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D'Souza GC, Pinto CN, Exten CL, Yingst JM, Foulds J, Anderson J, Allen R, Calo WA. Understanding factors associated with COVID-19 vaccination among health care workers using the Diffusion of Innovation Theory. Am J Infect Control 2024; 52:509-516. [PMID: 38218328 DOI: 10.1016/j.ajic.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND The COVID-19 vaccine was initially offered to frontline health care workers (HCWs), due to the high risk of contracting COVID-19 through occupational exposure to patients. Low HCW vaccine uptake can impact overall community-level vaccine uptake. This study used the Diffusion of Innovation (DOI) Theory to understand factors related to COVID-19 vaccine uptake in HCWs. METHODS We surveyed Pennsylvanian HCWs (excluding Philadelphia) from August 2022 to February 2023. Survey questions inquired about demographics, COVID-19 vaccination status, reasons for receiving/declining the COVID-19 vaccine, and sources of information about the vaccine. RESULTS Participants (n = 3,490) were 85% female, 89% White, and 93% (n = 3,255) reported receiving at least one dose of a COVID-19 vaccine. HCWs were categorized into adopter categories of the DOI Theory: innovators (56%), early adopters (9%), early majority (11%), late majority (7%), and laggards (17%). The major reason that prompted participants to get the vaccine was to protect them against COVID-19 infection (78%), while the major reason for declining the vaccine was due to concern about possible side effects from the vaccine (78%). CONCLUSIONS We applied the DOI Theory to characterize adopters and identify factors related to COVID-19 vaccine uptake in HCWs. As updated COVID-19 vaccines are approved for the United States market, our findings may be used to improve vaccine education and communication among HCWs to support vaccine uptake.
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Affiliation(s)
- Gail C D'Souza
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Casey N Pinto
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA; Penn State Cancer Institute, Cancer Control Program, Hershey, PA
| | - Cara L Exten
- Penn State Ross and Carol Nese College of Nursing, Penn State University, University Park, PA
| | - Jessica M Yingst
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA; Penn State Cancer Institute, Cancer Control Program, Hershey, PA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA; Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA; Penn State Cancer Institute, Cancer Control Program, Hershey, PA
| | - Jocelyn Anderson
- Penn State Ross and Carol Nese College of Nursing, Penn State University, University Park, PA
| | - Rachel Allen
- Penn State Ross and Carol Nese College of Nursing, Penn State University, University Park, PA
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA; Penn State Cancer Institute, Cancer Control Program, Hershey, PA.
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Heisler-Mackinnon JA, Queen T, Yi Kong W, Kennedy KL, Thomas T, Calo WA, Gilkey MB. Identifying effective vaccine champions: Findings from a national survey of primary care professionals. Vaccine 2024:S0264-410X(24)00403-1. [PMID: 38575435 DOI: 10.1016/j.vaccine.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Vaccine champions are common in primary care, but little is known about which champions are effective. METHODS In 2022, we surveyed 2,144 US primary care professionals (PCPs) who reported working with vaccine champions. Respondents rated the champion with whom they worked most closely on their effectiveness at improving vaccination rates. RESULTS About half (49 %) of PCPs perceived their closest champion as highly effective. PCPs perceived advanced practice providers and nursing staff as highly effective somewhat more often than physicians (52 % and 58 % vs 43 %, p <.001). Other correlates of perceived effectiveness included being a formally appointed versus informal champion, working extremely versus less closely with PCPs, and using a high (4-5) versus low (0-1) number of implementation strategies to improve vaccination rates (all p <.001). CONCLUSIONS Results suggest vaccine champions may benefit from having formal roles and opportunities to work closely with colleagues to improve vaccination rates using multiple strategies.
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Affiliation(s)
- Jennifer A Heisler-Mackinnon
- Lineberger Comprehensive Cancer Center, University of North Carolina, UNC Lineberger Building, 450 West Drive, Chapel Hill, NC 27514, USA; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, CB #7440, Chapel Hill, NC 27599-7440, USA.
| | - Tara Queen
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, CB #7440, Chapel Hill, NC 27599-7440, USA.
| | - Wei Yi Kong
- Mayo Clinic, Division of Epidemiology, 200 1st St. SW, Rochester, MN 55905, USA.
| | - Kathryn L Kennedy
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, CB #7440, Chapel Hill, NC 27599-7440, USA.
| | - Tami Thomas
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Modesto A. Maidique Campus, 11200 SW 8 Street - AHC 3, Miami, FL 33199, USA.
| | - William A Calo
- Penn State College of Medicine, The Pennsylvania State University, 90 Hope Drive, Hershey, PA 17033, USA.
| | - Melissa B Gilkey
- Lineberger Comprehensive Cancer Center, University of North Carolina, UNC Lineberger Building, 450 West Drive, Chapel Hill, NC 27514, USA; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, CB #7440, Chapel Hill, NC 27599-7440, USA
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3
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Brewington MK, Queen TL, Heisler-MacKinnon J, Calo WA, Weaver S, Barry C, Kong WY, Kennedy KL, Shea CM, Gilkey MB. Who are vaccine champions and what implementation strategies do they use to improve adolescent HPV vaccination? Findings from a national survey of primary care professionals. Implement Sci Commun 2024; 5:28. [PMID: 38520032 PMCID: PMC10958944 DOI: 10.1186/s43058-024-00557-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/12/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Implementation science researchers often cite clinical champions as critical to overcoming organizational resistance and other barriers to the implementation of evidence-based health services, yet relatively little is known about who champions are or how they effect change. To inform future efforts to identify and engage champions to support HPV vaccination, we sought to describe the key characteristics and strategies of vaccine champions working in adolescent primary care. METHODS In 2022, we conducted a national survey with a web-based panel of 2527 primary care professionals (PCPs) with a role in adolescent HPV vaccination (57% response rate). Our sample consisted of pediatricians (26%), family medicine physicians (22%), advanced practice providers (24%), and nursing staff (28%). Our survey assessed PCPs' experience with vaccine champions, defined as health care professionals "known for helping their colleagues improve vaccination rates." RESULTS Overall, 85% of PCPs reported currently working with one or more vaccine champions. Among these 2144 PCPs, most identified the champion with whom they worked most closely as being a physician (40%) or nurse (40%). Almost all identified champions worked to improve vaccination rates for vaccines in general (45%) or HPV vaccine specifically (49%). PCPs commonly reported that champion implementation strategies included sharing information (79%), encouragement (62%), and vaccination data (59%) with colleagues, but less than half reported that champions led quality improvement projects (39%). Most PCPs perceived their closest champion as being moderately to extremely effective at improving vaccination rates (91%). PCPs who did versus did not work with champions more often recommended HPV vaccination at the earliest opportunity of ages 9-10 rather than later ages (44% vs. 33%, p < 0.001). CONCLUSIONS Findings of our national study suggest that vaccine champions are common in adolescent primary care, but only a minority lead quality improvement projects. Interventionists seeking to identify champions to improve HPV vaccination rates can expect to find them among both physicians and nurses, but should be prepared to offer support to more fully engage them in implementing interventions.
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Affiliation(s)
- Micaela K Brewington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| | - Tara L Queen
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer Heisler-MacKinnon
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Sandra Weaver
- UNC Family Medicine and Pediatrics, UNC Health, Chapel Hill, NC, USA
| | | | - Wei Yi Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Kathryn L Kennedy
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Christopher M Shea
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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Bufalini CM, Kraschnewski JL, Riley TD, Wile K, Spanos K, Wong A, Myrick JG, Schaefer EW, Calo WA. Stories to Prevent Cancer: A Pilot Study Using Cancer Survivor Narratives to Increase Human Papillomavirus Vaccine Intentions. Cancer Control 2024; 31:10732748241237328. [PMID: 38454302 PMCID: PMC10924551 DOI: 10.1177/10732748241237328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/21/2023] [Accepted: 02/19/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) vaccination rates are lower than other recommended adolescent vaccines. Cancer survivor narratives are used to promote cancer prevention and control, but little is known about their impact on adolescent HPV vaccination. OBJECTIVE This pilot study explored the feasibility and effects of a video education intervention using a cancer survivor narrative to improve parents' attitudes toward and intentions to get the HPV vaccine. METHODS This study utilized a one-group design; participants completed a pre-intervention survey, watched the video before attending their sons' wellness visits, and completed a post-intervention survey within one week of their appointment. Using the narrative persuasion framework, we developed a 4-minute video of a local HPV-related cancer survivor to promote the HPV vaccine as cancer prevention. We recruited 37 participants between June and October 2020. Participants were parents of males ages 9-17 who had not yet initiated HPV vaccination. RESULTS After the video, more parents agreed that HPV vaccination is safe (pre: 66% vs. post: 82%; P = .045) and that their child's chances of getting HPV-related cancer in the future are high (pre: 24% vs. post: 46%; P = .014). Overall, 91% of parents felt the cancer survivor story helped them understand the risks of HPV cancers, and 52% said the story influenced their decision to start HPV vaccination for their child. CONCLUSIONS Our findings suggest that cancer survivor narratives influence parents' vaccine opinions and understanding of their child's risk of HPV infection, leading to increased parental intent to get the HPV vaccine for their adolescent males.
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Affiliation(s)
- Chelsea M. Bufalini
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Jennifer L. Kraschnewski
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Timothy D. Riley
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Kevin Wile
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Katherine Spanos
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Ashley Wong
- George Washington University Hospital, Washington, DC, USA
| | - Jessica Gall Myrick
- Bellisario College of Communications, Pennsylvania State University, University Park, PA, USA
| | - Eric W. Schaefer
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - William A. Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
- Penn State Cancer Institute, Hershey, PA, USA
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García YL, Ruiz LA, Calo WA, Vadaparampil ST, Mendoza A, Cintrón RV. Prevalence of High-Risk Human Papillomavirus Genotypes among Young Women in Puerto Rico; a retrospective longitudinal study. Res Sq 2023:rs.3.rs-3591893. [PMID: 38076882 PMCID: PMC10705711 DOI: 10.21203/rs.3.rs-3591893/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Background Human Papillomavirus (HPV) is the most common sexually transmitted infection. High-risk HPV types are the main cause of cervical cancer. Annually, cervical cancer is among the top 10 cancers in Puerto Rican women, with 22% of these cases ending in death. The purpose of this study was to establish the prevalence of high-risk HPV genotypes in a large cohort of young women living in Puerto Rico. Methods A retrospective longitudinal analysis was performed with a sample of 5,749 HPV results obtained from a clinical database of women ages 21 to 29 from 2014-2016. Results Outcomes indicate that among those with a positive HPV result, about one-third (35.2%) had a high-risk HPV infection. Women between the ages of 21 to 23 showed the highest prevalence (40.6%) of high-risk HPV. Among genotypes HPV 16 and 18, genotype 16 was the most prevalent. Interestingly, 85.4% of results were positive for other high-risk HPV types other than 16 or 18. Of the 458 women who had at least two tests completed, 217 had an initial positive result for HPV and only 108 (49.7%) resolved the infection. Conclusions This study confirms the high prevalence of several genotypes of high-risk HPV in young women in a large Puerto Rican sample.
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Calo WA, Shah PD, Fogel BN, Ruffin Iv MT, Moss JL, Hausman BL, Segel JE, Francis E, Schaefer E, Bufalini CM, Johnston N, Hogentogler E, Kraschnewski JL. Increasing the adoption of evidence-based communication practices for HPV vaccination in primary care clinics: The HPV ECHO study protocol for a cluster randomized controlled trial. Contemp Clin Trials 2023; 131:107266. [PMID: 37301468 PMCID: PMC10528011 DOI: 10.1016/j.cct.2023.107266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND The safe, highly-effective human papillomavirus (HPV) vaccine remains underused in the US. The Announcement Approach Training (AAT) has been shown to effectively increase HPV vaccine uptake by training providers to make strong vaccine recommendations and answer parents' common questions. Systems communications, like recall notices, can further improve HPV vaccination by reducing missed clinical opportunities for vaccination. Never tested in supporting HPV vaccination, the ECHO (Extension for Community Healthcare Outcomes) model is a proven implementation strategy to increase best practices among healthcare providers. This trial uses a hybrid effectiveness-implementation design (type II) to evaluate two ECHO-delivered interventions intended to increase HPV vaccination rates. METHODS This 3-arm cluster randomized controlled trial will be conducted in 36 primary care clinics in Pennsylvania. Aim 1 evaluates the impact of HPV ECHO (AAT to providers) and HPV ECHO+ (AAT to providers plus recall notices to vaccine-declining parents) versus control on HPV vaccination (≥1 dose) among adolescents, ages 11-14, between baseline and 12-month follow-up (primary outcome). Using a convergent mixed-methods approach, Aim 2 evaluates the implementation of the HPV ECHO and HPV ECHO+ interventions. Aim 3 explores exposure to and impact of vaccine information from providers and other sources (e.g., social media) on secondary acceptance among 200 HPV vaccine-declining parents within 12 months. DISCUSSION We expect to demonstrate the effectiveness and evaluate the implementation of two highly scalable interventions to increase HPV vaccination in primary care clinics. Our study seeks to address the communication needs of both providers and parents, increase HPV vaccination, and, eventually, prevent HPV-related cancers. TRIAL REGISTRATION ClinicalTrials.govNCT04587167. Registered on October 14, 2020.
