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Liu S, Durantini MR, Calabrese C, Sanchez F, Albarracin D. A systematic review and meta-analysis of strategies to promote vaccination uptake. Nat Hum Behav 2024:10.1038/s41562-024-01940-6. [PMID: 39090405 DOI: 10.1038/s41562-024-01940-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/01/2024] [Indexed: 08/04/2024]
Abstract
Although immunization can dramatically curb the mortality and morbidity associated with vaccine-preventable diseases, vaccination uptake remains suboptimal in many areas of the world. Here, in this meta-analysis, we analysed the results from 88 eligible randomized controlled trials testing interventions to increase vaccination uptake with 1,628,768 participants from 17 countries with variable development levels (for example, Human Development Index ranging from 0.485 to 0.955). We estimated the efficacy of seven intervention strategies including increasing access to vaccination, sending vaccination reminders, providing incentives, supplying information, correcting misinformation, promoting both active and passive motivation and teaching behavioural skills. We showed that the odds of vaccination were 1.5 (95% confidence interval, 1.27 to 1.77) times higher for intervention than control conditions. Among the intervention strategies, using incentives and increasing access were most promising in improving vaccination uptake, with the access strategy being particularly effective in countries with lower incomes and less access to healthcare.
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Affiliation(s)
- Sicong Liu
- School of Physical Education and Sports Science, South China Normal University, Guangzhou, China.
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA, USA.
| | - Marta R Durantini
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher Calabrese
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA, USA
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, USA
| | - Flor Sanchez
- Department of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Dolores Albarracin
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA.
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Chandeying N, Thongseiratch T. EMR-Based Interventions on HPV Vaccination Initiation, Completion, and Receiving the Next Dose: A Meta-Analytic Review. Vaccines (Basel) 2024; 12:739. [PMID: 39066377 PMCID: PMC11281632 DOI: 10.3390/vaccines12070739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 06/22/2024] [Accepted: 06/23/2024] [Indexed: 07/28/2024] Open
Abstract
Despite the acknowledged importance of Human Papillomavirus (HPV) vaccination in reducing HPV-related diseases, the influence of electronic medical records (EMR) on HPV vaccination uptake (HVU) remains underexplored. This study aimed to evaluate the efficacy of EMR-based interventions on HVU. A systematic review and meta-analysis of randomized controlled trials were performed, focusing on studies that primarily used EMR-based interventions to measure initiation rates, completion rates, and receipt of the next required vaccine dose. Subgroup analyses were conducted to assess the differential effects of supplementary strategies, provider feedback, and parental education or reminders on these outcomes. The results of the comprehensive analysis provided robust evidence for the significant role of EMR interventions, demonstrating an average increase of 4.7% in vaccine initiation, 6.6% in vaccine completion, and 7.2% in receipt of the next HPV vaccine dose. Additionally, the subgroup analyses indicated that provider feedback and parental education could further enhance the effectiveness of EMR-based interventions. These findings support the broader adoption of digital health technologies in vaccination programs, offering vital insights for healthcare providers, policymakers, and researchers, and emphasizing the need for continued technological innovation to improve public health outcomes.
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Affiliation(s)
- Nutthaporn Chandeying
- Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand;
| | - Therdpong Thongseiratch
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla 90100, Thailand
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3
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Webster EM, Ahsan MD, Kulkarni A, Peñate E, Beaumont S, Ma X, Wilson-Taylor M, Chang J, Ipp L, Safford MM, Cantillo E, Frey M, Holcomb K, Chapman-Davis E. Building knowledge using a novel web-based intervention to promote HPV vaccination in a diverse, low-income population. Gynecol Oncol 2024; 181:102-109. [PMID: 38150834 DOI: 10.1016/j.ygyno.2023.12.005] [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: 09/26/2023] [Revised: 11/24/2023] [Accepted: 12/08/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES HPV vaccination rates remain suboptimal despite proven efficacy. Data suggest misconceptions or lack of knowledge are leading barriers. Our study aimed to develop and pilot a novel interactive education resource designed to educate parents and patients about HPV vaccines. METHODS This is a prospective pilot study conducted in an urban teaching hospital pediatric clinic. The Patient Activated Learning System (PALS) intervention included 3 web-based videos with HPV vaccine-related educational content. Participants were parents of adolescent patients, aged 11-17 years, and young adult patients, aged 18-26 years. Enrolled participants completed an HPV vaccine knowledge survey before and after watching PALS; paired scores were evaluated. Acceptability and participant-reported impact of PALS modules were measured via Likert-scale surveys. RESULTS 132 individuals were approached; 101 (76%) enrolled and completed the study. Participants self-identified as Hispanic (50%), non-Hispanic Black (23%), non-Hispanic White (7%), Asian (6%), American/Alaskan/Hawaiian Native or Pacific Islander (5%). Half reported earning ≤$40,000 annually; 57% had only a high school education. Post-intervention knowledge scores were increased compared to baseline (9.87/27 points vs 17.53/27 points, p < 0.01). PALS modules were reported as enjoyable to use and understandable (89% and 93%, respectively), and improved participants' understanding of the importance of HPV vaccination (90%). Of the 18 patients unvaccinated at baseline, 39% received 1 shot of the HPV vaccine within one month. CONCLUSION The PALS HPV vaccine educational intervention was feasible, acceptable, and improved knowledge among a diverse, underserved population. Our intervention may positively influence HPV vaccination rates, with potential to overcome HPV vaccine hesitancy.
