Adolescent girls' attitudes on human papillomavirus vaccination

Behavioral interventions for vaccination uptake: A systematic review and meta-analysis

BACKGROUND

Human behavior and more specifically behavioral insight-based approaches to vaccine uptake have often been overlooked. While there have been a few narrative reviews indexed in Medline on behavioral interventions to increase vaccine uptake, to our knowledge, none have been systematic reviews and meta-analyses covering not just high but also low-and-middle income countries.

METHODS

We included 613 studies from the Medline database in our systematic review and meta-analysis categorizing different behavioral interventions in 9 domains: education campaigns, on-site vaccination, incentives, free vaccination, institutional recommendation, provider recommendation, reminder and recall, message framing, and vaccine champion. Additionally, considering that there is variability in the acceptance of vaccines among different populations, we assessed studies from both high-income countries (HICs) and low- to middle-income countries (LMICs), separately.

FINDINGS

Our results showed that behavioral interventions can considerably improve vaccine uptake in most settings. All domains that we examined improved vaccine uptake with the highest effect size associated with provider recommendation (OR: 3.4 (95%CI: 2.5-4.6); Domain: motivation) and on-site vaccination (OR: 2.9 (95%CI: 2.3-3.7); Domain: practical issues). While the number of studies conducted in LMICs was smaller, the quality of studies was similar with those conducted in HICs. Nevertheless, there were variations in the observed effect sizes.

INTERPRETATION

Our findings indicate that "provider recommendation" and "on-site vaccination" along with other behavioral interventions can be employed to increase vaccination rates globally.

Knowledge, attitude, and uptake of human papilloma virus vaccine and associated factors among female preparatory school students in Bahir Dar City, Amhara Region, Ethiopia

BACKGROUND

The human papillomavirus vaccine is one of the main preventative measures for cervical cancer. However, global vaccine uptake is low; the problem is particularly acute in low and middle-income countries. The purpose of this study is to assess female preparatory school students' knowledge, attitude, and uptake of the human papillomavirus vaccine and associated factors in Bahir Dar City, Ethiopia.

METHODS

Institutional-based cross-sectional study was conducted among 633 female preparatory school students in Bahir Dar city from March 1-30, 2021. Participants were selected using the multistage sampling technique. Data were collected using a structured self-administered questionnaire and entered into Epi-data and exported to SPSS for analysis. Binary and multivariable logistic regression analyses were done using an odds ratio with a 95% confidence interval. Finally-value < 0.05 was considered significant in multivariable analysis.

RESULT

The proportion of Human Papillomavirus (HPV) vaccine uptake, knowledge of the vaccine, and respondents' attitudes toward the vaccine were 45.3% (95% CI = 41.6-49.4%), 58.1% (95% CI = 54.4-61.9%), and 16% (95% CI = 13.2-19.5%), respectively. Having a history of sexual contact AOR = 2.80 (95% CI = 1.64-4.76), hearing about HPV infection AOR = 1.59 (95% CI = 1.13-2.24), and having a positive attitude toward HPV vaccine AOR = 1.46 (95% CI = 1.03-2.08) were significantly associated with knowledge about the HPV vaccine. Discussion of reproductive health issues with family AOR = 2.558 (95%CI = 1.800-3.636), and having good knowledge about HPV vaccine AOR = 3.571(95%CI = 2.494-5.113) were associated with a positive attitude toward the HPV vaccine. Good knowledge AOR = 2.36(95%CI = 1.48-3.76) and a positive attitude toward HPV vaccine AOR = 2.87(95%CI = 1.70-4.85) were strongly associated with HPV vaccine utilization.

CONCLUSION

In this study, there was a very low uptake of HPV vaccination among female students, and only a small proportion of them had good knowledge of the HPV vaccine and a favorable attitude toward the HPV vaccine.

Overcoming Vaccine Hesitancy for Future COVID-19 and HIV Vaccines: Lessons from Measles and HPV Vaccines

BACKGROUND

The discovery of vaccines significantly reduced morbidity and mortality of infectious diseases and led to the elimination and eradication of some. Development of safe and effective vaccines is a critical step to the control of infectious diseases; however, there is the need to address vaccine hesitancy because of its potential impact on vaccine uptake.