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Affiliation(s)
- William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Penn State Cancer Institute, Hershey, PA, USA.
| | - Parth D Shah
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Benjamin N Fogel
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Mack T Ruffin Iv
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Jennifer L Moss
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Penn State Cancer Institute, Hershey, PA, USA; Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Bernice L Hausman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Department of Humanities, Penn State College of Medicine, Hershey, PA, USA
| | - Joel E Segel
- Penn State Cancer Institute, Hershey, PA, USA; Department of Health Policy and Administration, Pennsylvania State University, University Park, PA, USA
| | - Erica Francis
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Eric Schaefer
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Chelsea M Bufalini
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | | | - Ellie Hogentogler
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Jennifer L Kraschnewski
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
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Gilkey MB, Heisler-MacKinnon J, Boynton MH, Calo WA, Moss JL, Brewer NT. Impact of Brief Quality Improvement Coaching on Adolescent HPV Vaccination Coverage: A Pragmatic Cluster Randomized Trial. Cancer Epidemiol Biomarkers Prev 2023; 32:957-962. [PMID: 36480272 PMCID: PMC10244480 DOI: 10.1158/1055-9965.epi-22-0866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/21/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Health departments in the United States routinely conduct quality improvement (QI) coaching to help primary care providers optimize vaccine delivery. In a prior trial focusing on multiple adolescent vaccines, this light-touch intervention yielded only short-term improvements in HPV vaccination. We sought to evaluate the impact of an enhanced, HPV vaccine-specific QI coaching intervention when delivered in person or virtually. METHODS We partnered with health departments in three states to conduct a pragmatic cluster randomized trial in 2015 to 2016. We randomized 224 primary care clinics to receive no intervention (control), in-person coaching, or virtual coaching. Health department staff delivered the brief (45-60 minute) coaching interventions, including HPV vaccine-specific training with assessment and feedback on clinics' vaccination coverage (i.e., proportion of patients vaccinated). States' immunization information systems provided data to assess coverage change for HPV vaccine initiation (≥1 doses) at 12-month follow-up, among patients ages 11 to 12 (primary outcome) and 13 to 17 (secondary outcome) at baseline. RESULTS Clinics served 312,227 patients ages 11 to 17. For ages 11 to 12, coverage change for HPV vaccine initiation was higher in the in-person and virtual coaching arms than in the control arm at 12-month follow-up (1.2% and 0.7% point difference, both P < 0.05). For ages 13 to 17, coverage change was higher for virtual coaching than control (1.4% point difference, P < 0.001), but in-person coaching did not yield an intervention effect. CONCLUSIONS Our brief QI coaching intervention produced small long-term improvements in HPV vaccination. IMPACT Health departments may benefit from targeting QI coaching to specific vaccines, like HPV vaccine, that need them most.
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Affiliation(s)
- Melissa B Gilkey
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | | | - Marcella H Boynton
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
- North Carolina Translational & Clinical Sciences Institute, University of North Carolina, Chapel Hill, North Carolina
- Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Jennifer L Moss
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Noel T Brewer
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
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Calo WA, Aumiller B, Murray A, Crawford L, Bermudez M, Weaver L, Henao MP, Gray NM, DeLoatch V, Rivera-Collazo D, Gomez J, Kraschnewski JL. Expanding opportunities for chronic disease prevention for Hispanics: the Better Together REACH program in Pennsylvania. Front Public Health 2023; 11:1134044. [PMID: 37408745 PMCID: PMC10318166 DOI: 10.3389/fpubh.2023.1134044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/23/2023] [Indexed: 07/07/2023] Open
Abstract
Background Hispanics in Lebanon and Reading, Pennsylvania, experience high levels of socioeconomic and health disparities in risk factors for chronic disease. In 2018, our community-academic coalition "Better Together" received a Racial and Ethnic Approaches to Community Health (REACH) award to improve healthy lifestyles. This report describes our work-in-progress and lessons learned to date from our REACH-supported initiatives in Lebanon and Reading. Methods For the past 4 years, our coalition has leveraged strong community collaborations to implement and evaluate culturally-tailored practice- and evidence-based activities aimed at increasing physical activity, healthy nutrition, and community-clinical linkages. This community case report summarizes the context where our overall program was implemented, including the priority population, target geographical area, socioeconomic and health disparities data, community-academic coalition, conceptual model, and details the progress of the Better Together initiative in the two communities impacted. Results To improve physical activity, we are: (1) creating new and enhancing existing trails connecting everyday destinations through city redesigning and master planning, (2) promoting outdoor physical activity, (3) increasing awareness of community resources for chronic disease prevention, and (4) supporting access to bikes for youth and families. To improve nutrition, we are: (1) expanding access to locally-grown fresh fruit and vegetables in community and clinical settings, through the Farmers Market Nutrition Program to beneficiaries of the Women, Infants, and Children (WIC) program and the Veggie Rx to patients who are at risk for or have diabetes, and (2) providing bilingual breastfeeding education. To enhance community-clinical linkages, we are training bilingual community health workers to connect at-risk individuals with diabetes prevention programs. Conclusions Intervening in areas facing high chronic disease health disparities leads us to develop a community-collaborative blueprint that can be replicated across Hispanic communities in Pennsylvania and the United States.
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Affiliation(s)
- William A. Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Betsy Aumiller
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Andrea Murray
- Department of Medicine, Penn State College of Medicine, Hershey, PA, United States
| | - Laurie Crawford
- Department of Medicine, Penn State College of Medicine, Hershey, PA, United States
| | - Madeline Bermudez
- Department of Medicine, Penn State College of Medicine, Hershey, PA, United States
| | - Lisa Weaver
- Penn State Health St. Joseph, Reading, PA, United States
- Penn State Berks, Reading, PA, United States
| | - Maria Paula Henao
- Department of Medicine, Penn State College of Medicine, Hershey, PA, United States
| | | | - Vicki DeLoatch
- Lebanon Family Health Services, Lebanon, PA, United States
| | | | - Janelle Gomez
- Department of Medicine, Penn State College of Medicine, Hershey, PA, United States
| | - Jennifer L. Kraschnewski
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
- Department of Medicine, Penn State College of Medicine, Hershey, PA, United States
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Kraschnewski JL, Heilbrunn ES, Calo WA, Kong L, Lehman E, Hogentogler E, Fisher A, Osevala N, Paules CI, Whitaker J, Urso J, Chamberlain L, Suda KM, Stedjan M, McNeil L. Accelerating guideline dissemination in nursing homes during the COVID-19 pandemic: A patient-centered randomized controlled trial. Geriatr Nurs 2023; 51:439-445. [PMID: 37167902 PMCID: PMC10126215 DOI: 10.1016/j.gerinurse.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Nursing homes were ill-equipped for the pandemic; though facilities are required to have infection control staff, only 3% have taken a basic infection control course. Little is known about the implementation of effective practices outside of the acute care setting. We proposed an intervention utilizing Project ECHO, to connect Penn State University experts with nursing home staff and administrators to explore how infection control guidelines can be implemented effectively. METHODS A stratified cluster randomized design was used to assign nursing homes to either AHRQ-funded COVID-19 ECHO or AHRQ-funded COVID-19 ECHO+. RESULTS 136 nursing homes participated. There were no significant differences in COVID-19 infection rate, hospitalization, deaths, or influenza, between ECHO or ECHO+. DISCUSSION The ECHO model has significant strengths when compared to traditional training, as it allows for remote learning delivered by a multidisciplinary team of experts and utilizes case discussions that match the context of nursing homes.
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Affiliation(s)
- Jennifer L Kraschnewski
- Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA; Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA; Department of Pediatrics, The Pennsylvania State University College of Medicine, Hershey, PA, USA.
| | - Emily S Heilbrunn
- Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - William A Calo
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Lan Kong
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Erik Lehman
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Ellie Hogentogler
- Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Abbey Fisher
- Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Nicole Osevala
- Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Catherine I Paules
- Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Janice Whitaker
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, State College, PA, USA
| | | | - Linda Chamberlain
- Pennsylvania Department of Health, Division of Home Health, Harrisburg, PA, USA
| | - Kim M Suda
- Helion, A Division of Highmark Health, PA, USA
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Moss JL, Stoltzfus KC, Popalis ML, Calo WA, Kraschnewski JL. Assessing the use of constructs from the consolidated framework for implementation research in U.S. rural cancer screening promotion programs: a systematic search and scoping review. BMC Health Serv Res 2023; 23:48. [PMID: 36653800 PMCID: PMC9846667 DOI: 10.1186/s12913-022-08976-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/16/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cancer screening is suboptimal in rural areas, and interventions are needed to improve uptake. The Consolidated Framework for Implementation Research (CFIR) is a widely-used implementation science framework to optimize planning and delivery of evidence-based interventions, which may be particularly useful for screening promotion in rural areas. We examined the discussion of CFIR-defined domains and constructs in programs to improve cancer screening in rural areas. METHODS We conducted a systematic search of research databases (e.g., Medline, CINAHL) to identify studies (published through November 2022) of cancer screening promotion programs delivered in rural areas in the United States. We identified 166 records, and 15 studies were included. Next, two reviewers used a standardized abstraction tool to conduct a critical scoping review of CFIR constructs in rural cancer screening promotion programs. RESULTS Each study reported at least some CFIR domains and constructs, but studies varied in how they were reported. Broadly, constructs from the domains of Process, Intervention, and Outer setting were commonly reported, but constructs from the domains of Inner setting and Individuals were less commonly reported. The most common constructs were planning (100% of studies reporting), followed by adaptability, cosmopolitanism, and reflecting and evaluating (86.7% for each). No studies reported tension for change, self-efficacy, or opinion leader. CONCLUSIONS Leveraging CFIR in the planning and delivery of cancer screening promotion programs in rural areas can improve program implementation. Additional studies are needed to evaluate the impact of underutilized CFIR domains, i.e., Inner setting and Individuals, on cancer screening programs.
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Affiliation(s)
- Jennifer L Moss
- Penn State College of Medicine, Hershey, PA, USA.
- Department of Family and Community Medicine, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, 90 Hope Drive, #2120E, MC A172, P.O. Box 855, Hershey, PA, 17033, USA.
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11
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Calo WA, Lennon RP, Ruffin Iv MT, Keller C, Spanos K, D'Souza G, Kraschnewski JL. Support for HPV vaccine school-entry requirements in the United States: The role of exemption policies. Vaccine 2022; 40:7426-7432. [PMID: 36030125 DOI: 10.1016/j.vaccine.2022.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 03/23/2022] [Accepted: 08/09/2022] [Indexed: 01/28/2023]
Abstract
In the United States (U.S.), only five states or territories require human papillomavirus (HPV) vaccination for school attendance, even though almost all U.S. jurisdictions have debated adopting this type of policy. In this U.S. based study, we sought to estimate the level of support for HPV vaccine school-entry requirements with varying exemption policies and documentation procedures to obtain exemptions. Between July and August 2019, we conducted a web-based survey with a national sample of 1,109 U.S. parents of 11- to 17-year-olds. The survey assessed support for four school-entry vaccine requirement policies: without exemption or with exemption for medical, religious or philosophical reasons. Analyses used multivariable logistic regression to assess correlates of support for each policy. Overall, 38% of parents agreed with laws requiring HPV vaccination for school attendance without exemptions. When including exemption provisions, agreement increased to 45% for philosophical reasons, 50% for religious reasons, and 59% for medical reasons. Parents more often agreed on requirements without any exemptions if they were female (OR = 1.37, 95% CI:1.01-1.87), their child had initiated HPV vaccination (OR = 2.05, 95% CI:1.50-2.87), reported high levels of vaccine confidence (OR = 2.41, 95% CI:1.77-3.27), or reported having values similar to those of the people in their community (OR = 1.85, 95% CI:1.39-2.47). Parents more often agreed with requirements that included religious or philosophical exemptions if they reported having values similar to their community or high levels of psychological reactance (all p <.05). Many parents also supported requiring a written notice signed by a health care provider (40%) or religious leader (49%) to obtain a medical or religious exemption, respectively. In conclusion, exemption policies greatly increase parent support of school-entry requirements for HPV vaccination but may decrease their impact in practice. A large number of U.S. parents support strict documentation to obtain exemptions, signaling a promising area of policymaking to strengthen vaccine policies for school attendance.
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Affiliation(s)
- William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA.
| | - Robert P Lennon
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Mack T Ruffin Iv
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Chelsea Keller
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Katherine Spanos
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Gail D'Souza
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Jennifer L Kraschnewski
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
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12
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Calo WA, Marin E, Aumiller B, Murray A, Baptiste C, Bermudez M, Crawford L, DeLoatch V, Kraschnewski JL. Implementing Locally Tailored Strategies to Promote Redemption of Farmers' Market Nutrition Program Vouchers Among WIC Participants in Central Pennsylvania. Health Promot Pract 2022; 23:100S-107S. [PMID: 36374600 PMCID: PMC10440099 DOI: 10.1177/15248399221112453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
The Pennsylvania Farmers' Market Nutrition Program (FMNP) provides vouchers to participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to purchase locally grown fruits, vegetables (F&V), and herbs every year from June to November. Voucher redemption is suboptimal among WIC participants in Lebanon County, a community with high numbers of low-income and Hispanic families. Supported by a Racial and Ethnic Approaches to Community Health (REACH) award, our community-academic coalition partnered with the local WIC provider to implement locally tailored strategies to promote redemption of FMNP vouchers. In 2019, we surveyed FMNP participants (n = 100) to examine opportunities for improved voucher redemption. Increasing sites for voucher use (47%) and a larger variety of F&V (27%) were the most commonly selected improvements participants identified. Participants also supported improvements to increase awareness of available seasonal produce (14%), text/phone reminders to redeem vouchers (13%), and having recipes to cook meals with FMNP-approved F&V (12%). These findings led us to implement a weekly, Farm-to-WIC "grab bag" program in 2020/2021. We partnered with a local farmer to offer a variety of FMNP-approved produce in $3 and $6 grab bags at the local WIC provider. Each grab bag included healthy recipes using the included produce. In 2021, we launched a text/phone reminder intervention to encourage voucher redemption among FMNP participants (n = 57). Our work demonstrates the value of community-academic partnerships to identify and implement feasible strategies that are responsive to local needs as well as supporting existing programs providing greater access to affordable produce.