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Affiliation(s)
- Emily M Webster
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, United States of America.
| | - Muhammad Danyal Ahsan
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, United States of America
| | - Amita Kulkarni
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, United States of America
| | - Emilio Peñate
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, United States of America
| | - Shanice Beaumont
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, United States of America
| | - Xiaoyue Ma
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
| | - Melanie Wilson-Taylor
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States of America
| | - Jane Chang
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States of America
| | - Lisa Ipp
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States of America
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States of America
| | - Evelyn Cantillo
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, United States of America
| | - Melissa Frey
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, United States of America
| | - Kevin Holcomb
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, United States of America
| | - Eloise Chapman-Davis
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, United States of America
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Chandeying N, Thongseiratch T. Systematic review and meta-analysis comparing educational and reminder digital interventions for promoting HPV vaccination uptake. NPJ Digit Med 2023; 6:162. [PMID: 37644090 PMCID: PMC10465590 DOI: 10.1038/s41746-023-00912-w] [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: 02/28/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
Global Human papillomavirus (HPV) vaccination rates remain low despite available WHO-approved vaccines. Digital interventions for promoting vaccination uptake offer a scalable and accessible solution to this issue. Here we report a systematic review and meta-analysis examining the efficacy of digital interventions, comparing educational and reminder approaches, for promoting HPV vaccination uptake (HVU). This study also identifies factors influencing the effectiveness of these interventions. We searched PubMed, PsycInfo, Web of Science, and the Cochrane Library from each database's inception to January 2023. Three raters independently evaluate the studies using a systematic and blinded method for resolving disagreements. From 1929 references, 34 unique studies (281,280 unique participants) have sufficient data. Client reminder (OR, 1.41; 95% CI, 1.23-1.63; P < 0.001), provider reminder (OR, 1.39; 95% CI, 1.11-1.75; P = 0.005), provider education (OR, 1.18; 95% CI, 1.05-1.34; P = 0.007), and client education plus reminder interventions (OR, 1.29; 95% CI, 1.04-1.59; P = 0.007) increase HVU, whereas client education interventions do not (OR, 1.08; 95% CI, 0.92-1.28; P = 0.35). Digital intervention effectiveness varies based on participants' gender and the digital platform used. Interventions targeting male or mixed-gender participants demonstrate greater benefit, and reminder platforms (SMS, preference reminders, or electronic health record alerts) are more effective in increasing HVU. Digital interventions, particularly client and provider reminders, along with provider education, prove significantly more effective than client education alone. Incorporating digital interventions into healthcare systems can effectively promote HPV vaccination uptake. Reminder interventions should be prioritized for promoting HVU.
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Affiliation(s)
- Nutthaporn Chandeying
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Therdpong Thongseiratch
- Child Development Unit, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
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Gray A, Fisher CB. Factors associated with HPV vaccine acceptability and hesitancy among Black mothers with young daughters in the United States. Front Public Health 2023; 11:1124206. [PMID: 37139381 PMCID: PMC10150885 DOI: 10.3389/fpubh.2023.1124206] [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: 01/04/2023] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Compared to other-race peers, Black women are disproportionately impacted by human papillomavirus [HPV] infection, related health outcomes, and cervical cancer mortality as a result of suboptimal HPV vaccine uptake during adolescence. Few studies in the United States have examined psychosocial determinants of HPV vaccine acceptability and hesitancy among Black parents. The current study integrated the health belief model and the theory of planned behavior to evaluate the extent to which psychosocial factors are associated with pediatric HPV vaccination intentions among this population. Methods Black mothers (N = 402; age range = 25 to 69 years, M = 37.45, SD = 7.88) of daughters ages 9 to 15 years completed an online survey assessing HPV infection and vaccine beliefs and attitudes across four domains: Mother's HPV Perceptions, Mother's Vaccine Attitudes, Cues to Action, and Perceived Barriers to HPV Vaccination. Participants indicated their willingness to vaccinate their daughter on a 5-level ordinal scale ("I will definitely not have my daughter get the vaccine" to "I will definitely have my daughter get the vaccine") which was dichotomously recoded for binomial logistic regressions. Results Half of the sample (48%) intended to vaccinate their daughter. Number of daughters, mother's HPV vaccine status, perceived HPV vaccine benefits, HPV vaccine safety concerns, pediatric HPV vaccine peer norms, and doctor recommendations emerged as independent factors of Black mothers' intentions to vaccinate their daughters against HPV when controlling for all other factors. Discussion In addition to medical training to increase doctor recommendation of the HPV vaccine for Black girls, population-tailored public health messaging aimed at promoting HPV vaccine acceptance among Black mothers is urgently needed. This messaging should engage community support and emphasize the benefits of vaccination for adolescent Black girls while also addressing parental concerns regarding the safety of pediatric HPV vaccination.
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Affiliation(s)
- Aaliyah Gray
- Department of Psychology, Fordham University, Bronx, NY, United States
- Department of Epidemiology, Florida International University, Miami, FL, United States
- *Correspondence: Aaliyah Gray,
| | - Celia B. Fisher
- Department of Psychology, Fordham University, Bronx, NY, United States
- Center for Ethics Education, Fordham University, Bronx, NY, United States
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Siddiqui FA, Padhani ZA, Salam RA, Aliani R, Lassi ZS, Das JK, Bhutta ZA. Interventions to Improve Immunization Coverage Among Children and Adolescents: A Meta-analysis. Pediatrics 2022; 149:186948. [PMID: 35503337 DOI: 10.1542/peds.2021-053852d] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Vaccinations are recognized as a feasible, cost-effective public health intervention for reducing the burden and associated mortality of many infectious diseases. The purpose of this study was to evaluate the effectiveness of potential interventions to improve the uptake of vaccines among children and adolescents. METHODS We performed a literature search until December 2020. Eligible studies were identified using Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, and other sources. We included studies conducted on children and adolescents aged 5 to 19 years. Studies comprised of hospitalized children and those with comorbid conditions were excluded. Two authors independently performed the meta-analysis. RESULTS Findings from 120 studies (123 articles), of which 95 were meta-analyzed, reveal that vaccination education may increase overall vaccination coverage by 19% (risk ratio [RR], 1.19; 95% confidence interval [CI], 1.12-1.26), reminders by 15% (RR, 1.15; 95% CI, 1.11-1.18), interventions for providers by 13% (RR, 1.13; 95% CI, 1.07-1.19), financial incentives by 67% (RR, 1.67; 95% CI, 1.40-1.99), and multilevel interventions by 25% (RR, 1.25; 95% CI, 1.10-1.41). The impact of school-based clinics and policy and legislation on overall vaccination coverage is still uncertain, and no impact of a multicomponent intervention on overall vaccination coverage was found. CONCLUSIONS Educational interventions, reminders, provider-directed interventions, financial incentives, and multilevel interventions may improve vaccination coverage among school-aged children and adolescents.