METHODS

We conducted a narrative review of studies on interventions to address measles and human papillomavirus vaccine hesitancy. We discussed how lessons learned from these studies could be applied towards COVID-19 and future human immunodeficiency virus vaccines.

RESULTS

We found that there are several successful approaches to improving vaccine acceptance. Interventions should be context specific and build on the challenges highlighted in various settings.

CONCLUSION

Strategies could be used alone or in combination with others. The most successful interventions directly targeted the population for vaccination. Use of financial incentives could be a potential tool to improve vaccine uptake.

Low rate of human papillomavirus vaccination among schoolgirls in Lebanon: barriers to vaccination with a focus on mothers' knowledge about available vaccines

Background

Human papillomavirus (HPV) infection is an established predisposing factor of cervical cancer. In this study, we assessed the awareness about genital warts, cervical cancer, and HPV vaccine among mothers having girls who are at the age of primary HPV vaccination attending a group of schools in Lebanon. We also assessed the rate of HPV vaccination among these girls and the barriers to vaccination in this community.

Subjects and methods

This is a cross-sectional, school-based survey. A 23-item, self-administered, anonymous, pretested, structured questionnaire with closed-ended questions was used to obtain data. The questionnaire was sent to the mothers through their student girls, and they were asked to return it within a week. Data were analyzed using the Statistical Package for Social Sciences version 21.0. Bivariate analysis was performed using the chi-square test to compare categorical variables, whereas continuous variables were compared using the Student's t-test. Fisher's exact test was used when chi-square test could not be employed.

Results

The response rate in our survey was 39.4%. Among the responders, the rate of awareness about HPV infection was 34%, where 72% of the mothers had heard about cervical cancer, and 34% knew that a vaccine is available to prevent cervical cancer. HPV vaccination uptake rate was 2.5%. This lack of vaccination was primarily attributed to the low rate of mothers' awareness about the vaccine (34%). Factors significantly affecting awareness about the vaccine were the mothers' marital age, nationality, level of education, employment, and family income. Barriers to HPV vaccination, other than awareness, were uncertainty about safety or efficacy of the vaccine, conservative ideas of mothers regarding their girls' future sexual life, and relatively high price of the vaccine.

Conclusion

Vaccine uptake is low among eligible girls attending this group of schools. The barriers to vaccination are multiple; the most important one is the mothers' lack of knowledge about HPV, cervical cancer, and the modes of prevention. Awareness campaigns along with a multimodal strategy that targets the identified barriers would be recommended to achieve higher rates of HPV vaccination.

A study on the predictors of Korean male students' intention to receive human papillomavirus vaccination

AIMS AND OBJECTIVES

The objective was to survey the current state of human papillomavirus (HPV) vaccination and the predictors of vaccination intention among Korean male students of high school (ages 15-19) and university (ages 17-27).

BACKGROUND

Human papillomavirus is a sexually transmitted infectious agent causing uterine cervical, anal, and/or penile cancer and genital warts in males and females. Infection rate of human papillomavirus increases from the age when sexual intercourse first occurs. Therefore, motivation to receive human papillomavirus vaccination is needed to protect infection.

DESIGN

Cross-sectional descriptive survey was performed only in male students. They are less aware of human papillomavirus than females, because human papillomavirus vaccination has been targeted on females for preventing cervical cancer in Korea.

METHODS

Data were collected using a self-reporting questionnaire for male high school and university students sampled from a city in Korea. Human papillomavirus vaccine-related knowledge, health beliefs, demographic, and sexual history information variables relating to intentions to vaccinate were assessed.

RESULTS

The human papillomavirus vaccination rate was very low and the levels of knowledge and health beliefs were low. The significant predictors that raised the intention of human papillomavirus vaccination were a university student, experience of sexual intercourse and perceiving the benefits of human papillomavirus vaccination.

CONCLUSIONS

To promote human papillomavirus vaccination, educational programming targeting males should include health beliefs and knowledge, emphasising that vaccination is important to prevent uterine cervical cancer and to role as a preventative measure against common male diseases.

