1
|
Chan DNS, Lee PPK, So WKW. Exploring the Barriers and Facilitators Influencing Human Papillomavirus Vaccination Decisions Among South Asian and Chinese Mothers: a Qualitative Study. J Racial Ethn Health Disparities 2024; 11:1465-1477. [PMID: 37195592 PMCID: PMC10191075 DOI: 10.1007/s40615-023-01623-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/23/2023] [Accepted: 04/26/2023] [Indexed: 05/18/2023]
Abstract
Human papillomavirus (HPV) vaccines are safe and effective in preventing HPV infection and HPV-related cancers. However, the HPV vaccine uptake rate is lower among the ethnic minority population than in the majority population. This qualitative study explored the barriers and facilitators influencing South Asian minority and Chinese mothers' decisions to vaccinate their daughters against HPV in Hong Kong. South Asian and Chinese mothers with at least one daughter aged 9 to 17 years were recruited to this study. Twenty-two semi-structured focus group interviews were conducted, and the transcripts were analysed via content analysis. Two barriers and three facilitating factors were common among South Asian and Chinese mothers: inadequate knowledge of cervical cancer, HPV or the HPV vaccine and high perceived barriers to HPV vaccination due to vaccine cost, the receipt of reliable information from schools or the government, high perceived benefits of HPV vaccination to health, and the presence of vaccination programme arranged by school or government. Despite these commonalities, South Asian mothers experienced more barriers to making the decision to vaccinate than Chinese mothers. Particularly, obtaining family support was an important factor for South Asian mothers. The vaccination decision was considered a joint decision between the mother and father, and the father's agreement was of particular importance to Pakistani mothers. This study identified the factors that hindered and facilitated South Asian and Chinese mothers' decisions to vaccinate their daughters against HPV. The comparison between groups improves our understanding of the distinct needs of South Asian in Hong Kong.
Collapse
Affiliation(s)
- Dorothy Ngo Sheung Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Pinky Pui Kay Lee
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Winnie Kwok Wei So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
2
|
Luo Y, Liu T, Yang X, Lu M, Kou Z, Xu X. Human papillomavirus vaccination and contributing factors of vaccination intention among adolescents and young adults in China from a socio-ecological perspective: A cross-sectional study. Public Health Nurs 2024; 41:602-616. [PMID: 38554075 DOI: 10.1111/phn.13315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 03/06/2024] [Accepted: 03/20/2024] [Indexed: 04/01/2024]
Abstract
OBJECTIVES Adolescents and young adults are the main target population for human papillomavirus (HPV). The study aimed to investigate school students' HPV vaccination intentions and explore the contributing factors from a socio-ecological perspective. DESIGN A questionnaire survey was conducted in three secondary schools and three colleges in China. SAMPLE A total of 1756 students aged 14-22 years participated in this study. Among the 1756 participants, 182 students have received the HPV vaccine. For the remaining 1574 students, we analyzed their HPV vaccination intentions and the influencing factors. MEASUREMENTS Survey items for sociodemographics, knowledge and awareness of HPV, sexual intercourse and sexual knowledge, subjective socioeconomic status, self-efficacy, eHealth literacy, perceived social support from family, and the availability of HPV vaccine information were measured. RESULTS Only 182 (10.4%) had received the HPV vaccine among the 1756 participants. Among the remaining 1574 students, the majority of the students (1403, 89.1%) were willing to receive the HPV vaccine. Binary logistic regression analysis showed that students who were female, had lower self-efficacy, scored higher on sexual knowledge, believed vaccination preventing related diseases, worried about side effects after vaccination, thought oneself at risk of contracting HPV, had higher family support, knew the availability of the HPV vaccine in Mainland China from healthcare institutions, and with family residence in rural areas were more willing to receive the HPV vaccine. CONCLUSIONS Students had high HPV vaccination intentions while had low vaccination rate. Intrapersonal, interpersonal and institutional or community factors predicted HPV vaccination intention. Public health nurses in communities and schools could target the modifiable factors to promote students' HPV vaccine uptake.
Collapse
Affiliation(s)
- Ying Luo
- Qingdao University, School of Nursing, Qingdao, Shandong, China
| | - Ting Liu
- Qingdao University, School of Nursing, Qingdao, Shandong, China
| | - Xiuling Yang
- Qingdao University, School of Nursing, Qingdao, Shandong, China
| | - Mingqin Lu
- Qingdao University, School of Nursing, Qingdao, Shandong, China
| | - Zhiru Kou
- Qingdao University, School of Nursing, Qingdao, Shandong, China
| | - Xiaohan Xu
- Qingdao University, School of Nursing, Qingdao, Shandong, China
| |
Collapse
|
3
|
Zhang L, Yang J, Cao Y, Kang W. Sociocultural-psychological predictors influencing parents' decision-making regarding HPV vaccination for their adolescent daughters in mainland China: An extended TPB model. Front Public Health 2023; 10:1035658. [PMID: 36684984 PMCID: PMC9853056 DOI: 10.3389/fpubh.2022.1035658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 12/12/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction Enhancing human papillomavirus (HPV) vaccine uptake rates to protect women's health is an important public health issue worldwide. China has taken a series of measures in recent years to promote HPV vaccination among school-aged girls, but the vaccine uptake rate remains low. Investigating the factors influencing vaccination-related decision-making of adolescent girls' parents is key to solving the problem. This study aimed to examine the influence of sociocultural-psychological predictors, including exposure to HPV-related stories (positive/negative), affective reactions (pride/regret), injunctive norms on the Internet and perceived moral obligation, on parents' HPV vaccination-related decision-making for girls aged 13-15 years in mainland China. Methods A cross-sectional online survey using quota sampling was conducted in February 2022. Four hundred and five valid and qualified questionnaires were obtained. Partial least squares structural equation modeling was performed by SmartPLS 3 (i) to evaluate the reliability and validity of the measurement models of 11 constructs, and (ii) to test the effect relationships of the sociocultural-psychological predictors on parents' intention to vaccinate their daughters. Results The study findings showed that parental decision-making regarding HPV vaccination was influenced by sociocultural and psychological factors. At the level of individual psychological factors, exposure to positive stories was significantly associated with perceived vaccine effectiveness (β = 0.331, t = 8.448, p < 0.001), which strongly predicted the attitude toward vaccination (β = 0.521, t = 8.133, p < 0.001); anticipated pride had more positive influence on vaccination-related decision-making (β = 0.156, t = 2.176, p < 0.05) than anticipated regret. In terms of social influence, injunctive norms on the Internet had a significantly positive influence on vaccination intention (β = 0.127, t = 2.382, p < 0.05), similar to descriptive norms (β = 0.135, t = 3.358, p < 0.01). Perceived moral obligation at the cultural level was the strongest predictor of parental decision-making regarding HPV vaccination (β = 0.193, t = 2.139, p < 0.05). Discussion This study is the first in mainland China to systematically examine the sociocultural-psychological predictors of parents' decision-making to vaccinate their 13-15-year-old daughters against HPV. A new extended TPB model with a sociocultural-psychological approach was developed. This model can support the investigation of factors affecting HPV vaccine uptake rates in the mainland Chinese population and similar populations and help to understand the differences in vaccination-related decision-making between Eastern and Western cultures. Furthermore, the study provided some suggestions for HPV vaccination communication campaigns targeting adolescent girls' parents.