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Affiliation(s)
- Faareha A Siddiqui
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Zahra A Padhani
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Razia Aliani
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Zohra S Lassi
- Robinson Research Institute, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan.,Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada
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Mohamed R, Kelly KM, Nili M, Kelley GA. A systematic review with meta-analysis of parental interventions for human papillomavirus vaccine uptake. J Am Pharm Assoc (2003) 2022; 62:1142-1153. [DOI: 10.1016/j.japh.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/26/2022]
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Zhang X, Tang L. Cultural adaptation in HPV vaccine intervention among racial and ethical minority population: a systematic literature review. HEALTH EDUCATION RESEARCH 2022; 36:479-493. [PMID: 34542147 DOI: 10.1093/her/cyab034] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/05/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
Racial and ethnic minorities in the United States face higher risks of human papillomavirus (HPV) and are less likely to benefit from HPV vaccines. Effective HPV vaccine promotion efforts need to acknowledge and adapt to the cultural characteristics of these minority groups. This systematic review examines and evaluates the cultural adaptations in the HPV vaccine intervention studies conducted in racial and ethnic minority communities in the United States. We searched five databases and identified 26 peer-reviewed English-language journal articles published between 2010 and 2019. These articles were analyzed using Healey et al.'s (2017) cultural adaptation framework for community health interventions. Almost all of these interventions involved some cultural adaptation. However, there is a lack of use of theories in guiding intervention design, lack of systematic, planned cultural adaptations and insufficient in-depth understanding of the targeted population's cultural characteristics associated with their HPV-related attitudes, beliefs and behaviors. Future intervention studies should identify specific cultural characteristics related to vaccine attitudes and behaviors to create more targeted cultural adaptations in HPV vaccine promotion.
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Rani U, Darabaner E, Seserman M, Bednarczyk RA, Shaw J. Public Education Interventions and Uptake of Human Papillomavirus Vaccine: A Systematic Review. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E307-E315. [PMID: 33208719 DOI: 10.1097/phh.0000000000001253] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Human papillomavirus (HPV) vaccine uptake remains suboptimal in the United States. Public education is considered an important aspect of increasing vaccination rates. OBJECTIVES We systematically reviewed the literature on the impact of public education on HPV vaccine uptake. DESIGN PubMed was searched to identify studies published between January 1, 2007, and April 30, 2018, meeting the following inclusion criteria: the study was conducted in the US, education was directed toward the public, and the research included HPV vaccine uptake and/or completion as outcomes. RESULTS A total of 3764 studies were screened, and 30 published studies were included in the review. Among those, 13 focused on parent/guardian education, 8 on young adults, 6 on parent/daughter dyads, 1 focused only on adolescents, and 2 studies recruited a mixed-age population. Studies that included parents and young adults and were delivered by experts led to increased uptake of HPV vaccination (n = 14). A majority of the studies included female and Non-Hispanic White population (n = 20). Less than a third of studies included minority groups: Hispanic (n = 4), African American (n = 1), Cambodian American (n = 1), Indian American (n = 1), Korean American (n = 1), and combined Haitian and African American (n = 1) population. Minority group interventions that provided individually tailored messages, addressed misconceptions, removed barriers to vaccination, and engaged parents and community members improved HPV vaccine acceptance (n = 5). CONCLUSION Interventions that delivered HPV-related education by authoritative sources and included parents improved HPV vaccination rates among adolescents and young adults. Community engagement played an important role in vaccine uptake among minority populations. Future studies should focus on male participants and minority populations to reduce disparities in HPV-related cancer incidence and HPV vaccine coverage.
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Affiliation(s)
- Uzma Rani
- Department of Pediatrics, (Ms Rani) and Department of Pediatrics, Division of Infectious Diseases (Dr Shaw), State University of New York Upstate Medical University, Golisano Children's Hospital, Syracuse, New York; Hunter-Rice Health Sciences Library, Samaritan Medical Center, Watertown, New York (Ms Darabener); American Cancer Society, Latham, New York (Mr Seserman); and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia (Dr Bednarczyk)
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Mavundza EJ, Iwu-Jaja CJ, Wiyeh AB, Gausi B, Abdullahi LH, Halle-Ekane G, Wiysonge CS. A Systematic Review of Interventions to Improve HPV Vaccination Coverage. Vaccines (Basel) 2021; 9:vaccines9070687. [PMID: 34201421 PMCID: PMC8310215 DOI: 10.3390/vaccines9070687] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022] Open
Abstract
Human papillomavirus (HPV) infection is the most common sexually transmitted infection worldwide. Although most HPV infections are transient and asymptomatic, persistent infection with high-risk HPV types may results in diseases. Although there are currently three effective and safe prophylactic HPV vaccines that are used across the world, HPV vaccination coverage remains low. This review evaluates the effects of the interventions to improve HPV vaccination coverage. We searched the Cochrane Central Register of Controlled Trials, PubMed, Web of Science, Scopus, and the World Health Organization International Clinical Trials Registry Platform and checked the reference lists of relevant articles for eligible studies. Thirty-five studies met inclusion criteria. Our review found that various evaluated interventions have improved HPV vaccination coverage, including narrative education, outreach plus reminders, reminders, financial incentives plus reminders, brief motivational behavioral interventions, provider prompts, training, training plus assessment and feedback, consultation, funding, and multicomponent interventions. However, the evaluation of these intervention was conducted in high-income countries, mainly the United States of America. There is, therefore, a need for studies to evaluate the effect of these interventions in low-and middle-income countries, where there is a high burden of HPV and limited HPV vaccination programs.
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Affiliation(s)
- Edison J. Mavundza
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town 7501, South Africa;
- Correspondence:
| | - Chinwe J. Iwu-Jaja
- Department of Nursing and Midwifery, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa;
| | - Alison B. Wiyeh
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA;
| | - Blessings Gausi
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa;
| | - Leila H. Abdullahi
- African Institute for Development Policy, Nairobi P.O. Box 14688-00800, Kenya;
| | | | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town 7501, South Africa;
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa;
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
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Acampora A, Grossi A, Barbara A, Colamesta V, Causio FA, Calabrò GE, Boccia S, de Waure C. Increasing HPV Vaccination Uptake among Adolescents: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7997. [PMID: 33143171 PMCID: PMC7663345 DOI: 10.3390/ijerph17217997] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/02/2020] [Accepted: 10/27/2020] [Indexed: 12/28/2022]
Abstract
Human Papillomavirus (HPV) vaccination is a well-known fundamental strategy in the prevention of cervical cancer, as it is always caused by HPV infection. In fact, primary prevention of the infection corresponds to primary prevention of HPV-related cancers and other diseases. Since an effective prevention at the population level is the final goal, it is mandatory for healthcare systems to achieve a high HPV vaccination coverage among the adolescents to reduce the circulation of the virus and the burden of HPV-related diseases. This research identified, through a systematic literature review, 38 papers on strategies adopted to increase HPV vaccination coverage among adolescents. The evaluated strategies targeted adolescents/parents and/or healthcare providers and could be grouped in three main types: (1) reminder-based, (2) education, information, and communication activities, and (3) multicomponent strategies. Several types of strategy, such as those relied only on reminders and integrating different interventions, showed a positive impact on vaccination coverage. Nonetheless, the heterogeneity of the interventions suggests the importance to adapt such strategies to the specific national/local contexts to maximize vaccination coverage.
