Effects of information framing on human papillomavirus vaccination

Estimating the effects of interventions on increasing vaccination: systematic review and meta-analysis

As global vaccination rates have reached their lowest point in nearly 15 years, effective interventions are being required globally to promote vaccination; however, there is a lack of rigorous evaluation of the effect of various interventions. Through a global synthesis, we analysed data from approximately 6 125 795 participants across 319 studies in 41 countries to reveal the global landscape of four intervention themes and to assess their effectiveness in increasing vaccination rates. We found an overall positive effect of the interventions across four main themes on improving vaccination. Specifically, dialogue-based interventions increased vaccination rates by 43.1% (95% CI: 29.8 to 57.9%, with effect sizes measured as relative risks (RRs)), though they may not always be effective in adolescents or in the sample with a higher percentage of male participants. Incentive-based interventions, whether implemented alone or combined with other intervention themes, failed to demonstrate a significant effect in children. Reminder/recall-based interventions were also effective for promoting vaccination (38.5% increase, 95% CI: 28.9 to 48.9%), particularly for completing vaccine series. Multi-component interventions exhibited excellent effectiveness in vaccination (54.3% increase, 95% CI: 40.5 to 69.6%), with the combination of dialogue, incentive and reminder/recall proving more effective than other multi-component interventions, but showing no significant effects in populations with high initial vaccination rates. However, we found that in most cases combining additional interventions with a single intervention may not significantly improve their effectiveness, especially for incentive-based interventions, but dialogue-based and reminder/recall-based interventions appear to be beneficial in some specific combinations. These findings underscore the importance of governments, public health officials and advocacy groups implementing appropriate vaccine interventions by selecting interventions tailored to specific populations, strategically promoting the completion of vaccine series and effectively combining interventions to promote global vaccination and save more lives.

HPV vaccine-related articles shared on Facebook from 2019 to 2021: Did COVID make a difference?

Objective

HPV vaccination is recommended for children beginning at age 9 to prevent several types of cancer. Many parents turn to Facebook for health information. This study describes changes in HPV vaccine-related articles shared on Facebook amidst the COVID-19 pandemic.

Methods

HPV-related articles shared on Facebook (2019-2021) were collected using Buzzsumo, a social media analytics tool and analyzed using content analysis. Articles were categorized by valence, misinformation, evidence types, persuasive tactics, and framing. We quantified these data and tested for difference by article year.

Results

Of the 138 included articles, 51% had positive valence towards the vaccine and 36% had negative valence. In 2021, there was a significant increase in positive messaging (72% vs. 44% in 2019/2020; p < 0.01) and misinformation decreased from 50% in 2019 to 24% in 2021 (p = 0.04). Persuasive strategies were more common in 2019 than in later years.

Conclusion

Despite decreased engagement in 2021, more positive HPV vaccine messaging was observed, although a quarter of articles still contained misinformation. Our results can inform strategies for communicating with parents about the HPV vaccine.

Innovation

Our study is the first to analyze HPV-related articles linked on Facebook and to assess for differences during the pandemic.

Negativity in online news coverage of vaccination rates in Serbia: a content analysis

OBJECTIVE

This content analysis study explored how online news media communicates and frames vaccination rates and herd immunity (the effect where enough people are immune, the virus is contained).

METHODS

We analyzed 160 vaccination-related news stories by nine highest-trafficked news websites in Serbia, published July-December 2017, around the start of the measles outbreak. We coded both the news story as a whole and every vaccination-rate mention (N = 339).

RESULTS

News stories framed current vaccination rates and changes in them in a predominantly negative way (175/241 and 67/98 mentions, respectively) (e.g., "only 50% vaccinated", "fewer parents vaccinating their children"), especially when referring to the measles vaccine (202/262 mentions). A total of 23/86 of news stories mentioning vaccination rates did not provide any numerical values. Reference groups for vaccination rates were rarely specified. Out of the 32 news stories mentioning herd immunity, 11 explained the effect.

CONCLUSIONS

Even routine communication of vaccination rates can be biased through negative frames and imprecise descriptions. Lamenting low immunization rates could activate a negative descriptive social norm ("many people are not getting vaccinated"), which may be especially ill-advised in the absence of an explanation of the social benefit of achieving herd immunity through vaccination.

Facebook's shared articles on HPV vaccination: analysis of persuasive strategies

BACKGROUND

The current study analyzed articles shared on Facebook between 2019 and 2021 that discuss the HPV vaccine. Results address a gap in knowledge about the persuasive strategies used in HPV vaccine discourse on Facebook.

