Caregiver and adolescent factors associated with delayed completion of the three-dose human papillomavirus vaccination series

A scoping review of the use of parent-adolescent dyads in HPV vaccination research

OBJECTIVE

Parental vaccine hesitancy is a significant contributor to low adolescent HPV vaccination. Shared HPV vaccination decision-making among adolescents and parents is an important determinant of vaccination uptake. We performed a scoping review to identify studies that used parent-adolescent dyads in HPV vaccination research.

METHODS

We searched peer-reviewed articles in PubMed, Embase, and PsychInfo from 2012 to 2023. Randomized or observational studies with parent-adolescent dyads related to HPV vaccination were eligible for inclusion. Articles were coded for the main themes related to use of parent-adolescent dyads in HPV vaccination research.

RESULTS

Fifteen articles met the inclusion criteria and were categorized into two main themes: qualitative decision-making and quantitative vaccination intentions. Dyad members reported substantially different roles, barriers, and facilitators of HPV vaccine decisions and intentions. Dyad members disagreed on who made the final decision. Provider recommendation style and content were important to parental confidence in the vaccine decision.

CONCLUSION

The recent evidence for parent-adolescent HPV vaccination dyad research is sparse but indicates that factors that account for dyad vaccination decisions and intentions often differ between dyad members.

PRACTICE IMPLICATIONS

Studies in this review support ongoing research with parent-adolescent dyads to target HPV vaccine interventions at individual dyad members to increase HPV vaccination.

The Association of Health Literacy with Intention to Vaccinate and Vaccination Status: A Systematic Review

Despite health literacy (HL) being recognized as a driver of health-promoting behavior, its influence on the vaccination decision-making process remains unclear. This study summarized current evidence on the association between HL and both intention to vaccinate and vaccination status. We searched PubMed, Scopus, and Web of Science, retrieving observational studies published until January 2022 that used HL-validated tools to investigate the above associations for any vaccine. Quality was assessed using the Newcastle-Ottawa scale. Twenty-one articles were included; of these, six investigated the intention to vaccinate and the remainder vaccination status. Articles on intention looked at SARS-CoV-2 vaccination using heterogeneous HL tools and were of high/fair quality. Vaccination status, mainly for influenza or pneumococcal vaccines, was explored using various HL tools; the quality was generally high. We found inconsistent results across and within vaccine types, with no clear conclusion for either vaccination intention or status. A weak but positive association was reported between a high HL level and influenza vaccination uptake for individuals aged more than 65 years. HL did not seem to significantly influence behavior towards vaccination. Differences in the methods used might explain these results. Further research is needed to investigate the role of HL in the vaccination decision-making process.

Pathways linking parental health literacy with health behaviours directed at the child: a scoping review

Health literacy (HL) is thought to be crucial for the management of the manifold demands relating to child health which parents are faced with. Albeit many studies have investigated parental HL and health behaviours (HBs) directed at the child, knowledge about the pathways which link parental HL with HB is scarce. The aim of this scoping review was to identify and comprehensively describe the variety of pathways linking parental HL with HBs directed at the child which were empirically analysed in previous studies. Following established scoping review methods database searches were conducted in MEDLINE, EMBASE, PsycINFO and WebofScience on 5 March 2020. Eligibility criteria included primary, empirical studies assessing parental HL and HB directed at the child in the general parent population. Titles and abstracts were screened independently by six reviewers for potentially relevant publications and data were extracted using standardized data extraction forms. The search identified 6916 articles for title and abstract screening. After full-text review, 50 studies were included in this review. Most studies (N = 24) assumed a direct association between HL and HBs and only few studies (N = 4) used more complex models investigating different pathways or mediation and/or moderation models. Overall, the evidence on the underlying pathways linking parental HL and HBs directed at the child is mixed and fairly limited. Therefore, hypothesis-driven research and integration of results into theoretical frameworks is needed for advancing both the research on HL and public health practice.

Evaluation of a Text Messaging-Based Human Papillomavirus Vaccination Intervention for Young Sexual Minority Men: Results from a Pilot Randomized Controlled Trial

BACKGROUND

Men who have sex with men (MSM) are at high risk for human papillomavirus (HPV) infection and HPV-related anal cancer. Although a safe and effective vaccine is available to prevent HPV infection, HPV vaccine uptake among young MSM remains low.