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Affiliation(s)
- Anna Acampora
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.A.); (A.G.); (A.B.); (V.C.); (F.A.C.); (S.B.)
| | - Adriano Grossi
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.A.); (A.G.); (A.B.); (V.C.); (F.A.C.); (S.B.)
| | - Andrea Barbara
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.A.); (A.G.); (A.B.); (V.C.); (F.A.C.); (S.B.)
| | - Vittoria Colamesta
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.A.); (A.G.); (A.B.); (V.C.); (F.A.C.); (S.B.)
- Unità Operativa Complessa Direzione Sanitaria S. Spirito e Nuovo Regina Margherita, Local Health Unit ASL RM1, 00193 Rome, Italy
| | - Francesco Andrea Causio
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.A.); (A.G.); (A.B.); (V.C.); (F.A.C.); (S.B.)
| | - Giovanna Elisa Calabrò
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.A.); (A.G.); (A.B.); (V.C.); (F.A.C.); (S.B.)
- VIHTALI (Value in Health Technology and Academy for Leadership & Innovation), Spin-Off of Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.A.); (A.G.); (A.B.); (V.C.); (F.A.C.); (S.B.)
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Chiara de Waure
- Department of Experimental Medicine, University of Perugia, 06132 Perugia, Italy;
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Dang JHT, Stewart SL, Blumberg DA, Rodriguez HP, Chen MS. "There's Always Next Year": Primary Care Team and Parent Perspectives on the Human Papillomavirus Vaccine. Hum Vaccin Immunother 2020; 16:1814-1823. [PMID: 32048896 DOI: 10.1080/21645515.2019.1710410] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Acceptance of the human papillomavirus (HPV) vaccination among parents and clinicians is high, but uptake remains low. Little is known about organizational and primary care team factors that influence the uptake of the HPV vaccine. Interviews with clinicians, clinic support staff, and parents of adolescent patients were conducted to better understand the interrelationships among the people and the organizational processes that influence HPV vaccine uptake at the point of care. Between July 2016 and February 2017, semi-structured interviews of 40 participants (18 clinicians, 12 clinic support staff, and 10 parents of adolescent patients) in a primary care network were conducted. Organizational structures and processes, such as electronic provider reminders, availability of "vaccination only" appointments, and knowledgeable primary care team members contributed to HPV vaccine uptake. Consistently high support of HPV vaccination was found among key informants; however, rather than refuse HPV vaccination, parents are opting to delay vaccination to a future visit. When parents express the desire to delay, clinicians and care team members described often recommending addressing HPV vaccination at a future visit, giving parents the impression that receiving the vaccine was not time-sensitive for their child. Discordance in HPV vaccination recommendations among providers and clinic support staff may contribute to delayed HPV vaccination. Strong, high-quality HPV vaccine recommendations are needed from all primary team members. Clinic interventions to accelerate HPV vaccine uptake may benefit from a team-based approach where every member of the primary care team is delivering the same consistent messaging about the importance of timely HPV vaccination.
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Affiliation(s)
- Julie H T Dang
- Davis Comprehensive Cancer Center, University of California, Sacramento, CA, USA
| | - Susan L Stewart
- Davis School of Medicine, Division of Biostatistics, Department of Public Health Sciences, University of California , Sacramento, CA, USA
| | - Dean A Blumberg
- Davis Health Department of Pediatrics, University of California , Sacramento, CA, USA
| | - Hector P Rodriguez
- Berkeley, School of Public Health, Division of Health Policy and Management, University of California , Berkeley, CA, USA
| | - Moon S Chen
- Davis Comprehensive Cancer Center, University of California, Sacramento, CA, USA
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McKillop CN, Leonard T, Pruitt SL, Tiro JA. Do traditional economic theories of free riding behavior explain spatial clustering of HPV vaccine uptake? SSM Popul Health 2019; 8:100421. [PMID: 31206005 PMCID: PMC6558301 DOI: 10.1016/j.ssmph.2019.100421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/30/2019] [Accepted: 06/01/2019] [Indexed: 10/31/2022] Open
Abstract
Rationale Geographic clusters of low vaccination uptake reduce the population-level efficacy of vaccination programs. However, little is known about the mechanisms that drive geographic patterns in vaccination rates. Traditional economic theory considers vaccination as a classic public good and suggests that free riding-individuals taking advantage of public goods by relying on others' immunization behavior without contributing toward them-is a primary cause of low vaccination rates. However, behavioral economics suggests that free riding does not fully explain observed individual behavior, and the presence of both high and low clusters of vaccination rates suggest that this theory alone does not fully explain geographic patterns of vaccination. Objective We assessed geographic clustering of HPV vaccination uptake and examined the evidence for or against free riding in HPV vaccination decisions. Methods We analyzed HPV vaccination decisions of low-income adolescent females (N = 601) residing in urban neighborhoods in Dallas, Texas, USA during 2011-2012. Spatial econometric models were estimated to assess the relationship between neighborhood vaccination rates and individual vaccination decisions. Results We found a positive and significant relationship between individual HPV vaccination choices and the average neighborhood vaccination rate at the time parents were making vaccine decisions for their adolescent daughters while controlling for neighborhood sorting and other confounders. Conclusion Individuals were more likely to complete the HPV vaccination series when others in their neighborhood had already completed the series. We do not find evidence for free riding in HPV vaccination decisions.