RELEVANCE TO CLINICAL PRACTICE

Male high school students should be included as a major target population for school human papillomavirus education programmes, as they are at the age of commencing sexual intercourse. In addition, public health policies including human papillomavirus vaccination in the national immunisation programme are warranted.

Factors related to HPV vaccine uptake and 3-dose completion among women in a low vaccination region of the USA: an observational study

BACKGROUND

To assess the demographic and attitudinal factors associated with HPV vaccine initiation and completion among 18-26 year old women in Utah.

METHOD

Between January 2013 and December 2013, we surveyed 325 women from the University of Utah Community Clinics about their HPV vaccine related beliefs and behaviors. Odds ratios (ORs) were estimated from logistic regression models to identify variables related to HPV vaccine initiation and series completion.

RESULTS

Of the 325 participants, 204 (62.8 %) had initiated the vaccine and 159 (48.9 %) had completed the 3-dose series. The variables associated with HPV vaccine initiation were lower age (OR = 1.18 per year); being unmarried (OR = 3.62); not practicing organized religion (OR = 2.40); knowing how HPV spreads (OR = 6.29); knowing the connection between HPV and cervical cancer (OR = 3.90); a belief in the importance of preventive vaccination (OR = 2.45 per scale unit); strength of doctor recommendation (OR = 1.86 per scale unit); and whether a doctor's recommendation was influential (OR = 1.70 per scale unit). These variables were also significantly associated with HPV vaccine completion.

CONCLUSION

The implications of these findings may help inform policies and interventions focused on increasing HPV vaccination rates among young women. For example, without this information, programs might focus on HPV awareness; however, the results of this study illustrate that awareness is already high (near saturation) in target populations and other factors, such as strong and consistent physician recommendations, are more pivotal in increasing likelihood of vaccination. Additionally, our findings indicate the need for discussions of risk assessment be tailored to the young adult population.

Attitude, Acceptability and Knowledge of HPV Vaccination among Local University Students in Hong Kong

The Human Papillomavirus (HPV) vaccine has the great potential to prevent HPV-related infections for millions of women and men worldwide. However, the success of the vaccine is highly dependent on the vaccination rate. Factors influencing the attitudes of undergraduate students towards HPV vaccination should be studied. This is a cross-sectional survey that was conducted to estimate the HPV vaccination rate among undergraduate students in Hong Kong, and to identify the predictors of their attitude towards HPV vaccination. The results showed that the HPV vaccination rate was 13.3%. Factors related to knowledge of vaccination were the main predictors of the students’ attitude towards vaccination (there were seven predictors, with B = 1.36 to 2.30; p < 0.05), followed by gender (B = −1.40; p < 0.05), acceptable maximum price (B = 0.35; p < 0.05), and willingness to receive the HPV vaccine if it can protect against cervical/anal cancer and genital warts (B = −1.90; p < 0.001). The regression model that was developed based on the predictors had a moderate effect size (adj-R² = 0.33). To conclude, the HPV vaccination rate among undergraduate students in Hong Kong was low. They should be provided with more active education and activities to promote HPV vaccination to improve their knowledge on the subject.

University students' knowledge and attitudes regarding cervical cancer, human papillomavirus, and human papillomavirus vaccines in Turkey

OBJECTIVES

The current descriptive study aimed to determine university students' knowledge and attitudes regarding cervical cancer, human papillomavirus (HPV), and HPV vaccines in Turkey.

PARTICIPANTS

A total of 800 students participated.

METHODS

This study was carried out between September 1, 2012, and October 30, 2012, in 8 female dormitories.

RESULTS

In response to the question "What are cervical cancer risk factors?" 10.0% of students said HPV; 90.9% were unaware of how to protect themselves from HPV. Of the students, 99.7% had not had an HPV vaccination, only 32.6% wanted to get an HPV vaccination, and 20.7% did not want to be vaccinated, as they believe it "might have adverse effects."

CONCLUSIONS

The results of the present study show that female university students have low levels of awareness and knowledge toward cervical cancer risk factors, HPV, and HPV vaccination.