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Affiliation(s)
| | - Evelyn Marin
- Penn State College of Medicine, Hershey, PA, USA
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13
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Ssentongo P, McCall-Hosenfeld JS, Calo WA, Moss J, Lengerich EJ, Chinchilli VM, Ba DM. Association of human papillomavirus vaccination with cervical cancer screening: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29329. [PMID: 35839062 DOI: 10.1097/md.0000000000029329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Prophylactic vaccination and routine screening are effective at preventing most cases of cervical cancer. Globally, cervical cancer is the fourth most frequently diagnosed cancer among women. The aim of this study was to investigate the association between human papillomavirus virus (HPV) vaccination (1, 2, or 3 doses) and cervical cancer screening. METHODS PubMed (MEDLINE), Scopus, Web of Science, and Cochrane Library electronic databases were systematically searched from July 1, 2006, up to September 30, 2021. We pooled estimates using random-effects models. Heterogeneity between studies was quantified using Cochran Q test and I2 statistics. In total, 12 studies involving 2.4 million individuals were included in the meta-analysis. RESULTS In the adjusted estimates, uptake of HPV vaccination was associated with increased cervical cancer screening (pooled relative risk [RR]: 1.35; 95% confidence interval [CI]: 1.21, 1.50; n = 12). Between-study heterogeneity was large (I2 = 99%). Compared to unvaccinated, those who received 3 doses of HPV vaccine had the highest uptake of cervical cancer screening (RR: 1.85; 95% CI: 1.58, 2.17), followed by those who received 2 doses (RR: 1.34; 95% CI: 1.21, 1.47). No statistically significant association with screening was found for those who received a single dose of the HPV vaccine. CONCLUSION In this meta-analysis, uptake of HPV vaccination was associated with higher cervical cancer screening. It is plausible that vaccinated individuals are more likely to engage in preventive health behaviors. Healthcare providers should remind patients to continue with routine screening for cervical cancer regardless of their HPV vaccine status since vaccination does not protect against all HPV types.
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Affiliation(s)
- Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
- College of Engineering Science and Mechanics, The Pennsylvania State University, State College, PA
| | - Jennifer S McCall-Hosenfeld
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
- Department of Medicine, Penn State College of Medicine, Hershey, PA
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Jennifer Moss
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA
| | - Eugene J Lengerich
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
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14
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Smith RA, Bone C, Visco A, Calo WA, Wright J, Groff D, Lennon RP. Skeptical Health Mavens May Limit COVID-19 Vaccine Diffusion: Using the Innovation Diffusion Cycle to Interpret Results of a Cross-sectional Survey among People Who are Socially Vulnerable. J Health Commun 2022; 27:375-381. [PMID: 35983888 DOI: 10.1080/10810730.2022.2111619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We sought to identify barriers to COVID-19 vaccine uptake among persons who are socially vulnerable in light of the natural cycle of innovation diffusion. Widespread adoption of a health innovation requires a cadre of opinion leaders to build on successes experienced by early adopters. One type of opinion leader in healthcare are health mavens: members of a community who maintain up-to-date health knowledge and share their knowledge others. We surveyed 139 persons who are socially vulnerable regarding their COVID-19 vaccination intention, and evaluated their responses based on psychological traits captured by two scales: innovativeness and health mavenism. Health mavenism was not strongly correlated with COVID-19 vaccine intention. Health mavens often relied on their own healthcare providers (n = 46) and health agency websites (n = 42) for vaccine information. Those who relied on their faith leaders (n = 4) reported a lower likelihood of getting vaccinated (31.5% vs. 76.0%, p < .05). The observed lack of support by health mavens represents a critical barrier to COVID-19 vaccine uptake; targeting campaigns to health mavens may increase COVID-19 vaccine uptake in socially vulnerable communities.
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Affiliation(s)
- Rachel A Smith
- Department of Communication Arts and Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Curtis Bone
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Ashley Visco
- Community Relations Department, Penn State Health, Hershey, Pennsylvania, USA
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jessica Wright
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Destin Groff
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Robert P Lennon
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
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15
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Llavona-Ortiz JY, Spanos KE, Kraschnewski JL, D’Souza G, Myrick JG, Sznajder KK, Calo WA. Associations Between Human Papillomavirus Vaccine Decisions and Exposure to Vaccine Information in Social Media. Cancer Control 2022; 29:10732748221138404. [PMID: 36394959 PMCID: PMC9679613 DOI: 10.1177/10732748221138404] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Abstract
PURPOSE Exposure to different types of vaccine information in social media can result in parents making disparate vaccine decisions, including not following national guidelines for human papillomavirus (HPV) vaccination. We sought to characterize parents' exposure to and engagement with information about HPV vaccination in social media, and the associations between exposure to such information and vaccine decisions for their adolescent children. METHODS In 2019, we conducted a web-based survey with a national sample of 1073 parents of adolescents who use social media. The survey assessed whether parents have seen information in favor, against, or mixed about HPV vaccination. Multivariable logistic regressions assessed correlates of vaccine decisions, including HPV vaccine initiation, delay, and refusal. RESULTS Sixty-one percent of parents reported that their children have initiated HPV vaccination. Over one-third of parents (37%) reported seeing HPV vaccine information on social media, which was either in favor (20%), against (5%), or a mix (12%). Parents exposed to information in favor were more likely than those who saw no information to have initiated HPV vaccination (OR = 1.74, 95% CI:1.24, 2.44). Parents exposed to information against vaccination were more likely to have delayed (OR = 3.29, 95% CI:1.66, 6.51) or refused (OR = 4.72, 95% CI:2.35, 9.50) HPV vaccination. Exposure to mixed information was also significantly associated with vaccine delay and refusal. DISCUSSION Our findings suggest that the type of information seen on social media regarding HPV vaccination may influence the decisions parents make about vaccinating their children. Efforts should be sought to increase online information in favor of HPV vaccination and combat vaccine misinformation in social media.
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Affiliation(s)
| | | | - Jennifer L. Kraschnewski
- Department of Public Health
Sciences, Penn State College of
Medicine, Hershey, PA, USA
- Department of Medicine, Penn State College of
Medicine, Hershey, PA, USA
| | - Gail D’Souza
- Department of Public Health
Sciences, Penn State College of
Medicine, Hershey, PA, USA
| | - Jessica Gall Myrick
- Donald P. Bellisario College of
Communications, Pennsylvania State
University, University Park, PA, USA
| | - Kristin K. Sznajder
- Department of Public Health
Sciences, Penn State College of
Medicine, Hershey, PA, USA
| | - William A. Calo
- Department of Public Health
Sciences, Penn State College of
Medicine, Hershey, PA, USA
- Penn State Cancer
Institute, Hershey, PA, USA
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16
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Calo WA, Rivera M, Mendez-Lazaro PA, Garcia-Camacho SI, Bernhardt Utz YM, Acosta-Perez E, Ortiz AP. Disruptions in Oncology Care Confronted by Patients with Gynecologic Cancer Following Hurricanes Irma and Maria in Puerto Rico. Cancer Control 2022; 29:10732748221114691. [PMID: 35833604 PMCID: PMC9290156 DOI: 10.1177/10732748221114691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In September 2017, hurricanes Irma and Maria affected Puerto Rico (PR) and the US Virgin Islands (USVI), causing major disruptions in basic services and health care. This study documented the stressors and experiences of patients with gynecologic cancer receiving oncology care in PR following these hurricanes. METHODS We conducted 4 focus groups (December 2018-April 2019) among women aged ≥21 years from PR who were diagnosed with gynecological cancer between September 2016 and September 2018 (n = 24). Using the same eligibility criteria, we also interviewed patients from the USVI (n = 2) who were treated in PR. We also conducted key-informant interviews with oncology care providers and administrators (n = 23) serving gynecologic cancer patients in PR. Discussions were audio-recorded, transcribed verbatim, and coded to identify emergent themes using a constant comparison method. RESULTS Analyses of focus group discussions and interviews allowed us to identify the following emergent themes: 1) disruptions in oncology care were common; 2) communication between oncology providers and patients was challenging before and after the hurricanes hit; 3) patient resilience was key to resume care; and 4) local communities provided much-needed social support and resources. CONCLUSIONS This study provides firsthand information about the disruptions in oncology care experienced by and the resiliency of women with gynecologic cancer following hurricanes Irma and Maria. Our findings underscore the need to incorporate oncology care in the preparedness and response plans of communities, health systems, and government agencies to maintain adequate care for cancer patients during and after disasters such as hurricanes.
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Affiliation(s)
- William A Calo
- Department of Public Health Sciences, 12310Penn State College of Medicine, Hershey, PA, USA.,12310Penn State Cancer Institute, Hershey, PA, USA
| | - Mirza Rivera
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, 12320University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | - Pablo A Mendez-Lazaro
- Department of Environmental Health, Graduate School of Public Health, 12320University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | - Sandra I Garcia-Camacho
- Division of Cancer Control and Population Sciences, 591857University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA
| | - Yanina M Bernhardt Utz
- Division of Cancer Control and Population Sciences, 591857University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA
| | - Edna Acosta-Perez
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, 12320University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA.,Hispanic Alliance of Clinical and Translational Research, 12320University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | - Ana P Ortiz
- Division of Cancer Control and Population Sciences, 591857University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA.,Department of Epidemiology and Biostatistics, Graduate School of Public Health, 12320University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
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17
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Lennon RP, Fraleigh R, Van Scoy LJ, Keshaviah A, Hu XC, Snyder BL, Miller EL, Calo WA, Zgierska AE, Griffin C. Developing and testing an automated qualitative assistant (AQUA) to support qualitative analysis. Fam Med Community Health 2021; 9:fmch-2021-001287. [PMID: 34824135 PMCID: PMC8627418 DOI: 10.1136/fmch-2021-001287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Qualitative research remains underused, in part due to the time and cost of annotating qualitative data (coding). Artificial intelligence (AI) has been suggested as a means to reduce those burdens, and has been used in exploratory studies to reduce the burden of coding. However, methods to date use AI analytical techniques that lack transparency, potentially limiting acceptance of results. We developed an automated qualitative assistant (AQUA) using a semiclassical approach, replacing Latent Semantic Indexing/Latent Dirichlet Allocation with a more transparent graph-theoretic topic extraction and clustering method. Applied to a large dataset of free-text survey responses, AQUA generated unsupervised topic categories and circle hierarchical representations of free-text responses, enabling rapid interpretation of data. When tasked with coding a subset of free-text data into user-defined qualitative categories, AQUA demonstrated intercoder reliability in several multicategory combinations with a Cohen’s kappa comparable to human coders (0.62–0.72), enabling researchers to automate coding on those categories for the entire dataset. The aim of this manuscript is to describe pertinent components of best practices of AI/machine learning (ML)-assisted qualitative methods, illustrating how primary care researchers may use AQUA to rapidly and accurately code large text datasets. The contribution of this article is providing guidance that should increase AI/ML transparency and reproducibility.
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Affiliation(s)
- Robert P Lennon
- Family and Community Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Robbie Fraleigh
- Applied Research Laboratory, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Lauren J Van Scoy
- Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | | | - Xindi C Hu
- Mathematica Policy Research Inc, Princeton, New Jersey, USA
| | - Bethany L Snyder
- Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio, USA
| | - Erin L Miller
- Family and Community Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - William A Calo
- Public Health Services, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Aleksandra E Zgierska
- Family and Community Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Christopher Griffin
- Applied Research Laboratory, Pennsylvania State University, University Park, Pennsylvania, USA
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18
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Calo WA, Francis E, Kong L, Hogentogler R, Heilbrunn E, Fisher A, Hood N, Kraschnewski J. Project ECHO for Nursing Homes: A Patient-centered, Randomized-controlled Trial to Implement Infection Control and Quality of Life Best Practices in Nursing Homes (Preprint). JMIR Res Protoc 2021; 11:e34480. [PMID: 35476823 PMCID: PMC9109778 DOI: 10.2196/34480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/18/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022] Open
Abstract
Background Nursing homes in the United States were devastated by COVID-19, with 710,000 cases and 138,000 deaths nationally through October 2021. Although facilities are required to have infection control staff, only 3% of designated infection preventionists have taken a basic infection control course prior to the COVID-19 pandemic. Most research has focused on infection control in the acute care setting. However, little is known about the implementation of infection control practices and effective interventions in nursing homes. This study utilizes Project ECHO (Extension for Community Health Outcomes), an evidence-based telementoring model, to connect Penn State University subject matter experts with nursing home staff and administrators to proactively support evidence-based infection control guideline implementation. Objective Our study seeks to answer the research question of how evidence-based infection control guidelines can be implemented effectively in nursing homes, including comparing the effectiveness of two ECHO-delivered training interventions on key patient-centered outcomes such as reducing the number of residents with a COVID-19 diagnosis. Methods A stratified cluster randomized design was utilized. Using a 1:1 ratio, we randomly assigned 136 nursing homes to ECHO or ECHO Plus arms. Randomization was stratified by geographic location, baseline COVID-19 infection rate, and facility capacity. The study had two phases. In phase one, completed in July 2021, nursing homes in both study arms received a 16-week infectious disease and quality improvement training intervention via real-time, interactive videoconferencing and the ECHO learning model. Phase one sessions were up to 90 minutes in duration. In phase two, completed in November 2021, the ECHO group was offered optional 60-minute office hours for 9 weeks and the ECHO Plus group received 9 weeks of 60-minute sessions on emerging topics and an additional 8-session refresher series on infection control. Results A total of 290 nursing home facilities were assessed for eligibility, with 136 nursing homes recruited and randomly assigned to ECHO or ECHO Plus. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we will simultaneously evaluate the study’s effectiveness and implementation outcomes at baseline (intervention start date), and at 4, 6, 12, and 18 months. The primary outcome is the COVID-19 infection rate in nursing homes. Secondary outcomes include COVID-19 hospitalizations and deaths, flu-like illness, and quality of life. Surveys and interviews with participants will also provide data as to the adoption, implementation, and maintenance of best practices taught throughout ECHO sessions. Conclusions A multipronged approach to improving infection control and emergency preparedness in nursing homes is important, given the toll that the COVID-19 pandemic has taken on residents and staff. The ECHO model has significant strengths when compared to traditional training, as it allows for remote learning delivered by a multidisciplinary team of experts, and utilizes case discussions that match the context and capacity of nursing homes. Trial Registration ClinicalTrials.gov NCT04499391; https://clinicaltrials.gov/ct2/show/NCT04499391
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Affiliation(s)
- William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Penn State University, Hershey, PA, United States
| | - Erica Francis
- Department of Medicine, College of Medicine, Penn State University, Hershey, PA, United States
| | - Lan Kong
- Department of Public Health Sciences, Penn State College of Medicine, Penn State University, Hershey, PA, United States
| | - Ruth Hogentogler
- Department of Medicine, College of Medicine, Penn State University, Hershey, PA, United States
| | - Emily Heilbrunn
- Department of Medicine, College of Medicine, Penn State University, Hershey, PA, United States
| | - Abbey Fisher
- Department of Medicine, College of Medicine, Penn State University, Hershey, PA, United States
| | - Nancy Hood
- Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | - Jennifer Kraschnewski
- Department of Medicine, College of Medicine, Penn State University, Hershey, PA, United States
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19
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Margolis MA, Brewer NT, Shah PD, Calo WA, Alton Dailey S, Gilkey MB. Talking about recommended age or fewer doses: what motivates HPV vaccination timeliness? Hum Vaccin Immunother 2021; 17:3077-3080. [PMID: 33961539 DOI: 10.1080/21645515.2021.1912550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
HPV vaccination is recommended for U.S. adolescents at ages 11-12 and requires two versus three doses if the series is started before age 15. We evaluated how talking about recommended age or fewer doses motivates on-time HPV vaccination. Our national, online experiment randomized 1,263 parents of adolescents to view one of three messages about HPV vaccination recommendations or no message. Messages framed guidelines as recommending: vaccination at age 11-12; fewer doses for those who start vaccination at age 11-12; or, fewer doses for those who start vaccination before age 15. We then assessed parents' preferred age for HPV vaccination, categorizing preferences of ≤12 years as on-time. Parents who viewed "at age 11-12" versus no message more often preferred on-time HPV vaccination (63% vs. 43%, p < .05) and did not differ from those viewing "fewer doses at age 11-12" (63% vs. 64%, p > .05). Parents who viewed "fewer doses before age 15" less often preferred on-time HPV vaccination (39%, p < .05). Recommending HPV vaccination at age 11-12 encouraged on-time vaccination, while offering fewer doses had little impact. Providers should avoid framing HPV vaccination guidelines in reference to age 15 because doing so may discourage on-time vaccination by introducing confusion about the recommended age.
