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McNally K, Weinstein A, Lindley L, Wallin R, Roess A. Moving the Needle: A Qualitative Exploration of the School Nurses' Experience with Virginia's Human Papillomavirus Mandate. J Sch Nurs 2024:10598405241241229. [PMID: 38594950 DOI: 10.1177/10598405241241229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
In all US localities, students provide proof of compliance with vaccination requirements to attend school. Despite benefits, vaccine legislation remains contentious. The human papillomavirus (HPV) vaccine is recommended for adolescents and prevents cancer, but its inclusion in school immunization requirements is challenged. Virginia was the first state to mandate HPV vaccination. HPV is the only required vaccine in VA that allows caregivers to elect out. School nurses are trusted members of communities and enforce vaccine compliance. This study aims to understand Virginia school nurses' practice in implementing the HPV vaccine mandate through the exploration of their subjective experiences. Semi-structured interviews were conducted. Thematic analysis using the socioecological model guided data analysis. Factors that influence nursing practice were identified at all socioecological model levels The data from this study is intended to provide an understanding of school nursing practice so that interventions to improve HPV vaccination rates can be developed.
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Affiliation(s)
- Kimberly McNally
- George Mason University College of Public Health, Fairfax, VA, USA
| | - Ali Weinstein
- George Mason University College of Public Health, Fairfax, VA, USA
| | - Lisa Lindley
- Lehigh University College of Health, Bethlehem, PA, USA
| | - Robin Wallin
- Alexandria City Public Schools, Alexandria, VA, USA
| | - Amira Roess
- Lehigh University College of Health, Bethlehem, PA, USA
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McNally K, Roess A, Weinstein A, Lindley L, Wallin R. School Nurses' Experiences and Roles in Promoting and Administering the HPV Vaccine: A Systematic Review Using the Socioecological Framework. J Sch Nurs 2024; 40:43-57. [PMID: 37828750 DOI: 10.1177/10598405231206109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
Understanding the school nurse's experience in human papillomavirus (HPV) vaccine promotion can reduce vaccine disparities. HPV vaccination is critical to cancer prevention. Despite the importance of the school nurse in vaccine promotion, there is a lack of understanding. This article aims to examine the knowledge, attitude, experience, and role of school nurses related to HPV vaccination and promotion in school settings. A systematic search for school nurses and their experiences related to HPV vaccination was conducted. A thematic synthesis was undertaken using the socioecological model. This review highlights the complexity of HPV vaccine promotion in schools over time. Multilevel factors impact nursing practice. Nurses have good vaccine knowledge and positive attitudes. Poor workflow processes, competing demands, and vaccine communication challenge school nurses. The themes that were synthesized informed the LEADS model. With the support of school nurses, reaching the goal of eliminating cervical cancer as a public health problem is possible.
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Affiliation(s)
- Kimberly McNally
- George Mason University College of Health and Human Services, Fairfax, VA, USA
| | | | | | - Lisa Lindley
- Alexandria City Public Schools, Alexandria, VA, USA
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Cuesta-Zigorraga A, Arrue M, Labaka A. A Nurse-Led Education Program to Improve COVID-19 Prevention Knowledge Among Adolescent Students. THE JOURNAL OF SCHOOL HEALTH 2023; 93:1091-1098. [PMID: 37698191 DOI: 10.1111/josh.13392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 07/01/2023] [Accepted: 07/17/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Adolescents are more susceptible than originally thought to COVID-19, and they could play a significant role in community transmission. We aim to evaluate a health education program on students' declarative knowledge and risk awareness concerning COVID-19-related public health recommendations. METHODS A quasi-experimental pre-post pilot study was conducted. A number of 487 students aged between 12 and 17 years old participated in an educational program. Following Socratic Method, preventive actions were simulated in order to encourage students to seek answers about the correct application of measures. The program covered 3 prevention areas: (1) practice hygienic handwashing; (2) instruction on the appropriate use of masks; and (3) promotion of physical distancing, and was implemented in class by 3 registered nurses. RESULTS Following the educational program, declarative knowledge regarding handwashing and mask use improved along with the students' total score. In the pre-test, students 16 years and older as well as female students obtained higher scores in declarative knowledge. Age-dependent differences between groups vanished in the post-test, but girls still achieved better scores. CONCLUSION This nurse-led health education program proved to be effective to enhance declarative knowledge about COVID-19-related public health recommendations.