METHODS

Using Buzzsumo.com, we collected 138 articles, shared on Facebook between 2019 and 2021, with the highest "engagement scores," or total number of reactions, comments, and shares. Using a content analysis methodology, three independent coders were trained in using the study codebook, achieved acceptable inter-rater reliability (Krippendorf's alpha = 0.811), and coded each article in Atlas.ti.

RESULTS

Seventy-two articles had a positive valence toward the HPV vaccine, 48 had a negative valence, and 18 were mixed-valence or neutral. Pro-vaccine articles presented a variety of evidence types in support of benefits of HPV vaccination. Pro-vaccine articles primarily originated from national and local news sources. Anti-vaccine articles combined presentation of evidence with persuasive arguments and strategies, such as mistrust of institutions, fear appeals, ideological appeals, presenting a high number of arguments or detail, and minimizing the severity of HPV. Three sources were responsible for producing 62.5% of all anti-vaccine articles in the dataset. Mixed-valence or neutral articles mixed cancer prevention discourse with ideological appeals about protecting parental rights, and were mostly produced by local news outlets.

CONCLUSION

The results of this study can help health communicators anticipate the types of discourses that vaccine-hesitant parents may have encountered online. Implications and suggestions for practice are discussed.

Trust Matters: The Effects of Social Media Use on the Public's Health Policy Support Through (mis)beliefs in the Context of HPV Vaccination

This study examines whether social media exposure is associated with the public's beliefs and misbeliefs about human papillomavirus (HPV) vaccination and how those (mis)beliefs are associated with the public's support for HPV vaccination-related policies. This study also explores whether trust in HPV vaccination-related regulatory organizations moderates the associations between social media exposure and public policy support through (mis)beliefs. We found that social media exposure was positively associated with misbeliefs about HPV vaccination. The findings also indicated that while beliefs about benefits were positively associated with policy support for HPV vaccination, misbeliefs were negatively associated with this support. More interestingly, our analysis revealed that the negative association of HPV-related misbeliefs with vaccination policy support was larger for those who had low levels of trust, compared to their high-trust counterparts.

COVID-19 Vaccine Intention and Social Cognitive Theory: The Role of Individual Responsibility and Partisan Media Use in a Moderated Moderated Mediation Model

Despite the sheer devastation caused by the COVID-19 pandemic in the United States, vaccine hesitancy is a major barrier to a successful implementation of the vaccine. We apply two moderators to examine the associations of efficacy and expectancies with COVID-19 vaccine intention. Specifically, we use national survey data collected online in 2020 (N = 1264) and a moderated moderated mediation PROCESS model to examine 1) the associations between self-efficacy about COVID-19 and vaccine intention mediated by positive outcome expectancies and 2) moderating roles of individual responsibility and partisan media use. The findings show that the path from efficacy to expectancies is moderated by individual responsibility, while the path from expectancies to vaccine intention is moderated by liberal media use. Our findings support the strategic application of SCT to emphasize the role of personal responsibility in campaigns to encourage vaccination for the COVID-19 virus.

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.

Messaging of Different Disease Outcomes for Human Papillomavirus Vaccination: A Systematic Review

PURPOSE

The purpose of this systematic review was to assess how messaging for human papillomavirus (HPV) vaccination to prevent different health outcomes (sexually transmitted infection, anogenital warts ([AGW], and/or cancer) influences intentions or initiation for the vaccine series.

METHODS

We searched PubMed, MEDLINE, and Embase databases for all previously published articles with an evaluation, discussion, or comparison of messages containing content about HPV infections, AGW, precancers, or cancer through June 3, 2021. Results about messages were summarized by study population and design.

RESULTS

We identified 25 studies evaluating or comparing messages containing content about HPV-associated outcomes. Study designs included randomized trials (n = 12), cross-sectional surveys (n = 8), and qualitative approaches (n = 5). Few studies directly compared different messages using randomized designs or included vaccination uptake as the outcome. While many studies found support for cancer prevention messages, some studies also found equal or greater support for messages focusing on prevention of sexually transmitted infection/AGW. Variability was observed within and between studied populations (parents/adults, adolescents, young adults, healthcare providers, and adult males) and gender (male and female adolescents).

DISCUSSION

A greater understanding and deeper attention to myriad health outcomes of HPV infections could increase vaccination uptake in a variety of populations for health promotion across the lifespan.

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.