A randomized crossover study of medroxyprogesterone acetate and Diane-35 in adolescent girls with polycystic ovarian syndrome

OBJECTIVE

To investigate the effects of 4-month treatment of medroxyprogesterone acetate (MPA) and Diane-35 on the clinical and biochemical features of hyperandrogenism and quality of life of adolescent girls with polycystic ovarian syndrome (PCOS).

DESIGN

A prospective, randomized, cross-over study.

SETTING

An accredited pediatric and adolescent gynecology clinic of a university-affiliated tertiary hospital.

PARTICIPANTS

76 adolescents girls aged 14 to 19 years old with PCOS were recruited from July 2007 to July 2010.

INTERVENTIONS

Girls were randomized into 2 groups. Group 1 received oral MPA for 4 months, followed by a washout period of 4 months, and then Diane-35 for another 4 months. Group 2 received the same combination but in the reverse order.

MAIN OUTCOME MEASURES

Clinical and biochemical features of hyperandrogenism and quality of life were assessed.

RESULTS

There was no significant difference between the 2 groups at baseline. No significant difference was found in the clinical and biochemical parameters of hyperandrogenism before and after treatment with MPA. Significant reduction of the acne score, LH/FSH ratio, and testosterone level was seen after taking Diane-35. Hirsutism was also improved but it did not reach statistical significant. When comparing post-MPA and post-Diane-35, the post-Diane-35 group had significantly improved acne score and LH/FSH ratio. No significant difference was found on quality of life between both groups after treatment.

CONCLUSION

Diane-35 may be a more suitable treatment option in adolescent girls diagnosed with PCOS when compared to MPA.

Development, theoretical framework, and evaluation of a parent and teacher-delivered intervention on adolescent vaccination

The Advisory Committee on Immunization Practices recommended immunization schedule for adolescents includes three vaccines (tetanus, diphtheria, and acellular pertussis [Tdap]; human papillomavirus [HPV] vaccine; and meningococcal conjugate vaccine [MCV4]) and an annual influenza vaccination. Given the increasing number of recommended vaccines for adolescents and health and economic costs associated with nonvaccination, it is imperative that effective strategies for increasing vaccination rates among adolescents are developed. This article describes the development, theoretical framework, and initial first-year evaluation of an intervention designed to promote vaccine acceptance among a middle and high school-based sample of adolescents and their parents in eastern Georgia. Adolescents, parents, and teachers were active participants in the development of the intervention. The intervention, which consisted of a brochure for parents and a teacher-delivered curriculum for adolescents, was guided by constructs from the health belief model and theory of reasoned action. Evaluation results indicated that our intervention development methods were successful in creating a brochure that met cultural relevance and the literacy needs of parents. We also demonstrated an increase in student knowledge of and positive attitudes toward vaccines. To our knowledge, this study is the first to extensively engage middle and high school students, parents, and teachers in the design and implementation of key theory-based educational components of a school-based, teacher-delivered adolescent vaccination intervention.

"HPV? Never heard of it!": a systematic review of girls' and parents' information needs, views and preferences about human papillomavirus vaccination

BACKGROUND AND OBJECTIVE

Two human papillomavirus vaccines were licenced in 2006/2007 for cervical cancer prevention. National vaccination programmes for schoolgirls were subsequently introduced in some European countries, North America and Australia. To understand factors influencing vaccine uptake and to inform the development of appropriate UK educational materials, we aimed to synthesise evidence of girls' and parents' information needs, views and preferences regarding HPV vaccination.

DESIGN

Systematic review and mixed method synthesis of qualitative and survey data.

DATA SOURCES

Twelve electronic databases; bibliographies of included studies 1980 to August 2011.

REVIEW METHODS

Two reviewers independently screened papers and appraised study quality. Studies were synthesised collaboratively using framework methods for qualitative data, and survey results integrated where they supported, contrasted or added to the themes identified.