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Affiliation(s)
| | - Marta Arrue
- Faculty of Medicine and Nursing, Department of Nursing, University of the Basque Country (UPV/EHU), Donostia, Spain
| | - Ainitze Labaka
- Faculty of Medicine and Nursing, Department of Nursing, University of the Basque Country (UPV/EHU), Donostia, Spain
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McNally K, Weinstein A, Lindley L, Wallin R, Roess A. A Multilevel Analysis of School-Level Human Papillomavirus Vaccination Coverage in Virginia. J Sch Nurs 2023:10598405231214981. [PMID: 38031333 DOI: 10.1177/10598405231214981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
School nurses improve public health through vaccine promotion and mandate compliance. Despite recommendations and support for comprehensive adolescent HPV vaccination from organizations like the National Association of School Nurses as of 2023 only Virginia, Washington DC, Rhode Island, and Hawaii mandate HPV vaccine in schools. Virginia's mandate allows caregivers to opt out of vaccination. It is important to consider how school-level vaccine compliance is associated with school and community factors. A multilevel analysis explored the association between school and county-level factors and HPV vaccination rates. This study shows schools that report higher rates of economically disadvantaged students had higher HPV vaccine coverage. HPV vaccine rates increased from 2019 to 2021 after the implementation of a gender-inclusive mandate. Virginia HPV rates still lag behind states with no mandate. The results suggest that school nursing practice related to HPV vaccine compliance may be impacted by community factors like economic status.
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Affiliation(s)
- Kimberly McNally
- Department of Global and Community Health, George Mason University College of Public Health, Fairfax, VA, USA
| | - Ali Weinstein
- Department of Global and Community Health, George Mason University College of Public Health, Fairfax, VA, USA
| | - Lisa Lindley
- Department of Global and Community Health, George Mason University College of Public Health, Fairfax, VA, USA
| | - Robin Wallin
- Alexandria City Public Schools, Alexandria, VA, USA
| | - Amira Roess
- Department of Global and Community Health, George Mason University College of Public Health, Fairfax, VA, USA
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Brunson A, Troy C, Noblet S, Hebert JR, Friedman DB. Insights from Research Network Collaborators on How to Reach Rural Communities with Cancer Prevention and Control Programs. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2023; 44:43-53. [PMID: 37724031 DOI: 10.1177/0272684x211065318] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
PURPOSE This paper examines community leaders' and researchers' recommendations for reaching rural communities in a southeastern U.S. state with cancer prevention and control programming. RESEARCH DESIGN A qualitative inquiry of a grant network's research and community councils was conducted to explore members' opinions on how to engage rural communities and obtain input on how to recruit rural organizations for a mini-grants program. STUDY SAMPLE AND DATA COLLECTION Telephone/virtual interviews were conducted with all 13 council members. Responses were analyzed using thematic analysis and findings were examined within the context of system-centric and patient-centric dimensions. RESULTS Council members discussed limited education, lack of insurance, low socioeconomic status, health care avoidance, and transportation as barriers to cancer prevention and control. They recommended reaching rural populations by partnering with community and faith-based organizations, use of targeted multi-media, and tailored cancer education trainings. CONCLUSIONS Findings are used for guiding outreach with rural communities and recruitment of rural organizations for a cancer-focused mini-grants initiative.