Collapse
Affiliation(s)
- Lingmin Zhang
- School of Journalism and Communication, Guangzhou University, Guangzhou, China
| | - Jian Yang
- School of Journalism and Communication, Guangzhou University, Guangzhou, China,*Correspondence: Jian Yang ✉
| | - Ye Cao
- Archives Office, Guizhou Open University, Guiyang, China
| | - Wanying Kang
- School of Media and Communication, Shenzhen University, Shenzhen, China
| |
Collapse
|
4
|
Okuhara T, Terada M, Kagawa Y, Okada H, Kiuchi T. Anticipated Affect That Encourages or Discourages Human Papillomavirus Vaccination: A Scoping Review. Vaccines (Basel) 2023; 11:vaccines11010124. [PMID: 36679969 PMCID: PMC9867028 DOI: 10.3390/vaccines11010124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/06/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023] Open
Abstract
We reviewed studies that examined the anticipated affects associated with human papillomavirus (HPV) vaccination to identify gaps in the literature and the currently available practice implications for encouraging HPV vaccination. We systematically searched MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, PsycArticles, Academic Search Complete, Scopus, and Web of Science to find English articles that quantitatively and qualitatively examined anticipated affects associated with HPV vaccination. A total of twenty-one studies were identified. Seventeen studies examined the anticipated inaction regret (i.e., not being vaccinated). Most of the included studies reported that anticipated inaction regret had a significantly positive association with HPV vaccination outcomes, such as vaccination behavior, intention, willingness, and acceptability. Furthermore, seven studies reported that anticipated inaction regret had a significantly positive and stronger association with vaccination outcomes than cognitive beliefs, such as vaccine effectiveness and safety, and perceived susceptibility and severity. The present review indicated that the stronger the participants' anticipated inaction regret, the more likely they were to receive the HPV vaccine. Messages targeting the anticipated affect may be as effective as or more effective than messages targeting cognitive beliefs in encouraging HPV vaccination among people. However, most of the studies included in the present review adopted a cross-sectional design with vaccination intention and willingness as outcomes. Therefore, future studies should examine the influence of anticipated affects on the utilization of HPV vaccines using experimental designs to accumulate stronger evidence.
Collapse
|
5
|
Maftei A, Petroi CE. "I'm luckier than everybody else!": Optimistic bias, COVID-19 conspiracy beliefs, vaccination status, and the link with the time spent online, anticipated regret, and the perceived threat. Front Public Health 2022; 10:1019298. [PMID: 36457316 PMCID: PMC9706105 DOI: 10.3389/fpubh.2022.1019298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
The catastrophic wave in the fall of 2021 drove Romania to the top of the list of dangerous COVID-19 infections, with the highest mortality rate in Europe. At the same time, Romania had one of the lowest vaccination rates. In this context, the present research aimed to explore the link between vaccination intention/status, optimistic bias, COVID-19 conspiracy beliefs, the time spent online, and vaccination (anticipated) regret. Our convenience sample was formed by 408 adults aged 18-63 years (M = 22.11, SD = 6.18, 69.9 % females), who were distributed into four groups: (1) non-vaccinated who definitely refused COVID-19 vaccination, (2) non-vaccinated who considered COVID-19 vaccination, (3) non-vaccinated who reported their absolute willingness to COVID-19 vaccination, and (4) people who were COVID-19 vaccinated. We conducted our analyses separately, depending on these groups (i.e., vaccination intentions/status). Data were collected using an online questionnaire between November 10, 2021, and January 03, 2022. In our cross-sectional approach, following correlation and ANOVA analyses, among the observed patterns were (1) the significant negative relation between optimism bias and the perceived COVID-19 threat; (2) the positive link between anticipated regret, post-vaccination regret, age, and conspiracy beliefs. We discuss our findings considering their contribution to health policies and practices.
Collapse
Affiliation(s)
- Alexandra Maftei
- Faculty of Psychology and Education Sciences, Alexandru Ioan Cuza University, Iaşi, Romania
| | - Cosmina Elena Petroi
- Faculty of Psychology and Education Sciences, Alexandru Ioan Cuza University, Iaşi, Romania
| |
Collapse
|
6
|
Conhecimento de acadêmicos de enfermagem sobre a vacina contra o papilomavírus humano. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao02291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
7
|
Liu M, Cui T, Wang Q, Han Y, Han Y, Yang L, Shi N, Yi Y, Jin H. Using an extended protection motivation theory to explain vaccine hesitancy: a cross-sectional study among Chinese adults. Hum Vaccin Immunother 2022; 18:2026136. [PMID: 35103578 PMCID: PMC8993063 DOI: 10.1080/21645515.2022.2026136] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Vaccine hesitancy was listed as one of the top 10 issues threatening global health in 2019. The objectives of this study were to (a) use an extended protection motivation theory (PMT) with an added trust component to identify predictors of vaccine hesitancy and (b) explore the predictive ability of vaccine hesitancy on vaccination behavior. Methods We conducted an online questionnaire from February 9 to April 9, 2021, in China. The target population was Chinese residents aged 18 and over. A total of 14,236 responses were received. Structural equation modeling was used to test the extended PMT model hypotheses. Results A total of 10,379 participants were finally included in this study, of whom 52.0% showed hesitancy toward vaccination. 2854 (27.5%) participants reported that they got flu shots in the past year, and 2561 (24.7%) participants were vaccinated against COVID-19. 2857 (27.5%) participants engaged in healthcare occupation. The model explained 85.7% variance of vaccine hesitancy. Self-efficacy was the strongest predictor, negatively associated with vaccine hesitancy (β = −0.584; p < .001). Response efficacy had a negative effect on vaccine hesitancy (β = −0.372; p < .001), while threat appraisal showed a positive effect (β = 0.104; p < .001). Compared with non-health workers, health workers showed more vaccine hesitancy, and response efficacy was the strongest predictor (β = −0.560; p < .001). Vaccine hesitancy had a negative effect on vaccination behavior (β = −0.483; p < .001), and the model explained 23.4% variance of vaccination behavior. Conclusions This study demonstrates that the extended PMT model is efficient in explaining vaccine hesitancy. However, the predictive ability of vaccine hesitancy on vaccination behavior is limited.
