing messages containing content about HPV-associated outcomes. Study designs included randomized trials (n = 12), cross-sectional surveys (n = 8), and qualitative approaches (n = 5). Few studies directly compared different messages using randomized designs or included vaccination uptake as the outcome. While many studies found support for cancer prevention messages, some studies also found equal or greater support for messages focusing on prevention of sexually transmitted infection/AGW. Variability was observed within and between studied populations (parents/adults, adolescents, young adults, healthcare providers, and adult males) and gender (male and female adolescents). DISCUSSION A greater understanding and deeper attention to myriad health outcomes of HPV infections could increase vaccination uptake in a variety of populations for health promotion across the lifespan.
Collapse
Affiliation(s)
- Linda M Niccolai
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.
| | - Nicholaus P Johnson
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Ashlynn Torres
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Erin L Sullivan
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Caitlin E Hansen
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
8
|
Yarıcı F, Mammadov B. An analysis of the knowledge of adults aged between 18 and 45 on HPV along with their attitudes and beliefs about HPV vaccine: the Cyprus case. BMC Womens Health 2023; 23:70. [PMID: 36793099 PMCID: PMC9933404 DOI: 10.1186/s12905-023-02217-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/08/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The aim of this research is to analyze knowledge of adults between 18 and 45 years of age and living in the Northern Cyprus about Human Papilloma Virus (HPV) along with their attitudes and beliefs towards HPV vaccine. MATERIALS AND METHODS The research, which was planned as a descriptive and cross-sectional, was executed on the web. The research was completed with 1108 women and men adults between 18 and 45 years of age, living in the Northern Cyprus and volunteered to participate in the study. RESULTS 51.90% of the adults participating in the study were found to be women, 8.84% had a Sexually transmitted disease (STD) before and 63.27% of the individuals who had a sexually transmitted disease before also had had HPV and they knew it, 77.55% had undergone a treatment for their disease, 59.18% were found to be actively infected with HPV. Statistically significant and positive correlations were determined between the overall scores of the participants from the Human Papillomavirus Knowledge Questionnaire (HPV-KQ) and their scores in the perceived severity, perceived benefits and perceived susceptibility sub-dimensions of the Health Belief Model Scale for Human Papilloma Virus and Its Vaccination (HBMS-HPVV) (p < 0.05). There was a statistically significant and negative correlation between HPV-KQ scores, questions on Current HPV Vaccination Program and the perceived barriers sub-dimension of the HBMS-HPVV whereas there was a statistically significant and positive correlation between the HPV-KQ scores, questions on Current HPV Vaccination Program and the perceived benefits and perceived susceptibility sub-dimensions of the HBMS-HPVV (p < 0.05). CONCLUSIONS It has emerged that the participants do not have enough information about HPV, they do not know the ways and symptoms of protection from HPV, they do not have enough information about early diagnosis and screening, and they know very little about the HPV vaccine. Health policies should be developed to increase the awareness of individuals about HPV, to increase education and to provide free vaccines.
Collapse
Affiliation(s)
- Filiz Yarıcı
- Faculty of Healty, Near East University, Near East Boulevard, 99138, Nicosia, TRNC Mersin 10, Turkey.
| | - Betül Mammadov
- grid.412132.70000 0004 0596 0713Faculty of Healty, Near East University, Near East Boulevard, 99138 Nicosia, TRNC Mersin 10 Turkey
| |
Collapse
|
9
|
Casey SM, Paiva T, Perkins RB, Villa A, Murray EJ. Could oral health care professionals help increase human papillomavirus vaccination rates by engaging patients in discussions? J Am Dent Assoc 2023; 154:10-23.e17. [PMID: 36503668 DOI: 10.1016/j.adaj.2022.09.014] [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: 04/20/2022] [Revised: 08/29/2022] [Accepted: 09/21/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Oral health care professionals are well positioned to contribute to the prevention of human papillomavirus (HPV)-related oropharyngeal and other HPV-related cancers through engaging patients in conversations about HPV vaccination. This scoping review evaluates evidence regarding oral health care provider knowledge of, and discussion related to, HPV prevention, transmission, and associated risks, including oropharyngeal cancer. This review outlines relevant barriers to, and facilitators of, this knowledge and discussion. In addition, to determine the potential population that could be reached by an oral health care provider for a conversation about HPV vaccination, this review evaluates the prevalence of HPV vaccination as well as dental visits in a US population. TYPES OF STUDIES REVIEWED Four databases were systematically searched (MEDLINE [PubMed], EMBASE, APA PsycInfo, Cumulative Index to Nursing and Allied Health Literature). Studies written in English and conducted in the United States were eligible. Eligibility criteria were not restricted to publication year or oral health care provider type. Behavioral Risk Factor Surveillance System 2018 data were analyzed to evaluate the prevalence of HPV vaccination and dental visits among patients aged 18 through 49 years. RESULTS After duplicate record removal and second-stage screening, 32 full-text articles were retrieved, and data were independently extracted by 2 reviewers. Twenty-four studies were included in this review. Knowledge regarding HPV prevalence, transmission, disease processes, and risks varied. In general, discussions related to HPV in dental settings were infrequent. Facilitators to improve knowledge and discussion included guidance from professional dental organizations, education, and communication skills. Behavioral Risk Factor Surveillance System data showed that most people who are not vaccinated have visited their oral health care providers in the past year, highlighting the potential role of oral health care providers regarding discussion of HPV and promoting awareness and acceptance of vaccination. CONCLUSIONS AND PRACTICAL IMPLICATIONS This review indicates that discussions related to HPV were infrequent in the oral health care setting, which may be related to lack of knowledge and communication skills among oral health care professionals; however, evidence exists supporting the interest of oral health care professionals in improving vaccine uptake to prevent oropharyngeal cancer.
Collapse
|
10
|
Aragones A, Gany F, Kaplan A, Bruno D. An opportunity to increase human papillomavirus vaccination rates: Change the guidelines. Hum Vaccin Immunother 2022; 18:2136444. [PMID: 36282533 PMCID: PMC9746429 DOI: 10.1080/21645515.2022.2136444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/27/2022] [Accepted: 10/07/2022] [Indexed: 02/09/2023] Open
Abstract
Given the low rates of Human Papillomavirus (HPV) vaccination initiation and timely series completion in 11- and 12-year old children, we sought to assess potential opportunities for initiating routine vaccination at a younger age. A cross-sectional study of Latino parents of HPV vaccine-eligible 9- or 10-year-old children in New York City assessed whether there were opportunities to discuss the HPV vaccine during their most recent primary care provider (PCP) visit. Parents were approached between November, 2016 and January, 2018. Of 86 parents who participated, 97% reported having visited the child's PCP in the previous year for an annual checkup and 85% reported that they had neither discussed the HPV vaccine nor received a recommendation for the vaccine during that visit. In a population of Latino parents, predominantly Mexican immigrants with less than a high school education and limited English proficiency, most 9- to 10-year-old children followed the recommendation for an annual PCP visit. Lowering the recommended age for routine vaccination with the HPV vaccine to 9 - 10 years of age should be considered as an important strategy to increase HPV vaccination rates in this and other populations.
Collapse
Affiliation(s)
- Abraham Aragones
- Immigrant Health & Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- School of Public Health, Downstate Health Sciences University, State University of New York, Brooklyn, NY, USA
| | - Francesca Gany
- Immigrant Health & Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Denise Bruno
- School of Public Health, Downstate Health Sciences University, State University of New York, Brooklyn, NY, USA
| |
Collapse
|
11
|
Groene EA, Horvath KJ, Yared N, Mohammed I, Muscoplat M, Kuramoto S, Richter T, Kulasingam S. Missed Opportunities for Human Papillomavirus Vaccination by Parental Nativity, Minnesota, 2015-2018. Public Health Rep 2022; 137:867-877. [PMID: 34252324 PMCID: PMC9379833 DOI: 10.1177/00333549211027244] [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] [Accepted: 06/01/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Human papillomavirus (HPV) vaccination coverage in the United States is far below coverage for other routine adolescent vaccines. We examined whether missed opportunities for HPV vaccination among adolescents differ by parental nativity (country of origin) in Minnesota. METHODS We retrospectively analyzed birth record and immunization information data for adolescents in Minnesota born during 2004-2007 using data from January 1, 2015, through December 31, 2018. Using logistic regression, we assessed the association between parental nativity and missed opportunities for HPV vaccine initiation, or receipt of other vaccines without receipt of the HPV vaccine. We adjusted for parent/child demographic and vaccination characteristics. We defined nativity as the number of non-US-born parents and maternal region of birth. RESULTS Adolescents with mothers born in Eastern Europe (adjusted odds ratio [aOR] = 2.33; 95% CI, 2.01-2.73) and Africa (aOR = 1.36; 95% CI, 1.28-1.43) had greater adjusted odds of missed opportunities for HPV vaccination than adolescents with US-born mothers. However, adolescents with mothers from Latin America and the Caribbean had lower odds of missed opportunities than adolescents with US-born mothers (aOR = 0.61; 95% CI, 0.58-0.65). Adolescents with 1 or 2 non-US-born parents had lower odds of missed opportunities for HPV vaccination than adolescents with 2 US-born parents (1 parent: aOR = 0.92; 95% CI, 0.88-0.96; 2 parents: aOR = 0.90; 95% CI, 0.87-0.94). CONCLUSIONS Future studies should evaluate outreach to groups with HPV vaccination disparities and identify other drivers of missed opportunities among adolescents with US-born parents, such as multiparity.
Collapse
Affiliation(s)
- Emily A. Groene
- School of Public Health, University of Minnesota, Minneapolis,
MN, USA
| | - Keith J. Horvath
- School of Public Health, University of Minnesota, Minneapolis,
MN, USA
| | - Nicholas Yared
- School of Public Health, University of Minnesota, Minneapolis,
MN, USA
| | - Inari Mohammed
- School of Public Health, University of Minnesota, Minneapolis,
MN, USA
| | - Miriam Muscoplat
- Minnesota Immunization Information Connection, Minnesota
Department of Health, St. Paul, MN, USA
| | - Sydney Kuramoto
- Minnesota Immunization Information Connection, Minnesota
Department of Health, St. Paul, MN, USA
| | - Tyler Richter
- School of Public Health, University of Minnesota, Minneapolis,
MN, USA
| | | |
Collapse
|
12
|
Barnard JG, Marsh R, Anderson-Mellies A, Williams JL, Fisher MP, Cockburn MG, Dempsey AF, Cataldi JR. Pre-implementation evaluation for an HPV vaccine provider communication intervention among primary care clinics. Vaccine 2022; 40:4835-4844. [PMID: 35792022 PMCID: PMC10575754 DOI: 10.1016/j.vaccine.2022.06.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 05/06/2022] [Accepted: 06/23/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Interventions to improve health care provider communication about HPV vaccination can increase vaccine acceptance. Our objectives were to (1) identify clinics in locations with high HPV-associated cancer and low HPV-vaccination rates that would potentially benefit from dissemination of a proposed HPV Provider Communication intervention and (2) use qualitative interviews and a dissemination and implementation framework to assess readiness for change and fit of the HPV Provider Communication intervention to the context of these clinics. METHODS Local HPV-associated cancer and HPV vaccination rates were assigned to Practice-Based Research Network clinics using data from the Colorado Central Cancer Registry, the Colorado Immunization Information System, and the American Community Survey. Staff from 38 clinics located in areas with high numbers of adolescents not up-to-date for HPV vaccine and high rates of HPV-associated cancers were recruited for qualitative interviews. Interview questions used the Promoting Action on Research Implementation in Health Services (PARIHS) conceptual framework and addressed the proposed intervention, current vaccination practices and prior quality improvement (QI) experience. RESULTS Twenty-seven interviews were completed with clinicians, clinic managers, and other staff across 17 clinics (9 pediatric, 5 family medicine, 3 public/school-based health). Most clinics had some prior QI experience and there were few thematic differences between sites with more or less foundation for QI/immunization work. Participants were motivated to improve the health of their patients and valued both guidelines and local experience as important evidence to consider adopting an intervention. Interviewees were more interested in implementing the proposed intervention if it aligned with existing priorities and fit within clinic workflows. Facilitation needs included adequate time and external facilitation support for data tracking and analysis. CONCLUSIONS Qualitative interviews to understand clinic context and fit of an HPV Provider Communication intervention can inform implementation in settings with the highest potential for clinical impact.