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Affiliation(s)
- Caitlin N McKillop
- Economics Department, State University of New York at Cortland, 28 Graham St, Old Main 136A, Cortland, NY, 13045, United States
| | - Tammy Leonard
- Economics Department, University of Dallas, 1845 E Northgate Drive, Irving, TX, 75062, United States
| | - Sandi L Pruitt
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center and Harold C. Simmons Cancer Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, United States
| | - Jasmin A Tiro
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center and Harold C. Simmons Cancer Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, United States
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Gerend MA, Stephens YP, Kazmer MM, Slate EH, Reyes E. Predictors of Human Papillomavirus Vaccine Completion Among Low-Income Latina/o Adolescents. J Adolesc Health 2019; 64:753-762. [PMID: 30777636 PMCID: PMC6534422 DOI: 10.1016/j.jadohealth.2018.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/11/2018] [Accepted: 12/04/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE The purpose of this longitudinal study was to identify individual and interpersonal factors associated with human papillomavirus (HPV) vaccine series completion in a sample of low-income Latina/o adolescent girls and boys. METHODS Caregiver-adolescent dyads (N = 161) were recruited from a rural Federally Qualified Health Center in southwest Florida when the adolescent (aged 11-17 years) received the first dose of HPV vaccine. Dyads completed a baseline assessment that measured demographic and cultural characteristics, past medical history, provider-patient communication, HPV knowledge, health beliefs about completing the series, and the adolescent's experience receiving the first dose. Using multivariable logistic regression, we identified caregiver- and adolescent-related factors associated with series completion (receipt of three doses of HPV vaccine within 1 year of initiation) as indicated in the adolescent's medical record and state immunization registry. RESULTS Within 1 year of initiation, 57% (n = 92) completed the three-dose series. Missed opportunities for completion were observed for 20% of the sample who returned to the clinic. Caregiver-related predictors of completion included education, self-efficacy to complete the series, and knowledge of the required number of doses. Adolescent-related predictors included age, influenza vaccination within the past 2 years, having a chronic medical condition, reason for the baseline visit, and receipt of written information about HPV vaccination from a health care provider. CONCLUSIONS Findings highlight important opportunities for improving completion of the HPV vaccine series among Latina/o adolescents. Intervention efforts should involve health care providers and parent-adolescent dyads and prioritize evidence-based strategies for reducing missed opportunities for series completion.
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Affiliation(s)
- Mary A Gerend
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University (FSU), Tallahassee, Florida.
| | | | - Michelle M Kazmer
- School of Information, College of Communication and Information, Florida State University, Tallahassee, Florida
| | - Elizabeth H Slate
- Department of Statistics, College of Arts & Sciences, Florida State University, Tallahassee, Florida
| | - Elena Reyes
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University (FSU), Tallahassee, Florida
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15
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Jacobson Vann JC, Jacobson RM, Coyne‐Beasley T, Asafu‐Adjei JK, Szilagyi PG. Patient reminder and recall interventions to improve immunization rates. Cochrane Database Syst Rev 2018; 1:CD003941. [PMID: 29342498 PMCID: PMC6491344 DOI: 10.1002/14651858.cd003941.pub3] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Immunization rates for children and adults are rising, but coverage levels have not reached optimal goals. As a result, vaccine-preventable diseases still occur. In an era of increasing complexity of immunization schedules, rising expectations about the performance of primary care, and large demands on primary care providers, it is important to understand and promote interventions that work in primary care settings to increase immunization coverage. One common theme across immunization programs in many nations involves the challenge of implementing a population-based approach and identifying all eligible recipients, for example the children who should receive the measles vaccine. However, this issue is gradually being addressed through the availability of immunization registries and electronic health records. A second common theme is identifying the best strategies to promote high vaccination rates. Three types of strategies have been studied: (1) patient-oriented interventions, such as patient reminder or recall, (2) provider interventions, and (3) system interventions, such as school laws. One of the most prominent intervention strategies, and perhaps best studied, involves patient reminder or recall systems. This is an update of a previously published review. OBJECTIVES To evaluate and compare the effectiveness of various types of patient reminder and recall interventions to improve receipt of immunizations. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL to January 2017. We also searched grey literature and trial registers to January 2017. SELECTION CRITERIA We included randomized trials, controlled before and after studies, and interrupted time series evaluating immunization-focused patient reminder or recall interventions in children, adolescents, and adults who receive immunizations in any setting. We included no-intervention control groups, standard practice activities that did not include immunization patient reminder or recall, media-based activities aimed at promoting immunizations, or simple practice-based awareness campaigns. We included receipt of any immunizations as eligible outcome measures, excluding special travel immunizations. We excluded patients who were hospitalized for the duration of the study period. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane and the Cochrane Effective Practice and Organisation of Care (EPOC) Group. We present results for individual studies as relative rates using risk ratios, and risk differences for randomized trials, and as absolute changes in percentage points for controlled before-after studies. We present pooled results for randomized trials using the random-effects model. MAIN RESULTS The 75 included studies involved child, adolescent, and adult participants in outpatient, community-based, primary care, and other settings in 10 countries.Patient reminder or recall interventions, including telephone and autodialer calls, letters, postcards, text messages, combination of mail or telephone, or a combination of patient reminder or recall with outreach, probably improve the proportion of participants who receive immunization (risk ratio (RR) of 1.28, 95% confidence interval (CI) 1.23 to 1.35; risk difference of 8%) based on moderate certainty evidence from 55 studies with 138,625 participants.Three types of single-method reminders improve receipt of immunizations based on high certainty evidence: the use of postcards (RR 1.18, 95% CI 1.08 to 1.30; eight studies; 27,734 participants), text messages (RR 1.29, 95% CI 1.15 to 1.44; six studies; 7772 participants), and autodialer (RR 1.17, 95% CI 1.03 to 1.32; five studies; 11,947 participants). Two types of single-method reminders probably improve receipt of immunizations based on moderate certainty evidence: the use of telephone calls (RR 1.75, 95% CI 1.20 to 2.54; seven studies; 9120 participants) and letters to patients (RR 1.29, 95% CI 1.21 to 1.38; 27 studies; 81,100 participants).Based on high certainty evidence, reminders improve receipt of immunizations for childhood (RR 1.22, 95% CI 1.15 to 1.29; risk difference of 8%; 23 studies; 31,099 participants) and adolescent vaccinations (RR 1.29, 95% CI 1.17 to 1.42; risk difference of 7%; 10 studies; 30,868 participants). Reminders probably improve receipt of vaccinations for childhood influenza (RR 1.51, 95% CI 1.14 to 1.99; risk difference of 22%; five studies; 9265 participants) and adult influenza (RR 1.29, 95% CI 1.17 to 1.43; risk difference of 9%; 15 studies; 59,328 participants) based on moderate certainty evidence. They may improve receipt of vaccinations for adult pneumococcus, tetanus, hepatitis B, and other non-influenza vaccinations based on low certainty evidence although the confidence interval includes no effect of these interventions (RR 2.08, 95% CI 0.91 to 4.78; four studies; 8065 participants). AUTHORS' CONCLUSIONS Patient reminder and recall systems, in primary care settings, are likely to be effective at improving the proportion of the target population who receive immunizations.