Collapse
Affiliation(s)
- Minqi Liu
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education School of Public Health Southeast University Nanjing, PR China.,Department of Epidemiology and Health Statistics, School of Public Health, Southeast University Nanjing, PR China
| | - Tingting Cui
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education School of Public Health Southeast University Nanjing, PR China.,Department of Epidemiology and Health Statistics, School of Public Health, Southeast University Nanjing, PR China
| | - Qiang Wang
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education School of Public Health Southeast University Nanjing, PR China.,Department of Epidemiology and Health Statistics, School of Public Health, Southeast University Nanjing, PR China
| | - Ying Han
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education School of Public Health Southeast University Nanjing, PR China.,Department of Epidemiology and Health Statistics, School of Public Health, Southeast University Nanjing, PR China
| | - Yue Han
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education School of Public Health Southeast University Nanjing, PR China.,Department of Epidemiology and Health Statistics, School of Public Health, Southeast University Nanjing, PR China
| | - Liuqing Yang
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education School of Public Health Southeast University Nanjing, PR China.,Department of Epidemiology and Health Statistics, School of Public Health, Southeast University Nanjing, PR China
| | - Naiyang Shi
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education School of Public Health Southeast University Nanjing, PR China.,Department of Epidemiology and Health Statistics, School of Public Health, Southeast University Nanjing, PR China
| | - Youqin Yi
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education School of Public Health Southeast University Nanjing, PR China.,Department of Epidemiology and Health Statistics, School of Public Health, Southeast University Nanjing, PR China
| | - Hui Jin
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education School of Public Health Southeast University Nanjing, PR China.,Department of Epidemiology and Health Statistics, School of Public Health, Southeast University Nanjing, PR China
| |
Collapse
|
8
|
Schwendener CL, Kiener LM, Jafflin K, Rouached S, Juillerat A, Meier V, Schärli Maurer S, Muggli F, Gültekin N, Baumann A, Debergh M, Gruillot C, Huber B, Merten S, Buhl A, Deml MJ, Tarr PE. HPV vaccine awareness, knowledge and information sources among youth in Switzerland: a mixed methods study. BMJ Open 2022; 12:e054419. [PMID: 35105636 PMCID: PMC8808397 DOI: 10.1136/bmjopen-2021-054419] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We aimed to provide a detailed characterisation of human papillomavirus (HPV) vaccine awareness, knowledge and information sources in the HPV vaccine decision-making process of youth, both male and female, in Switzerland. DESIGN With a mixed-method study design, we conducted quantitative questionnaires and qualitative interviews, which lasted 20-45 min. SETTING AND PARTICIPANTS We recruited participants, 15-26 years of age, in physicians' offices, in a local sexual health clinic, and during military enlistment. We administered quantitative questionnaires to 997 youth participants (585 male, 412 female) and conducted qualitative interviews with 31 youth (17 male, 14 female). PRIMARY AND SECONDARY OUTCOME MEASURES We assessed HPV vaccine awareness, knowledge, information sources and vaccination status. RESULTS In the study's quantitative component, 108 (20%) male and 262 (65%) female participants had received ≥1 dose of HPV vaccine. 697 (70%) participants were knowledgeable about the HPV vaccine. Females were more likely to be knowledgeable than males (342/412 (83%) vs 355/585 (61%); p<0.01). Younger participants in the sample compared with older participants were more likely to be aware of HPV vaccine (135/148 (91%) vs 695/849 (82%); p<0.01). The three most mentioned information sources were school health programmes (442 (53%)), healthcare providers (190 (23%)) and participants' social networks (163 (20%)). Overall, 554/710 (78%) participants had a female-gendered perception of HPV vaccine, a finding which was further supported and explained by qualitative data. CONCLUSIONS Despite a male HPV vaccine recommendation being made >4 years prior to the data collection, HPV vaccine knowledge was higher among females than males, and a female-gendered perception of HPV vaccine remains prevalent. Internet and social media were minor HPV vaccine information sources. Study findings demonstrate that HPV knowledge matters for HPV vaccine uptake and suggest that we should improve HPV information quality and access for youth, particularly by tailoring knowledge campaigns to young men.
Collapse
Affiliation(s)
- Corina L Schwendener
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Laura M Kiener
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kristen Jafflin
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Sarah Rouached
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Anna Juillerat
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Vincent Meier
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Franco Muggli
- Rekrutierungszentrum Monte Ceneri, Swiss Armed Forces, Bern, Switzerland
| | - Nejla Gültekin
- Eidgenössisches Departement für Verteidigung, Bevölkerungsschutz und Sport VBS Schweizer Armee, Swiss Armed Forces, Bern, Switzerland
| | - Aron Baumann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Marlyse Debergh
- Institute of Sociological Research, University of Geneva, Geneva, Geneva, Switzerland
| | - Catherine Gruillot
- PROFA Consultation de santé sexuelle - planning familial, Renens, Switzerland
| | - Benedikt Huber
- Department of Pediatrics, HFR Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Sonja Merten
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Andrea Buhl
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Michael J Deml
- Institute of Sociological Research, University of Geneva, Geneva, Geneva, Switzerland
- Division of Social and Behavioural Sciences, School of Public Health & Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
| | - Philip E Tarr
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, Basel, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
9
|
Han G, Son H. Environmental factors affecting mothers' decision-making about the HPV vaccination for their daughters. Hum Vaccin Immunother 2021; 17:4412-4417. [PMID: 34402397 DOI: 10.1080/21645515.2021.1965808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE This study aimed to investigate environmental factors influencing mothers' decision-making regarding vaccination of the human papillomavirus (HPV) for their daughters. METHODS This was a cross-sectional study, with data collected using online surveys from July to September 2018. Participants were 230 mothers of second-year female middle-school students in South Korea. The proportional stratification sampling method was used to reflect the difference in medical level between regions. Independent variables consisted of individual (demographic characteristics, HPV-related characteristics, knowledge, attitude, and subjective norms) and environmental factors (the influence of healthcare providers, school, and community environments) were examined. The potential factors influencing vaccination uptake were determined using hierarchical logistic regression. RESULTS The factors influencing mothers' decision-making about the HPV vaccine for their daughters were their attitude toward HPV vaccination (OR = 0.78 p < .001), whether a healthcare provider provided HPV-vaccine-related information (OR = 2.42, p = .030), and presenting positive-framed information (OR = 4.21, p = .020). CONCLUSIONS To increase HPV vaccination among the target population, it is necessary to consider environmental factors identified in this study. Healthcare providers should provide accurate information regarding the vaccination. Information emphasizing the vaccination's benefits is particularly important.