Collapse
Affiliation(s)
- Juliana G Barnard
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rebekah Marsh
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Johnny L Williams
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael P Fisher
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Myles G Cockburn
- University of Colorado Cancer Center, Aurora, CO, USA; Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | | | - Jessica R Cataldi
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| |
Collapse
|
13
|
Gilkey MB, Grabert BK, Heisler-MacKinnon J, Bjork A, Boynton MH, Kim K, Dailey SA, Liu A, Todd KG, Schauer SL, Sill D, Coley S, Brewer NT. Coaching and Communication Training for HPV Vaccination: A Cluster Randomized Trial. Pediatrics 2022; 150:188506. [PMID: 35818840 PMCID: PMC9535352 DOI: 10.1542/peds.2021-052351] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES US health departments routinely conduct in-person quality improvement (QI) coaching to strengthen primary care clinics' vaccine delivery systems, but this intervention achieves only small, inconsistent improvements in human papillomavirus (HPV) vaccination. Thus, we sought to evaluate the effectiveness of combining QI coaching with remote provider communication training to improve impact. METHODS With health departments in 3 states, we conducted a pragmatic 4-arm cluster randomized clinical trial with 267 primary care clinics (76% pediatrics). Clinics received in-person QI coaching, remote provider communication training, both interventions combined, or control. Using data from states' immunization information systems, we assessed HPV vaccination among 176 189 patients, ages 11 to 17, who were unvaccinated at baseline. Our primary outcome was the proportion of those, ages 11 to 12, who had initiated HPV vaccination at 12-month follow-up. RESULTS HPV vaccine initiation was 1.5% points higher in the QI coaching arm and 3.8% points higher in the combined intervention arm than in the control arm, among patients ages 11 to 12, at 12-month follow-up (both P < .001). Improvements persisted at 18-month follow-up. The combined intervention also achieved improvements for other age groups (ages 13-17) and vaccination outcomes (series completion). Remote communication training alone did not outperform the control on any outcome. CONCLUSIONS Combining QI coaching with remote provider communication training yielded more consistent improvements in HPV vaccination uptake than QI coaching alone. Health departments and other organizations that seek to support HPV vaccine delivery may benefit from a higher intensity, multilevel intervention approach.
Collapse
Affiliation(s)
- Melissa B. Gilkey
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Brigid K. Grabert
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | | | - Adam Bjork
- Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, Georgia,United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - Marcella H. Boynton
- North Carolina Translational & Clinical Sciences Institute, University of North Carolina, Chapel Hill, North Carolina,Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - KyungSu Kim
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Susan Alton Dailey
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina
| | - Amy Liu
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - Karen G. Todd
- WakeMed Health and Hospitals, WakeMed Physician Practices, Raleigh, North Carolina
| | - Stephanie L. Schauer
- Immunization Program, Division of Public Health, Wisconsin Department of Health Services, Madison, Wisconsin
| | - Danielle Sill
- Immunization Program, Division of Public Health, Wisconsin Department of Health Services, Madison, Wisconsin
| | - Scott Coley
- Bureau of Immunization, New York State Department of Health, Albany, New York
| | - Noel T. Brewer
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| |
Collapse
|
14
|
Balogun FM, Omotade OO. Facilitators and barriers of healthcare workers' recommendation of HPV vaccine for adolescents in Nigeria: views through the lens of theoretical domains framework. BMC Health Serv Res 2022; 22:824. [PMID: 35752809 PMCID: PMC9233785 DOI: 10.1186/s12913-022-08224-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The human Papillomavirus (HPV) vaccine has demonstrated efficacy in the prevention of cervical cancer when given in early adolescence. The recommendation of the vaccine by health care workers (HCW) is crucial to the uptake of the vaccine by adolescents and the process of this recommendation is important as it determines subsequent uptake of the vaccine. Understanding of the facilitators and barriers of recommendation of this vaccine can help in the development of strategies to improve its recommendation rates and uptake. This study therefore explored the facilitators and barriers for the recommendation of HPV vaccine for adolescents by HCW in Ibadan, Nigeria using the Theoretical Domain Framework (TDF). METHODS Key informant interviews were conducted with 14 purposively selected HCW who were in charge of vaccination. Content analysis was used after deductive coding of the data using the domains of the TDF. Relevant concepts for facilitators and barriers of HPV vaccine recommendation and quotes were then identified. RESULTS Mean age of the HCW was 47.7 ± 6.5 years and they consisted of eight nurses, four medical doctors, one medical social worker and one health visitor. Ten domains of the TDF were represented among the facilitators and barriers against the recommendation of HPV vaccination by the HCW, except the goals; memory, attention, decision process; emotion; and behavioral regulation domains. The domains with the highest frequency of concepts were: knowledge, skills, social/professional role and identity, beliefs about capabilities, beliefs about consequences, intention and environmental context and resources. Domains with conflicting statements in the concept were: environmental context and resources, and beliefs about consequences. While those with perceived strength of concept were: social influences, reinforcement and optimism. CONCLUSION All the 10 identified domains of the TDF are potential areas of focus for strategies for improving the recommendation of HPV vaccine for adolescents by health care workers in Nigeria and other countries with similar sociocultural settings.
Collapse
Affiliation(s)
- Folusho M Balogun
- Institute of Child Health, College of Medicine, University of Ibadan, PMB 5116, Oyo, 200001, Ibadan, Nigeria. .,Institute of Child Health, University College Hospital, Ibadan, Nigeria.
| | - Olayemi O Omotade
- Institute of Child Health, College of Medicine, University of Ibadan, PMB 5116, Oyo, 200001, Ibadan, Nigeria.,Institute of Child Health, University College Hospital, Ibadan, Nigeria
| |
Collapse
|
15
|
Recommending Human Papillomavirus Vaccination at Age 9: A National Survey of Primary Care Professionals. Acad Pediatr 2022; 22:573-580. [PMID: 35081470 PMCID: PMC9081141 DOI: 10.1016/j.acap.2022.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/06/2022] [Accepted: 01/13/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Several US health organizations, including the American Academy of Pediatrics, now encourage primary care professionals to recommend human papillomavirus (HPV) vaccination before the traditionally targeted ages of 11 to 12 years as a strategy to increase vaccination timeliness. To understand the feasibility of this approach, we sought to evaluate primary care professionals' current recommendation timing and willingness to recommend HPV vaccination at age 9. METHODS A national sample of 1047 primary care professionals completed our online survey in 2021. Respondents were physicians (71%), advanced practitioners (17%), and nurses (12%). RESULTS About one-fifth (21%) of primary care professionals reported that they already routinely recommend HPV vaccination at ages 9 to 10. Among the remaining 822 respondents, over half (61%) reported being somewhat or more willing to start recommending at age 9. Willingness was higher among those working in family medicine versus pediatrics (adjusted odds ratio [aOR]: 1.40, 95% confidence interval [CI] 1.03, 1.92), but lower among those with ≥20 years of practice experience versus ≤9 years (aOR: 0.65, 95% CI 0.44, 0.96). Many primary care professionals believed age 9 recommendations would have the advantage of protecting adolescents before HPV exposure (67%) or increasing vaccination timeliness (55%). The most commonly perceived disadvantage was that parents are not ready to talk about HPV vaccination at age 9 (73%). CONCLUSION Over two-thirds of primary care professionals in our national sample reported they recommend HPV vaccination at ages 9 to 10 or are somewhat or more willing to do so. Training may be needed to help primary care professionals address perceived parental hesitancy toward age 9 recommendations.
Collapse
|
16
|
McGee LU, Ressler KS, Boom JA, Bulsara S, Sangi-Haghpeykar H, Jibaja-Weiss ML, Montealegre JR. Incomplete Records as a Leading Cause of Missed Opportunity for Human Papillomavirus Vaccine Initiation in a Safety Net Health System. Acad Pediatr 2021; 21:1118-1125. [PMID: 33359360 DOI: 10.1016/j.acap.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 11/25/2020] [Accepted: 12/15/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The goal of this study was to categorize reasons behind missed opportunities for human papillomavirus (HPV) vaccine initiation in an under-resourced population and to identify associated patient and clinic characteristics. METHODS Manual chart review was performed for patients aged 11 to 18 years who visited a primary care clinic in a health system in Texas, USA between 06/01/18 and 08/31/18 and were due for an initial HPV vaccine dose but did not receive it. Reasons for HPV vaccine noninitiation were categorized as follows: incomplete immunization record, no documentation of discussion (no documentation that the HPV vaccine was offered or ordered), refusal, staff/provider error, and medical. Multinomial logistic regression was used to examine factors associated with each category. RESULTS Of 4467 adolescents seen in the study period, 575 (12.9%) were due for the first dose of HPV vaccine but did not receive it. The most common reason for noninitiation was incomplete immunization record (37%), followed by no documentation of discussion (24%), refusal (20%), staff/provider error (15%), and medical (4%). The highest odds of incomplete immunization were among older adolescents. The highest odds of no documentation of discussion were during sick visits. The highest odds of staff/provider error were among patients with commercial insurance. The lowest odds of refusal were in patients with county/indigent insurance. CONCLUSIONS The most common reason for missed opportunity visits for HPV vaccine initiation was lack of adequate immunization records. Our study highlights the importance of immunization record access and bidirectional reporting as important targets for future interventions.