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Affiliation(s)
- Marjorie A Margolis
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Parth D Shah
- Public Health Sciences Division, Hutchinson Institute for Cancer Outcomes Research, Seattle, WA, USA
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.,Penn State Hershey Cancer Institute, Hershey, PA, USA
| | - Susan Alton Dailey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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Hoke AM, Stuckey HL, Keller CM, Lu Z, Hivner EA, Calo WA, Strick JM, Kraschnewski JL. In Their Own Words: Resources Needed by School Nurses to Facilitate Student Immunization Compliance. J Sch Health 2021; 91:218-226. [PMID: 33433022 PMCID: PMC8013341 DOI: 10.1111/josh.12993] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/15/2020] [Accepted: 10/24/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND All 50 states have school-entry immunization requirements, and many also allow exemptions based on medical and non-medical reasons. School nurses are responsible for managing student immunization compliance based on state policies, but lack standardized resources and guidance. METHODS Pennsylvania school nurses (N = 21) participated in semi-structured interviews regarding their strategies for communication and management of student immunization information, along with resources needed for practice improvement. Data were analyzed using descriptive content analysis. RESULTS Nurses reported similarities in timelines used for communication of immunization requirements, but differences in mechanisms used to secure and manage immunization records. Nurses reported a need for clarity regarding exclusions and exemption policy implementation and requested standardized resources and guidance for navigating immunization compliance. CONCLUSIONS A need exists for standardized processes that support immunization compliance. Furthermore, nurses highlighted a need for additional training and enhanced networks to develop creative strategies for promoting immunization uptake among families.
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Affiliation(s)
- Alicia M. Hoke
- Penn State College of Medicine, 90 Hope DriveHersheyPA17061
| | | | | | - Zhexi Lu
- Penn State College of Medicine, 90 Hope DriveHersheyPA17061
| | | | | | - Janine M. Strick
- Pennsylvania Department of Health, Division of Immunizations, 625 Forster StreetHarrisburgPA17120‐0701
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21
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Ortiz AP, Soto-Salgado M, Calo WA, Hull P, Fernández ME, Colon-López V, Tortolero-Luna G. Elimination of cervical cancer in U.S. Hispanic populations: Puerto Rico as a case study. Prev Med 2021; 144:106336. [PMID: 33678233 DOI: 10.1016/j.ypmed.2020.106336] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 12/15/2022]
Abstract
Cervical cancer remains a major burden for women around the world. In 2018, the World Health Organization called for the elimination of cervical cancer worldwide (<4 cases per 100,000 women-years), within the 21st century. In the U.S., despite great progress toward this goal, existing disparities among racial/ethnic groups in cervical cancer raise concerns about whether elimination can be achieved for all women. We describe: 1) disparities in cervical cancer among Hispanics in the U.S. and factors that contribute to their increased risk, 2) prevention and control efforts to increase equity in the elimination of cervical cancer in this population, and 3) cervical cancer control efforts in Puerto Rico (PR), a U.S. territory, as a case study for cervical cancer elimination among a minority and underserved Hispanic population. Hispanics have the highest incidence rates of cervical cancer among all racial/ethnic groups in the U.S. Despite being more likely to complete HPV vaccination series, lower cervical cancer screening and access to treatment may lead to a higher cervical cancer mortality in Hispanics compared to non-Hispanic White women. These disparities are influenced by multiple individual-, sociocultural-, and system-level factors. To achieve the goal of cervical cancer elimination in the U.S., systematic elimination plans that consider the needs of Hispanic populations should be included within the Comprehensive Cancer Control Plans of each state. Because PR has implemented coordinated efforts for the prevention and control of cervical cancer, it represents a notable case study for examining strategies that can lead to cervical cancer elimination among Hispanics.
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Affiliation(s)
- Ana Patricia Ortiz
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico, United States of America; Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America.
| | - Marievelisse Soto-Salgado
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America; Department of Biochemistry, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States of America
| | - Pamela Hull
- University of Kentucky Markey Cancer Center, United States of America; Department of Behavioral Science, University of Kentucky College of Medicine, United States of America
| | - María E Fernández
- Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, Houston, TX, United States of America
| | - Vivian Colon-López
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico, United States of America; Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - Guillermo Tortolero-Luna
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico, United States of America
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22
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Abstract
Pennsylvania responded to the COVID-19 pandemic by closing schools and moving to online instruction in March 2020. We surveyed Pennsylvania school nurses (N = 350) in May 2020 to assess the impact of COVID-19 on nurses' concerns about returning to school and impact on practice. Data were analyzed using χ2 tests and regression analyses. Urban school nurses were more concerned about returning to the school building without a COVID-19 vaccine than rural nurses (OR = 1.58, 95% CI [1.05, 2.38]). Nurses in urban locales were more likely to report being asked for guidance on COVID-19 (OR = 1.69, 95% CI [1.06, 2.68]), modify communication practices (OR = 2.33, 95% CI [1.42, 3.82]), and be "very/extremely concerned" about their safety (OR = 2.16, 95% CI [1.35, 3.44]). Locale and student density are important factors to consider when resuming in-person instruction; however, schools should recognize school nurses for their vital role in health communication to assist in pandemic preparedness and response.
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Affiliation(s)
- Alicia M Hoke
- Department of Pediatrics, 12310Penn State College of Medicine, Hershey, PA, USA
| | - Chelsea M Keller
- Department of Public Health Sciences, 12310Penn State College of Medicine, Hershey, PA, USA
| | - William A Calo
- Department of Public Health Sciences, 12310Penn State College of Medicine, Hershey, PA, USA.,Department of Family and Community Medicine, 12310Penn State College of Medicine, Hershey, PA, USA
| | - Deepa L Sekhar
- Department of Pediatrics, 12310Penn State College of Medicine, Hershey, PA, USA
| | - Erik B Lehman
- Department of Public Health Sciences, 12310Penn State College of Medicine, Hershey, PA, USA
| | - Jennifer L Kraschnewski
- Department of Pediatrics, 12310Penn State College of Medicine, Hershey, PA, USA.,Department of Public Health Sciences, 12310Penn State College of Medicine, Hershey, PA, USA.,Department of Medicine, 12310Penn State College of Medicine, Hershey, PA, USA
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23
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Spanos KE, Kraschnewski JL, Moss JL, Wong A, Calo WA. Parent support for social media standards combatting vaccine misinformation. Vaccine 2021; 39:1364-1369. [PMID: 33551299 DOI: 10.1016/j.vaccine.2021.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/30/2020] [Accepted: 01/03/2021] [Indexed: 11/18/2022]
Abstract
We sought to assess parental support for varying standards that social media sites can employ to combat vaccine misinformation. Between July and August 2019, we conducted a web-based survey with a national sample of 1073 parents of adolescents and who use social media. The survey assessed support for ten standards about vaccine misinformation. Multivariable logistic regression assessed correlates of support. Overall, 61% of parents supported at least one standard. Support for each standard varied greatly (12-51%), with higher support for less restrictive standards. Parents more often supported standards if their child had already initiated human papillomavirus (HPV) vaccination, if they were non-Hispanic black or Hispanic, if they agreed that vaccine misinformation is harmful, or if they saw information on social media in favor of HPV vaccine (all p < .05). Our findings suggest favorable support for standards that social media sites can implement to combat vaccine misinformation.
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Affiliation(s)
- Katherine E Spanos
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Jennifer L Kraschnewski
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Jennifer L Moss
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Ashley Wong
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Penn State Cancer Institute, Hershey, PA, USA.
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24
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Mama SK, Bhuiyan N, Foo W, Segel JE, Bluethmann SM, Winkels RM, Wiskemann J, Calo WA, Lengerich EJ, Schmitz KH. Rural-urban differences in meeting physical activity recommendations and health status in cancer survivors in central Pennsylvania. Support Care Cancer 2020; 28:5013-5022. [PMID: 32036469 PMCID: PMC7415488 DOI: 10.1007/s00520-020-05342-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/02/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE This study explored rural-urban differences in meeting physical activity (PA) recommendations and health status in cancer survivors in central Pennsylvania and associations between PA and health status. METHODS Cancer survivors (N = 2463) were identified through a state cancer registry and mailed questionnaires assessing PA and health status. Rural-urban residence was based on county of residence at diagnosis. Participants self-reported frequency and duration of leisure-time PA and were classified as meeting: (1) aerobic recommendations (≥ 150 min/week), (2) muscle-strengthening recommendations (≥ 2 times/week), (3) both aerobic and muscle-strengthening recommendations, or (4) neither recommendation. Logistic regression models examined associations between rural-urban residence and meeting PA recommendations and associations between PA and health status, adjusting for age, cancer type, gender, and income. RESULTS Nearly 600 (N = 591, 24.0%) cancer survivors returned completed questionnaires (rural 9.5%, urban 90.5%). Half (50.0%) of rural cancer survivors reported no leisure-time PA compared to 35.2% of urban cancer survivors (p = 0.020), and urban cancer survivors were 2.6 times more likely to meet aerobic PA recommendations (95% CI 1.1-6.4). Odds of reporting good physical and mental health were 2.3 times higher among survivors who reported meeting aerobic recommendations compared to those who did not meet PA recommendations (95% CI 1.1-4.5), adjusting for rurality and covariates. CONCLUSIONS Results demonstrate persistent rural-urban differences in meeting PA recommendations in cancer survivors and its association with self-reported health. IMPLICATIONS FOR CANCER SURVIVORS Findings underscore the need for interventions to increase PA in rural cancer survivors in an effort to improve health status and reduce cancer health disparities.
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Affiliation(s)
- Scherezade K Mama
- Department of Kinesiology, The Pennsylvania State University, 268J Recreation Building, University Park, PA, 16802, USA.
- Penn State Cancer Institute, Hershey, PA, USA.
| | - Nishat Bhuiyan
- Department of Kinesiology, The Pennsylvania State University, 268J Recreation Building, University Park, PA, 16802, USA
| | - Wayne Foo
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Joel E Segel
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, USA
| | - Shirley M Bluethmann
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Renate M Winkels
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
- Human Nutrition & Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Joachim Wiskemann
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
| | - William A Calo
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Eugene J Lengerich
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Kathryn H Schmitz
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
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25
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Calo WA, Doerksen SE, Spanos K, Pergolotti M, Schmitz KH. Implementing Strength after Breast Cancer (SABC) in outpatient rehabilitation clinics: mapping clinician survey data onto key implementation outcomes. Implement Sci Commun 2020; 1:69. [PMID: 32885221 PMCID: PMC7427930 DOI: 10.1186/s43058-020-00060-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 07/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background While 3.5 million breast cancer survivors in the USA are indicative of promising disease-free survival, many experience adverse effects in recovering from treatment. Evidence-based exercise programs may be a low-cost, easily disseminable solution to the challenge of recovering from adverse treatment affects. Therefore, after establishing efficacy in a large randomized controlled trial, we developed the Strength after Breast Cancer (SABC) program and the accompanying online course for clinicians interested in physical therapy to learn to deliver this rehabilitative exercise program to individuals with breast cancer. We surveyed clinicians who took the course to assess implementation of the program in outpatient rehabilitation clinics. Methods Ninety-six clinicians completed the survey between June and December, 2017 (24% response). Guided by Proctor's implementation outcomes framework, the respondents were asked if they had implemented (adoption) and are still implementing the program (sustainability), and which programmatic components they implemented (fidelity). Respondents were asked how many patients completed the program (reach), how patients got into the program (reach), the program's delivery format (appropriateness), and whether clinics were reimbursed by third-party payers (cost). Finally, respondents were asked what barriers they faced in delivery of SABC (feasibility) and whether others in the clinic completed the course (penetration). Results Seventy-six percent of respondents implemented SABC and among those, 93% (68/73) were still delivering it. All programmatic components were implemented by over two thirds of respondents (67-95%). On average, the program was delivered to 13 patients per clinic by the time respondents took the survey. Most patient referrals were from oncology clinics (50%). The majority of clinicians delivered SABC one-on-one (96%) and 72% of clinics were compensated via third-party payers. Major barriers were lack of referrals from oncologists (40%) and clinic's competing demands (33%). We found no differences (Fisher's exact test p > .05) in reported barriers between those who implemented the program and those who did not. Conclusion Our findings suggest that the online training was sufficient to successfully implement the SABC program in outpatient rehabilitation clinics with high levels of adoption, fidelity, reach, and capacity for sustainability. Information on patient acceptability, cost-effectiveness, and how to overcome implementation barriers are still needed.