Collapse
Affiliation(s)
- Gyumin Han
- College of Nursing, Pusan National University, Yangsan-si, Republic of Korea
| | - Hyunmi Son
- College of Nursing, Pusan National University, Yangsan-si, Republic of Korea
| |
Collapse
|
10
|
Ilogu LC, Lugovska O, Vojtek I, Prugnola A, Callegaro A, Mazzilli S, Van Damme P. The intent of students to vaccinate is influenced by cultural factors, peer network, and knowledge about vaccines. Hum Vaccin Immunother 2021; 18:1938492. [PMID: 34191678 PMCID: PMC8920151 DOI: 10.1080/21645515.2021.1938492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Young adults are the future vaccine decision-makers as parents or health-care professionals. To understand their attitudes and behaviors toward vaccination, we conducted a cross-sectional survey of 2079 students attending the University of Antwerp, Belgium and the University of Pisa, Italy. Principal component analysis was used to investigate associations between survey responses and the intent to vaccinate. Vaccination knowledge, attitudes, and behaviors among university students in Italy and Belgium were high. However, only one-half of respondents displayed an intent to vaccinate. High levels of knowledge, positive attitudes, and confidence in vaccines were positively associated with age, higher level of study, being a medical student, a recent vaccination experience, and not knowing trusted persons who did not believe in vaccines. Country of origin was highly correlated with the survey responses and was clustered with lifestyle, family, and data source variables, suggesting a strong modifying effect of culture and family attitudes on how vaccines are perceived in this age-group. Recent meningococcal vaccination campaigns and public discussions around mandatory vaccination in Italy may have influenced these results. We show that the intent to vaccinate was correlated with two main clusters of variables linked to culture (country, family, lifestyle), and to scholarship (knowledge, attitudes, data source) that together influence the behavior of students with respect to vaccination. Our study reinforces previous findings that knowledge about vaccines is key to shaping attitudes and behaviors, but also shows that cultural and lifestyle factors are another platform that could be leveraged in promoting vaccination among young people.
Collapse
Affiliation(s)
- Laura Chinenye Ilogu
- Département Biologie, Faculté des Sciences et Techniques, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Olga Lugovska
- Département Biologie, Faculté des Sciences et Techniques, Université Claude Bernard Lyon 1, Villeurbanne, France
| | | | | | | | - Sara Mazzilli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | |
Collapse
|
11
|
Caso D, Capasso M, Fabbricatore R, Conner M. Understanding the psychosocial determinants of Italian parents' intentions not to vaccinate their children: an extended theory of planned behaviour model. Psychol Health 2021; 37:1111-1131. [PMID: 34180333 DOI: 10.1080/08870446.2021.1936522] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study aimed to identify the psychosocial factors involved in Italian parents' intentions not to vaccinate their children. For this purpose, we used an extended version of the Theory of Planned Behaviour, which included both proximal and distal factors influencing intention not to vaccinate children. DESIGN Participants included 447 Italian parents, each completed an online questionnaire, which measured intention not to vaccinate children, attitude toward not vaccinating, subjective norms, perceived behavioural control, anticipated regret, negative attitude toward vaccines, risk perception, trust in healthcare institutions, trust in science and religious morality. RESULTS Results showed that attitude toward not vaccinating was strongly associated with intention not to vaccinate children. Furthermore, attitude toward not vaccinating was associated with negative attitude toward vaccines, which in turn was affected by all the distal factors considered (risk perception, trust in healthcare institutions, trust in science, religious morality). Finally, negative attitude toward vaccines fully mediated the effect of the distal factors on attitude toward not vaccinating children. CONCLUSION These findings provide support for the validity of the proposed extended TPB model in explaining parents' intention not to vaccinate children. Theoretical and practical implications, in terms of understanding and promoting vaccination behaviour, are discussed.
Collapse
Affiliation(s)
- Daniela Caso
- Department of Humanities, University of Naples Federico II, Naples, Italy
| | - Miriam Capasso
- Department of Humanities, University of Naples Federico II, Naples, Italy
| | - Rosa Fabbricatore
- Department of Social Sciences, University of Naples Federico II, Naples, Italy
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
| |
Collapse
|
12
|
de Vries M, Claassen L, Te Wierik MJM, Coban F, Wong A, Timmermans DRM, Timen A. Meningococcal W135 Disease Vaccination Intent, the Netherlands, 2018-2019. Emerg Infect Dis 2021; 26:1420-1429. [PMID: 32568034 PMCID: PMC7323551 DOI: 10.3201/eid2607.191812] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
To control the rise in Neisseria meningitidis strain W infections, during 2018–2019, the Netherlands launched a catch-up meningococcal conjugate (MenACWY) vaccination campaign for teenagers (13–18 years of age). Applying a mental models approach, we surveyed teenagers and their parents about their knowledge and beliefs about meningococcal disease, the MenACWY vaccination, vaccinations in general, and their MenACWY vaccination intentions. Using random forest analysis, we studied predictions of vaccination intentions by knowledge and beliefs. Survey response rate was 52.8% among teenagers and 59.4% among parents. MenACWY vaccination intentions were best predicted by knowledge and beliefs about vaccinations in general, surpassing knowledge and beliefs about meningococcal disease and the MenACWY vaccination. For teenagers, their parents’ intention that the teenager be vaccinated was a strong predictor of the teenagers’ own vaccination intention. To optimize vaccination uptake during future outbreaks, we recommend that communications emphasize the effectiveness and safety of vaccines and continue to focus on parents.
Collapse
|
13
|
Zhang KC, Fang Y, Cao H, Chen H, Hu T, Chen Y, Zhou X, Wang Z. Behavioral Intention to Receive a COVID-19 Vaccination Among Chinese Factory Workers: Cross-sectional Online Survey. J Med Internet Res 2021; 23:e24673. [PMID: 33646966 PMCID: PMC7945977 DOI: 10.2196/24673] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/16/2020] [Accepted: 02/26/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND COVID-19 vaccines will become available in China soon. Understanding communities' responses to the forthcoming COVID-19 vaccines is important. We applied the theory of planned behavior as the theoretical framework. OBJECTIVE This study investigates the prevalence of and factors associated with behavioral intention to receive self-financed or free COVID-19 vaccinations among Chinese factory workers who resumed work during the pandemic. We examined the effects of factors including sociodemographics, perceptions related to COVID-19 vaccination, exposure to information about COVID-19 vaccination through social media, and COVID-19 preventive measures implemented by individuals and factories. METHODS Participants were full-time employees 18 years or older who worked in factories in Shenzhen. Factory workers in Shenzhen are required to receive a physical examination annually. Eligible workers attending six physical examination sites were invited to complete a survey on September 1-7, 2020. Out of 2653 eligible factory workers, 2053 (77.4%) completed the online survey. Multivariate two-level logistic regression models and ordinal logistic regression models were fitted. RESULTS The prevalence of behavioral intention to receive a COVID-19 vaccination was 66.6% (n=1368, conditional on 80% vaccine efficacy and market rate) and 80.6% (n=1655, conditional on 80% vaccine efficacy and free vaccines). After adjusting for significant background characteristics, positive attitudes toward COVID-19 vaccination (adjusted odds ratio [AOR] 1.20, 95% CI 1.15-1.25 and AOR 1.24, 95% CI 1.19-1.30), perceived support from significant others for getting a COVID-19 vaccination (AOR 1.43, 95% CI 1.32-1.55 and AOR 1.37, 95% CI 1.25-1.50), and perceived behavioral control to get a COVID-19 vaccination (AOR 1.51, 95% CI 1.32-1.73 and AOR 1.28, 95% CI 1.09-1.51) were positively associated with both dependent variables (conditional on 80% vaccine efficacy and market rate or free vaccines, respectively). Regarding social media influence, higher frequency of exposure to positive information related to COVID-19 vaccination was associated with a higher intention to receive a COVID-19 vaccination at market rate (AOR 1.53, 95% CI 1.39-1.70) or a free vaccination (AOR 1.52, 95% CI 1.35-1.71). Higher self-reported compliance with wearing a face mask in the workplace (AOR 1.27, 95% CI 1.02-1.58 and AOR 1.67, 95% CI 1.24-2.27) and other public spaces (AOR 1.80, 95% CI 1.42-2.29 and AOR 1.34, 95% CI 1.01-1.77), hand hygiene (AOR 1.21, 95% CI 1.00-1.47 and AOR 1.52, 95% CI 1.19-1.93), and avoiding social gatherings (AOR 1.22, 95% CI 1.01-1.47 and AOR 1.55, 95% CI 1.23-1.95) and crowded places (AOR 1.24, 95% CI 1.02-1.51 and AOR 1.73, 95% CI 1.37-2.18) were also positively associated with both dependent variables. The number of COVID-19 preventive measures implemented by the factory was positively associated with the intention to receive a COVID-19 vaccination under both scenarios (AOR 1.08, 95% CI 1.04-1.12 and AOR 1.06, 95% CI 1.01-1.11). CONCLUSIONS Factory workers in China reported a high behavioral intention to receive a COVID-19 vaccination. The theory of planned behavior is a useful framework to guide the development of future campaigns promoting COVID-19 vaccination.