Message framing and COVID-19 vaccination intention: Moderating roles of partisan media use and pre-attitudes about vaccination

One of the ways to overcome the sheer devastation of the COVID-19 pandemic is to get vaccinated. However, vaccine hesitancy could be a significant barrier. The main purposes of the current study are to examine the impact of four types of theory-driven messages on COVID-19 vaccination intention and to understand the moderating role of partisan media use and vaccination attitudes. The study used a between-subject randomized online experiment with four conditions. The manipulation messages were presented as screenshots from the CDC's Facebook page. The total number of participants were 387 (female 43%, mean age 37 years). The participants were from the U.S. and older than 18 years. The findings show that loss vs. gain message frames did not have any impact on COVID-19 vaccine intention. The moderating effects of conservative media and attitudes show that in general, those who consumed lower conservative media and held positive attitudes were higher on vaccine intention, and individual vs. collective frames did not have a strong impact. However, among those participants who scored high on conservative media use, and held negative vaccination attitudes, the individual frame had a higher impact on vaccine intention. The current study experimentally tested the intertwined relationships among message frames, partisan media use, and attitudes on vaccine intention. These relationships are critical considering the political nature of the pandemic.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12144-022-02851-3.

The Impact of Theory in HPV Vaccination Promotion Research: A Systematic Review and Meta-Analysis

OBJECTIVE

Numerous studies examined HPV vaccination promotional strategies. However, an overview of theory use, a synthesis of strategies' effectiveness and an examination of the moderating influence of theory are absent.

DATA SOURCE

We retrieved studies from Academic Search Complete, Business Source Complete, PubMed, PsycINFO, Web of Science, CMMC, CINAHL, and MEDLINE.

STUDY INCLUSION AND EXCLUSION CRITERIA

1) peer-reviewed articles written in English, 2) experimental or quasi-experimental, 3) measure HPV vaccination-related outcomes, 4) had to contain a control condition and report statistics necessary for conversion (for meta-analysis only).

DATA EXTRACTION

70 and 30 studies were included for the systematic review and meta-analysis respectively.

DATA SYNTHESIS

Four major categories were coded: study information, theory use, type of theory, and outcomes. Two independent coders coded the sample (Cohen's Kappa ranged from .8 to 1).

RESULTS

Most of the studies were based in the U.S. (77%, k = 54) with convenient samples (80%, k = 56), targeted toward females (46%, k = 32), and around a quarter did not employ any theories (47%, k = 33). Among theory-driven studies, the most commonly used were Framing (22%, k = 19), Health Belief Model (HBM; 13%, k = 12), and Narrative (7%, k = 6). Among controlled studies, promotional strategies were significantly more effective compared to the control (r+ = .25, p < .001). Strategies guided by the information, motivation, behavioral skills model (IMB) were more effective (r+ = .75, p < .001) than studies guided by framing theory (r+ = -.23, p < .001), HBM (r+ = .01, p < .001), and other theories (r+ = .11, p < .001).

CONCLUSION

This review contributes to HPV vaccination promotion literature by offering a comprehensive overview of promotional strategies and practical suggestions for future research and practices.

The association between maternal human papillomavirus (HPV) experiences and HPV vaccination of their children

HPV vaccination prevents most HPV-related cancers yet vaccination rates remain low. In this cross-sectional study, we examined the association between maternal HPV experiences and HPV vaccination uptake among children and whether this association may be explained by perceived benefits of vaccination. We used logistic regression models to estimate the effect of (1) maternal history of abnormal Pap smear, (2), family/friend history of cervical cancer, and (3) maternal history of cervical cancer on HPV vaccination uptake among children. Separate mediation analyses were conducted to determine if perceived benefits mediated the relationship between each maternal HPV experience and HPV vaccination uptake. History of abnormal Pap smear (OR = 1.50, 95% CI = 1.15, 1.97), family history of cervical cancer (OR = 1.72, CI = 1.26, 2.35), and personal history of cervical cancer (OR = 3.00, CI = 1.82, 4.95) predicted HPV vaccination of children. Perceived benefits mediated the relationship between history of abnormal Pap smear (indirect effect =.146, SE =.069, 95% CI =.014, .289), family history of cervical cancer (indirect effect =.228, SE =.079, CI =.080, .387), and personal history of cervical cancer (indirect effect =.298, SE =.116, CI =.082, .533) on HPV vaccination. Our results suggest that personal experiences with HPV-related disease may influence maternal HPV vaccine decision-making.