Collapse
Affiliation(s)
- Lindy U McGee
- Department of Pediatrics, Baylor College of Medicine (LU McGee, JA Boom, and JR Montrealegre), Houston, Tex; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine (LU McGee, S Bulsara, ML Jibaja-Weiss, and JR Montealegre), Houston, Tex.
| | - Kelly S Ressler
- Department of Medical Education, Baylor College of Medicine (KS Ressler), Houston, Tex
| | - Julie A Boom
- Department of Pediatrics, Baylor College of Medicine (LU McGee, JA Boom, and JR Montrealegre), Houston, Tex
| | - Shaun Bulsara
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine (LU McGee, S Bulsara, ML Jibaja-Weiss, and JR Montealegre), Houston, Tex
| | - Haleh Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Baylor College of Medicine (H Sangi-Haghpeykar), Houston, Tex
| | - Maria L Jibaja-Weiss
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine (LU McGee, S Bulsara, ML Jibaja-Weiss, and JR Montealegre), Houston, Tex; School of Health Professions, Baylor College of Medicine (ML Jibaja-Weiss), Houston, Tex
| | - Jane R Montealegre
- Department of Pediatrics, Baylor College of Medicine (LU McGee, JA Boom, and JR Montrealegre), Houston, Tex; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine (LU McGee, S Bulsara, ML Jibaja-Weiss, and JR Montealegre), Houston, Tex
| |
Collapse
|
17
|
Perkins RB, Foley S, Hassan A, Jansen E, Preiss S, Isher-Witt J, Fisher-Borne M. Impact of a Multilevel Quality Improvement Intervention Using National Partnerships on Human Papillomavirus Vaccination Rates. Acad Pediatr 2021; 21:1134-1141. [PMID: 34023489 DOI: 10.1016/j.acap.2021.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a multilevel intervention using national partnerships on human papillomavirus (HPV) vaccination rates. METHODS The American Cancer Society's Vaccinate Adolescents against Cancer program is a multilevel intervention focusing on systems and providers. The 2017 cohort introduced national partnerships to deliver intervention elements and Maintenance of Certification and continuing medical education credits for physicians. Eleven federally qualified health center (FQHC) systems completed interventions in 2017. Interventions included provider training and ≥1 other evidence-based systems improvement. We compared adolescent vaccination rates in the preintervention period (2016) and intervention period (2017) among adolescents who turned 13 during the calendar year. Intervention effectiveness was assessed using repeated measures paired t tests and Cohen's d effect size for vaccination rate change. RESULTS All FQHC systems implemented provider training plus an average of 2.3 additional systems improvements. Series initiation increased by an average of 23.6 percentage points (47.2%-70.8%). HPV completion rates increased by an average of 22.7 percentage points (24.6%-46.3%). Meningococcal and Tdap vaccination rates increased by 23.3 and 25.9 percentage points respectively (47.9%-71.2% and 48.8%-74.7%). All changes were statistically significant (all P < .05) and indicated large effect sizes (Cohen's d3 1.15). Among clinicians completing postintervention surveys, 90% reported making changes to their health care system or direct patient care based on what they had learned. CONCLUSIONS Multilevel interventions focusing on provider training and systems changes can substantially improve on-time adolescent vaccination coverage and can be successfully performed using national partnerships and a train-the-trainer model.
Collapse
Affiliation(s)
- Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center (RB Perkins), Boston, Mass
| | - Shaylen Foley
- American Cancer Society, Vaccinate Adolescents Against Cancer Program (S Foley, A Hassan, S Preiss, JI Witt, and M Fisher-Borne), Atlanta, Ga
| | - Anna Hassan
- American Cancer Society, Vaccinate Adolescents Against Cancer Program (S Foley, A Hassan, S Preiss, JI Witt, and M Fisher-Borne), Atlanta, Ga
| | - Emily Jansen
- Boston University School of Medicine, Continuing Medical Education Office (E Jansen), Boston, Mass
| | - Sandy Preiss
- American Cancer Society, Vaccinate Adolescents Against Cancer Program (S Foley, A Hassan, S Preiss, JI Witt, and M Fisher-Borne), Atlanta, Ga
| | - Jennifer Isher-Witt
- American Cancer Society, Vaccinate Adolescents Against Cancer Program (S Foley, A Hassan, S Preiss, JI Witt, and M Fisher-Borne), Atlanta, Ga.
| | - Marcie Fisher-Borne
- American Cancer Society, Vaccinate Adolescents Against Cancer Program (S Foley, A Hassan, S Preiss, JI Witt, and M Fisher-Borne), Atlanta, Ga
| |
Collapse
|
18
|
A Scoping Review of Cervical Cancer Risk Factors, Prevention, Diagnosis, and Treatment in U.S. Active Duty Military Women. Womens Health Issues 2021; 31 Suppl 1:S53-S65. [PMID: 34454704 DOI: 10.1016/j.whi.2021.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Maintaining military readiness requires integration and delivery of appropriate sex-specific health care services for active duty servicewomen (ADSW). Cervical cancer screening (CCS) provides early detection, intervention, and treatment, allowing for reductions in human papillomavirus (HPV) infections and cervical cancer cases. This scoping review examines existing cervical cancer evidence related to ADSW and identifies research gaps, leverage points, and policy recommendations within the context of the social ecological model for military women's health. METHODS We conducted a scoping literature search using both indexed databases and nonindexed sources. We managed retrieved records from 2000 to 2018 with Endnote reference and DistillerSR systematic review software. RESULTS Of 1,006 records from indexed databases and 208 records from nonindexed resources retrieved, 40 publications met the inclusion criteria. Cervical cancer research addressing ADSW is limited. Servicewomen have high rates of known cancer risk factors and face challenges related to deployments and change of duty station that affect continuity of health care and timely follow-up for abnormal CCS. Multimodal interventions with stakeholder support can encourage CCS adherence and increase HPV vaccination rates. CONCLUSION Maintaining military readiness among ADSW requires robust evidence-based prevention efforts to address risk factors that are reportedly higher among servicewomen, as well as challenges to continuity in health care delivery that may increase the likelihood of cervical cancer incidence. Recognizing the role of HPV vaccination as cancer prevention, collaborations and partnerships, research, best practices, and creative solutions to close ADSW's sex-specific health gaps will help to ensure a fit and ready force.
Collapse
|
19
|
Madhivanan P, Krupp K, Coudray M, Colbert B, Ruiz-Perez D, Cui H, Bokulich N, Narasimhan G, Mathee K, Cook RL, Schwebke J, Roe D. Longitudinal assessment of nonavalent vaccine HPV types in a sample of sexually active African American women from ten U.S. Cities. Vaccine 2021; 39:4810-4816. [PMID: 34294478 DOI: 10.1016/j.vaccine.2021.07.026] [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: 11/29/2020] [Accepted: 07/11/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Chronic infection with high-risk human papillomavirus is a necessary cause for cervical carcinogenesis. This study examined prevalence of nonavalent vaccine preventable HPV types over four months among sexually active women in the United States. METHODS This sub-study obtained meta-data for 80 of the 1,365 women (18-25 years), enrolled in the BRAVO study, a randomized, open-label trial of home screening and treatment of asymptomatic bacterial vaginosis at high-risk for sexually transmitted infections conducted between 2008 and 2013. Participants were randomized to treatment or standard-of-care, and followed every 2-months for 12 months. Stored vaginal swabs from the first three visits were tested for the nine vaccine preventable HPV types using quantitative PCR. Prevalence and associated 95% confidence intervals for the HPV types were assessed using R (version 3.6.1). RESULTS The average age of the participants was 21.5 (SD ± 2.11) years, with 60% having ever been pregnant and all were African-American. Majority (71%) reported ≥ two sex partners in the prior year with 89% having unprotected vaginal sex and 45% having a new sex partner in the prior year. About 30% had ≥ one of the nine nonavalent vaccine HPV types at all three time points over a period of four months, 15% at two of any three visits, 19% at one of the three visits and 36% were negative for all nine vaccine HPV types at all time points. The most frequently detected HPV vaccine types were 52, 58, 16, and 18. The prevalence of any vaccine HPV types, and high-risk HPV types was 63.8% and 58.8%, respectively. CONCLUSIONS Our findings suggest that HPV vaccination which is currently recommended for all unvaccinated persons through age 26 years, is likely to be more beneficial than previously thought as nonavalent HPV vaccine was not available during the time these data were collected.
Collapse
Affiliation(s)
- P Madhivanan
- Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA; College of Medicine, University of Arizona, Tucson, USA; University of Arizona Comprehensive Cancer Center, Tucson, USA.
| | - K Krupp
- Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA; University of Arizona Comprehensive Cancer Center, Tucson, USA.
| | - M Coudray
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, USA; College of Medicine, University of Central Florida, Orlando, USA.
| | - B Colbert
- Herbert Wertheim College of Medicine, Florida International University, Miami, USA.
| | - D Ruiz-Perez
- Bioinformatic Research Group (BioRG), School of Computing and Information Sciences, Florida International University, Miami, USA.
| | - H Cui
- University of Arizona Comprehensive Cancer Center, Tucson, USA.
| | - N Bokulich
- Laboratory of Food Systems Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Switzerland.
| | - G Narasimhan
- Herbert Wertheim College of Medicine, Florida International University, Miami, USA.
| | - K Mathee
- Herbert Wertheim College of Medicine, Florida International University, Miami, USA.
| | - R L Cook
- College of Public Health and Health Professions, University of Florida, Gainesville, USA.
| | - J Schwebke
- College of Medicine, University of Birmingham, Alabama, USA.
| | - D Roe
- Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA; University of Arizona Comprehensive Cancer Center, Tucson, USA.
| |
Collapse
|
20
|
Grabert BK, Heisler-MacKinnon J, Liu A, Margolis MA, Cox ED, Gilkey MB. Prioritizing and implementing HPV vaccination quality improvement programs in healthcare systems: the perspective of quality improvement leaders. Hum Vaccin Immunother 2021; 17:3577-3586. [PMID: 34152924 DOI: 10.1080/21645515.2021.1913965] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Human papillomavirus (HPV) vaccination could prevent most of the ~34,000 HPV-attributable cancers diagnosed annually in the US, but uptake remains suboptimal. Healthcare systems are key partners in implementing HPV vaccination quality improvement (QI) programs. To inform future system-level HPV vaccine initiatives, we sought to understand HPV vaccine QI from the perspective of QI program leaders in healthcare systems. We conducted telephone interviews with a multi-state sample of 17 QI leaders in 15 systems. We analyzed data qualitatively via thematic analysis to describe QI leaders' perspectives on prioritizing and implementing HPV vaccine QI. All QI leaders endorsed HPV vaccination as beneficial, and some had already prioritized increasing uptake to improve adolescent health and meet payor reimbursement standards. Those not prioritizing HPV vaccination cited concerns including the relatively small size of adolescent patient populations, lack of buy-in among providers, and the need to focus on health services perceived as more profitable or urgent. When implementing HPV vaccine QI programs, QI leaders reported key barriers to be the lack of robust data systems and acceptable QI metrics, limited time, and pressures of a fee-for-service clinical environment. Facilitators included automation and standardization in QI efforts and passionate vaccine champions. Almost all QI leaders reported future plans to implement HPV vaccine QI projects. Findings suggest that many healthcare systems are motivated to improve HPV vaccination. However, resistance to guideline-consistent quality metrics, the narrow target of one vaccine in the adolescent patient population, payment structures, and constrained time of providers are key barriers to practice improvements.