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Affiliation(s)
- Ashley Brunson
- College of Arts and Sciences, University of South Carolina, Columbia, SC, USA
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Catherine Troy
- College of Arts and Sciences, University of South Carolina, Columbia, SC, USA
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
- South Carolina Honors College, University of South Carolina, Columbia, SC, USA
| | - Samuel Noblet
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
- South Carolina Cancer Prevention and Control Research Network (Prevention Research Center), University of South Carolina, Columbia, SC, USA
| | - James R Hebert
- South Carolina Cancer Prevention and Control Research Network (Prevention Research Center), University of South Carolina, Columbia, SC, USA
- Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology & Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
- South Carolina Cancer Prevention and Control Research Network (Prevention Research Center), University of South Carolina, Columbia, SC, USA
- Office for the Study of Aging, University of South Carolina, Columbia, SC, USA
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Shin MB, Sloan K, Baezconde-Garbanati L, Dang E, Garcia S, Palinkas LA, Unger JB, Willgerodt M, Crabtree BF, Tsui J. Multilevel perspectives on school-based opportunities to improve HPV vaccination among medically underserved adolescents: Beyond school entry mandates. Hum Vaccin Immunother 2023; 19:2251815. [PMID: 37666253 PMCID: PMC10478734 DOI: 10.1080/21645515.2023.2251815] [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: 05/01/2023] [Revised: 07/12/2023] [Accepted: 08/01/2023] [Indexed: 09/06/2023] Open
Abstract
School-based HPV vaccination programs have improved vaccine uptake among adolescents globally. However, school-based HPV vaccination strategies in the United States (US) have mainly focused on school-entry mandates for vaccination, which have passed in only five states/jurisdictions. Many schools and school-based health centers (SBHCs) already provide health services to medically underserved adolescents and opportunities to improve disparities in HPV vaccine education and uptake are underexplored. This qualitative study of clinic and community members assessed potential opportunities within and outside schools to increase HPV vaccination. Data were generated from a larger mixed-methods study designed to understand experiences with HPV vaccination evidence-based strategies in medically underserved communities. The parent study included interviews and focus groups conducted with clinic (providers, clinic leaders, staff) and community (racial/ethnic minority parents, advocates, payers, policy representatives) members in Los Angeles and New Jersey between December 2020-January 2022. We created a reduced dataset of text related to schools/SBHCs (30 in-depth interviews, 7 focus groups) and conducted a directed content analysis. Participants indicated that schools and SBHCs are ideal venues for reaching medically underserved adolescents experiencing barriers to primary care access. Parents/providers expressed mutual interest in HPV vaccine administration/education in schools, but some advocates/policy participants experienced challenges due to increasing politicization of vaccines. Participants highlighted policies for expanding HPV vaccine education and administration in schools, including minor consent and increasing SBHC funding for HPV vaccines. More research is needed to explore existing infrastructure, partner motivation, and opportunities to improve HPV vaccination among medically underserved adolescents within schools beyond vaccine mandates.
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Affiliation(s)
- Michelle B. Shin
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WAUSA
| | - Kylie Sloan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lourdes Baezconde-Garbanati
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Emily Dang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Samantha Garcia
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lawrence A. Palinkas
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B. Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Mayumi Willgerodt
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WAUSA
| | | | - Jennifer Tsui
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
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Robinson MS, England M, Luthy KE, Peterson NE. HPV Infection and Vaccination: A Question and Answer Guide for School Nurses. NASN Sch Nurse 2023; 38:134-144. [PMID: 36757046 DOI: 10.1177/1942602x221146758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
School nurses frequently interact with school-age children and their parents/guardians regarding vaccinations. As a trusted source of information, the school nurse is in a unique position to share vaccine information with parents/guardians and school-age children that may dispel myths and, consequently, improve vaccination rates. Nevertheless, some parents/guardians are still reluctant to vaccinate their school-age children against Human Papilloma Virus (HPV) for a variety of reasons. Common barriers to HPV vaccination include a lack of understanding of the vaccine's purpose, concerns regarding the vaccine's safety, and insufficient recommendation from healthcare workers. However, school nurses have many duties in addition to ensuring vaccine compliance. School nurses may have difficulty remaining up-to-date on evidence-based answers to parents'/guardians' questions about HPV vaccine. Therefore, the purpose of this article is to provide school nurses with a quick reference question and answer guide to parents'/guardians' common HPV-related vaccination questions.