Collapse
Affiliation(s)
- Ke Chun Zhang
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Yuan Fang
- Department of Early Childhood Education, The Education University of Hong Kong, Hong Kong, China
| | - He Cao
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Hongbiao Chen
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Tian Hu
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Yaqi Chen
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Xiaofeng Zhou
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Zixin Wang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
14
|
Mo PKH, Luo S, Wang S, Zhao J, Zhang G, Li L, Li L, Xie L, Lau JTF. Intention to Receive the COVID-19 Vaccination in China: Application of the Diffusion of Innovations Theory and the Moderating Role of Openness to Experience. Vaccines (Basel) 2021; 9:vaccines9020129. [PMID: 33562894 PMCID: PMC7915878 DOI: 10.3390/vaccines9020129] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 01/03/2023] Open
Abstract
COVID-19 has caused a devastating impact on public health and made the development of the COVID-19 vaccination a top priority. Herd immunity through vaccination requires a sufficient number of the population to be vaccinated. Research on factors that promote intention to receive the COVID-19 vaccination is warranted. Based on Diffusion of Innovations Theory, this study examines the association between the perceived efficacy of the COVID-19 vaccination, use of social media for COVID-19 vaccine-related information, openness to experience and descriptive norm with the intention to receive the COVID-19 vaccination, and the moderating role of openness to experience among 6922 university students in mainland China. The intention to receive the free and self-paid COVID-19 vaccination is 78.9% and 60.2%, respectively. Results from path analyses show that perceived efficacy of the COVID-19 vaccination, use of social media for COVID-19 vaccine-related information, and openness to experience and descriptive norm are all positively associated with the intention to receive COVID-19 free and self-paid vaccination. The association between the perceived efficacy of the COVID-19 vaccination and descriptive norm with the intention to receive the COVID-19 vaccination is stronger among those with a lower level of openness to experience. Our findings support the usefulness of Diffusion of Innovations Theory and the moderating role of openness of experience in explaining intention to receive the COVID-19 vaccination.
Collapse
Affiliation(s)
- Phoenix Kit-han Mo
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (P.K.-h.M.); (S.L.); (L.X.)
| | - Sitong Luo
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (P.K.-h.M.); (S.L.); (L.X.)
| | - Suhua Wang
- Graduate School of Baotou Medical College, Baotou Medical College, Baotou 014040, China;
| | - Junfeng Zhao
- Department of Psychology, School of Education, Henan University, Kaifeng 475100, China;
| | - Guohua Zhang
- Department of Psychology, School of Psychiatry, Wenzhou Medical University, Wenzhou 325035, China;
| | - Lijuan Li
- School of Public Health, Dali University, Dali 671003, China;
| | - Liping Li
- Medical College, Shantou University, Shantou 515041, China;
| | - Luyao Xie
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (P.K.-h.M.); (S.L.); (L.X.)
| | - Joseph T. F. Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (P.K.-h.M.); (S.L.); (L.X.)
- Correspondence:
| |
Collapse
|
15
|
Zhang KC, Fang Y, Cao H, Chen H, Hu T, Chen YQ, Zhou X, Wang Z. Parental Acceptability of COVID-19 Vaccination for Children Under the Age of 18 Years: Cross-Sectional Online Survey. JMIR Pediatr Parent 2020; 3:e24827. [PMID: 33326406 PMCID: PMC7775376 DOI: 10.2196/24827] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND It is expected that COVID-19 vaccines will become available in China by the end of 2020. Vaccinating children against COVID-19 would contribute to the control of the pandemic and the recovery of the global economy. For children under the age of 18 years, parents are usually the decision makers regarding their children's vaccination. OBJECTIVE The goal of this study was to investigate parental acceptability of free COVID-19 vaccination for children under the age of 18 years in China. METHODS This is a secondary analysis of a cross-sectional, closed online survey among 2053 factory workers in Shenzhen, China, implemented from September 1 to 7, 2020. Participants of the online survey were full-time employees aged 18 years or over who had resumed work in factories in Shenzhen. Factory workers in Shenzhen are required to receive physical examinations once a year. Eligible workers attending six designated physical examination sites were invited to complete an online survey. This study was based on a subsample of those who had at least one child under the age of 18 years (N=1052). After being briefed that COVID-19 vaccines developed by China are likely to be available by the end of 2020, participants were asked about their likelihood of having their children under the age of 18 years take up free COVID-19 vaccination provided by the government, if it existed. Multivariate logistic regression models were fitted to examine the associations of perceptions related to COVID-19 vaccination based on the theory of planned behavior (TPB) and exposure to information related to COVID-19 through social media with parental acceptability, after controlling for significant background characteristics. RESULTS The prevalence of parents' acceptability of COVID-19 vaccination for their children was 72.6% (764/1052). After adjusting for significant background characteristics, positive attitudes toward COVID-19 vaccination (adjusted odds ratio [AOR] 1.70, 95% CI 1.50-1.91), the perception that a family member would support them in having their children take up COVID-19 vaccination (ie, perceived subjective norm) (AOR 4.18, 95% CI 3.21-5.43), and perceived behavioral control to have the children take up COVID-19 vaccination (AOR 1.84, 95% CI 1.49-2.26) were associated with higher parental acceptability of COVID-19 vaccination. Regarding social media influence, higher exposure to positive information related to COVID-19 vaccination was associated with higher parental acceptability of COVID-19 vaccination (AOR 1.35, 95% CI 1.17-1.56). Higher exposure to negative information related to COVID-19 vaccination was negatively associated with the dependent variable (AOR 0.85, 95% CI 0.74-0.99). CONCLUSIONS Parents' acceptability of COVID-19 vaccination for their children under 18 years of age was high in China. The TPB is a useful framework to guide the development of future campaigns promoting COVID-19 vaccination targeting parents. Transparency in communicating about the vaccine development process and vaccine safety testing is important. Public health authorities should also address misinformation in a timely manner.