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Affiliation(s)
- Julie C Jacobson Vann
- The University of North Carolina at Chapel HillSchool of NursingCarrington HallChapel HillNorth CarolinaUSA27599‐7460
| | - Robert M Jacobson
- Mayo ClinicPediatric and Adolescent Medicine200 First Street, SWRochesterMinnesotaUSA55905‐0001
| | - Tamera Coyne‐Beasley
- University of North CarolinaGeneral Pediatrics and Adolescent MedicineChapel HillNorth CarolinaUSA
| | - Josephine K Asafu‐Adjei
- University of North Carolina at Chapel HillDepartment of Biostatistics, School of Nursing120 North Medical Drive, 2005 Carrington HallChapel HillNorth CarolinaUSA27599
| | - Peter G Szilagyi
- University of California Los AngelesDepartment of Pediatrics90024Los AngelesCaliforniaUSA90024
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Francis DB, Cates JR, Wagner KPG, Zola T, Fitter JE, Coyne-Beasley T. Communication technologies to improve HPV vaccination initiation and completion: A systematic review. PATIENT EDUCATION AND COUNSELING 2017; 100:1280-1286. [PMID: 28209248 DOI: 10.1016/j.pec.2017.02.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 02/03/2017] [Accepted: 02/05/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This systematic review examines the effectiveness of communication technology interventions on HPV vaccination initiation and completion. METHODS A comprehensive search strategy was used to identify existing randomized controlled trials testing the impact of computer-, mobile- or internet-based interventions on receipt of any dose of the HPV vaccine. Twelve relevant studies were identified with a total of 38,945 participants. RESULTS The interventions were delivered using several different methods, including electronic health record (i.e. recall/reminder) prompts, text messaging, automated phone calls, interactive computer videos, and email. Vaccine initiation and completion was greater for technology-based studies relative to their control conditions. CONCLUSION There is evidence that interventions utilizing communication technologies as their sole or primary mode for HPV vaccination intervention delivery may increase vaccination coverage. PRACTICE IMPLICATIONS Communication technologies hold much promise for the future of HPV vaccination efforts, especially initiatives in practice-based settings.
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Affiliation(s)
- Diane B Francis
- Manship School of Mass Communication, 249 Hodges Hall, Louisiana State University, Baton Rouge, LA, USA.
| | - Joan R Cates
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Kyla P Garrett Wagner
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Tracey Zola
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Jenny E Fitter
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Tamera Coyne-Beasley
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Abstract
The adolescent period heralds the pediatric patient's transition into adulthood. It is a time of dynamic development during which effective preventive care measures can promote safe behaviors and the development of lifelong health habits. One of the foundations of preventive adolescent health care is timely vaccination, and every visit can be viewed as an opportunity to update and complete an adolescent's immunizations.In the past decade, the adolescent immunization schedule has expanded to include 2 doses of quadrivalent meningococcal conjugate vaccine, 1 dose of tetanus, diphtheria, acellular pertussis, absorbed vaccine, 2 or 3 doses of human papillomavirus vaccine, depending on the child's age, and an annual influenza vaccine. In addition, during adolescent visits, health care providers can determine whether catch-up vaccination is needed to meet early childhood recommendations for hepatitis B; hepatitis A; measles, mumps, rubella; poliovirus; and varicella vaccines. New serogroup B meningococcal vaccines are now available for those at increased risk for meningococcal disease; in addition, these serogroup B meningococcal vaccines received a Category B recommendation for healthy adolescents, where individual counseling and risk-benefit evaluation based on health care provider judgements and patient preferences are indicated. This clinical report focuses on the epidemiology of adolescent vaccine-preventable diseases by reviewing the rationale for the annual universally recommended adolescent immunization schedule of the American Academy of Pediatrics, the American Academy of Family Physicians, the Centers for Disease Control and Prevention, and the American Congress of Obstetricians and Gynecologists. In addition, the barriers that negatively influence adherence to this current adolescent immunization schedule will be highlighted.
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Affiliation(s)
- Henry H Bernstein
- Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, New York; and
| | - Joseph A Bocchini
- Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, Louisiana
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Zimmerman RK, Moehling KK, Lin CJ, Zhang S, Raviotta JM, Reis EC, Humiston SG, Nowalk MP. Improving adolescent HPV vaccination in a randomized controlled cluster trial using the 4 Pillars™ practice Transformation Program. Vaccine 2017; 35:109-117. [PMID: 27876200 PMCID: PMC5836294 DOI: 10.1016/j.vaccine.2016.11.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Uptake of meningococcal vaccine (MCV) and tetanus, diphtheria and pertussis (Tdap) vaccine among adolescents has approached Healthy People 2020 goals, but human papillomavirus (HPV) vaccination has not. This study evaluated an intervention using the 4 Pillars™ Practice Transformation Program to increase HPV, MCV and Tdap uptake among adolescents in primary care practices. METHODS Practices with at least 50 patients 11-17years old with estimated vaccination rates less than national goals, were assigned to intervention (n=11) and control (n=11) groups in a randomized controlled cluster trial; 9 intervention and 11 control sites completed the study. The baseline and active study periods were 7/1/2013-6/30/2014 and 7/1/2014-3/31/2015, respectively. Vaccination and demographic data for patients who had a visit in both study periods were derived from de-identified EMR extractions. Primary outcomes were vaccination rates and percentage point (PP) changes. Data were analyzed in 2015-16. RESULTS Among the cohort of 10,861 adolescent patients, 38% were 11-13years old; 50% were female; 18% were non-white; and 64% were commercially insured. Average baseline HPV initiation rates were 52.5% for intervention and 61.8% for control groups. After 9months, the intervention sites increased HPV initiation 10.2PP compared with 7.3PP in control sites (P<0.001); HPV series completion rates did not differ between groups. Implementation of >10 strategies to improve rates significantly increased the likelihood of HPV series initiation (OR=2.06, 95% CI=1.43, 2.96). CONCLUSIONS Using >10 strategies from the 4 Pillars™ Practice Transformation Program is effective for increasing HPV series initiation among adolescents. Clinical trial registry number: NCT02165722.