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Affiliation(s)
- William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, 500 University Drive, Mail Code CH69, Hershey, PA 17033 USA.,Penn State Cancer Institute, Hershey, PA USA
| | - Shawna E Doerksen
- Department of Public Health Sciences, Penn State College of Medicine, 500 University Drive, Mail Code CH69, Hershey, PA 17033 USA
| | - Katherine Spanos
- Department of Public Health Sciences, Penn State College of Medicine, 500 University Drive, Mail Code CH69, Hershey, PA 17033 USA.,Dartmouth College, Hanover, NH USA
| | - Mackenzi Pergolotti
- ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA USA.,Department of Occupational Therapy, Colorado State University, Fort Collins, CO USA
| | - Kathryn H Schmitz
- Department of Public Health Sciences, Penn State College of Medicine, 500 University Drive, Mail Code CH69, Hershey, PA 17033 USA.,Penn State Cancer Institute, Hershey, PA USA
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26
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Calo WA, Murray A, Francis E, Bermudez M, Kraschnewski J. Reaching the Hispanic Community About COVID-19 Through Existing Chronic Disease Prevention Programs. Prev Chronic Dis 2020; 17:E49. [PMID: 32584753 PMCID: PMC7316420 DOI: 10.5888/pcd17.200165] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Publicly available data on racial and ethnic disparities related to coronavirus disease 2019 (COVID-19) are now surfacing, and these data suggest that the novel virus has disproportionately sickened Hispanic communities in the United States. We discuss why Hispanic communities are highly vulnerable to COVID-19 and how adaptations were made to existing infrastructure for Penn State Project ECHO (Extension for Community Healthcare Outcomes) and Better Together REACH (a community–academic coalition using grant funds from Racial and Ethnic Approaches to Community Health) to address these needs. We also describe programming to support COVID-19 efforts for Hispanic communities by using chronic disease prevention programs and opportunities for replication across the country.
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Affiliation(s)
- William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.,Penn State Cancer Institute, Hershey, Pennsylvania
| | - Andrea Murray
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Erica Francis
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Madeline Bermudez
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Jennifer Kraschnewski
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.,Department of Medicine, Penn State College of Medicine, 90 Hope Drive, Mail Code A210, Hershey, PA 17033.
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27
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Leon Y, Ruiz LA, Calo WA, Vadaparampil ST, Velez-Cintron R. Abstract C127: Prevalence of human papillomavirus infection in a sample of 21- to 29-year-old women living in Puerto Rico. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-c127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Human Papillomavirus (HPV) is the most common sexually transmitted infection worldwide. High-risk HPV infections are observed in women with genotypes 16 and 18, among others, and are the main risk factor for cervical cancer. Cervical cancer is the seventh most diagnosed cancer among women in Puerto Rico, and accounts for 2.5% of mortality rates. The aim of this study was to establish the prevalence of high-risk HPV, in a large cohort of women ages 21 to 29 living in Puerto Rico during 2014-2016. Method: A retrospective longitudinal analysis was performed to a sample of 5,749 HPV results that were recorded in a clinical database of Puerto Rican women ages 21 to 29 from 2014-2016. Furthermore, the prevalence of the high-risk HPV genotypes, 16 and / or 18, was ascertained along with the proportion of women who resolved the initial positive infection during the study period. Results and Conclusion: We found that among those with a positive HPV result, about one-third (35.17%) had a high-risk HPV infection. Women between the ages 21 to 23 showed the highest prevalence (40.6%) of high-risk HPV compared to the other age groups. Among all high-risk HPV, genotype 16 was the most prevalent. About a subsample of 458 women had at least two positive results of HPV infection, 217 of those women had an initial positive result for HPV and only 108 (49.7%) showed a resolution of the infection. Our study confirms there is a high prevalence of high-risk HPV in young women compared to other age groups. Discussion: Women with persistent HPV infection have a major risk factor for developing cervical cancer. There is an urgent need to develop a good prevention strategy to reduce the high-risk HPV infections, especially in the younger population, as was shown in this study. Future research is needed to assess the impact of preventive methods, such as the HPV vaccine, and the outcome in the prevalence and incidence of cervical cancer and other HPV-related cancers. Promoting education and awareness could further reduce the HPV-associated cancer burden, prevalence and incidence in this minority population.
Citation Format: Yaritza Leon, Lynnette A Ruiz, William A Calo, Susan T Vadaparampil, Rosa Velez-Cintron. Prevalence of human papillomavirus infection in a sample of 21- to 29-year-old women living in Puerto Rico [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C127.
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Affiliation(s)
| | - Lynnette A Ruiz
- 2Division of Basic Sciences, Ponce Health Sciences University-Ponce Research Institute, Ponce, PR, USA,
| | - William A Calo
- 3Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA,
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28
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Ortiz AP, Calo WA, Mendez-Lazaro P, García-Camacho S, Mercado-Casillas A, Cabrera-Márquez J, Tortolero-Luna G. Strengthening Resilience and Adaptive Capacity to Disasters in Cancer Control Plans: Lessons Learned from Puerto Rico. Cancer Epidemiol Biomarkers Prev 2020; 29:1290-1293. [PMID: 32317299 DOI: 10.1158/1055-9965.epi-19-1067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/18/2019] [Accepted: 04/15/2020] [Indexed: 11/16/2022] Open
Abstract
Patients with cancer are among the most vulnerable populations in the aftermath of a disaster. They are at higher risk of medical complications and death due to the collapse of or disruptions in the health care system, the community infrastructure, and the complexity of cancer care. The United Nations' Sendai Framework for Disaster Reduction states that people with life-threatening and chronic diseases should be considered in disaster plans to manage their risks. With extreme weather or disasters becoming more intense and frequent and with the high burden of cancer in the United States and its territories, it is important to develop region-specific plans to mitigate the impact of these events on the cancer patient population. After Hurricanes Irma and Maria hit Puerto Rico and the U.S. Virgin Islands in 2017, the need to develop and implement such plans for patients with cancer was evident. We describe ongoing efforts and opportunities for disseminating and implementing emergency response plans to maintain adequate cancer care for patients during and after disasters. While plans for patients with cancer should be housed within the emergency support function infrastructure of each jurisdiction, the Centers for Disease Control and Prevention's Comprehensive Cancer Control Plans provide excellent community-centered mechanisms to support these efforts.
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Affiliation(s)
- Ana P Ortiz
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico. .,Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - William A Calo
- Penn State College of Medicine, Hershey, Pennsylvania.,Penn State Cancer Institute, Hershey, Pennsylvania
| | - Pablo Mendez-Lazaro
- Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Sandra García-Camacho
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Ana Mercado-Casillas
- Office of Public Health Preparedness and Response, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Jessica Cabrera-Márquez
- Office of Public Health Preparedness and Response, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Guillermo Tortolero-Luna
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
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Calo WA, Brewer NT. HPV vaccine requirements, opt-outs and providers' support: Key studies missing from a recent systematic review. Hum Vaccin Immunother 2019; 16:128-130. [PMID: 31339803 DOI: 10.1080/21645515.2019.1646580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.,Penn State Cancer Institute, Hershey, PA, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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30
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Spencer JC, Calo WA, Brewer NT. Disparities and reverse disparities in HPV vaccination: A systematic review and meta-analysis. Prev Med 2019; 123:197-203. [PMID: 30930259 PMCID: PMC6724708 DOI: 10.1016/j.ypmed.2019.03.037] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 03/21/2019] [Accepted: 03/28/2019] [Indexed: 01/20/2023]
Abstract
Studies disagree about whether racial and ethnic groups have lower or higher human papillomavirus (HPV) vaccination uptake, an important issue given large disparities in some HPV cancers. We sought to characterize and explain racial and ethnic differences in HPV vaccination. We systematically searched PubMed, CINAHL, Embase, and Web of Science to identify US studies through mid-2017 reporting associations of race and ethnicity with HPV vaccination. We identified 118 studies (n = 3,095,486) published in English that reported HPV vaccine initiation or follow-through in the US from which we could calculate effect sizes. We used random effects meta-analysis to synthesize effect sizes for comparisons of Whites or non-Hispanics to Blacks, Hispanics, Asians, or all minority groups combined. Studies showed no racial or ethnic differences in HPV vaccine initiation overall. However, when restricting to studies using provider-verified vaccination data, minorities were 6.1% [3.3%-8.8%] more likely than Whites to initiate HPV vaccination. Advantages were larger for Hispanics, males, and younger samples (age < 18). In contrast, minorities were 8.6% [5.6%, 11.7%], less likely than Whites to follow-through with the full HPV vaccine series, a disparity present across all participant and study characteristics. More recent studies found larger advantages for racial and ethnic minorities in HPV vaccine initiation and smaller disparities in follow-through. In summary, high-quality studies found racial and ethnic minorities are more likely to initiate but less likely to follow-through with HPV vaccination, a clear finding that self-report studies obscure. Higher HPV vaccine initiation among minorities suggests potential reductions in HPV cancer disparities.
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Affiliation(s)
- Jennifer C Spencer
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States of America.
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, United States of America
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina, United States of America
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31
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Calo WA, Shah PD, Gilkey MB, Vanderpool RC, Barden S, Doucette WR, Brewer NT. Implementing pharmacy-located HPV vaccination: findings from pilot projects in five U.S. states. Hum Vaccin Immunother 2019; 15:1831-1838. [PMID: 30945968 DOI: 10.1080/21645515.2019.1602433] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Pharmacies are promising alternative settings for human papillomavirus (HPV) vaccination because of their population reach, convenience, and existing infrastructure for vaccine delivery. However, pharmacies in the US are rarely used for adolescent HPV vaccination. We sought to document challenges and opportunities of implementing pharmacy-located HPV vaccination services in five US states by mapping process evaluation results onto key implementation science constructs: service penetration, acceptability, appropriateness, feasibility, fidelity, adoption, and sustainability. Pilot projects were planned in North Carolina (k = 2 pharmacies), Michigan (k = 10), Iowa (k = 2), Kentucky (k = 1), and Oregon (no pharmacy recruited) with varying procedures and recruitment strategies. Sites had open enrollment for a combined 12 months. Despite substantial efforts in these states, only 13 HPV vaccine doses were administered to adolescents and three doses to age-eligible young adults. We identified two major reasons for these underperforming results. First, poor outcomes on service penetration and appropriateness pointed to engagement barriers: low parent demand and engagement among pharmacy staff. Second, poor outcomes on feasibility, adoption, and sustainability appeared to result from administrative hurdles: lacking third party reimbursement (i.e., billing commercial payers, participation in Vaccines for Children program) and limited integration into primary care systems. In summary, pilot projects in five states all struggled to administer HPV vaccines. Opportunities for making pharmacies a successful setting for adolescent HPV vaccination include expanding third party reimbursement to cover all vaccines administered by pharmacists, increasing public awareness of pharmacists' immunization training, and improving care coordination with primary care providers.
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Affiliation(s)
- William A Calo
- a Department of Public Health Sciences, Penn State College of Medicine , Hershey , PA , USA.,b Penn State Cancer Institute , Hershey , PA , USA
| | - Parth D Shah
- c The Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center , Seattle , WA , USA
| | - Melissa B Gilkey
- d Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA.,e Lineberger Comprehensive Cancer Center, University of North Carolina , Chapel Hill , NC , USA
| | - Robin C Vanderpool
- f Department of Health, Behavior and Society, College of Public Health, University of Kentucky , Lexington , KY , USA
| | - Sarah Barden
- g Michigan Pharmacists Association , Lansing , MI , USA
| | - William R Doucette
- h Health Services Research Division, University of Iowa College of Pharmacy , Iowa City , IA , USA
| | - Noel T Brewer
- d Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA.,e Lineberger Comprehensive Cancer Center, University of North Carolina , Chapel Hill , NC , USA
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Calo WA, Gilkey MB, Leeman J, Heisler-MacKinnon J, Averette C, Sanchez S, Kornides ML, Brewer NT. Coaching primary care clinics for HPV vaccination quality improvement: Comparing in-person and webinar implementation. Transl Behav Med 2019; 9:23-31. [PMID: 29471460 DOI: 10.1093/tbm/iby008] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
State health departments commonly use quality improvement coaching as an implementation strategy for improving low human papillomavirus (HPV) vaccination coverage, but such coaching can be resource intensive. To explore opportunities for improving efficiency, we compared in-person and webinar delivery of coaching sessions on implementation outcomes, including reach, acceptability, and delivery cost. In 2015, we randomly assigned 148 high-volume primary care clinics in Illinois, Michigan, and Washington State to receive either in-person or webinar coaching. Coaching sessions lasted about 1 hr and used our Immunization Report Card to facilitate assessment and feedback. Clinics served over 213,000 patients ages 11-17. We used provider surveys and delivery cost assessment to collect implementation data. This report is focused exclusively on the implementation aspects of the intervention. More providers attended in-person than webinar coaching sessions (mean 9 vs. 5 providers per clinic, respectively, p = .004). More providers shared the Immunization Report Card at clinic staff meetings in the in-person than webinar arm (49% vs. 20%; p = .029). In both arms, providers' belief that their clinics' HPV vaccination coverage was too low increased, as did their self-efficacy to help their clinics improve (p < .05). Providers rated coaching sessions in the two arms equally highly on acceptability. Delivery cost per clinic was $733 for in-person coaching versus $461 for webinar coaching. In-person and webinar coaching were well received and yielded improvements in provider beliefs and self-efficacy regarding HPV vaccine quality improvement. In summary, in-person coaching cost more than webinar coaching per clinic reached, but reached more providers. Further implementation research is needed to understand how and for whom webinar coaching may be appropriate.