Collapse
Affiliation(s)
- Brigid K Grabert
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.,Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer Heisler-MacKinnon
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Amy Liu
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, USA
| | - Marjorie A Margolis
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.,Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Elizabeth D Cox
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Melissa B Gilkey
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.,Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
21
|
Margolis MA, Brewer NT, Shah PD, Calo WA, Alton Dailey S, Gilkey MB. Talking about recommended age or fewer doses: what motivates HPV vaccination timeliness? Hum Vaccin Immunother 2021; 17:3077-3080. [PMID: 33961539 DOI: 10.1080/21645515.2021.1912550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
HPV vaccination is recommended for U.S. adolescents at ages 11-12 and requires two versus three doses if the series is started before age 15. We evaluated how talking about recommended age or fewer doses motivates on-time HPV vaccination. Our national, online experiment randomized 1,263 parents of adolescents to view one of three messages about HPV vaccination recommendations or no message. Messages framed guidelines as recommending: vaccination at age 11-12; fewer doses for those who start vaccination at age 11-12; or, fewer doses for those who start vaccination before age 15. We then assessed parents' preferred age for HPV vaccination, categorizing preferences of ≤12 years as on-time. Parents who viewed "at age 11-12" versus no message more often preferred on-time HPV vaccination (63% vs. 43%, p < .05) and did not differ from those viewing "fewer doses at age 11-12" (63% vs. 64%, p > .05). Parents who viewed "fewer doses before age 15" less often preferred on-time HPV vaccination (39%, p < .05). Recommending HPV vaccination at age 11-12 encouraged on-time vaccination, while offering fewer doses had little impact. Providers should avoid framing HPV vaccination guidelines in reference to age 15 because doing so may discourage on-time vaccination by introducing confusion about the recommended age.
Collapse
Affiliation(s)
- Marjorie A Margolis
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Parth D Shah
- Public Health Sciences Division, Hutchinson Institute for Cancer Outcomes Research, Seattle, WA, USA
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.,Penn State Hershey Cancer Institute, Hershey, PA, USA
| | - Susan Alton Dailey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
22
|
Stoecker C. Shooting from the 'Scrip: Scope of Practice Laws and Access to Immunizations in the Pharmacy Setting. Vaccines (Basel) 2021; 9:vaccines9050444. [PMID: 34063185 PMCID: PMC8147434 DOI: 10.3390/vaccines9050444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/25/2021] [Accepted: 04/27/2021] [Indexed: 11/24/2022] Open
Abstract
In the past two decades, most states in the United States have added authorization for pharmacists to administer some vaccinations. Expansions of this authority have also come with prescription requirements or other regulatory burdens. The objective of this study was to evaluate the impact of these expansions on influenza immunization rates in adults age 65 and over. A panel data, differences-in-differences regression framework to control for state-level unobserved confounders and shocks at the national level was used on a combination of a dataset of state-level statute and regulatory changes and influenza immunization data from the Behavioral Risk Factor Surveillance System. Giving pharmacists permission to vaccinate had a positive impact on adult influenza immunization rates of 1.4 percentage points for adults age 65 and over. This effect was diminished by the presence of laws requiring pharmacists to obtain patient-specific prescriptions. There was no evidence that allowing pharmacists to administer vaccinations led patients to have fewer annual check-ups with physicians or not have a usual source of health care. Expanding pharmacists’ scope of practice laws to include administering the influenza vaccine had a positive impact on influenza shot uptake. This may have implications for relaxing restrictions on other forms of care that could be provided by pharmacists.
Collapse
Affiliation(s)
- Charles Stoecker
- Department of Global Health Management and Policy, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| |
Collapse
|
23
|
Bouza B, Hammig B, Schaefer Whitby P. Physicians’ Experiences of Recommending the HPV Vaccine to Females with an Intellectual Disability. SEXUALITY AND DISABILITY 2021. [DOI: 10.1007/s11195-021-09688-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
24
|
Butterfield R, Dhanani S. The Development of Human Papillomavirus (HPV) Vaccines and Current Barriers to Implementation. Immunol Invest 2021; 50:821-832. [PMID: 33724139 DOI: 10.1080/08820139.2021.1897612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The identification of the human papillomavirus (HPV) as the causative agent of multiple cancers allowed for the development of vaccines and immunization strategies to prevent cancers caused by HPV infection. The public health ramifications of reduction of HPV disease burden are momentous in scope. Vaccine hesitancy has impacted widespread vaccination, but strategies have been identified to combat vaccine safety and efficacy misinformation and promote immunization.
Collapse
Affiliation(s)
| | - Salimah Dhanani
- Department of Pediatrics, Albany Medical Center, Albany, New York, USA
| |
Collapse
|
25
|
Shah MD, Glenn BA, Chang LC, Chung PJ, Valderrama R, Uyeda K, Szilagyi PG. Reducing Missed Opportunities for Human Papillomavirus Vaccination in School-Based Health Centers: Impact of an Intervention. Acad Pediatr 2020; 20:1124-1132. [PMID: 32294534 DOI: 10.1016/j.acap.2020.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Human papillomavirus (HPV) immunization rates among US adolescents are low. Missed opportunities (MOs) for HPV vaccination are common. School-based health centers (SBHCs) have potential to boost HPV vaccination, but their role in addressing MOs has not been examined. METHODS We implemented a multicomponent intervention, consisting of 3 immunization process workflow modifications combined with provider performance feedback, in 2 Los Angeles area SBHCs and conducted a pre/post evaluation of MOs. Our primary outcome was SBHC-based MOs for HPV vaccination during all visits, including visits for confidential reproductive health care (ie, confidential visits). Secondary outcomes were MOs for meningococcal (MenACWY) and influenza vaccination during visits for nonconfidential care. RESULTS MOs for HPV vaccination decreased during all visit types from the baseline to the intervention period (82.3% to 46.1%; adjusted risk ratio [RR] = 0.558, P < .0001). The rate decrease appeared to be greater during physical examination visits than confidential visits (83.4% to 31.6% vs 98.7% to 70.4%, respectively). MOs for MenACWY (74.5% to 35.0%; adjusted RR = 0.47, P < .0001) and influenza (86.7% to 69.3%; adjusted RR = 0.792, P < .0001) vaccination also decreased during nonconfidential visits. Vaccine refusal was the most frequently documented reason for HPV vaccine MOs during both physical examination and confidential visits. CONCLUSIONS A pragmatic, multicomponent SBHC intervention reduced MOs for HPV vaccination during all visit types. MOs for MenACWY and influenza vaccination also decreased during nonconfidential visits. Findings suggest that practice-level improvements in SBHCs can improve delivery of HPV and other adolescent vaccines.
Collapse
Affiliation(s)
- Megha D Shah
- Division of General Pediatrics, Department of Pediatrics, David Geffen School of Medicine and UCLA Mattel Children's Hospital (University of California, Los Angeles) (MD Shah, PJ Chung, R Valderrama, and PG Szilagyi), Los Angeles, Calif.
| | - Beth A Glenn
- UCLA Kaiser Permanente Center for Health Equity (BA Glenn and LC Chang), Los Angeles, Calif; Jonsson Comprehensive Cancer Center at UCLA (BA Glenn and LC Chang), Los Angeles, Calif; Department of Health Policy and Management, UCLA Fielding School of Public Health (BA Glenn), Los Angeles, Calif
| | - L Cindy Chang
- UCLA Kaiser Permanente Center for Health Equity (BA Glenn and LC Chang), Los Angeles, Calif; Jonsson Comprehensive Cancer Center at UCLA (BA Glenn and LC Chang), Los Angeles, Calif
| | - Paul J Chung
- Division of General Pediatrics, Department of Pediatrics, David Geffen School of Medicine and UCLA Mattel Children's Hospital (University of California, Los Angeles) (MD Shah, PJ Chung, R Valderrama, and PG Szilagyi), Los Angeles, Calif
| | - Rebecca Valderrama
- Division of General Pediatrics, Department of Pediatrics, David Geffen School of Medicine and UCLA Mattel Children's Hospital (University of California, Los Angeles) (MD Shah, PJ Chung, R Valderrama, and PG Szilagyi), Los Angeles, Calif
| | - Kimberly Uyeda
- Los Angeles Unified School District (K Uyeda), Los Angeles, Calif. Dr Shah is now with the Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, Los Angeles, Calif. Dr Chung is now with the Department of Health Systems Science, Kaiser Permanente School of Medicine, Pasadena, Calif. Dr Uyeda is now with the California School-Based Health Alliance, Oakland, Calif
| | - Peter G Szilagyi
- Division of General Pediatrics, Department of Pediatrics, David Geffen School of Medicine and UCLA Mattel Children's Hospital (University of California, Los Angeles) (MD Shah, PJ Chung, R Valderrama, and PG Szilagyi), Los Angeles, Calif
| |
Collapse
|
26
|
Perkins RB, Banigbe B, Fenton AT, O’Grady AK, Jansen EM, Bernstein JL, Joseph NP, Eun TJ, Biancarelli DL, Drainoni ML. Effect of a multi-component intervention on providers' HPV vaccine communication. Hum Vaccin Immunother 2020; 16:2736-2743. [PMID: 32401592 PMCID: PMC7734092 DOI: 10.1080/21645515.2020.1747923] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/22/2020] [Indexed: 10/24/2022] Open
Abstract
Objective: To evaluate the effect of a multi-component intervention including communication training on provider beliefs and recommendation practices around the human papillomavirus (HPV) vaccine using both self-reports and audio-recordings of clinical interactions. Methods: We conducted a mixed method study at five family medicine and pediatric practices. Providers self-reported beliefs and practices about HPV vaccination via surveys and qualitative interviews conducted pre- and post-intervention. We also assessed provider recommendation style using audio-recordings of clinical interactions pre- and post-intervention. Content analysis was used to identify themes in qualitative interviews. Matched pre- and post-intervention surveys were analyzed for changes in provider beliefs and attitudes. Pre- and post-intervention audio recordings of clinical interactions were analyzed for observed differences in recommendation styles. Bivariate analyses of quantitative data used Chi-square and Fisher's exact tests; t-tests were used for continuous variables. Results: Providers reported in interviews that the intervention led to communication changes by increasing their knowledge, reframing the HPV vaccine as a routine vaccination, and providing tools for engaging with parents. Surveys indicated that the proportion of providers reporting that the HPV vaccine is one of the most important adolescent vaccines increased from 71% pre-intervention to 100% post-intervention (p = .03). Audio-recording analysis demonstrated that use of an indicated (presumptive) recommendation style increased from 62.5% pre-intervention to 79.6% post-intervention (p = .047). Conclusions: Educating providers about HPV vaccination and giving them tools to facilitate communication with parents can reframe HPV as a routine adolescent vaccination and motivate providers to routinely use effective recommendation styles in practice.