RESULTS

Twenty-eight qualitative studies and 44 surveys were included. Where vaccination was offered, uptake was high. Intention to decline was related to a preference for vaccinating later to avoid appearing to condone early sexual activity, concerns about vaccine safety and low perception of risk of HPV infection. Knowledge was poor and there were many misconceptions; participants tried to assess the potential benefits and harms of vaccination but struggled to interpret limited information about HPV in the context of existing knowledge about sexually transmitted infections and cancer. Conclusion Many girls and their parents have limited understanding to an extent that impinges on their ability to make informed choices about HPV vaccination and could impact on future uptake of cervical screening. This is a considerable challenge to those who design and provide information, but getting the messages right for this programme could help in developing patient information about other HPV related cancers.

Barriers to receiving human papillomavirus vaccination among female students in a university in Hong Kong

This paper investigates, using a qualitative approach, barriers to receiving Human Papillomavirus (HPV) vaccine among female undergraduate students in a Hong Kong university. By conducting individual semi-structured interviews with 35 young women aged 19 to 23, seven intertwining perceptual, social and cultural, healthcare provider and financial barriers were identified. These barriers included the perception as being low-risk due to an absence of sexual contact, lack of confidence in the safety of the vaccine, suspicion of parents concerning the intention to get vaccinated, lack of positive discussion among peers, insufficient information from primary-care doctors, difficulty in choosing a suitable HPV vaccine and cost of the vaccine. Future HPV-vaccination promotion therefore not only needs to enhance risk perception and needs awareness of young women, but also educate parents and correct their misconceptions. As primary care doctors are the first line of contact with patients, providing more support to enhance their knowledge of the HPV vaccine and to encourage their enthusiasm in providing responsive disease-prevention education can motivate young women to get vaccinated.

Female human papillomavirus (HPV) vaccination: global uptake and the impact of attitudes

Human papillomavirus (HPV) is the causative agent in cervical cancer and has been implicated in a range of other malignancies. Preventative vaccines are now internationally available and provide high levels of protection from common viral strains. The introduction of a comprehensive vaccination programme (except 'program' in computers) could prevent over 60% of current cervical cancer cases, but this is dependent on such programmes achieving a high level of coverage. In this review, we summarise the current trends in female HPV vaccination coverage throughout the world, and place it in the context of available research on attitudes towards vaccination amongst the public and health professionals. Where countries have the resources for mass vaccination programmes, uptake has varied. School-based opt-out programmes consistently achieve highest coverage, whilst countries and regions without systematic vaccination schemes have low coverage. In all countries, the success of vaccination programmes is dependent on the support of the public and healthcare professionals. Whilst public acceptance is dependent on multiple factors, it has repeatedly been shown that recommendation by a health professional, particularly clinicians, is key to vaccine uptake. Worryingly, it appears that a proportion of clinicians still have significant reservations about promoting vaccination, particularly for younger age groups. A commitment now, to fully educating both the public and clinicians, has the potential to make a dramatic future impact.

Human papillomavirus (HPV) infection and vaccines: knowledge, attitude and perception among female students at the University of Lagos, Lagos, Nigeria

Aim: This study sought to determine knowledge of and attitude towards human papillomavirus (HPV) infection, HPV-related diseases and HPV vaccines among female undergraduate students at the University of Lagos.

Methods: A self-administered questionnaire was administered between May and July 2010, to 368 female students aged 16–29 years, who were selected from two faculties of the University of Lagos using two-stage sampling method. Data collected included: socio-demographic characteristics, sexual history, awareness and knowledge of HPV infection, cervical cancer and genital warts, and HPV vaccine; the perceived risk of acquiring genital HPV infection and developing cervical cancer or genital warts, and the willingness to receive an HPV vaccine.

Results: Only 64 (17.7%) and 52 (14.4%) of the students had ever heard of HPV infection and HPV vaccines respectively. The median HPV knowledge on a 15-item score was 2. Overall, only 11.1% knew that genital HPV infection can cause cervical cancer. Fourteen (6.9%) of those who were aware of cervical cancer agreed they were at risk of developing the disease. Of the 52 students who had heard of the HPV vaccine, 24 (46.2%) knew it was given for cervical cancer prevention and 30 (57.7%) expressed their willingness to receive the vaccine.

Conclusion: The knowledge of and the perceived susceptibility to HPV infection and HPV-related diseases among female students in the University of Lagos were generally low. The need for a well-designed HPV-educational program to bridge the knowledge gap cannot be overemphasized.