Inattention or reluctance? Parental responses to vaccination reminder letters

This paper studies non-adherence in the Danish Childhood Vaccination Program using a nationwide introduction of a vaccination reminder letter policy and administrative data from 2011-2017. First, I provide causal estimates of how the reminder letter policy affects vaccination adherence using a Regression Discontinuity Design (RDD). Second, I link parental responses to the reminder letter to parents' causes for being non-adherent. I find that the reminder letter policy positively affects adherence. However, 72% of non-adherent parents are non-responsive to the reminder letter indicating that reluctance and not inattention is the leading cause for non-adherence. Thus, other policies beyond reminder letters - such as mandatory vaccination laws - are necessary to substantially increase vaccination coverage.

Do traditional economic theories of free riding behavior explain spatial clustering of HPV vaccine uptake?

Rationale

Geographic clusters of low vaccination uptake reduce the population-level efficacy of vaccination programs. However, little is known about the mechanisms that drive geographic patterns in vaccination rates. Traditional economic theory considers vaccination as a classic public good and suggests that free riding-individuals taking advantage of public goods by relying on others' immunization behavior without contributing toward them-is a primary cause of low vaccination rates. However, behavioral economics suggests that free riding does not fully explain observed individual behavior, and the presence of both high and low clusters of vaccination rates suggest that this theory alone does not fully explain geographic patterns of vaccination.

Objective

We assessed geographic clustering of HPV vaccination uptake and examined the evidence for or against free riding in HPV vaccination decisions.

Methods

We analyzed HPV vaccination decisions of low-income adolescent females (N = 601) residing in urban neighborhoods in Dallas, Texas, USA during 2011-2012. Spatial econometric models were estimated to assess the relationship between neighborhood vaccination rates and individual vaccination decisions.

Results

We found a positive and significant relationship between individual HPV vaccination choices and the average neighborhood vaccination rate at the time parents were making vaccine decisions for their adolescent daughters while controlling for neighborhood sorting and other confounders.

Conclusion

Individuals were more likely to complete the HPV vaccination series when others in their neighborhood had already completed the series. We do not find evidence for free riding in HPV vaccination decisions.

Hispanic Mothers' Beliefs About Having Their Adolescent Sons Initiate the HPV Vaccine Series

Rates of HPV vaccination among adolescent Hispanic males lag far behind the Healthy People 2020 80% goal. This study identified Hispanic mothers' salient beliefs regarding having their sons initiate the HPV vaccine series. Twenty-seven Hispanic mothers completed in-depth interviews. They responded to questions that elicited the salient behavioral, normative and control beliefs associated with initiating the HPV vaccine series. We content analyzed their responses. We found that, regarding having their sons initiate the HPV vaccine, mothers: (1) express mostly positive feelings; (2) believe that the vaccine has positive effects, with side effects as the main negative effect; (3) believe that their sons' father and doctor support vaccination while some friends do not; and (4) believe that vaccine affordability, transportation and the support of their sons' father facilitate vaccine initiation. Overall, mothers held positive salient beliefs about the HPV vaccine including that it protects their son's health, has minimal side effects and is recommended by physicians. We are more likely to increase vaccination rates among adolescent Hispanic males if we address mothers' salient beliefs, including reinforcing their positive beliefs.

What is the most useful tool in HPV vaccine promotion? Results from an experimental study

Introduction: Human papillomavirus infection (HPV) affects 70-80% of female population throughout the lifetime, exposing them to the risk of developing genital warts and cervical cancer. Despite these correlated risks and the demonstrated efficacy of the vaccine, coverage rates for two-three doses are around 70% in Italy and 67% in Piemonte (below the expected 95%). Aim of the study is to investigate whether this situation is due to a lack of information and awareness among young adults. Results: Students showed increased knowledge after the intervention and more than 90% found the 3 informative materials as sources of useful information. After the intervention students would strongly recommend HPV vaccination (OR = 3.45; p < 0.001). Discussion: Higher rates of correct answers after the distribution of informative material underline the importance of knowledge delivery. Differences among the kind of material were reported; it appears that a combination of leaflet's positive features, such as clarity and intelligibility, and article's completeness of information represents the best solution to reach communication goals in vaccination campaigns targeted on educated populations. Methods: Researchers conducted an experimental study on a large population of undergraduate students from University of Turin. Participants' knowledge about HPV was assessed with questionnaires before and after the examination of 3 different kinds of informative material (journal article describing HPV infection, gynecologist video-interview and institutional leaflet about HPV prevention) on HPV and vaccine. Differences among groups were explored by using univariate tests, differences in pre- post- knowledge were assessed with McNemar tests. Relevant associations were searched with logistic regression models.