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Affiliation(s)
- William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.,Penn State Cancer Institute, Hershey, PA, USA
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer Leeman
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer Heisler-MacKinnon
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Chrystal Averette
- Washington State Department of Health, Office of Immunization and Child Profile, Olympia, WA, USA
| | - Stephanie Sanchez
- Michigan Department of Community Health, Division of Immunization, Lansing, MI, USA
| | - Melanie L Kornides
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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Shah PD, Calo WA, Gilkey MB, Boynton MH, Alton Dailey S, Todd KG, Robichaud MO, Margolis MA, Brewer NT. Questions and Concerns About HPV Vaccine: A Communication Experiment. Pediatrics 2019; 143:peds.2018-1872. [PMID: 30670584 PMCID: PMC6361359 DOI: 10.1542/peds.2018-1872] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2018] [Indexed: 12/11/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5972295740001PEDS-VA_2018-1872Video Abstract OBJECTIVES: We sought to identify effective responses to parents' questions and concerns about human papillomavirus (HPV) vaccine. METHODS In 2017-2018, we surveyed a national sample of 1196 US parents of children aged 9 to 17 years. We recorded brief videos of a pediatrician providing messages that addressed 7 HPV vaccination topics that commonly elicit questions or concerns (eg, recommended age). We randomly assigned parents to 1 of the message topics; parents then viewed 4 videos on that topic in random order and evaluated the messages. RESULTS Parents were more confident in HPV vaccine when they were exposed to messages that addressed lack of knowledge about HPV vaccine (b = 0.13; P = .01), messages that included information about cancer prevention (b = 0.11; P < .001), messages that required a higher reading level (b = 0.02; P = .01), and messages that were longer (b = 0.03; P < .001). Parents were less confident in HPV vaccine when exposed to messages in which urgency was expressed (b = -0.06; P = .005). Analyses conducted by using HPV vaccine motivation as an outcome revealed the same pattern of findings. CONCLUSIONS We provide research-tested messages that providers can use to address parents' HPV vaccination questions and concerns about 7 common topics. Important principles for increasing message effectiveness are to include information on the benefits of vaccination (including cancer prevention) and avoid expressing urgency to vaccinate when addressing parents' questions or concerns. Additionally, providers may need to be prepared to have longer conversations with parents who express concerns about HPV vaccine, especially regarding safety and side effects.
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Affiliation(s)
- Parth D. Shah
- Public Health Sciences Division, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington;,Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
| | - William A. Calo
- Department of Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania;,Penn State Cancer Institute, Hershey, Pennsylvania; and
| | - Melissa B. Gilkey
- Department of Health Behavior, Gillings School of Global Public Health,,Lineberger Comprehensive Cancer Center, School of Medicine, and
| | - Marcella H. Boynton
- Department of Health Behavior, Gillings School of Global Public Health,,Lineberger Comprehensive Cancer Center, School of Medicine, and
| | | | - Karen G. Todd
- Public Health Leadership Program and,SAFEchild Advocacy Center, Raleigh, North Carolina
| | | | | | - Noel T. Brewer
- Department of Health Behavior, Gillings School of Global Public Health,,Lineberger Comprehensive Cancer Center, School of Medicine, and
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Margolis MA, Brewer NT, Shah PD, Calo WA, Gilkey MB. Stories about HPV vaccine in social media, traditional media, and conversations. Prev Med 2019; 118:251-256. [PMID: 30414396 DOI: 10.1016/j.ypmed.2018.11.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/25/2018] [Accepted: 11/04/2018] [Indexed: 11/18/2022]
Abstract
How stories from media and social interactions shape parents' HPV vaccination decisions is poorly understood. We sought to characterize parents' exposure to such stories, as well as associations between story exposure and vaccination behavior. Study participants were 1263 parents of U.S. adolescents who had not yet completed the HPV vaccine series. In 2017, these parents completed an online survey about whether they had heard stories of people who were harmed by HPV vaccine or who got diseases HPV vaccine could have prevented. Almost half of parents had heard HPV vaccine stories, which were about vaccine harms only (19%), vaccine preventable diseases only (11%), or both (15%). Stories of harms more often came from social and traditional media; stories of preventable diseases more often came from conversations (all p < 0.01). Parents who heard only stories about harms were less likely than those who heard no stories to have initiated HPV vaccination (23% vs. 33%, aOR:0.48; 95% CI:0.33:0.69). They were more likely to have delayed (79% vs. 66%, aOR:2.00; 95% CI:1.09:3.71) or refused (72% vs. 24%, aOR:8.87; 95% CI:4.09:19.25) HPV vaccination. Exposure to both stories about harms and preventable diseases was similarly associated with initiation, delay and refusal. Exposure to only stories about preventable diseases was not associated with initiation, delay or refusal. In conclusion, stories of HPV vaccine harms may be associated more strongly with vaccination behavior than stories of HPV vaccine preventable diseases. Communication campaigns should consider strategies to elevate stories of preventable diseases in social and traditional media.
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Affiliation(s)
- Marjorie A Margolis
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 317 Rosenau Hall CB7440, Chapel Hill, NC 27599, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 317 Rosenau Hall CB7440, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, USA
| | - Parth D Shah
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, USA
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, USA; Penn State Hershey Cancer Institute, USA
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 317 Rosenau Hall CB7440, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, USA.
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Calo WA, Gilkey MB, Malo TL, Robichaud M, Brewer NT. A content analysis of HPV vaccination messages available online. Vaccine 2018; 36:7525-7529. [PMID: 30366803 DOI: 10.1016/j.vaccine.2018.10.053] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/13/2018] [Accepted: 10/15/2018] [Indexed: 12/11/2022]
Abstract
Parents have varied HPV vaccine communication needs, which presents a challenge for healthcare providers. To improve communication resources for providers, we sought to characterize HPV vaccination messages available in existing educational materials. In fall 2016, we searched PubMed, educational material clearinghouses, and Google for English language HPV vaccination messages. We extracted messages that a provider might use when raising the topic of HPV vaccination, answering common questions, and motivating vaccination. Two reviewers independently coded each message. The search identified 267 unique messages about HPV vaccination. Messages generally were long (mean no. of words = 44, standard deviation [SD] = 33) and required a high level of education to read (mean reading grade level = 10, SD = 3). Only 32% of messages were shorter than 25 words, and 12% had a readability at or below grade 6. Most frequent were messages to address common parent questions or concerns (62%); the most common topics were diseases prevented by HPV vaccine (18%) and safety and side effects (16%). Many messages included information about cancer prevention (26%) and same-day vaccination (13%). Few messages (6%) used a presumptive style to recommend HPV vaccination. In conclusion, available messages about HPV vaccination were markedly varied. We identified few messages that were both brief (to facilitate providers memorizing them) and accessible (to facilitate parents understanding them). Future research should identify which messages lead to HPV vaccine uptake.
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Affiliation(s)
- William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA; Penn State Cancer Institute, Hershey, PA 17033, USA.
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Teri L Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Meagan Robichaud
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA
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Shah PD, Calo WA, Marciniak MW, Gilkey MB, Brewer NT. Support for Pharmacist-Provided HPV Vaccination: National Surveys of U.S. Physicians and Parents. Cancer Epidemiol Biomarkers Prev 2018; 27:970-978. [PMID: 29871883 DOI: 10.1158/1055-9965.epi-18-0380] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/19/2018] [Accepted: 05/30/2018] [Indexed: 11/16/2022] Open
Abstract
Background: State laws about pharmacists providing human papillomavirus (HPV) vaccines vary considerably, limiting many pharmacists' ability to provide this important cancer prevention service. We characterized physician and parent support for pharmacist-provided HPV vaccination for adolescents who are past due for vaccination.Methods: In 2014 to 2015, we conducted two national U.S. surveys of 776 primary care physicians (PCPs) and 1,504 parents of adolescents. Respondents indicated the extent to which they supported pharmacist-provided HPV vaccination for 13- to 17-year-olds who are past due. Respondents could endorse the provision unconditionally, or only if certain conditions were met, such as pharmacists receiving proper vaccination training. We used multivariable logistic regression to assess correlates of support.Results: Most physicians (79%) and parents (81%) endorsed pharmacist-provided HPV vaccination if pharmacists had received proper vaccination training, reported vaccine doses to adolescents' PCP, and referred adolescents to PCPs for other health services. Family medicine physicians were more likely than pediatricians to support trained pharmacists providing HPV vaccination [OR = 1.62; 95% confidence interval (CI) 1.17-2.22]. Support was also higher among physicians who practiced in Western states (OR = 2.11; 95% CI, 1.30-3.40). Parents' odds of endorsing trained pharmacists provision of HPV vaccine increased with higher overall satisfaction with their pharmacy's services (OR = 1.10; 95% CI, 1.02-1.19), belief in pharmacists' competence in vaccination practices (OR = 1.42; 95% CI, 1.18-1.70), and overall vaccine confidence (OR = 1.30; 95% CI, 1.15-1.48).Conclusions: To increase support for HPV vaccination services, pharmacists should raise awareness about their immunization training and standardize vaccination protocols that ensure coordination with primary care.Impact: Stakeholders' feedback and buy-in is important to help guide expansion of HPV vaccination in pharmacies. Cancer Epidemiol Biomarkers Prev; 27(8); 970-8. ©2018 AACR.
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Affiliation(s)
- Parth D Shah
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina. .,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.,Penn State Cancer Institution, Hershey, Pennsylvania
| | - Macary W Marciniak
- Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.,UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina. .,UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
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Calo WA, Bluethmann S, Foo W, Lengerich E, Mama S, Segel J, Winkels R, Wiskemann J, Schmitz K. Exploring Racial/Ethnic Differences in Physical Activity and Behavioral Risk Factors among Cancer Survivors in Central Pennsylvania. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536320.65565.a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Shah PD, Calo WA, Marciniak MW, Golin CE, Sleath BL, Brewer NT. Service quality and parents' willingness to get adolescents HPV vaccine from pharmacists. Prev Med 2018; 109:106-112. [PMID: 29330033 PMCID: PMC5843559 DOI: 10.1016/j.ypmed.2018.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/30/2017] [Accepted: 01/07/2018] [Indexed: 12/11/2022]
Abstract
We sought to examine whether pharmacy service quality was associated with parents' willingness to have immunizing pharmacists administer human papillomavirus (HPV) vaccine to their adolescent children. Participants were a national sample of 1504 US parents of adolescents ages 11 to 17 who completed an online survey in 2014. Analyses used structural equation modeling. Parents rated service quality and feelings of satisfaction with their pharmacies as moderate to high. Many (44%) were willing to get HPV vaccine from immunizing pharmacists for their adolescent children. Compared with parents who went to chain pharmacies, parents who went to independent pharmacies gave higher ratings of service quality (professionalism, confidentiality, milieu, all p < .001). Parents who went to clinic pharmacies, compared with parents who went to chain pharmacies gave lower ratings for milieu (p < .01). Parents who went to independent pharmacies had lower willingness to get HPV vaccine from pharmacists compared to parents who went to chain pharmacies (p = .001), but there was no difference in willingness for parents who went to clinic versus chain pharmacies. Service quality and satisfaction partially mediated the effect between independent pharmacies compared to chain pharmacies and willingness (p < .05). Parents who knew their pharmacists or expressed more confidence in HPV vaccine also had higher willingness to get their children HPV vaccine from pharmacist. Many parents were willing to go to immunizing pharmacists for their children's HPV vaccination. Pharmacies that are considering offering HPV vaccine may be able to improve vaccine uptake by increasing perception of service quality.
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Affiliation(s)
- Parth D Shah
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, United States; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, United States.
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, United States; Penn State Cancer Institute, United States
| | - Macary W Marciniak
- Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, University of North Carolina, United States
| | - Carol E Golin
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, United States; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, United States
| | - Betsy L Sleath
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, United States; Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, United States
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, United States; Lineberger Comprehensive Cancer Center, University of North Carolina, United States.
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Fernandez ME, Walker TJ, Weiner BJ, Calo WA, Liang S, Risendal B, Friedman DB, Tu SP, Williams RS, Jacobs S, Herrmann AK, Kegler MC. Developing measures to assess constructs from the Inner Setting domain of the Consolidated Framework for Implementation Research. Implement Sci 2018; 13:52. [PMID: 29587804 PMCID: PMC5870186 DOI: 10.1186/s13012-018-0736-7] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 03/05/2018] [Indexed: 01/13/2023] Open
Abstract
Background Scientists and practitioners alike need reliable, valid measures of contextual factors that influence implementation. Yet, few existing measures demonstrate reliability or validity. To meet this need, we developed and assessed the psychometric properties of measures of several constructs within the Inner Setting domain of the Consolidated Framework for Implementation Research (CFIR). Methods We searched the literature for existing measures for the 7 Inner Setting domain constructs (Culture Overall, Culture Stress, Culture Effort, Implementation Climate, Learning Climate, Leadership Engagement, and Available Resources). We adapted items for the healthcare context, pilot-tested the adapted measures in 4 Federally Qualified Health Centers (FQHCs), and implemented the revised measures in 78 FQHCs in the 7 states (N = 327 respondents) with a focus on colorectal cancer (CRC) screening practices. To psychometrically assess our measures, we conducted confirmatory factor analysis models (CFA; structural validity), assessed inter-item consistency (reliability), computed scale correlations (discriminant validity), and calculated inter-rater reliability and agreement (organization-level construct reliability and validity). Results CFAs for most constructs exhibited good model fit (CFI > 0.90, TLI > 0.90, SRMR < 0.08, RMSEA < 0.08), with almost all factor loadings exceeding 0.40. Scale reliabilities ranged from good (0.7 ≤ α < 0.9) to excellent (α ≥ 0.9). Scale correlations fell below 0.90, indicating discriminant validity. Inter-rater reliability and agreement were sufficiently high to justify measuring constructs at the clinic-level. Conclusions Our findings provide psychometric evidence in support of the CFIR Inner Setting measures. Our findings also suggest the Inner Setting measures from individuals can be aggregated to represent the clinic-level. Measurement of the Inner Setting constructs can be useful in better understanding and predicting implementation in FQHCs and can be used to identify targets of strategies to accelerate and enhance implementation efforts in FQHCs.