Collapse
Affiliation(s)
- Ke Chun Zhang
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Yuan Fang
- Department of Early Childhood Education, The Education University of Hong Kong, Hong Kong, China
| | - He Cao
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Hongbiao Chen
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Tian Hu
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Ya Qi Chen
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Xiaofeng Zhou
- Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Zixin Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
16
|
Della Polla G, Pelullo CP, Napolitano F, Angelillo IF. HPV vaccine hesitancy among parents in Italy: a cross-sectional study. Hum Vaccin Immunother 2020; 16:2744-2751. [PMID: 32298210 PMCID: PMC7734096 DOI: 10.1080/21645515.2020.1744367] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This cross-sectional survey determined the vaccine hesitancy related to Human papillomavirus (HPV) and the determinants among parents of adolescents aged 12 and 13 years in Italy. Data was collected through a self-administered questionnaire. Two-thirds of the parents (66.7%) had heard of HPV infection and knew that the vaccination was a preventive measure. Parents who had vaccinated their child against the HPV were more likely to have this knowledge. The vast majority (88%) considered the immunization useful for the prevention of HPV-related cancers with an average value of 8.4. This positive attitude was higher among parents who had heard of HPV infection and knew that vaccination was a preventive measure, who had received information from physicians, who had vaccinated their child against the HPV, who were concerned that their child could contract the HPV infection, and who needed information on HPV vaccination. More than half (57.9%) self-reported that they had vaccinated their child against HPV and only 6.2% had delayed the administration of a dose. One-third (33.3%) were hesitant toward anti-HPV vaccination with a total Parent Attitudes about Childhood Vaccines Survey (PACV) score ≥50. Unmarried respondents, those who had not heard of HPV infection and did not know that the vaccination was a preventive measure, who did not believe that the vaccination was useful for the prevention of HPV-related cancers, and who needed information on HPV vaccination were more likely to be hesitant. Communication and education strategies must be undertaken to ensure that parents are fully informed and health-care professionals should provide materials with details regarding the risk of acquiring a HPV infection and vaccine usefulness.
Collapse
Affiliation(s)
- Giorgia Della Polla
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Concetta Paola Pelullo
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Francesco Napolitano
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | | |
Collapse
|
17
|
Immunization Campaigns and Strategies against Human Papillomavirus in Italy: The Results of a Survey to Regional and Local Health Units Representatives. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6764154. [PMID: 31355274 PMCID: PMC6637711 DOI: 10.1155/2019/6764154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 06/04/2019] [Indexed: 12/11/2022]
Abstract
Objective. The study aimed to assess the impact of HPV immunization campaigns organizational aspects, the characteristics of immunization program (vaccination targets and type of offer), and communicative strategies adopted by four Italian administrative regions on vaccination coverage observed. Methods. From November 2017 to March 2018, regional and Local Health Units (LHUs) representatives were invited to complete an online survey including 54 questions evaluating vaccination invite systems, access systems to vaccination centres, reminder and recall systems, and adverse events surveillance. An overall descriptive analysis was conducted. Since observed vaccine coverage (VC) obtained in females (2002-2004 birth cohorts) was lower than objectives fixed by the Italian Ministry of Health, variables were assessed using the national VC mean obtained in the 2003 girls birth cohort as outcome. Results. Twenty-six LHUs belonging to 4 Northern and Southern Italian regions participated in the study. Organizational aspects significantly related to VC lower than the national mean were access to vaccine centres without appointment and parents' reservation as appointment planning system. Recall systems for both the first and the second dose, including the appointment in the invitation letter, the availability of regional immunization registry, and education of healthcare workers on universal HPV immunization strategies, instead, were related to higher VC. As regards preadolescent immunization strategies, both VC obtained in girls and boys were far from the Ministerial goals. Only 20% of LHUs introduced multicohort female strategies while all LHUs adopted copayment targeting both men and women. Immunizations strategies targeting subjects at risk were implemented only in half of participating LHUs. Conclusions. VC observed in participating LHUs are largely lower than the national objectives in all anti-HPV vaccine targets. Both organizational and educational strategies have to be implemented to improve the VC goals.
Collapse
|
18
|
Fielding R. Developing a preventive psycho-oncology for a global context. The International Psycho-Oncology Society 2018 Sutherland Award Lecture. Psychooncology 2019; 28:1595-1600. [PMID: 31222864 DOI: 10.1002/pon.5139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/22/2019] [Accepted: 05/22/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Growing rates of cancer and survivorship, in situations of severe resource constraints, force a rethink about managing cancer-related psychosocial distress (CRPD). Here, a prevention-oriented natural history of distress is proposed, derived from developments in our understanding of the evolution and decay of CRPD. METHODS The literature indicates that at least four classes or natural histories of CRPD are identifiable. These are described in the context of prevention-oriented activities in psycho-oncology: (1) CRPD in persons with good coping resources, resulting from reaction to the diagnosis and treatment lifestyle disruption, which is largely self-limiting and preferably self-managed; (2) CRPD arising from residual, or late effects of disease or treatment, potentially persistent and debilitating; (3) CRPD in persons with preexisting coping difficulties; and (4) CRPD arising from existential issues such as mortality and fear of recurrence. RESULTS It is hypothesized that different natural histories of CRPD display different evolution, indicating potential causal processes, treatment priorities, and preventive strategies. In particular, the effective management of residual symptoms is crucial to prevent CRPD chronicity. Optimal patient involvement in treatment decision-making is also required. CONCLUSIONS There is a need to develop methods to differentiate if, early in the illness trajectory, the distressed patient is not able to self-manage the stress of cancer diagnosis and treatment. Not all distressed patients want or need help, and addressing just the CRPD may be inadequate where unresolved residual symptoms prevent renormalization after treatment. Improved doctor-patient communication around treatment decisions is warranted.
Collapse
Affiliation(s)
- Richard Fielding
- Centre for Psycho-Oncology Research & Training and Hong Kong Jockey Club Integrated Cancer Centre, The University of Hong Kong, Pokfulam, Hong Kong
| |
Collapse
|
19
|
Wang LDL, Lam WWT, Fielding R. Development and pre/post testing of a decision aid supporting Chinese parental and young women's HPV vaccination decision-making. Women Health 2019; 60:330-340. [PMID: 31195899 DOI: 10.1080/03630242.2019.1626791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We developed and tested the acceptability and utility of a novel HPV vaccination decision aid (DA) among Chinese young women aged 18-26 years and parents of adolescent girls aged 9-17 years. From March to May 2016, a total of 101 parents plus 109 young women completed baseline surveys assessing their HPV vaccination knowledge, decision self-efficacy, decision conflict, and HPV vaccination intention. Two weeks after receiving the DA, 84 (83.2%) parents and 92 (84.4%) young women completed re-assessments. Chi-square tests or t-tests were performed to compare the before-and-after differences. Cohen's d was calculated to indicate the effect size. After reading the DA, both participating young women's and parents' knowledge of HPV vaccination (Cohen's d = 0.62 among young women and d = 0.59 among parents) and decision self-efficacy (d = 0.38 among young women and d = 0.59 among parents) significantly increased. Both young women's and parents' decision conflict (d = -0 · 98 and -1.06) significantly decreased. The proportion of young women intending to receive HPV vaccination and parents deciding to vaccinate daughters against HPV significantly increased (p < 0 · 0001). The DA showed good acceptability and utility facilitating HPV vaccination decision-making for most Chinese young women and parents of adolescent girls. Further randomized controlled trials of this tool are essential.