Using Facebook to reach adolescents for human papillomavirus (HPV) vaccination

BACKGROUND

Despite numerous public health campaigns to promote the human papillomavirus (HPV) vaccine, uptake among adolescents in the US has remained below the Healthy People 80% goal for 3-dose completion. The Philadelphia Department of Public Health (PDPH) used an innovative social media strategy to raise awareness and increase rates of HPV immunization initiation and series completion among adolescents.

METHODS

Between June 2012 and July 2013, PDPH launched a Facebook campaign to target Philadelphia adolescents (13-18 years) with specific messages about HPV immunization benefits and announce opportunities for vaccination. Six distinct advertising campaigns ran for two-week intervals. Facebook metrics and vaccine clinic data were used to track success. Reminder-recall letters were also sent to adolescents as part of the campaign.

RESULTS

On average, each advertising campaign reached 155,110 adolescents and engaged 2106 adolescents. The advertising campaigns that focused on HPV disease risk and local resources were the most successful in engaging adolescents. During advertising campaigns, there were sizeable increases in both reach and engagement compared to non-campaign periods. Overall, 3400 adolescents became fans of the campaign and 176 doses of HPV vaccine were administered to 152 adolescents. Only 2 adolescents were vaccinated as a result of the Facebook campaign while the rest were prompted by reminder-recall letters or through community events.

CONCLUSION

The campaign was well-received, far-reaching and generated awareness and conversations among adolescents. However, the campaign did not appear to be a sufficient driver for HPV uptake even when common barriers to HPV immunization were minimized.

Listen to the public and fulfil their information interests - translating vaccine communication research findings into guidance for regulators

Regulatory authorities have a crucial role in communicating about the vaccines they license. In terms of content and timing, their communication to the public is usually driven by data on quality, safety and efficacy. However, concerns over safety and vaccine hesitancy have emerged in some communities in various countries, and this demands a new approach to communication, starting with listening to the public debate. Reviewing communication research findings, coming in particular from the cognitive, decision‐making and media sciences, constitutes one mechanism of listening and has led the European Union (EU) regulatory network to developing guidance about which common concerns and information needs of the public to address through proactive and prepared communication. The guidance has been welcomed by EU and international fora. The current article summarizes the recommendations and shares the underlying research findings, as well as a proof of concept that communication research can be valuable for regulators. It is critical that regulators integrate the communication process with product risk assessment in the framework of pharmacovigilance, to ensure that public concerns are addressed in the assessments and that information about evidence and uncertainty relating to safety is provided to the public and vaccination policy makers in a specific, clear and accurate manner. Additionally, information from regulatory authorities should support healthcare professionals in their communication with patients. Meeting the information interests of the public is the principal prerequisite for informed decisions as well as safe and effective use of vaccines and medicines overall. This is also fundamental for trust in the authorities' commitment to patient and population health.

Who Is to Blame? Framing HPV to Influence Vaccination Intentions among College Students

Human papillomavirus (HPV) is a prevalent sexually transmitted infection (STI) among college students. Although previous research has studied HPV-related health communication strategies using various framing techniques, the goal of this study is to test how two unique message frames-whether mentioning HPV as an STI and whether to attribute the cause of infection as external or internal-would influence young adults' intentions to receive the recommended HPV vaccine. Results indicate that gender and causal attribution framing influenced participants' intentions to receive the HPV vaccine.

Multimodal Counseling Interventions: Effect on Human Papilloma Virus Vaccination Acceptance

Human papilloma virus (HPV) vaccine was developed to reduce HPV-attributable cancers, external genital warts (EGW), and recurrent respiratory papillomatosis. Adolescent HPV vaccination series completion rates are less than 40% in the United States of America, but up to 80% in Australia and the United Kingdom. Population-based herd immunity requires 80% or greater vaccination series completion rates. Pro-vaccination counseling facilitates increased vaccination rates. Multimodal counseling interventions may increase HPV vaccination series non-completers’ HPV-attributable disease knowledge and HPV-attributable disease prophylaxis (vaccination) acceptance over a brief 14-sentence counseling intervention. An online, 4-group, randomized controlled trial, with 260 or more participants per group, found that parents were more likely to accept HPV vaccination offers for their children than were childless young adults for themselves (68.2% and 52.9%). A combined audiovisual and patient health education handout (PHEH) intervention raised knowledge of HPV vaccination purpose, p = 0.02, and HPV vaccination acceptance for seven items, p < 0.001 to p = 0.023. The audiovisual intervention increased HPV vaccination acceptance for five items, p < 0.001 to p = 0.006. That HPV causes EGW, and that HPV vaccination prevents HPV-attributable diseases were better conveyed by the combined audiovisual and PHEH than the control 14-sentence counseling intervention alone.