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Affiliation(s)
- Richard K Zimmerman
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Krissy K Moehling
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Chyongchiou J Lin
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Song Zhang
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Jonathan M Raviotta
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Evelyn C Reis
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Sharon G Humiston
- Immunization Action Coalition, Minneapolis, MN, United States; Children's Mercy Hospital, Kansas City, MO, United States
| | - Mary Patricia Nowalk
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
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19
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Albright K, Barnard J, O’Leary ST, Lockhart S, Jimenez-Zambrano A, Stokley S, Dempsey A, Kempe A. Noninitiation and Noncompletion of HPV Vaccine Among English- and Spanish-Speaking Parents of Adolescent Girls: A Qualitative Study. Acad Pediatr 2017; 17:778-784. [PMID: 28359835 PMCID: PMC5846096 DOI: 10.1016/j.acap.2017.03.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 03/17/2017] [Accepted: 03/17/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The Advisory Committee on Immunization Practices recommends routine human papillomavirus (HPV) vaccination for female adolescents aged 11 to 12 years, yet vaccination rates remain low. We conducted a qualitative study to understand English- and Spanish-speaking parents' reasons for noninitiation or noncompletion of the HPV vaccine series for their daughters. METHODS Parents of female adolescents aged 12 to 15 years who had not initiated or not completed the HPV vaccine series were identified through administrative data in 2 large urban safety net health care systems in Colorado. Focus groups and in-depth interviews were conducted with English-speaking parents and in-depth interviews were conducted with Spanish-speaking parents. All data were recorded, transcribed, and analyzed for thematic content by experienced analysts using established qualitative content analysis techniques. RESULTS Forty-one parents participated in the study. Thirty parents participated in individual interviews and 11 parents participated in 1 of 2 focus groups. The most common reasons for noninitiation and noncompletion among English-speaking parents included a low perceived risk of HPV infection, vaccine safety concerns, and distrust of government and/or medicine. In contrast, Spanish-speaking parents most often reported that providers had either not encouraged initiation of the HPV vaccine series or had not explained the necessity of completing the series. Some noninitiating parents, particularly Spanish-speaking ones, also cited concerns that vaccination would encourage sexual activity. CONCLUSIONS The reasons for noninitiation and noncompletion of the HPV vaccine series differed substantially between English- and Spanish-speaking parents. To maximize uptake of HPV vaccine, varying approaches might be needed to effectively target specific populations.
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Affiliation(s)
- Karen Albright
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colo; Department of Sociology and Criminology, University of Denver, Denver, Colo.
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Shay LA, Street RL, Baldwin AS, Marks EG, Lee SC, Higashi RT, Skinner CS, Fuller S, Persaud D, Tiro JA. Characterizing safety-net providers' HPV vaccine recommendations to undecided parents: A pilot study. PATIENT EDUCATION AND COUNSELING 2016; 99:1452-60. [PMID: 27401828 PMCID: PMC5007181 DOI: 10.1016/j.pec.2016.06.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 06/16/2016] [Accepted: 06/24/2016] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Although provider recommendation is a key predictor of HPV vaccination, how providers verbalize recommendations particularly strong ones is unknown. We developed a tool to describe strength and content of provider recommendations. METHODS We used electronic health records to identify unvaccinated adolescents with appointments at six safety-net clinics in Dallas, Texas. Clinic visit audio-recordings were qualitatively analyzed to identify provider recommendation types (presumptive vs. participatory introduction; strong vs. weak), describe content communicated, and explore patterns between recommendation type and vaccination. RESULTS We analyzed 43 audio-recorded discussions between parents and 12 providers. Most providers used a participatory introduction (42 discussions) and made weak recommendations (24 discussions) by using passive voice or adding a qualification (e.g., not school required). Few providers (11 discussions) gave strong recommendations (clear, personally-owned endorsement). HPV vaccination was lowest for those receiving only weak recommendations and highest when providers coupled the recommendation with an adjacent rationale. CONCLUSION Our new tool provides initial evidence of how providers undercut their recommendations through qualifications or support them with a rationale. Most providers gave weak HPV vaccine recommendations and used a participatory introduction. PRACTICE IMPLICATIONS Providers would benefit from communication skills training on how to make explicit recommendations with an evidence-based rationale.
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Affiliation(s)
- L Aubree Shay
- University of Texas School of Public Health, San Antonio Regional Campus, Department of Health Promotion and Behavioral Sciences, 7411 John Smith Drive, Suite 1100, San Antonio, TX 78229, USA.
| | - Richard L Street
- Texas A & M University, Department of Communication, 102 Bolton Hall, College Station, TX 77843-4234, USA; Baylor College of Medicine, Department of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.
| | - Austin S Baldwin
- Southern Methodist University, Department of Psychology, PO Box 750235, Dallas, TX 75275-0235, USA.
| | - Emily G Marks
- University of Texas Southwestern Medical Center, Department of Clinical Sciences, 5323 Harry Hines Blvd, Dallas, TX 75390-8557, USA.
| | - Simon Craddock Lee
- University of Texas Southwestern Medical Center, Department of Clinical Sciences, 5323 Harry Hines Blvd, Dallas, TX 75390-8557, USA; Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Road, Dallas, TX 75390, USA.
| | - Robin T Higashi
- University of Texas Southwestern Medical Center, Department of Clinical Sciences, 5323 Harry Hines Blvd, Dallas, TX 75390-8557, USA.
| | - Celette Sugg Skinner
- University of Texas Southwestern Medical Center, Department of Clinical Sciences, 5323 Harry Hines Blvd, Dallas, TX 75390-8557, USA; Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Road, Dallas, TX 75390, USA.
| | - Sobha Fuller
- Parkland Health & Hospital System, 5200 Harry Hines Blvd, Dallas, TX 75235, USA.
| | - Donna Persaud
- Parkland Health & Hospital System, 5200 Harry Hines Blvd, Dallas, TX 75235, USA.
| | - Jasmin A Tiro
- University of Texas Southwestern Medical Center, Department of Clinical Sciences, 5323 Harry Hines Blvd, Dallas, TX 75390-8557, USA; Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Road, Dallas, TX 75390, USA.