PURPOSE

This pilot randomized controlled trial tested the acceptability, feasibility, and preliminary efficacy of a text messaging-based HPV vaccination intervention for young sexual minority men.

METHODS

In 2018, unvaccinated sexual minority men aged 18-25 years were recruited from Chicago to participate in a 9 month sexual health program called txt2protect. Participants (N = 150) were randomized to the intervention or control condition. Intervention condition messages focused primarily on HPV vaccination, with only a brief mention of other sexual health practices (e.g., condom use and HIV testing), while control condition messages focused on a variety of sexual health practices with only a brief mention of HPV vaccination. Participants received daily text messages for the first 3 weeks and monthly text messages for the remaining ~8 months of the trial. Participants completed surveys at baseline and 3 week and 9 month follow-ups.

RESULTS

Participants reported high satisfaction with the intervention. Although trial retention was high (with over 88% completing the 9 month survey), the study fell short of meeting its recruitment goal. HPV vaccine series initiation was significantly higher among intervention participants (19.4%) compared to control participants (6.6%), odds ratio = 3.43, 95% confidence interval: 1.17, 10.08.

CONCLUSIONS

Findings suggest that txt2protect is an acceptable and potentially promising intervention for increasing HPV vaccine initiation among young sexual minority men.

CLINICAL TRIAL REGISTRATION

NCT02994108.

HPV VACCINE ADHERENCE AMONG ADOLESCENTS: INTEGRATIVE REVIEW

ABSTRACT Objective: to identify what factors are connected to adolescent adherence to the vaccination against Human Papillomavirus. Method: integrative developed using the following data base: Medical Literature Analysis and Retrieval System Online and Web of Science, Cumulative Index to Nursing and Allied Health Literature, Literatura Latino-Americana e do Caribe em Ciências da Saúde (Latin-American and Caribbean Literature in Health Sciences), and Base de dados de Enfermagem (Nursing Database); using the descriptors and keywords: Papillomaviridae, immunization, vaccines. The final sample had 31 original articles. Result: Vaccine adherence predictors were identified as: knowledge about virus infection risk, vaccination and its benefits; cervical cancer and genital warts prevention; sexual activity; being over 14 years old; mothers’ intention to adhere to vaccination; mother-child communication about sexually transmitted infections, contraception and condoms; vaccination offered in school; recommendation by teachers and health professionals; vaccine safety and effectiveness. Conclusion: Evidence points towards the necessity to redesign the presentation strategy of the vaccine, because despite the cultural differences among the countries where the studies were carried out, it is noticeable that society shelters adolescents aged from 10 to 14 years old, considering it early for sexual initiation and presenting difficulties to broach sexuality-related topics with children.

Achieving high HPV vaccine completion rates in a pediatric clinic population

Objective: To evaluate the efficacy of an intervention utilizing patient navigators (PNs) to 1) educate families on human papillomavirus (HPV) vaccination in a clinic setting and 2) provide personalized reminders for follow-up. Method: Families with 9-17 year-old children who had no record of completing the HPV vaccination series receiving primary or specialty care in 3 pediatric clinics were approached by PNs between February 1, 2015 and August 31, 2016. Demographic characteristics, visit type, preferred contact method, rates and correlates of completion, and appointments missed were analyzed. In addition, qualitative interviews of 21 providers and PNs assessed their perceptions of the program. Results: 1,391 adolescents were identified out of 2,162 patients approached as unvaccinated or partially vaccinated prior starters; among the unvaccinated, 930 received the 1st dose after being counseled by the PN (66.9%), either immediately or at a follow-up visit soon thereafter. This included 118 siblings of patients who did not have an appointment that day. Of initiators approached between 2/1/2015 and 8/31/2016, 93% (864/930) completed the series by 8/31/2017. No differences in series completion among initiators were observed by gender or race/ethnicity, but older patients (15-17 years old) were less likely to complete than 11-12 year olds. Of the 688 patients identified as prior starters, 85% completed the series through the program. Qualitative interviews demonstrated that providers felt the program addressed major barriers to HPV vaccination. Conclusion: Employing PNs dramatically increased HPV vaccine series completion among boys and girls with historically low HPV vaccination rates at pediatric clinics in Texas. Clinic providers felt this program addressed many barriers they observed prior to program implementation. This approach could markedly improve HPV vaccine series completion rates in the US.