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Affiliation(s)
- Maria E Fernandez
- University of Texas Health Science Center at Houston, Center for Health Promotion and Prevention Research, School of Public Health, 7000 Fannin St, Houston, TX, 77030, USA.
| | - Timothy J Walker
- University of Texas Health Science Center at Houston, Center for Health Promotion and Prevention Research, School of Public Health, 7000 Fannin St, Houston, TX, 77030, USA
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Box 357965, 1510 San Juan Road, Seattle, WA, 98195, USA
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Mail Code CH69
- 500 University Drive, Hershey, PA, 17033, USA
| | - Shuting Liang
- Emory Prevention Research Center, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30033, USA
| | - Betsy Risendal
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Comprehensive Cancer Center, 13001 E. 17th Place, MSF538, Aurora, CO, 80045, USA
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior and the Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Shin Ping Tu
- Department of Internal Medicine, University of California Davis, Suite 2400 , 4150 V Street, Sacramento, CA, 95817, USA
| | - Rebecca S Williams
- Center for Health Promotion and Disease Prevention, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, CB 7424, Chapel Hill, NC, 27599, USA
| | - Sara Jacobs
- Public Health Research Division, RTI International, 3040 East Cornwallis Road, Research Triangle Park, Durham, NC, 27709-2194, USA
| | - Alison K Herrmann
- UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, 650 Charles E. Young Dr. S., A2-125 CHS, Box 690015, Los Angeles, CA, 90095-6900, USA
| | - Michelle C Kegler
- Emory Prevention Research Center, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30033, USA
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Colón-López V, González D, Vélez C, Fernández-Espada N, Soler AF, Escobar KA, Ayala-Marín AM, Soto-Salgado M, Calo WA, Aragón AP, Rivera-Díaz M, Fernández ME. Community-Academic Partnership to Implement a Breast and Cervical Cancer Screening Education Program in Puerto Rico. P R Health Sci J 2017; 36:191-197. [PMID: 29220062 PMCID: PMC5835963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To describe how a community-academic partnership between Taller Salud Inc., a community-based organization, and the Puerto Rico Community Cancer Control Outreach Program of the University of Puerto Rico was crucial in the adaptation and implementation of Cultivando La Salud (CLS), an evidencebased educational outreach program designed to increase breast and cervical cancer screening among Hispanic women living in Puerto Rico. This collaboration facilitated the review and adaptation of the CLS intervention to improve cultural appropriateness, relevance, and acceptability for Puerto Rican women. METHODS A total of 25 interviewers and 12 Lay Health Workers (LHWs) were recruited and trained to deliver the program. The interviewers recruited women who were non-adherent to recommended screening guidelines for both breast and cervical cancer. LHWs then provided one-on-one education using the adapted CLS materials. RESULTS A total of 444 women were recruited and 48% of them were educated through this collaborative effort. CONCLUSION Our main accomplishment was establishing the academic-community partnership to implement the CLS program. Nevertheless, in order to promote better collaborations with our community partners, it is important to carefully delineate and establish clear roles and shared responsibilities for each partner for the successful execution of research activities, taking into consideration the community's needs.
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Affiliation(s)
- Vivian Colón-López
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR
- Department of Health Services Administration, Evaluation Program, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, PR
- University of Puerto Rico-MD Anderson Cancer Center Partnership for Excellence in Cancer Research Program, Medical Sciences Campus, University of Puerto Rico, San Juan, PR
| | - Daisy González
- University of Puerto Rico-MD Anderson Cancer Center Partnership for Excellence in Cancer Research Program, Medical Sciences Campus, University of Puerto Rico, San Juan, PR
| | - Camille Vélez
- University of Puerto Rico-MD Anderson Cancer Center Partnership for Excellence in Cancer Research Program, Medical Sciences Campus, University of Puerto Rico, San Juan, PR
| | - Natalie Fernández-Espada
- The University of Texas School of Public Health, Center for Health Promotion and Prevention Research, Houston, Texas
| | | | | | - Alelí M. Ayala-Marín
- University of Puerto Rico-MD Anderson Cancer Center Partnership for Excellence in Cancer Research Program, Medical Sciences Campus, University of Puerto Rico, San Juan, PR
- Doctoral Program on Health Sciences and Sport, Health Sciences Faculty, Department of Psychiatrist and Nurse, University of Zaragoza, Spain
| | - Marievelisse Soto-Salgado
- University of Puerto Rico-MD Anderson Cancer Center Partnership for Excellence in Cancer Research Program, Medical Sciences Campus, University of Puerto Rico, San Juan, PR
| | - William A. Calo
- Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Angela Pattatucci Aragón
- Department of Health Services Administration, Evaluation Program, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, PR
- University of Puerto Rico-MD Anderson Cancer Center Partnership for Excellence in Cancer Research Program, Medical Sciences Campus, University of Puerto Rico, San Juan, PR
| | - Marinilda Rivera-Díaz
- University of Puerto Rico-MD Anderson Cancer Center Partnership for Excellence in Cancer Research Program, Medical Sciences Campus, University of Puerto Rico, San Juan, PR
- Center for Social Research, College of Social Sciences, University of Puerto Rico, Rio Piedras Campus, San Juan, PR
| | - María E. Fernández
- The University of Texas School of Public Health, Center for Health Promotion and Prevention Research, Houston, Texas
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Kornides ML, Calo WA, Heisler-MacKinnon JA, Gilkey MB. U.S. Primary Care Clinics' Experiences During Introduction of the 9-Valent HPV Vaccine. J Community Health 2017; 43:291-296. [PMID: 28856551 DOI: 10.1007/s10900-017-0420-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Changes in the routine immunization schedule are common and may pose challenges to primary care clinics. We sought to assess the experiences of U.S. providers and clinic staff during the introduction of 9-valent HPV vaccine. In 2015-2016, we conducted a survey in a probability sample of 127 pediatric (40%) and family medicine (60%) clinics in three U.S. states. The 211 respondents included clinicians (63%) and staff (37%). Overall, 83% of clinics stocked 9-valent HPV vaccine, with adoption ranging from 60% among early respondents to 100% among later respondents. Almost all respondents believed that providers in their clinics would recommend the 9-valent vaccine as strongly as (66%) or more strongly than (33%) the quadrivalent vaccine. Over half (61%) had no concerns about the 9-valent vaccine, while others reported concerns about increased parental hesitancy (29%), private insurance coverage (17%), or other issues (10%). Respondents from pediatric versus family medicine clinics more often reported a concern (OR = 2.06, 95% CI 1.02-4.15). Among the 169 respondents who stocked 9-valent vaccine, about half (56%, n = 94) anticipated that providers in their clinics would recommend a "booster" dose of 9-valent HPV vaccine for adolescents who had completed the 3-dose series with prior versions. Among the 42 respondents who did not stock 9-valent vaccine, few (17%, n = 7) believed providers would recommend adolescents delay vaccination until it was available. In conclusion, providers and staff generally had positive views of 9-valent HPV vaccine and many had no concerns. For others, responses regarding parental hesitancy, insurance coverage, and the use of booster doses suggests opportunities for enhancing future educational support.
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Affiliation(s)
- Melanie L Kornides
- Department of Population Medicine, Center for Healthcare Research in Pediatrics (CHeRP), Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, USA.
| | - William A Calo
- Department of Public Health Sciences and Penn State Cancer Institute, Penn State College of Medicine, Hershey, PA, USA
| | - Jennifer A Heisler-MacKinnon
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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Colón-López V, Fernández-Espada N, Vélez C, Gonzalez VJ, Diaz-Toro EC, Calo WA, Savas LS, Pattatucci A, Fernández ME. Communication about sex and HPV among Puerto Rican mothers and daughters. Ethn Health 2017; 22:348-360. [PMID: 27882783 PMCID: PMC5557394 DOI: 10.1080/13557858.2016.1246938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Although opportunities to vaccinate against human papillomavirus (HPV) are available, vaccination rates in Puerto Rico remain low. Communication between parents and adolescents about sexual topics may influence decisions about HPV vaccination uptake, particularly among young women; yet, few studies have addressed this issue. This qualitative study explored Puerto Rican mothers' and daughters' communication on sex-related topics, and HPV, including the HPV vaccine. DESIGN Thirty participants, including 9 mothers and 21 daughters, participated in seven focus groups. Participants were divided into groups of mothers and daughters, and further stratified by vaccination status. Transcripts were analyzed using a modified grounded theory approach to identify emergent themes. RESULTS Focus group data revealed four main themes: (1) limited parent-daughter communication about sex-related topics; (2) daughters' discomfort discussing sex-related topics with their parents; (3) parental focus on abstinence; and, (4) limited parent-daughter communication about HPV and the HPV vaccine. CONCLUSION Although daughters in this study struggled with feelings of embarrassment, invasion of privacy, encouragement of abstinence, and the fear of parents' reaction to them being sexually active prior to marriage, they also recognized the need to increase the parent-daughter communication about sex-related topics including HPV and the HPV vaccine. Educational efforts should target both daughters and parents to increase communication skills and self-efficacy and to enable them to discuss sexual health in open and nonjudgmental conversations.
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Affiliation(s)
- Vivian Colón-López
- Division of Population Health Sciences, PR Comprehensive Cancer Center, University of Puerto Rico, Medical Sciences Campus, PMB 371 P.O. Box 70344, San Juan, PR 00936-8344 787-772-8300 ext. 1225
- Health Services Administration, Evaluation Program, Graduate School of Public Health, University of Puerto Rico; PMB 371 P.O. Box 70344 San Juan, PR 00936-8344, 787-772-8300 ext. 1225
| | - Natalie Fernández-Espada
- The University of Texas School of Public Health, Center for Health Promotion and Prevention Research, 7000 Fannin Street, 25 floor, Houston, Texas 77030-3875. 713-500-9659, 713-500-9626, 713-500-9638
| | - Camille Vélez
- UPR-MDACC Partnership for Excellence in Cancer Research Program, University of Puerto Rico, PMB 371 P.O. Box 70344, San Juan, PR 00936-8344, 787-772-8300 ext. 1150
| | - Velda J. Gonzalez
- School of Nursing, University of Puerto Rico, Medical Sciences Campus, PMB 371 P.O. Box 70344, San Juan, PR 00936-8344, 787-758-2525 ext. 1986
| | - Elba C. Diaz-Toro
- Division of Population Health Sciences, PR Comprehensive Cancer Center, University of Puerto Rico, Medical Sciences Campus, PMB 371 P.O. Box 70344, San Juan, PR 00936-8344 787-772-8300 ext. 1225
- Department of Restorative Sciences, School of Dental Medicine, University of Puerto Rico; PMB 371 P.O. Box 70344 San Juan, PR 00936-8344, 787-772-8300 ext. 1101
| | - William A. Calo
- University of North Carolina, Gillings School of Global Public Health, Department of Health Policy and Management, 1104-I McGavran-Greenberg Bldg, CB 7411, Chapel Hill, NC 27599, (919) 966-4784
| | - Lara S. Savas
- The University of Texas School of Public Health, Center for Health Promotion and Prevention Research, 7000 Fannin Street, 25 floor, Houston, Texas 77030-3875. 713-500-9659, 713-500-9626, 713-500-9638
| | - Angela Pattatucci
- UPR-MDACC Partnership for Excellence in Cancer Research Program, University of Puerto Rico, PMB 371 P.O. Box 70344, San Juan, PR 00936-8344, 787-772-8300 ext. 1150
- Health Services Administration, Evaluation Program, Graduate School of Public Health, University of Puerto Rico; PMB 371 P.O. Box 70344 San Juan, PR 00936-8344, 787-772-8300 ext. 1225
| | - María E. Fernández
- The University of Texas School of Public Health, Center for Health Promotion and Prevention Research, 7000 Fannin Street, 25 floor, Houston, Texas 77030-3875. 713-500-9659, 713-500-9626, 713-500-9638
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Cole AM, Tu SP, Fernandez ME, Calo WA, Hotz J, Wolver S. Reported Use of Electronic Health Records to Implement Evidence Based Approaches to Colorectal Cancer Screening in Community Health Centers. J Health Care Poor Underserved 2017; 26:1235-45. [PMID: 26548676 DOI: 10.1353/hpu.2015.0120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Community health centers (CHCs) are critical sources of primary care for medically underserved populations. Electronic health records (EHRs) are important for implementation of evidence-based approaches for cancer control. METHODS Cross-sectional study of CHCs from the Cancer Prevention Control Research Network's community health center Clinic Characteristics Survey. Proportions of CHCs using EHR data to: 1) measure colorectal cancer screening, 2) deliver reports, and 3) provide patient reminders for colorectal cancer screening. RESULTS Only 27% of CHCs perceive EHR system's colorectal cancer screening data as very accurate. Over half (57%) of respondent CHCs with EHRs reported it is easy or very easy to do colorectal cancer screening activities using EHR systems. CONCLUSIONS Poor EHR data quality and cumbersome EHR systems may be significant barriers to implementation of evidence-based approaches to colorectal cancer screening in CHCs.