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Update on barriers to human papillomavirus vaccination and effective strategies to promote vaccine acceptance. Curr Opin Pediatr 2016; 28:407-12. [PMID: 27093354 DOI: 10.1097/mop.0000000000000353] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article provides a clinically relevant review and analysis of the latest research regarding barriers to human papillomavirus (HPV) vaccination and strategic efforts to promote this vaccine. RECENT FINDINGS HPV vaccines are safe, effective, and could prevent the majority of HPV-attributable cancers, if vaccination coverage is high. However, uptake of HPV vaccine lags behind other vaccines recommended for 11 to 12-year olds. A lack of provider recommendation has consistently been found to be a key barrier to increasing vaccination rates. Lack of knowledge about the vaccine among parents coupled with an overestimation of parental vaccine hesitancy among providers also hinder vaccine uptake. Strongly recommending the vaccine as a safe, routine immunization that prevents cancer, and coadministering it with tetanus, diphtheria, and acellular pertussis vaccine and quadrivalent meningococcal conjugate vaccine, enhance vaccine uptake. In some cases, reminder and recall systems result in additional increases in vaccination rates. SUMMARY Recent publications reveal new information about the implementation of HPV vaccines. Provider recommendation is a key approach, as is offering it routinely at the same time as other universally recommended adolescent immunizations. With the integration of these concepts into the clinical setting, adolescents can be better protected against HPV and its associated diseases.
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Beavis AL, Levinson KL. Preventing Cervical Cancer in the United States: Barriers and Resolutions for HPV Vaccination. Front Oncol 2016; 6:19. [PMID: 26870696 PMCID: PMC4733925 DOI: 10.3389/fonc.2016.00019] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 01/18/2016] [Indexed: 11/13/2022] Open
Abstract
Human papillomavirus (HPV) vaccination rates for preadolescent and adolescent girls in the United States are far behind those of other developed nations. These rates differ substantially by region and state, socioeconomic status, and insurance status. In parents and young women, a lack of awareness and a misperception of the risk of this vaccine drive low vaccination rates. In physicians, lack of comfort with discussion of sexuality and the perception that the vaccine should be delayed to a later age contribute to low vaccination rates. Patient- and physician-targeted educational campaigns, systems-based interventions, and school-based vaccine clinics offer a variety of ways to address the barriers to HPV vaccination. A diverse and culturally appropriate approach to promoting vaccine uptake has the potential to significantly improve vaccination rates in order to reach the Healthy People 2020 goal of over 80% vaccination in adolescent girls. This article reviews the disparities in HPV vaccination rates in girls in the United States, the influences of patients’, physicians’, and parents’ attitudes on vaccine uptake, and the proposed interventions that may help the United States reach its goal for vaccine coverage.
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Affiliation(s)
- Anna Louise Beavis
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital , Baltimore, MD , USA
| | - Kimberly L Levinson
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital , Baltimore, MD , USA
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Tiro JA, Lee SC, Marks EG, Persaud D, Skinner CS, Street RL, Wiebe DJ, Farrell D, Bishop WP, Fuller S, Baldwin AS. Developing a Tablet-Based Self-Persuasion Intervention Promoting Adolescent HPV Vaccination: Protocol for a Three-Stage Mixed-Methods Study. JMIR Res Protoc 2016; 5:e19. [PMID: 26825137 PMCID: PMC4752693 DOI: 10.2196/resprot.5092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/01/2015] [Accepted: 10/02/2015] [Indexed: 11/24/2022] Open
Abstract
Background Human papillomavirus (HPV)-related cancers are a significant burden on the US health care system that can be prevented through adolescent HPV vaccination. Despite guidelines recommending vaccination, coverage among US adolescents is suboptimal particularly among underserved patients (uninsured, low income, racial, and ethnic minorities) seen in safety-net health care settings. Many parents are ambivalent about the vaccine and delay making a decision or talking with a provider about it. Self-persuasion—generating one’s own arguments for a health behavior—may be particularly effective for parents who are undecided or not motivated to make a vaccine decision. Objective Through a 3-stage mixed-methods protocol, we will identify an optimal and feasible self-persuasion intervention strategy to promote adolescent HPV vaccination in safety-net clinics. Methods In Stage 1, we will define content for a tablet-based self-persuasion app by characterizing (1) parents’ self-generated arguments through cognitive interviews conducted with parents (n=50) of patients and (2) parent-provider HPV vaccine discussions through audio recordings of clinic visits (n=50). In Stage 2, we will compare the effects of the four self-persuasion intervention conditions that vary by cognitive processing level (parents verbalize vs listen to arguments) and choice of argument topics (parents choose vs are assigned topics) on parental vaccine intentions in a 2 × 2 factorial design randomized controlled trial (n=160). This proof-of-concept trial design will identify which intervention condition is optimal by quantitatively examining basic self-persuasion mechanisms (cognitive processing and choice) and qualitatively exploring parent experiences with intervention tasks. In Stage 3, we will conduct a pilot trial (n=90) in the safety-net clinics to assess feasibility of the optimal intervention condition identified in Stage 2. We will also assess its impact on parent-provider discussions. Results This paper describes the study protocol and activities to date. Currently, we have developed the initial prototype of the tablet app for English- and Spanish-speaking populations, and completed Stage 1 data collection. Conclusions Our systematic collaboration between basic and applied behavioral scientists accelerates translation of promising basic psychological research into innovative interventions suitable for underserved, safety-net populations. At project’s end, we plan to have a feasible and acceptable self-persuasion intervention that can affect key cancer disparities in the United States through prevention of HPV-related cancers. Trial Registration ClinicalTrials.gov http://clinicaltrials.gov/ct2/show/NCT02537756 and http://clinicaltrials.gov/ct2/show/NCT02535845 (Archived by WebCite at http://www.webcitation.org/6e5XcOGXz and http://www.webcitation.org/6e5XfHoic, respectively).
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Affiliation(s)
- Jasmin A Tiro
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States.
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