Collapse
Affiliation(s)
- Linda Dong-Ling Wang
- School of Medicine, Yangzhou University, Yangzhou, China.,Centre for Psycho-Oncology Research and Training, School of Public Health, University of Hong Kong, Pokfulam, Hong Kong
| | - Wendy Wing Tak Lam
- Centre for Psycho-Oncology Research and Training, School of Public Health, University of Hong Kong, Pokfulam, Hong Kong
| | - Richard Fielding
- Centre for Psycho-Oncology Research and Training, School of Public Health, University of Hong Kong, Pokfulam, Hong Kong
| |
Collapse
|
20
|
The Acceptability of HPV Vaccines and Perceptions of Vaccination against HPV among Physicians and Nurses in Hong Kong. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101700. [PMID: 31091840 PMCID: PMC6572436 DOI: 10.3390/ijerph16101700] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/04/2019] [Accepted: 05/10/2019] [Indexed: 12/22/2022]
Abstract
Background: Human papillomavirus (HPV) is one of the most common sexually transmitted infections nationwide. Methods: This is the first cross-sectional survey assessing physicians’ and nurses’ knowledge of HPV and recording their attitudes to HPV vaccination in Hong Kong. Survey questions were derived from the Health Belief Model. Results: 1152 clinicians (170 physicians and 982 nurses) aged 21 and 60 participated in this study. A multiple stepwise regression model was used to examine associations between cognitive factors (clinicians’ attitudes) and subjects’ intention to HPV vaccine uptake. Results showed that only 30.2% of physicians and 21.2% nurses found vaccinating for HPV acceptable. Conclusions: Perceived self-efficacy was the only significant background and cognitive variable associated with physicians’ and nurses’ accepting HPV vaccines. Further, when nurses found HPV vaccination acceptable, cues to action was featured as a significant background variable in their choice.
Collapse
|
21
|
Degarege A, Krupp K, Fennie K, Srinivas V, Li T, Stephens DP, Madhivanan P. An integrative behavior theory derived model to assess factors affecting HPV vaccine acceptance using structural equation modeling. Vaccine 2019; 37:945-955. [PMID: 30655176 DOI: 10.1016/j.vaccine.2019.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/13/2018] [Accepted: 01/02/2019] [Indexed: 01/20/2023]
Abstract
The study examined factors that affect parental intention-to-vaccinate adolescent daughters with HPV vaccine in Mysore district, India. A cross-sectional study was conducted among 1609 parents of adolescent girls attending schools in Mysore District between February 2010 and October 2011. A validated questionnaire was used to assess parental attitudes, beliefs related with HPV infection, cervical cancer, HPV vaccine and vaccination in general. Structural equation modeling was used to estimate parameters and assess whether a model based on the integrative behavior theory would fit the current data. More than two-thirds (78.0%) of parents would accept vaccinating their daughters with HPV vaccine. Intention to HPV vaccination significantly increased with increase in the perception of parents about the benefits (standardized regression coefficient (β) = 0.39) or sources of information about HPV vaccine (β = 0.24), but intention decreased significantly with an increase in the perception about barriers to HPV vaccination β = -0.44). The effect of beliefs about severity of HPV infection or cervical cancer (β = 0.20), and beliefs about benefits (β = 0.20) or barriers (β = -0.25) to vaccination in general on intention to HPV vaccination were significantly mediated by parental attitudes and source of information about the vaccine. Geographical location significantly moderated the awareness about HPV on beliefs about severity of HPV infection or cervical cancer (β = 0.33), and the effect of religion on norms related to HPV vaccination (β = 0.19). Fit of the model to the data was acceptable. This study identified modifiable parental attitudes about HPV vaccine and beliefs related with HPV infection, cervical cancer and vaccination, which predicted parental intention-to-vaccinate their daughters with HPV vaccine in India. Health education interventions tailored to counter parental negative attitudes and beliefs about HPV vaccine and vaccination in general would be important for the community to promote HPV vaccination.
Collapse
Affiliation(s)
- Abraham Degarege
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, USA; Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Karl Krupp
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, USA; Public Health Research Institute of India, Mysore, India
| | - Kristopher Fennie
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, USA
| | | | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, USA
| | - Dionne P Stephens
- Department of Psychology, College of Arts, Sciences & Education, Florida International University, Miami, USA
| | - Purnima Madhivanan
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, USA; Public Health Research Institute of India, Mysore, India.
| |
Collapse
|
22
|
Napolitano F, D'Alessandro A, Angelillo IF. Investigating Italian parents' vaccine hesitancy: A cross-sectional survey. Hum Vaccin Immunother 2018; 14:1558-1565. [PMID: 29641945 DOI: 10.1080/21645515.2018.1463943] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This cross-sectional survey was designed to assess the prevalence of vaccine hesitancy and to identify factors associated among a randomly selected sample of parents. A questionnaire was self-administered from October to December 2017 to a sample of parents of children aged 2 to 6 years attending five randomly selected pre-schools in the geographic area of Naples, Italy. Out of the 727 selected parents, 437 returned the questionnaires for a response rate of 60.1%. The median of Parent Attitudes about Childhood Vaccines Survey (PACV) score among participants was 45.8 with a total of 141 parents (34.7%) scored a value ≥50 and were defined hesitant about the childhood vaccinations. Vaccine hesitancy was significantly more common among those who were concerned and among those were not sure that any one of the childhood shots might not be safe, among those who were concerned that their children might have a serious side effect from a shot, among those who were concerned that a shot might not prevent the disease, among those who delayed and refused at least a shot of vaccine for their children, and in those who are not sure and uncertain in the pediatrician. More than half of parents (53.8%) expressed a desire to receive additional information about the childhood vaccinations. Parents who were not sure and uncertain that to follow the recommended shot schedule is a good idea for their children and those who were parents of first-born children were more likely to need additional information. This study finds a high prevalence of vaccine hesitancy among parents suggesting that in the immunization program is necessary to achieve a higher quality of the relationship between pediatricians and the community.