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Calo WA, Gilkey MB, Shah P, Marciniak MW, Brewer NT. Parents' willingness to get human papillomavirus vaccination for their adolescent children at a pharmacy. Prev Med 2017; 99:251-256. [PMID: 28188796 PMCID: PMC5545978 DOI: 10.1016/j.ypmed.2017.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 11/18/2022]
Abstract
Pharmacies are promising alternative settings for human papillomavirus (HPV) vaccination because of their accessibility and existing infrastructure for vaccine delivery. We sought to examine parents' willingness to get HPV vaccination for their children at pharmacies. In 2014, we conducted a national, online survey of 1255 parents of 11- to 17-year-old adolescents in the United States. We used multivariable logistic regression to model parents' willingness for getting HPV vaccinations in pharmacies. Overall, 29% of parents would be willing to get HPV vaccine for their children at a pharmacy. Parental willingness was associated with believing that pharmacists are skilled at administering vaccines (OR=2.05, 95% CI:1.68-2.51), HPV vaccine was at least as important as other adolescent vaccines (OR=1.48, 95% CI:1.10-1.98), and getting vaccines in pharmacies would give children more opportunities to get health care (OR=2.17, 95% CI:1.63-2.89). Parental willingness was also more common among parents of adolescents ages 13-17 or who had already initiated the HPV vaccine series. Parents most often indicated that they would like to learn about HPV vaccination in pharmacies from their children's doctor (37%). Offering HPV vaccine in pharmacies may increase uptake as a meaningful number of parents would get the vaccine for their children in these settings. Physician referrals for completing the HPV vaccine series may serve as an important source for increasing awareness of and demand for adolescent vaccination services in pharmacies.
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Affiliation(s)
- William A Calo
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Melissa B Gilkey
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, MA, USA; Dana-Farber/Harvard Cancer Center, Boston, MA, USA
| | - Parth Shah
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Macary W Marciniak
- Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
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Correa-Fernández V, Díaz-Toro EC, Reitzel LR, Guo L, Chen M, Li Y, Calo WA, Shih YCT, Wetter DW. Combined treatment for at-risk drinking and smoking cessation among Puerto Ricans: A randomized clinical trial. Addict Behav 2017; 65:185-192. [PMID: 27825036 PMCID: PMC5358923 DOI: 10.1016/j.addbeh.2016.10.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 09/29/2016] [Accepted: 10/20/2016] [Indexed: 11/19/2022]
Abstract
Tobacco and alcohol use are linked behaviors that individually and synergistically increase the risk for negative health consequences. This study was a two-group, randomized clinical trial evaluating the efficacy of a behavioral intervention, "Motivation And Problem Solving Plus" (MAPS+), designed to concurrently address smoking cessation and the reduction of at-risk drinking. Targeted interventions may promote coaction, the likelihood that changing one behavior (smoking) increases the probability of changing another behavior (alcohol use). Puerto Ricans (N=202) who were smokers and at-risk drinkers were randomized to standard MAPS treatment focused exclusively on smoking cessation (S-MAPS), or MAPS+, focused on cessation and at-risk drinking reduction. Drinking outcomes included: number of at-risk drinking behaviors, heavy drinking, binge drinking, and drinking and driving. MAPS+ did not have a significant main effect on reducing at-risk drinking relative to S-MAPS. Among individuals who quit smoking, MAPS+ reduced the number of drinking behaviors, the likelihood of meeting criteria for heavy drinking relative to S-MAPS, and appeared promising for reducing binge drinking. MAPS+ did not improve drinking outcomes among individuals who were unsuccessful at quitting smoking. MAPS+ showed promise in reducing at-risk drinking among Puerto Rican smokers who successfully quit smoking, consistent with treatment enhanced coaction. Integrating an alcohol intervention into cessation treatment did not reduce engagement in treatment, or hinder cessation outcomes, and positively impacted at-risk drinking among individuals who quit smoking. Findings of coaction between smoking and drinking speak to the promise of multiple health behavior change interventions for substance use treatment and chronic disease prevention.
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Affiliation(s)
- Virmarie Correa-Fernández
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, United States.
| | - Elba C Díaz-Toro
- Division of Cancer Control and Population Sciences, University of Puerto Rico, Comprehensive Cancer Center, PMB 371, PO Box 70344, San Juan, PR 00936-8344, Puerto Rico.
| | - Lorraine R Reitzel
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, United States.
| | - Lin Guo
- Department of Psychology, Rice University, 6500 Main St, Bioscience Research Collaborative, Houston, TX 77030, United States.
| | - Minxing Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Unit 1411, P.O. Box 301402, Houston, TX 77230, United States.
| | - Yisheng Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Unit 1411, P.O. Box 301402, Houston, TX 77230, United States.
| | - William A Calo
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1102-F McGavran-Greenberg Bldg, CB 7411, Chapel Hill, NC 27599-7411, United States.
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Unit 1444, P.O. Box 301402, Houston, TX 77230, United States.
| | - David W Wetter
- Department of Population Health Sciences and The Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84108, United States.
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Gichane MW, Calo WA, McCarthy SH, Walmer KA, Boggan JC, Brewer NT. Human Papillomavirus Awareness in Haiti: Preparing for a National HPV Vaccination Program. J Pediatr Adolesc Gynecol 2017; 30:96-101. [PMID: 27498340 PMCID: PMC5545972 DOI: 10.1016/j.jpag.2016.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE Cervical cancer morbidity and mortality are pressing public health issues that affect women in Haiti. To inform efforts to develop a human papillomavirus (HPV) vaccination program in Haiti, we sought to understand HPV awareness and willingness to get HPV vaccination in Haiti. DESIGN, SETTING, AND PARTICIPANTS We interviewed a convenience sample of 475 women and men in 2 clinical settings in Port-au-Prince and Léogâne, Haiti between April and July 2014. INTERVENTIONS AND MAIN OUTCOME MEASURES HPV awareness and willingness to get HPV vaccine for daughters. RESULTS Few participants (27%, 130/475) had heard of HPV. Awareness of HPV was higher among respondents with a previous sexually transmitted infection compared with those without a previous sexually transmitted infection (odds ratio, 2.38; 95% confidence interval, 1.10-5.13). Adults who had heard of genital warts were also more likely to be aware of HPV compared with those who had not (odds ratio, 4.37; 95% confidence interval, 2.59-7.38). Only 10% (24/250) of parents had previously heard of HPV vaccine; however, after researchers explained the purpose of the vaccine, nearly all (96%, 240/250) said they would be willing to get HPV vaccine for their daughters if it were available. CONCLUSION Despite low awareness of HPV in Haiti, interest in HPV vaccination was nearly universal in our study of health care-seeking adults. This high acceptability suggests that HPV vaccination programs instituted in Haiti would be well received.
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Affiliation(s)
- Margaret W Gichane
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - William A Calo
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Kathy A Walmer
- Family Health Ministries, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina
| | - Joel C Boggan
- Department of Medicine, Durham VA Medical Center, Durham, North Carolina
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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Calo WA, Suárez E, Soto-Salgado M, Quintana RA, Ortiz AP. Assessing lung cancer incidence disparities between Puerto Ricans and other racial/ethnic groups in the United States, 1992-2010. J Immigr Minor Health 2016; 17:971-5. [PMID: 25564340 DOI: 10.1007/s10903-014-0153-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study compared the incidence of lung cancer among Puerto Ricans (PRs) with that of Whites, Blacks, and Hispanics in the United States. We computed age-standardized rates of lung cancer during 1992-2010 and percentages of change over time. Standardized rate ratios (SRR) were estimated to assess racial/ethnic and gender differences. All men groups showed a significant decline in lung cancer over time but PRs observed the smallest change (-1.2%). For both men and women, PRs had lower incidence rates compared to other racial/ethnic groups (SRR < 1; P < 0.05). Among all groups, men reported higher incidence rates than women but PRs showed the largest gender disparity (SRR = 2.29). This study showed that although PRs exhibited lower incidence rates of lung cancer, this subgroup of Hispanics faced an important burden of lung cancer, principally because PR men had the smallest decline over time and the largest gender difference among all groups.
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Affiliation(s)
- William A Calo
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1102-F McGavran-Greenberg Bldg, CB 7411, Chapel Hill, NC, 27599-7411, USA,
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Gilkey MB, Calo WA, Marciniak MW, Brewer NT. Parents who refuse or delay HPV vaccine: Differences in vaccination behavior, beliefs, and clinical communication preferences. Hum Vaccin Immunother 2016; 13:680-686. [PMID: 27763818 DOI: 10.1080/21645515.2016.1247134] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND We sought to estimate the national prevalence of HPV vaccine refusal and delay in a nationally-representative sample of parents of adolescents. We also compared parents who refused versus delayed HPV vaccine in terms of their vaccination beliefs and clinical communication preferences. METHODS In 2014 to 2015, we conducted an online survey of 1,484 US parents who reported on an 11- to 17-year-old child in their household. We used weighted multinomial logistic regression to assess correlates of HPV vaccine refusal and delay. RESULTS Overall, 28% of parents reported that they had ever "refused or decided not to get" HPV vaccine for their child, and an additional 8% of parents reported that they had "delayed or put off getting" HPV vaccine. Compared to no refusal/delay, refusal was associated with lower confidence in adolescent vaccination (relative risk ratio [RRR] = 0.66, 95% confidence interval [CI], 0.48-0.91), lower perceived HPV vaccine effectiveness (RRR = 0.68, 95% CI, 0.50-0.91), and higher perceived harms (RRR = 3.49, 95% CI, 2.65-4.60). In contrast, delay was associated with needing more information (RRR = 1.76, 95% CI, 1.08-2.85). Most parents rated physicians and information sheets as helpful for making decisions about HPV vaccination, although parents who reported refusal endorsed these resources less often. CONCLUSIONS Our findings suggest that HPV vaccine refusal is common among parents of adolescents and may have increased relative to previous estimates. Because the vaccination beliefs and communication preferences of parents who refuse appear to differ from those who delay, targeted communication strategies may be needed to effectively address HPV vaccine hesitancy.
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Affiliation(s)
- Melissa B Gilkey
- a Department of Population Medicine , Harvard Medical School & Harvard Pilgrim Health Care Institute , Boston , MA , USA
| | - William A Calo
- b Department of Health Policy and Management , University of North Carolina , Chapel Hill , NC , USA
| | - Macary W Marciniak
- c Eshelman School of Pharmacy , University of North Carolina , Chapel Hill , NC , USA
| | - Noel T Brewer
- d Department of Health Behavior & Lineberger Comprehensive Cancer Center , University of North Carolina , Chapel Hill , NC , USA
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Calo WA, Gilkey MB, Shah PD, Moss JL, Brewer NT. Parents' Support for School-Entry Requirements for Human Papillomavirus Vaccination: A National Study. Cancer Epidemiol Biomarkers Prev 2016; 25:1317-25. [PMID: 27543621 DOI: 10.1158/1055-9965.epi-15-1159] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 06/16/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The number of states proposing school-entry requirements for human papillomavirus (HPV) vaccination has increased over the last decade. However, data are currently limited regarding parents' support of such laws. We sought to obtain the first national estimates of parents' support of HPV vaccination school-entry requirements. METHODS A national sample of 1,501 parents of 11- to 17-year-old children completed a web-based survey between November 2014 and January 2015. Analyses used multivariable logistic regression to assess correlates of support for school-entry requirements for HPV vaccination. RESULTS Overall, 21% of parents agreed that laws requiring HPV vaccination for school attendance "are a good idea," and 54% disagreed. If school-entry requirements included opt-out provisions, agreement increased to 57%, and only 21% disagreed. Parents more often agreed with requirements without opt-out provisions if they were Hispanic [OR = 1.53; 95% confidence interval (CI), 1.05-2.22], believed HPV vaccine was as or more important than other adolescent vaccines (OR = 2.76; 95% CI, 1.98-3.83), or believed HPV vaccine was effective for preventing cervical cancer (OR = 2.55; 95% CI, 1.93-3.37). Parents less often agreed if they resided in Midwest states or believed that HPV vaccine was being pushed to make money for drug companies (both P < 0.05). CONCLUSION Opt-out provisions almost tripled parents' support for HPV vaccine school-entry requirements. Our findings suggest that race/ethnicity, attitudes about HPV vaccine, and region of residence may influence support for requirements without opt-out provisions. IMPACT Opt-out provisions greatly increase parent support of school-entry requirements for HPV vaccination but may make them ineffective. Cancer Epidemiol Biomarkers Prev; 25(9); 1317-25. ©2016 AACR.
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Affiliation(s)
- William A Calo
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Melissa B Gilkey
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts. Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | - Parth D Shah
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Jennifer L Moss
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina. Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
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Trogdon JG, Shafer PR, Shah PD, Calo WA. Are state laws granting pharmacists authority to vaccinate associated with HPV vaccination rates among adolescents? Vaccine 2016; 34:4514-4519. [PMID: 27496275 DOI: 10.1016/j.vaccine.2016.07.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/25/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES We explored whether state laws allowing pharmacists to administer human papillomavirus (HPV) vaccinations to adolescents are associated with a higher likelihood of HPV vaccine uptake. METHODS We examined provider-reported HPV vaccination among 13-17year olds in the National Immunization Survey-Teen: 2008-2014 for girls (N=48,754) and 2010-2014 for boys (N=31,802). Outcome variables were HPV vaccine initiation (⩾1 dose) and completion (⩾3 doses). The explanatory variable of interest was a categorical variable for the type of pharmacist authority regarding HPV vaccination for adolescents (<18years) in the state: not permitted (reference), by prescription, by collaborative practice protocol, or independent authority. We ran separate difference-in-difference regression models by sex. RESULTS During 2008-2014, 15 states passed laws allowing pharmacists to administer HPV vaccine to adolescents. Pharmacist authority laws were not statistically significantly associated with increased HPV vaccine initiation or completion. CONCLUSIONS As currently implemented, state laws allowing pharmacists to administer HPV vaccine to adolescents were not associated with uptake. Possible explanations that need further research include restrictions on pharmacists' third-party billing ability and the lack of promotion of pharmacy vaccination services to age-eligible adolescents.
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Affiliation(s)
- Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1101 McGavran-Greenberg Hall, Campus Box 7411, Chapel Hill, NC 27599-7411, United States.
| | - Paul R Shafer
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1101 McGavran-Greenberg Hall, Campus Box 7411, Chapel Hill, NC 27599-7411, United States.
| | - Parth D Shah
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 302 Rosenau Hall, Campus Box 7440, Chapel Hill, NC 27599-7440, United States.
| | - William A Calo
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1101 McGavran-Greenberg Hall, Campus Box 7411, Chapel Hill, NC 27599-7411, United States.
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