Collapse
Affiliation(s)
- Rebecca B. Perkins
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
| | | | - Anny T. Fenton
- Maine Medical Center Research Institute, Center for Outcomes, Research, & Evaluation (CORE), Portland, ME, USA
| | | | - Emily M. Jansen
- Boston University School of Medicine, Continuing Medical Education Office, Boston, MA, USA
| | - Judith L. Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Natalie P. Joseph
- Department of Pediatrics and Adolescent Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
| | - Terresa J. Eun
- Department of Sociology, Stanford University, Stanford, CA, USA
| | - Dea L. Biancarelli
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Mari-Lynn Drainoni
- Boston University School of Public Health, Boston, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Evans Center for 10 Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
27
|
Gilkey MB, Grabert BK, Malo TL, Hall ME, Brewer NT. Physicians' rhetorical strategies for motivating HPV vaccination. Soc Sci Med 2020; 266:113441. [PMID: 33069959 PMCID: PMC7550258 DOI: 10.1016/j.socscimed.2020.113441] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/12/2020] [Accepted: 10/09/2020] [Indexed: 11/02/2022]
Abstract
RATIONALE Receiving a healthcare provider's recommendation is a well-documented predictor of human papillomavirus (HPV) vaccination, and yet recommendations remain understudied and undertheorized. OBJECTIVE To qualitatively describe strategies providers use to motivate HPV vaccination. METHOD We surveyed a national sample of 771 U.S. primary care physicians. Data came from an open-ended item that assessed physicians' perspectives on the most effective thing they could say to persuade parents to get HPV vaccine for their 11- to 12-year-old children. Using a standardized codebook and two independent coders, we conducted a thematic analysis to identify rhetorical strategies underlying physicians' responses. RESULTS We identified two sets of strategies for motivating HPV vaccination. One set drew parents' attention to specific actors or vaccine characteristics. Physicians using these strategies asked parents to consider their children's individual risk in the short-term, named specific diseases that could be prevented, emphasized the novelty of HPV vaccine as a cancer prevention tool, and gave their personal endorsement for HPV vaccination. In contrast, the second set of strategies was more distancing and impersonal. Physicians using these strategies referenced future risk, described cancer prevention in general terms, framed HPV vaccine as similar to other vaccines, and shared organizational endorsements for HPV vaccination. Across these two sets of strategies, a tension emerged between the goals of engaging parents' perceptions of HPV as a threat to their children versus framing HPV vaccination as a normative standard of care. CONCLUSIONS Our findings suggest that theoretical frameworks, such as Construal Level Theory, may be helpful for positioning provider recommendations in the broader literature on persuasive communication. By identifying competing approaches to motivating HPV vaccination, this study lays the groundwork for future research to test the acceptability and impact of strategies for recommending routine preventive care.
Collapse
Affiliation(s)
- Melissa B Gilkey
- Department of Health Behavior & Lineberger Comprehensive Cancer Center, University of North Carolina, CB# 7440, Chapel Hill, NC, 27599, USA.
| | - Brigid K Grabert
- Lineberger Comprehensive Cancer Center, University of North Carolina, CB# 7440, Chapel Hill, NC, 27599, USA.
| | - Teri L Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina, CB# 7293, Chapel Hill, NC, 27599, USA.
| | - Megan E Hall
- Department of Health Behavior, University of North Carolina; CB# 7440, Chapel Hill, NC, 27599, USA.
| | - Noel T Brewer
- Department of Health Behavior & Lineberger Comprehensive Cancer Center, University of North Carolina, CB# 7440, Chapel Hill, NC, 27599, USA.
| |
Collapse
|
28
|
Tailored Messages Addressing Human Papillomavirus Vaccination Concerns Improves Behavioral Intent Among Mothers: A Randomized Controlled Trial. J Adolesc Health 2020; 67:253-261. [PMID: 32199723 DOI: 10.1016/j.jadohealth.2020.01.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/13/2019] [Accepted: 01/15/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of the study was to determine whether supplementing a bundled recommendation (recommendation for all 11- to 12-year-old platform vaccines) with tailored messaging that addressed one versus all parental concerns improved human papillomavirus (HPV) vaccination intent among mothers. METHODS We conducted a Web-based randomized controlled trial, randomizing mothers who did not intend to vaccinate their 11- to 14-year-old child against HPV to (1) bundled recommendation video ("control"); (2) control + video addressing the top HPV vaccine concern; or (3) control + ≥1 videos addressing all concerns. Outcomes were HPV vaccination intent (1 = extremely unlikely and 10 = extremely likely) and strength of main concern (1 = a little concerned and 10 = very concerned). We assessed differences in intervention effects using generalized linear models for vaccine intent and mixed models for the strength of main concern. RESULTS Of the 762 mothers, 51% had a female child, 82% of children were white, and 90% were non-Hispanic. The mean intent to vaccinate postintervention ranged from 3.5 (95% confidence interval [CI] = 3.1-3.8) in the control group to 4.2 (95% CI = 3.9-4.6) in the all-concerns group (p = .01). The mean strength of the concerns declined pre- to postintervention by .1 (95% CI = -.1 to .3) in the control group (p = .42), .6 (95% CI = .4-.9) in the top concern group (p < .001), and .7 (95% CI = .5-1.0) in the all-concerns group (p < .001). However, the mean strength of the main concerns postintervention remained high (≥7.0 for each group). CONCLUSIONS Tailored messages addressing all concerns improved HPV vaccination intent and reduced the strength of the main concern more than bundled messages alone, but intent remained low and strength of the main concerns remained high in this vaccine-hesitant population.
Collapse
|
29
|
Perkins RB, Legler A, Jansen E, Bernstein J, Pierre-Joseph N, Eun TJ, Biancarelli DL, Schuch TJ, Leschly K, Fenton ATHR, Adams WG, Clark JA, Drainoni ML, Hanchate A. Improving HPV Vaccination Rates: A Stepped-Wedge Randomized Trial. Pediatrics 2020; 146:peds.2019-2737. [PMID: 32540986 DOI: 10.1542/peds.2019-2737] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of a stepped-wedge randomized trial of Development of Systems and Education for Human Papillomavirus Vaccination (DOSE HPV), a multilevel intervention. METHODS DOSE HPV is a 7-session program that includes interprofessional provider education, communication training, data feedback, and tailored systems change. Five primary care pediatric and/or family medicine practices completed interventions between 2016 and 2018; all chose to initiate vaccination at ages 9 to 10. We compared vaccination rates in the preintervention, intervention, and postintervention periods among 9- to 17-year-olds using random-effects generalized linear regression models appropriate for stepped-wedge design, accounting for calendar time and clustering of patients by providers and clinic. Outcomes included (1) the likelihood that eligible patients would receive vaccination during clinic visits; (2) the likelihood that adolescents would complete the series by age 13; and (3) the cumulative effect on population-level vaccine initiation and completion rates. Postintervention periods ranged from 6 to 18 months. RESULTS In the intervention and postintervention periods, the adjusted likelihood of vaccination at an eligible visit increased by >10 percentage points for ages 9 to 10 and 11 to 12, and completion of the vaccine series by age 13 increased by 4 percentage points (P < .001 for all comparisons). Population-level vaccine initiation coverage increased from 75% (preintervention) to 84% (intervention) to 90% (postintervention), and completion increased from 60% (preintervention) to 63% (intervention) to 69% (postintervention). CONCLUSIONS Multilevel interventions that include provider education, data feedback, tailored systems changes, and early initiation of the human papillomavirus vaccine series may improve vaccine series initiation and completion beyond the conclusion of the intervention period.
Collapse
Affiliation(s)
| | - Aaron Legler
- Pediatrics and Adolescent Medicine, School of Medicine, Boston University and Boston Medical Center, Boston, Massachusetts
| | | | - Judith Bernstein
- Department of Health Law, Policy and Management, School of Public Health
| | - Natalie Pierre-Joseph
- Pediatrics and Adolescent Medicine, School of Medicine, Boston University and Boston Medical Center, Boston, Massachusetts
| | - Terresa J Eun
- Department of Sociology, Stanford University, Stanford, California
| | - Dea L Biancarelli
- Department of Health Law, Policy and Management, School of Public Health
| | | | - Karin Leschly
- East Boston Neighborhood Health Center, Boston, Massachusetts; and
| | - Anny T H R Fenton
- Center for Outcomes, Research, and Evaluation, Maine Medical Center Research Institute, Portland, Maine
| | - William G Adams
- Pediatrics and Adolescent Medicine, School of Medicine, Boston University and Boston Medical Center, Boston, Massachusetts
| | - Jack A Clark
- Department of Health Law, Policy and Management, School of Public Health
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy and Management, School of Public Health.,Evans Center for Implementation and Improvement Sciences.,Sections of Infectious Diseases and
| | | |
Collapse
|
30
|
Hansen CE, North A, Niccolai LM. Cognitive Bias in Clinicians' Communication about Human Papillomavirus Vaccination. HEALTH COMMUNICATION 2020; 35:430-437. [PMID: 30676109 PMCID: PMC6733664 DOI: 10.1080/10410236.2019.1567439] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
National guidelines recommend human papillomavirus (HPV) vaccination for all 11-12-year-olds, but uptake among United States adolescents remains low. A major barrier to greater uptake is the lack of effective recommendations for HPV vaccine from clinicians. One potential influence on clinicians' recommendations for HPV vaccine that has been relatively unexplored is that of cognitive biases, or errors in judgement that result from 'mental shortcuts' used to make decisions under uncertainty. Therefore, we analyzed qualitative data from interviews with 32 pediatric clinicians using a framework of nine cognitive biases relevant to HPV vaccination: omission bias, ambiguity aversion, present bias, availability bias, optimism bias, naturalness bias, protected values, anchoring bias, and confirmation bias. We used a directed content analysis approach to iteratively code and analyze all transcripts in the dataset. We found evidence for several cognitive biases that were related to weaker recommendations for HPV vaccine. Commonly identified biases included anchoring bias (perception that vaccination unnecessary due to age/pubertal status); present bias (perception of burdens related to discussing vaccination), and optimism bias (belief that patient at low risk for HPV acquisition). We found less frequent evidence for ambiguity aversion (perception of missing information regarding vaccination) and omission bias (deferring vaccination). Other biases were identified infrequently or not at all. Our findings suggest that several cognitive biases may be an influence on clinicians' communication about HPV vaccine. Raising awareness of cognitive biases related to making HPV vaccine recommendations could help to strengthen the recommendations that clinicians provide.
Collapse
Affiliation(s)
| | - Anna North
- HPV Working Group, Yale School of Public Health
| | - Linda M Niccolai
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health
| |
Collapse
|
31
|
Goodman EA, Goodpasture M. Human Papilloma Virus Vaccination After Pediatric Sexual Abuse Evaluations in the Outpatient Child Sexual Abuse Subspecialty Clinic: A Quality Improvement Project. JOURNAL OF FORENSIC NURSING 2020; 16:16-21. [PMID: 31567656 DOI: 10.1097/jfn.0000000000000251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The nonavalent human papilloma virus (HPV) vaccination prophylactically contributes to the prevention of nine types of HPV-associated oral and genital cancers. HPV vaccination rates remain lower than the national Healthy People 2020 goal of 80%. Victims of pediatric sexual abuse are at a higher risk for acquiring and developing HPV-related outcomes. Current research supports vaccination after sexual abuse as soon as eligible and suggests utilizing multiple types of medical encounters to increase vaccination rates.An institutional-review-board-approved quality improvement project was developed to determine the impact of promoting and providing HPV vaccination during the medical encounter after pediatric sexual abuse in a child protection team (CPT) clinic. Twenty percent of the 111 total clinic patients evaluated in the preintervention period and 21% of the 99 patients evaluated in the postintervention period were HPV vaccine eligible, illustrating a significant opportunity for impact. During the intervention period, 62% of patients who were vaccine eligible and presented for their CPT clinic visit received HPV vaccine. Barriers to vaccination in the outpatient CPT clinic setting included high appointment no-show rates, high social and medical visit complexity, and absence of an appropriate consenting caretaker. Implications for forensic nursing practice are discussed.