Human papillomavirus vaccination uptake and factors related to uptake in a traditional desert city in the United Arab Emirates

It is important to assess uptake of a new vaccine. The present survey estimated the uptake of the recently introduced human papillomavirus vaccine (HPVV) in the emirate of Abu Dhabi and also explored barriers to uptake. A questionnaire survey was conducted in secondary schools, enrolling 334 girls. The uptake percentage was estimated and factors associated with uptake were assessed with multilevel logistic regression. Crude vaccination uptake was 53%. Factors positively associated with uptake were, among others, having knowledge on human papillomavirus (vaccine) and having United Arab Emirates (UAE) nationality. The HPVV uptake of just over 50% could probably be improved by educating the target group and their parents before offering the HPVV and by making it free of costs for everyone.

Knowledge of human papillomavirus infection and its prevention among adolescents and parents in the greater Milan area, Northern Italy

Background

In order to be widely accepted by users, the implementation of a new health intervention requires them to be adequately informed about its clinical importance, benefits and risks. The aim of this study was to provide data on the knowledge of Italian adolescents and parents concerning human papillomavirus (HPV) infection and its prevention in order to allow the development of adequate training programmes.

Methods

Between 2 May and 15 June 2008, we made a cross-sectional survey of 863 high school students and 2,331 parents of middle and high school students using two anonymously completed questionnaires covering the knowledge of HPV infection and related diseases, and attitudes to vaccinations. The approached schools were a convenience sample of the schools of the greater Milan area, Northern Italy.

Results

More mothers than fathers were aware that HPV infection could concern their children (58% vs 53%; p = 0.004) and were favourable towards vaccinating their children against HPV (68% vs 65%; p = 0.03); among the students, more females than males were aware that HPV infection could concern themselves (45% vs 26%; p < 0.001) and would undergo vaccination against HPV (68% vs 40%; p < 0.001). The parents' propensity to vaccinate their children against HPV was significantly associated with professing the Catholic religion (odds ratio - OR = 0.61, 95% confidence interval - CI 0.46-0.82, being atheist), the gender of the offspring (OR = 1.88, 95% CI 1.53-2.30, having at least one daughter), a propensity to vaccinations in general (OR = 23.1, 95% CI 13.7-38.8), a knowledge that HPV vaccine is aimed at preventing cervical cancer (OR = 2.31, 95% CI 1.69-3.16), and an awareness that HPV could affect their own children (OR = 3.52, 95% CI 2.89-4.29). The students who were aware that HPV infection could affect themselves were more in favour of to HPV vaccination, regardless of whether they were male (OR = 5.73, 95% CI 2.85-11.5) or female (OR = 2.39, 95% CI 1.66-3.46).

Conclusions

Both students and parents seem to underestimate the likelihood of HPV infection, and this is associated with a lower propensity for vaccination. This is an important indication for future training programmes concerning HPV prevention designed to increase the acceptance of HPV vaccine in families.

Immunization updates and challenges

PURPOSE OF REVIEW

Childhood vaccination recommendations in the United States have increased throughout the years. Many providers, patients, and families are overwhelmed and have concerns regarding the safety and efficacy of vaccines. Various barriers and challenges exist for healthcare providers to successfully implement the vaccination recommendations. This review will discuss the 2009 and newly released 2010 immunization recommendations, as well as challenges and strategies to improve vaccination in children and adolescents.

RECENT FINDINGS

Seasonal influenza immunization continues to be promoted for all children, and recommendations for vaccination against novel influenza A have emerged as well. Concerns surrounding vaccine safety and necessity may cause increasing rates of vaccine refusal among some parents, but clear messages from providers and unbiased information about benefits and risks of immunization may counteract these doubts. Barriers to immunizing adolescents continue as access to healthcare in this age group changes.

SUMMARY

Pediatric providers currently face numerous challenges in improving rates of immunization among children and adolescents. Promoting coverage through the influenza vaccines, counseling parents with clear information about the risks and benefits of vaccines, and taking advantage of nonpreventive visits for immunization are some strategies suggested to address these challenges.