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Gizaw Z, Astale T, Kassie GM. What improves access to primary healthcare services in rural communities? A systematic review. BMC PRIMARY CARE 2022; 23:313. [PMID: 36474184 PMCID: PMC9724256 DOI: 10.1186/s12875-022-01919-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND To compile key strategies from the international experiences to improve access to primary healthcare (PHC) services in rural communities. Different innovative approaches have been practiced in different parts of the world to improve access to essential healthcare services in rural communities. Systematically collecting and combining best experiences all over the world is important to suggest effective strategies to improve access to healthcare in developing countries. Accordingly, this systematic review of literature was undertaken to identify key approaches from international experiences to enhance access to PHC services in rural communities. METHODS All published and unpublished qualitative and/or mixed method studies conducted to improvement access to PHC services were searched from MEDLINE, Scopus, Web of Science, WHO Global Health Library, and Google Scholar. Articles published other than English language, citations with no abstracts and/or full texts, and duplicate studies were excluded. We included all articles available in different electronic databases regardless of their publication years. We assessed the methodological quality of the included studies using mixed methods appraisal tool (MMAT) version 2018 to minimize the risk of bias. Data were extracted using JBI mixed methods data extraction form. Data were qualitatively analyzed using emergent thematic analysis approach to identify key concepts and coded them into related non-mutually exclusive themes. RESULTS Our analysis of 110 full-text articles resulted in ten key strategies to improve access to PHC services. Community health programs or community-directed interventions, school-based healthcare services, student-led healthcare services, outreach services or mobile clinics, family health program, empanelment, community health funding schemes, telemedicine, working with traditional healers, working with non-profit private sectors and non-governmental organizations including faith-based organizations are the key strategies identified from international experiences. CONCLUSION This review identified key strategies from international experiences to improve access to PHC services in rural communities. These strategies can play roles in achieving universal health coverage and reducing disparities in health outcomes among rural communities and enabling them to get healthcare when and where they want.
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Affiliation(s)
- Zemichael Gizaw
- grid.59547.3a0000 0000 8539 4635Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tigist Astale
- grid.452387.f0000 0001 0508 7211International Institute for Primary Health Care- Ethiopia, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Getnet Mitike Kassie
- grid.452387.f0000 0001 0508 7211International Institute for Primary Health Care- Ethiopia, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Fish LJ, Harrison SE, McDonald JA, Yelverton V, Williams C, Walter EB, Vasudevan L. Key stakeholder perspectives on challenges and opportunities for rural HPV vaccination in North and South Carolina. Hum Vaccin Immunother 2022; 18:2058264. [PMID: 35439108 PMCID: PMC9248957 DOI: 10.1080/21645515.2022.2058264] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/16/2022] [Indexed: 11/08/2022] Open
Abstract
The objective of this study was to identify factors at the individual, provider, and systems levels that serve as challenges or opportunities for increasing adolescent vaccination-including Human Papillomavirus (HPV) vaccination-in rural communities in the southern United States (US). As part of a broader study to increase HPV vaccine uptake in the southern US, we conducted in-depth interviews with vaccination stakeholders representing public health and education agencies in North Carolina (NC) and South Carolina (SC). Fourteen key stakeholders were recruited using purposive sampling to obtain insights into challenges and solutions to rural-urban disparities in HPV vaccination coverage. Stakeholders were also queried about their experiences and attitudes toward school-based vaccination promotion programs and campaigns. We used a rapid qualitative approach to analyze the data. Stakeholders identified factors at the individual, provider, and systems levels that serve as challenges to vaccination in rural communities. Similar to previous studies, stakeholders mentioned challenges with healthcare access and vaccine-related misconceptions that pose barriers to HPV vaccination for rural residents. Systems-level challenges identified included limited access to high-speed internet in rural areas that may impact providers' ability to interface with state-level digital systems such as the vaccination registry. Stakeholders identified a number of opportunities to increase HPV vaccination coverage, including through school-based health promotion programs. Stakeholders strongly supported school-based programs and approaches to strengthen confidence and demand for HPV vaccination and to help address persistent social determinants and system level factors that pose challenges to HPV vaccination coverage in many rural areas.
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Affiliation(s)
- Laura J. Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
| | - Sayward E Harrison
- Department of Psychology, Barnwell College, University of South Carolina, Columbia, SC, USA
- South Carolina Smart State Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA
| | | | - Valerie Yelverton
- Department of Health Services Policy & Management, University of South Carolina, Columbia, SC, USA
| | - Charnetta Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Emmanuel B. Walter
- Duke Human Vaccine Institute, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Lavanya Vasudevan
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
- Duke Human Vaccine Institute, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
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