Collapse
Affiliation(s)
- Elizabeth A Goodman
- Author Affiliations: East Carolina University
- Department of Pediatrics, Wake Forest Baptist Medical Center
| | | |
Collapse
|
32
|
Beliefs around childhood vaccines in the United States: A systematic review. Vaccine 2019; 37:6793-6802. [PMID: 31562000 DOI: 10.1016/j.vaccine.2019.08.068] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/30/2019] [Accepted: 08/26/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND While childhood vaccines are safe and effective, some parents remain hesitant to vaccinate their children, which has led to outbreaks of vaccine preventable diseases. The goal of this systematic review was to identify and summarize the range of beliefs around childhood vaccines elicited using open-ended questions, which are better suited for discovering beliefs compared to closed-ended questions. METHODS PubMed, Embase, and PsycINFO were searched using keywords for childhood vaccines, decision makers, beliefs, and attitudes to identify studies that collected primary data using a variety of open-ended questions regarding routine childhood vaccine beliefs in the United States. Study designs, population characteristics, vaccine types, and vaccine beliefs were abstracted. We conducted a qualitative analysis to conceptualize beliefs into themes and generated descriptive statistics. RESULTS Of 1727 studies identified, 71 were included, focusing largely on parents (including in general, and those who were vaccine hesitant or at risk of hesitancy). Seven themes emerged: Adverse effects was most prominent, followed by mistrust, perceived lack of necessity, pro-vaccine opinions, skepticism about effectiveness, desire for autonomy, and morality concerns. The most commonly described beliefs included that vaccines can cause illnesses; a child's immune system can be overwhelmed if receiving too many vaccines at once; vaccines contain harmful ingredients; younger children are more susceptible to vaccine adverse events; the purpose of vaccines is profit-making; and naturally developed immunity is better than that acquired from vaccines. Nearly a third of the studies exclusively assessed minority populations, and more than half of the studies examined beliefs only regarding HPV vaccine. CONCLUSIONS Few studies used open-ended questions to elicit beliefs about vaccines. Many of the studies that did so, focused on HPV vaccine. Concerns about vaccine safety were the most commonly stated beliefs about childhood vaccines, likely because studies were designed to capture barriers and challenges to vaccination.
Collapse
|
33
|
Shawhan A, Ruppe RL. Increasing Human Papillomavirus Vaccination Rates Among Adolescents: Overcoming Vaccine Hesitancy and Using Practice Improvements. J Nurse Pract 2019. [DOI: 10.1016/j.nurpra.2019.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
34
|
Educating healthcare providers to increase Human Papillomavirus (HPV) vaccination rates: A Qualitative Systematic Review. Vaccine X 2019; 3:100037. [PMID: 31463471 PMCID: PMC6708991 DOI: 10.1016/j.jvacx.2019.100037] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/25/2019] [Accepted: 07/25/2019] [Indexed: 11/22/2022] Open
Abstract
Objectives HPV vaccination rates in the United States lag behind other developed countries. Educational interventions are primarily directed at patients and parents rather than healthcare providers (HCPs), despite evidence that provider recommendation is a key determinant of vaccine uptake. The objectives for this review are to synthesize the available evidence related to the knowledge, attitudes, and beliefs of HCPs surrounding HPV vaccination, to summarize provider-specific educational interventions which have been evaluated, and to review existing provider-specific educational resources from national organizations and whether they align with the gaps identified. Methods A systematic search was performed using PubMed, Web of Science, CINAHL, and ERIC with MeSH terms human papillomavirus, vaccine, education, workshop, training, knowledge, attitude, belief, intention, and healthcare provider. Full text articles were obtained for studies that described the knowledge and attitudes of providers and/or impact of educational interventions. Data extraction was performed by four independent reviewers. Websites of American organizations with an interest in HPV vaccination were manually searched for provider resources. Results 1066 publications were identified, and 98 articles were fully reviewed with 40 ultimately included. Providers’ knowledge on HPV was generally low with a correspondingly low vaccine recommendation rate. Provider-specific education (e.g., didactic session and communication training) with complimentary interventions demonstrated increased knowledge and vaccine series initiation and completion. Themes identified in descriptive studies highlighted providers’ lack of general HPV and vaccine knowledge, low self-confidence in counselling and addressing parental concerns, and discomfort in discussing sexual issues related to vaccination. Many American organizations have provider-specific resources; however, the effectiveness of these materials has not been established. Conclusions HPV knowledge among providers remains low. Educational interventions to improve knowledge and communication appear to be effective. A breadth of resources from national organizations are available but their efficacy and level of utilization is largely unknown. Coordinated efforts are needed to evaluate provider-specific educational resources to improve vaccine uptake in the US.
Collapse
|
35
|
Castellino SM, Allen KE, Pleasant K, Keyes G, Poehling KA, Tooze JA. Suboptimal uptake of human papillomavirus (HPV) vaccine in survivors of childhood and adolescent and young adult (AYA) cancer. J Cancer Surviv 2019; 13:730-738. [PMID: 31342304 DOI: 10.1007/s11764-019-00791-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/13/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE To estimate the population-based incidence of HPV vaccination after childhood cancer. METHODS Pediatric and young adult cancer survivors identified in the institutional Comprehensive Cancer Center registry were linked to the North Carolina Immunization Registry (NCIR). Initiation and completion of any HPV vaccine was evaluated in survivors born between 1984 and 2002 with an NCIR record by December 2014. Descriptive statistics and Kaplan-Meier estimates of cumulative incidence were stratified by sex and age at eligibility for vaccine. Cox proportional hazards were conducted and stratified by sex. RESULTS Among 879 (n = 428 female; n = 451 male) study-eligible cancer survivors without prior HPV vaccination (n = 501 < 18 years, n = 378 ≥ 18 years at the time of eligibility), the cumulative incidence of HPV vaccine initiation following cancer therapy was 48.1% among females at 8.2 years and 29.2% among males at 5.0 years after vaccine eligibility among those < 18 years, and 6.2% among females at 8.1 years and 2.0% among males at 4.2 years after vaccine eligibility among those ≥ 18 years. Among those who initiated vaccination, 53% of females and 43% of males completed a 3-dose series. Younger age at cancer diagnosis (≤ 10 and 11-14 years vs. ≥ 15 years) and shorter interval from diagnosis to vaccine eligibility were more likely to initiate vaccination in models adjusted for age at eligibility, race/ethnicity, cancer type, relapse, and transplant. CONCLUSIONS Despite the benefit of a cancer prevention strategy, cancer survivors are sub-optimally vaccinated against HPV. IMPLICATIONS FOR CANCER SURVIVORS Immunization registries can help oncologists and primary care providers identify gaps in vaccination and target HPV vaccine delivery in survivors.
Collapse
Affiliation(s)
- Sharon M Castellino
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.
- Department of Pediatrics - Hematology/Oncology, Emory University School of Medicine; The Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Kristen E Allen
- Department of Pediatrics - Hematology/Oncology, Emory University School of Medicine; The Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Katherine Pleasant
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Graham Keyes
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Katherine A Poehling
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Janet A Tooze
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Wake Forest Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
36
|
Bonville CA, Domachowske JB, Suryadevara M. A quality improvement education initiative to increase adolescent human papillomavirus (HPV) vaccine completion rates. Hum Vaccin Immunother 2019; 15:1570-1576. [PMID: 31166137 DOI: 10.1080/21645515.2019.1627822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
HPV vaccine uptake is low, nationwide. Quality improvement (QI) principles have the potential to change practice; however, not all providers are confident with QI skills. We developed an educational program designed to enhance QI skills and improve HPV vaccination rates. Five pediatric practices participated in the pilot initiative. Training consisted of presentations regarding QI methods, data tracking and analysis, and system changes to reduce missed opportunities. Monthly for 6 months, participants performed chart audits, captured data, printed run charts, and developed, implemented, and tracked interventions. Outcome measures included rates of HPV vaccine completion and missed opportunities. A second phase included eight different pediatric practices who received similar training. Outcome measures included rates of HPV vaccine initiation and completion. Over the 6 months, mean HPV vaccine completion rates increased (45% to 65%) and missed opportunities for HPV vaccination decreased (45% to 19%) in the pilot program. When the program was replicated in phase 2, an increase was seen in both HPV vaccine initiation (46% to 61%) and completion (62% to 94%) rates. Combining QI education with workflow-focused strategies was associated with a reduction in missed opportunities and a substantial increase in HPV vaccine completion rates.
Collapse
Affiliation(s)
- Cynthia A Bonville
- a Department of Pediatrics, SUNY Upstate Medical University , Syracuse , NY , USA
| | - Joseph B Domachowske
- a Department of Pediatrics, SUNY Upstate Medical University , Syracuse , NY , USA
| | - Manika Suryadevara
- a Department of Pediatrics, SUNY Upstate Medical University , Syracuse , NY , USA
| |
Collapse
|
37
|
Stephens AB, Wynn CS, Stockwell MS. Understanding the use of digital technology to promote human papillomavirus vaccination - A RE-AIM framework approach. Hum Vaccin Immunother 2019; 15:1549-1561. [PMID: 31158064 PMCID: PMC6746491 DOI: 10.1080/21645515.2019.1611158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 04/01/2019] [Accepted: 04/21/2019] [Indexed: 12/14/2022] Open
Abstract
The human papillomavirus virus (HPV) vaccine is effective at preventing various cancers, but coverage falls short of targets that are needed for community protection. Here, we use the RE-AIM implementation framework (Reach, Effectiveness, Adoption, Implementation, Maintenance) to understand how text, email, and electronic health record (EHR) reminders and social media campaigns can be used as part of policy and practice interventions to increase HPV vaccination. These technology-based interventions could be used together and mainstreamed into clinical and system-based practice to have the greatest impact. Of the interventions explored, text-based, email-based, and EHR reminders have the most evidence behind them to support their effectiveness. While there are several studies of promotion of the HPV vaccine on social media, more studies are needed to demonstrate their effects and better methods are needed to be able to attribute results to these interventions.