Collapse
Affiliation(s)
- Francesco Napolitano
- a Department of Experimental Medicine , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Alessia D'Alessandro
- a Department of Experimental Medicine , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | | |
Collapse
|
23
|
Wong CKH, Man KKC, Ip P, Kwan M, McGhee SM. Mothers' Preferences and Willingness to Pay for Human Papillomavirus Vaccination for Their Daughters: A Discrete Choice Experiment in Hong Kong. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:622-629. [PMID: 29753361 DOI: 10.1016/j.jval.2017.10.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 10/05/2017] [Accepted: 10/13/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To determine the preference of mothers in Hong Kong and their willingness to pay (WTP) for human papillomavirus (HPV) vaccination for their daughters. METHOD A discrete choice experiment survey with a two-alternative study design was developed. Data were collected from pediatric specialist outpatient clinics from 482 mothers with daughters aged between 8 and 17 years. Preferences of the four attributes of HPV vaccines (protection against cervical cancer, protection duration, side effects, and out-of-pocket costs) were evaluated. The marginal and overall WTP were estimated using multinomial logistic regression. A subgroup analysis was conducted to explore the impact of socioeconomic factors on mothers' WTP. RESULTS Side effects, protection against cervical cancer, protection duration, and out-of-pocket cost determined the decision to receive or not receive the vaccine. All attributes had a statistically significant effect on the preference of and the WTP for the vaccine. Maximum WTP for ideal vaccines (i.e., 100% protection, lifetime protection duration, and 0% side effects) was HK$8976 (US $1129). The estimated WTP for vaccines currently available was HK$1620 (US $208), lower than the current market price. Among those who had a monthly household income of more than HK$100,000 (US $12,821), the WTP for vaccines currently offered was higher than the market price. CONCLUSIONS This study provides new data on how features of the HPV vaccine are viewed and valued by mothers by determining their perception of ideal or improved and current vaccine technologies. These findings could contribute to future policies on the improvement of HPV vaccine and be useful for the immunization service in Hong Kong.
Collapse
Affiliation(s)
- Carlos K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong.
| | - Kenneth K C Man
- Department of Paediatrics and Adolescent Medicine, Pok Fu Lam, The University of Hong Kong, Hong Kong
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Pok Fu Lam, The University of Hong Kong, Hong Kong
| | - Mike Kwan
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Lai Chi Kok, Kowloon, Hong Kong
| | - Sarah M McGhee
- School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong
| |
Collapse
|
24
|
Newman PA, Logie CH, Lacombe-Duncan A, Baiden P, Tepjan S, Rubincam C, Doukas N, Asey F. Parents' uptake of human papillomavirus vaccines for their children: a systematic review and meta-analysis of observational studies. BMJ Open 2018; 8:e019206. [PMID: 29678965 PMCID: PMC5914890 DOI: 10.1136/bmjopen-2017-019206] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 02/22/2018] [Accepted: 03/02/2018] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To examine factors associated with parents' uptake of human papillomavirus (HPV) vaccines for their children. DESIGN Systematic review and meta-analysis. DATA SOURCES Cochrane Library, AIDSLINE, CINAHL, EMBASE, PsycINFO, Social Sciences Abstracts, Ovid MEDLINE, Scholars Portal, Social Sciences Citation Index and Dissertation Abstracts International from inception through November 2017. METHODS We included studies that sampled parents and assessed uptake of HPV vaccines for their children (≤18 years) and/or sociodemographics, knowledge, attitudes or other factors associated with uptake. Study risk of bias was assessed using the Effective Public Health Practice Project tool. We pooled data using random-effects meta-analysis and conducted moderation analyses to examine variance in uptake by sex of child and parent. RESULTS Seventy-nine studies on 840 838 parents across 15 countries were included. The pooled proportion of parents' uptake of HPV vaccines for their children was 41.5% (range: 0.7%-92.8%), twofold higher for girls (46.5%) than for boys (20.3%). In the meta-analysis of 62 studies, physician recommendation (r=0.46 (95% CI 0.34 to 0.56)) had the greatest influence on parents' uptake, followed by HPV vaccine safety concerns (r=-0.31 (95% CI -0.41 to -0.16)), routine child preventive check-up, past 12 months (r=0.22 (95% CI 0.11 to 0.33)) and parents' belief in vaccines (r=0.19 (95% CI 0.08 to 0.29)). Health insurance-covered HPV vaccination (r=0.16 (95% CI 0.04 to 0.29)) and lower out-of-pocket cost (r=-0.15 (95% CI -0.22 to -0.07)) had significant effects on uptake. We found significant moderator effects for sex of child. CONCLUSIONS Findings indicate suboptimal levels of HPV vaccine uptake, twofold lower among boys, that may be improved by increasing physician recommendations, addressing parental safety concerns and promoting parents' positive beliefs about vaccines, in addition to expanding insurance coverage and reducing out-of-pocket costs. Limitations of this meta-analysis include the lack of intervention studies and high risk of bias in most studies reviewed. Further studies should disaggregate HPV vaccine uptake by sex of child and parent.
Collapse
Affiliation(s)
- Peter A Newman
- Centre for Applied Social Research, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Carmen H Logie
- Centre for Applied Social Research, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Lacombe-Duncan
- Centre for Applied Social Research, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Philip Baiden
- School of Social Work, The University of Texas at Arlington, Arlington, Texas, USA
| | - Suchon Tepjan
- Centre for Applied Social Research, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Clara Rubincam
- Centre for Applied Social Research, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Nick Doukas
- Centre for Applied Social Research, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Farid Asey
- Centre for Applied Social Research, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Parental acceptability of HPV vaccination for boys and girls aged 9-13 years in China - A population-based study. Vaccine 2018; 36:2657-2665. [PMID: 29606519 DOI: 10.1016/j.vaccine.2018.03.057] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study was to investigate parental acceptability of HPV vaccination for their sons and daughters aged 9-13 years under different cost scenarios, and factors associated with parental acceptability at market price. METHODS Participants were: (1) Chinese speaking parents aged 18-60 years with a Hong Kong ID card; (2) had a son or a daughter aged 9-13 years at the date of the survey; (3) the child had the right to abode in Hong Kong. Random telephone numbers were selected from up-to-date telephone directories of Hong Kong. A total of 300 eligible parents (boys' parents: 162; girls' parents: 138, response rate: 68.9% & 69%) provided verbal informed consent and completed the anonymous telephone interview during March to October 2016. Using parental acceptability of HPV vaccination at market price as the dependent variable, univariate and multiple logistic regression models were fitted. RESULTS The prevalence of HPV vaccination was very low among boys and girls (0.6% vs. 2.2%, p = 0.242). Among those whose children had not taken up HPV vaccination, the prevalence of parental acceptability of HPV vaccination for the index son and daughter were: 14.9% and 27.4% (market price), and 51.6% and 63.0% (free vaccination). Adjusted for sociodemographic variables, attitudinal variables based on the Health Belief Model were associated with parental acceptability of HPV vaccination for their sons (perception that it was not worthy, perceived cue to action from mass media and perceived self-efficacy) and for their daughters (perceived susceptibility and perceived severity of HPV infection among females, perceived benefit of HPV vaccination and perceived self-efficacy). CONCLUSION Coverage of HPV vaccination among children aged 9-13 years was very low. Instead of waiting for the free universal vaccination to become available, promotion of self-paid HPV vaccination targeting parents is urgently needed. Different strategies should be applied to boys' and girls' parents.
Collapse
|