Collapse
Affiliation(s)
- Ashley B Stephens
- Department of Pediatrics, Columbia University, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Chelsea S Wynn
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Melissa S Stockwell
- Department of Pediatrics, Columbia University, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| |
Collapse
|
38
|
Allison M, Emerson A, Pickett ML, Ramaswamy M. Incarcerated Adolescents' Attitudes Toward Human Papillomavirus Vaccine: Report From a Juvenile Facility in Kansas. Glob Pediatr Health 2019; 6:2333794X19855290. [PMID: 31236433 PMCID: PMC6572877 DOI: 10.1177/2333794x19855290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/15/2019] [Accepted: 05/15/2019] [Indexed: 01/26/2023] Open
Affiliation(s)
- Molly Allison
- University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | | |
Collapse
|
39
|
Fenton AT. Abandoning Medical Authority: When Medical Professionals Confront Stigmatized Adolescent Sex and the Human Papillomavirus (HPV) Vaccine. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2019; 60:240-256. [PMID: 31113247 DOI: 10.1177/0022146519849895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Despite authority's centrality to the medical profession, providers routinely forgo their medical authority during clinical encounters. Research focuses on patients challenging medical authority but indicates these confrontations are uncommon and providers seldom relinquish their authority in response. Using rare data of 75 audio recordings of adolescent vaccine discussions during clinical encounters and interviews with and observations of medical staff, I examine how staff leverage or abandon their medical authority to convince parents to vaccinate. I find medical professionals use less authority when at risk of stigmatizing patients: Medical professionals are less authoritative when recommending human papillomavirus (HPV) vaccination versus other adolescent vaccines, particularly when addressing the need to vaccinate before sexual onset due to concerns of labeling the child as sexually active. Medical staff defer to parents in ways that potentially discourage HPV vaccine uptake: They encourage HPV vaccination less than other vaccines and infrequently challenge parents' sex-related reasons for vaccine refusal.
Collapse
Affiliation(s)
- Anny T Fenton
- 1 Harvard University, Cambridge, MA, USA
- 2 Maine Medical Center Research Institute, Portland, ME
| |
Collapse
|
40
|
Abed Elhadi Shahbari N, Gesser-Edelsburg A, Mesch GS. Case of Paradoxical Cultural Sensitivity: Mixed Method Study of Web-Based Health Informational Materials About the Human Papillomavirus Vaccine in Israel. J Med Internet Res 2019; 21:e13373. [PMID: 31102371 PMCID: PMC6543802 DOI: 10.2196/13373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/17/2019] [Accepted: 04/23/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Designing web-based informational materials regarding the human papillomavirus (HPV) vaccine has become a challenge for designers and decision makers in the health authorities because of the scientific and public controversy regarding the vaccine's safety and effectiveness and the sexual and moral concerns related to its use. OBJECTIVE The study aimed to investigate how cultural sensitivity (CS) is articulated in the explanatory informational materials on the HPV vaccine that are posted on the websites of the Israeli health authorities. In addition, the study examined the effect of transparency on the expression of CS in the informational materials. METHODS The study employed a quantitative and qualitative content analysis of the texts of explanatory informational materials published on the Arabic and Hebrew websites of the Israel Ministry of Health and the Clalit health maintenance organization (HMO). RESULTS The findings revealed the differences in the dimensions of CS (based on the CS model by Resnicow) between the informational materials targeting the majority Jewish population and those targeting the minority Arab population. Indeed, the research findings point to a paradox. On the one hand, the materials appealing to the conservative Arab population exhibited CS, in that the sexual context of the vaccine was missing. On the other hand, analysis of Resnicow's deep dimensions showed that disregarding the sexual context does not allow the relevant target audience to reflect on the barriers and concerns. In addition, the way the information was provided exhibited a lack of transparency regarding the CS dimensions (surface and deep). CONCLUSIONS The public health authorities have 2 main objectives in the context of vaccinations. One is to raise the vaccination rates and the other is to provide full and culturally sensitive information to give the public the tools to make intelligent decisions. The findings of this study indicated that despite the high uptake rate for HPV vaccination in the Arab population, the health authorities did not exercise full transparency and CS in transmitting the association between engaging in sexual relations and the necessity of the vaccination. Thus, the major challenge for the health authorities is to find ways to implement the objective of communicating information about the vaccination in a way that is transparent and culturally sensitive, even if this raises questions and fears among the public deriving from their culture.
Collapse
|
41
|
Gilkey MB, Mohan D, Janssen EM, McRee AL, Kornides ML, Bridges JFP. Exploring variation in parental worries about HPV vaccination: a latent-class analysis. Hum Vaccin Immunother 2019; 15:1745-1751. [PMID: 30951396 PMCID: PMC6746473 DOI: 10.1080/21645515.2019.1574157] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/05/2019] [Accepted: 01/21/2019] [Indexed: 10/27/2022] Open
Abstract
Background. Prior research has identified diverse worries that parents have about HPV vaccination. We sought to understand how parents prioritize worries and to identify subgroups of parents according to shared patterns of worry. Methods. We surveyed a national sample of 431 U.S. parents of adolescents who reported never having talked to their child's healthcare provider about HPV vaccination. Parents completed a best-worst scaling experiment designed to prioritize 11 common worries about HPV vaccination. The experiment used a balanced incomplete block design to present 11 choice tasks consisting of repeated subsets of worries. We used conditional logistic regression to prioritize worries and latent class models with 1-10 classes to identify subgroups of parents with shared worries. Results. Parents most often worried about long-term side effects of HPV vaccination, which about one-third (36%) ranked as their top worry. Other common top-ranked worries were how new the vaccine is (12%), motives of drug companies (12%), short-term side effects (10%), and that it may be unnecessary (10%). Latent class analyses suggested a relatively large number of distinct worry profiles, with most classes characterized by a worry about long-term side effects in combination with one other worry. Discussion. Our findings suggest that providers should be prepared to address concerns about long-term side effects, as this worry was prioritized across many subgroups of parents. However, to best address worry, a tailored, rather than targeted, communication approach may be needed.
Collapse
Affiliation(s)
- Melissa B. Gilkey
- Department of Health Behavior & Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Divya Mohan
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | | | - Melanie L. Kornides
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - John F. P. Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| |
Collapse
|
42
|
Eun TJ, Hanchate A, Fenton AT, Clark JA, Aurora MN, Drainoni ML, Perkins RB. Relative contributions of parental intention and provider recommendation style to HPV and meningococcal vaccine receipt. Hum Vaccin Immunother 2019; 15:2460-2465. [PMID: 30862301 DOI: 10.1080/21645515.2019.1591138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
We described the relative contributions of parental intention and provider recommendation style to HPV and meningococcal vaccine receipt. Parent-child dyads that were eligible for both meningococcal and HPV vaccines participated in pre-visit surveys and consented to audio recording of their clinical interactions with healthcare providers related to vaccination. Surveys were analyzed for parent and child demographics and parental intention to vaccinate children with HPV and/or meningococcal vaccines. Audio recordings were analyzed for provider recommendation style, defined as indicated (provider stated vaccine was due at that visit) or not, and for child receipt of vaccines. Linear and logistic regression models were used to determine the relative contributions of parental intention and provider recommendation style to vaccine receipt. 56 parents/child dyads participated. 79% of children received HPV vaccines, and 93% received meningococcal vaccines. After controlling for demographic variables, parental intention did not differ by vaccine type. However, providers were less likely to use an indicated recommendation for HPV than for meningococcal vaccine. After controlling for demographic factors, parental intention, and provider recommendation style, vaccine type (HPV or meningococcal) was no longer associated with vaccine receipt Differences that were previously attributed to vaccine-specific factors may be explained by parents' and providers' roles in vaccine receipt. These findings suggest that interventions and policy recommendations regarding adolescent vaccination should focus on increasing parental demand for vaccines and ensuring that providers present all vaccines as the medical standard of care.
Collapse
Affiliation(s)
- Terresa J Eun
- Department of Sociology, Stanford University , Palo Alto, CA , California , USA
| | - Amresh Hanchate
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA
| | - Anny T Fenton
- Department ofSociology, Harvard University , Cambridge, MA , USA.,Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute , Scarborough, ME , USA
| | - Jack A Clark
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA
| | - Marisa N Aurora
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA.,Department of Health Policy and Management, Boston University School of Public Health , Boston, MA , USA
| | - Mari-Lynn Drainoni
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA.,Department of Health Policy and Management, Boston University School of Public Health , Boston, MA , USA.,Center for Healthcare Organization and Implementation Research, ENRM VA Hospital , Bedford , MA , USA
| | - Rebecca B Perkins
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA.,Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center , Boston, MA , USA
| |
Collapse
|
43
|
Teteh DK, Dawkins-Moultin L, Robinson C, LaGroon V, Hooker S, Alexander K, Kittles RA. Use of community forums to increase knowledge of HPV and cervical cancer in African American communities. J Community Health 2019; 44:492-499. [DOI: 10.1007/s10900-019-00665-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
44
|
Views of parents regarding human papillomavirus vaccination: A systematic review and meta-ethnographic synthesis of qualitative literature. Res Social Adm Pharm 2019; 15:331-337. [DOI: 10.1016/j.sapharm.2018.05.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/15/2018] [Accepted: 05/21/2018] [Indexed: 11/19/2022]
|
45
|
Bednarczyk RA. Addressing HPV vaccine myths: practical information for healthcare providers. Hum Vaccin Immunother 2019; 15:1628-1638. [PMID: 30676241 DOI: 10.1080/21645515.2019.1565267] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Human papillomavirus (HPV) vaccine uptake consistently lags behind that of other adolescent vaccines. In 2017, uptake of a single HPV vaccine dose and HPV vaccine series completion was 66% and 49%, respectively, compared to uptake of tetanus, diphtheria, and acellular pertussis vaccine (89%) and quadrivalent meningococcal conjugate vaccine (85%). Reasons for not vaccinating adolescents again HPV are varied, and in many cases, are rooted in commonly spread myths and misperceptions about the vaccine. In this review, we address five key myths - HPV vaccination is not effective at preventing cancer; Pap smears are sufficient to prevent cervical cancer; HPV vaccination is not safe; HPV vaccination is not needed since most infections are naturally cleared by the immune system; 11-12 years of age is too young to vaccinate. For each myth, we summarize the scientific evidence refuting the myth and provide speaking prompts for healthcare professionals to communicate about HPV vaccination.
Collapse
Affiliation(s)
- Robert A Bednarczyk
- a Hubert Department of Global Health, Rollins School of Public Health, Emory University , Atlanta GA , USA.,b Department of Epidemiology, Rollins School of Public Health, Emory University , Atlanta GA , USA.,c Cancer Prevention and Control Program, Winship Cancer Institute, Emory University , Atlanta GA , USA.,d Emory Vaccine Center, Emory University , Atlanta GA , USA
| |
Collapse
|
46
|
Suryadevara M, Bonville CA, Cibula DA, Domachowske JB, Suryadevara AC. Associations between population based voting trends during the 2016 US presidential election and adolescent vaccination rates. Vaccine 2019; 37:1160-1167. [PMID: 30691983 DOI: 10.1016/j.vaccine.2019.01.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 12/20/2018] [Accepted: 01/08/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Politics play a role in the dissemination of public health information, including immunization-related issues. We aim to describe relationships between HPV vaccination rates and state voting patterns during the 2016 US presidential election. METHODS We classified each of the 50 states as either "Red" or "Blue," based on whether a higher proportion of the state's casted votes were for the Republican or Democratic nominee during the 2016 US presidential election. State-specific HPV, Tdap, and meningococcal vaccination rates were obtained from the 2016-National Immunization Survey-Teen. State socio-demographic factors and HPV vaccine legislation were obtained from the US Census Bureau and National Conference of State Legislatures. Vaccination rates and socio-demographic variables were compared using independent t-tests. Multiple linear regression compared vaccination rates between "Red" and "Blue" states, adjusting for percentage of both uninsured children and educational attainment. RESULTS Compared to "Blue" states, "Red" states had significantly lower unadjusted HPV vaccine series initiation (56% vs 66%, p < 0.05) and completion (39% vs 50%, p < 0.05) rates; yet had similar rates of Tdap (88% vs 89%, p > 0.05) and meningococcal (79% vs 83%, p > 0.05) vaccinations. After adjusting for potential confounders, the regression-adjusted mean rate for HPV vaccine initiation and completion remained significantly lower for "Red" states compared to "Blue" states (57% vs 65%, p < 0.05, and 41% vs 48%, p < 0.05, respectively). CONCLUSION HPV vaccination rates are associated with statewide-level voting patterns. Future interventions aimed at improving HPV vaccination rates should consider engaging local and national elected leaders to be proactive in disseminating accurate and authoritative immunization information.
Collapse
Affiliation(s)
- Manika Suryadevara
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY 13210, United States.
| | - Cynthia A Bonville
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY 13210, United States
| | - Donald A Cibula
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, United States
| | - Joseph B Domachowske
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY 13210, United States
| | - Amar C Suryadevara
- Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical University, Syracuse, NY 13210, United States
| |
Collapse
|
47
|
Walling EB, Dodd S, Bobenhouse N, Reis EC, Sterkel R, Garbutt J. Implementation of Strategies to Improve Human Papillomavirus Vaccine Coverage: A Provider Survey. Am J Prev Med 2019; 56:74-83. [PMID: 30573149 PMCID: PMC6948017 DOI: 10.1016/j.amepre.2018.07.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Human papillomavirus (HPV) vaccine coverage in the U.S. is persistently suboptimal, despite research describing barriers to vaccination and strategies to increase vaccination coverage. The objective was to assess providers' approach to the HPV vaccine and their implementation of strategies to increase HPV vaccination coverage. The hypothesis was that adoption of improvement measures to address underuse of the HPV vaccine has not occurred. METHODS Community pediatric providers from two Midwestern practice-based research networks completed self-administered electronic surveys. Data were collected over 6 months in 2015 and organized and analyzed in 2016. RESULTS There were 100 providers that participated. Despite agreement with national recommendations, some providers delayed their recommendation until the adolescent was older and many reported missed vaccination opportunities. Many providers experienced parental concerns including safety of the HPV vaccine, belief their child was not at risk of HPV infection, and their child's resistance to receiving multiple shots. Providers identified the following as barriers to adherence to Advisory Committee on Immunization Practices guidelines: bad publicity of the HPV vaccine, information about the HPV vaccine on the web, and a lack of a follow-up system for those who delayed HPV vaccine initiation. Approximately half of the participants had implemented strategies to address these barriers beyond offering immunization-only appointments. CONCLUSIONS Participants were aware of barriers to HPV vaccine use, but many had not adopted a systematic approach to increase vaccine coverage. A better understanding of the challenges facing providers to adopting improvement measures and a strategy to address barriers to implementation are needed to improve HPV coverage.
Collapse
Affiliation(s)
- Emily B Walling
- Division of Hematology and Oncology, Department of Pediatrics, Washington University, School of Medicine, St. Louis, Missouri; Department of Pediatrics and Communicable Diseases, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan.
| | - Sherry Dodd
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Neil Bobenhouse
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Evelyn Cohen Reis
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Randy Sterkel
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Jane Garbutt
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
48
|
Eska JS, Lairson DR, Savas LS, Shegog R, Healy CM, Spinner SW, Fernandez ME, Vernon SW. Implementation costs of a multi-component program to increase human papillomavirus (HPV) vaccination in a network of pediatric clinics. THE JOURNAL OF APPLIED RESEARCH ON CHILDREN : INFORMING POLICY FOR CHILDREN AT RISK 2019; 10:8. [PMID: 32782853 PMCID: PMC7416872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION HPV vaccination is both a clinically and cost-effective way to prevent HPV-related cancers. Increased focus on preventing HPV infection and HPV-related cancers has motivated development of strategies to increase adolescent vaccination rates. This analysis estimates the average cost associated with implementing programs aimed at increasing HPV vaccination from the perspective of the clinic decision makers. As providers and healthcare organizations consider vaccination initiatives, it is important for them to understand the costs associated with implementing these programs. METHODS Healthcare provider assessment and feedback, reminders, and education; and parent education/reminder strategies were implemented in a large pediatric clinic network between October 2015 and February 2018 to improve HPV vaccination rates. A micro-costing method was used in 2018 to prospectively estimate program implementation costs with the clinic as the unit of analysis. A sensitivity analysis assessed the effects of variability in levels of participation. RESULTS Assessment and feedback reports and provider education were implemented among 51 clinics at average per clinic cost of $786 and $368 respectively. Electronic vaccination reminders were delivered to providers and parents at a per clinic cost of $824. The parent education implementation cost was $2,126 per clinic. CONCLUSION The four complimentary HPV evidence-based strategies were delivered at a total cost of $157,534 or $4,749 per clinic, including staff training and participant recruitment, reaching 155,000 HPV vaccine eligible adolescents.
Collapse
Affiliation(s)
- Jarrod S Eska
- University of Texas Health Science Center-Houston, Center for Health Promotion and Prevention Research, Houston, TX
| | - David R Lairson
- University of Texas Health Science Center-Houston, Center for Health Services Research, Houston, TX
| | - L S Savas
- University of Texas Health Science Center-Houston, Center for Health Promotion and Prevention Research, Houston, TX
| | - Ross Shegog
- University of Texas Health Science Center-Houston, Center for Health Promotion and Prevention Research, Houston, TX
| | - C Mary Healy
- Baylor College of Medicine, Pediatric Medicine- Infectious Disease, Houston, TX
| | | | - Maria E Fernandez
- University of Texas Health Science Center-Houston, Center for Health Promotion and Prevention Research, Houston, TX
| | - Sally W Vernon
- University of Texas Health Science Center-Houston, Center for Health Promotion and Prevention Research, Houston, TX
| |
Collapse
|
49
|
Fedewa SA, Preiss AJ, Fisher-Borne M, Goding Sauer A, Jemal A, Saslow D. Reaching 80% human papillomavirus vaccination prevalence by 2026: How many adolescents need to be vaccinated and what are their characteristics? Cancer 2018; 124:4720-4730. [PMID: 30257056 DOI: 10.1002/cncr.31763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/06/2018] [Accepted: 01/12/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Human papillomavirus vaccination (HPVV) prevents several types of cancer. The American Cancer Society recently established a goal that by 2026, 80% of adolescents will be up to date (UTD) before their 13th birthday. However, the number in need of vaccination to reach this goal is unknown. This study estimated the number of additional adolescents (11-12 years old) who need HPVV for 80% prevalence to be reached by 2026. METHODS The study used de-identified and publicly available data and exempt from institutional review board approval and informed consent. The 2016 National Immunization Survey for Teens was used to estimate the baseline HPVV prevalence. Linear growth to 80% HPVV prevalence by 2026 was applied to set intermediate targets. US Census Bureau data were used for population projections. This study estimated the cumulative number of additional adolescents 11 to 12 years old who would need to become UTD (ie, receive 2 doses) by first subtracting the number who would need to be vaccinated to achieve an intermediate target prevalence from the estimated number currently compliant and then summing these numbers between 2018 and 2026. RESULTS Nationwide, an additional 7.62 million males (95% confidence interval [CI], 6.78 million to 8.40 million) and an additional 6.77 million females (95% CI, 5.95 million to 7.55 million), aged 11 to 12 years, would need to receive 2 doses of the vaccine between 2018 and 2026 for 80% prevalence to be achieved. Most adolescents not UTD (80%) also needed to initiate vaccination, and more than 90% recently visited a health care provider. CONCLUSIONS It is estimated that at least 14.39 million additional adolescents aged 11 to 12 years in the United States will need to receive 2 doses of HPVV for a UTD HPVV prevalence of 80% to be achieved by 2026. To reach this goal, improvements in facilitators of HPVV initiation, including physician recommendations and parental acceptability, are needed.
Collapse
Affiliation(s)
- Stacey A Fedewa
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | | | | | - Ann Goding Sauer
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Debbie Saslow
- Cancer Control Interventions, American Cancer Society, Atlanta, Georgia
| |
Collapse
|
50
|
Lefèvre H, Schrimpf C, Moro MR, Lachal J. HPV vaccination rate in French adolescent girls: an example of vaccine distrust. Arch Dis Child 2018; 103:740-746. [PMID: 29222179 DOI: 10.1136/archdischild-2017-313887] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/13/2017] [Accepted: 11/13/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To explore the clinical issues of human papillomavirus (HPV) vaccination to develop explanatory hypotheses for the low level of vaccination among adolescent girls in France where the full course coverage is low (<15%). DESIGN We used semistructured interviews. Our qualitative and phenomenological procedure applied interpretative phenomenological analysis. PARTICIPANTS 16 physicians regularly faced with the prescription of HPV vaccine, represented several medical specialties (paediatrics, general practice, internal medicine, gynaecology), with hospitalist or private practices. MAIN OUTCOME MEASURES The results connect three superordinate themes grouping three concentric levels: within society, during the consultation and in the individual doctor's feelings. RESULTS The modalities and contents of the information about HPV vaccination raise questions about the limitations of the information doctors receive. The ineluctable association between sexuality and HPV vaccination explains their reluctance to raise topics considered to be private. The reasons for HPV vaccination illustrate the difficulty of arguing in favour of it. In view of the frequent parental reluctance, which weakens the parent-physician alliance, physicians must take responsibility for defending the benefits of vaccination. They nonetheless remain citizens whose opinions may implicitly echo the general reluctance, promoted by disinformation. In delaying or avoiding the subject of vaccination, they involuntarily become an instrument of anti-vaccination discourse. CONCLUSIONS It is imperative to improve the distribution of credible information about vaccination, unbiased and scientifically supported by a strong institutional position and to rethink the place of the clinician in the system of adolescent health and disease prevention in France.
Collapse
Affiliation(s)
- Hervé Lefèvre
- AP-HP, Cochin Hospital, Paris, France.,CESP, Faculty de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.,French Clinical Research Group, Adolescent Medicine and Health, Paris, France
| | - Cécile Schrimpf
- AP-HP, Cochin Hospital, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Marie Rose Moro
- AP-HP, Cochin Hospital, Paris, France.,CESP, Faculty de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jonathan Lachal
- AP-HP, Cochin Hospital, Paris, France.,CESP, Faculty de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| |
Collapse
|