The Silver Lining of Shame: Framing HPV to Influence Vaccination Intentions

College students suffer disproportionately from human papillomavirus (HPV), a sexually transmitted infection (STI) that could result in genital warts or cancers in both males and females. Research contends that stigma and shame may serve as barriers to disclosure intentions, as well as vaccination intentions. The goal of this study was to examine whether two framing strategies-whether to mention that HPV is sexually transmitted and whether to highlight the cause of infection as internal or external-would influence young adults' intentions to disclose a potential diagnosis and their intentions to get the recommended HPV vaccine. Results indicate that STI framing and gender had consistent impacts on disclosure and vaccination intentions. Further, causal attribution framing also influenced participants' intention to get the vaccine at no cost immediately and their intention to get the vaccine at the retail price of $375 in the future. Theoretical and practical implications of these results are discussed.

Influence of Information Framing on Patient Decisions to Treat Actinic Keratosis

Importance

Actinic keratosis (AK) is a skin growth induced by UV light exposure that requires long-term management because a small proportion of the disease can progress to squamous cell carcinoma. The influence of how clinicians frame or present information to patients may affect decision making about AK.

Objective

To evaluate the differences in patients' decisions on whether to receive treatment for AK related to information presentation or choice framing.

Design, Setting, and Participants

A prospective survey study was performed from June 1 to July 31, 2016, in participants who were able to read English. Participants were recruited through the Penn State Milton S. Hershey Dermatology Clinic and an online survey site. The survey was conducted through an online portal. A total of 571 individuals were recruited. Regression analysis, correlation coefficient analysis, and test-retest validation were conducted.

Main Outcomes and Measures

The proportions of patients choosing to receive treatment for AK. Analyses were performed to adjust for age, sex, educational level, history of skin cancer, and history of AK.

Results

Of the 571 recruited participants, 539 (94.4%) returned completed surveys. The mean (SD) age of respondents was 42.9 (17.8) years; 306 (56.8%) were women. The decision to receive treatment for AK varied from 57.7% (n = 311) to 92.2% (n = 497) for the 5 scenarios presented in the questions (P < .001). The question that presented AK as a "precancer" had the highest proportion of participants who preferred treatment (497 [92.2%]). Two questions that presented the risk of AK as not progressing to cancer had the lowest proportion of individuals who chose treatment (311 [57.7%] and 328 [60.9%]). Participants from the clinic and from the online portal were significantly different in age (mean [SD] age, 56.1 [17.6] vs 33.3 [10.0] years), sex (145 [63.6%] vs 161 [51.8%] were females), educational level (40 [17.5%] vs 80 [25.7%] had completed some graduate school), history of AK (46 [20.2%] vs 19 [6.1%] answered yes), and history of skin cancer (76 [33.3%] vs 15 [4.8%] answered yes) (all P ≤ .001). Based on a regression analysis, age, sex, and previous diagnosis of skin cancer were not significantly associated with the participants' responses.

Conclusions and Relevance

This study found that patients' decisions on whether to receive treatment for AK is significantly affected by physician wording, especially with alterations in the presentation of risk of malignant transformation.

Recruiting Young Gay and Bisexual Men for a Human Papillomavirus Vaccination Intervention Through Social Media: The Effects of Advertisement Content

Background

Web-based approaches, specifically social media sites, represent a promising approach for recruiting young gay and bisexual men for research studies. Little is known, however, about how the performance of social media advertisements (ads) used to recruit this population is affected by ad content (ie, image and text).

Objective

The aim of this study was to evaluate the effects of different images and text included in social media ads used to recruit young gay and bisexual men for the pilot test of a Web-based human papillomavirus (HPV) vaccination intervention.

Methods

In July and September 2016, we used paid Facebook advertisements to recruit men who were aged 18-25 years, self-identified as gay or bisexual, US resident, and had not received HPV vaccine. A 4x2x2 factorial experiment varied ad image (a single young adult male, a young adult male couple, a group of young adult men, or a young adult male talking to a doctor), content focus (text mentioning HPV or HPV vaccine), and disease framing (text mentioning cancer or a sexually transmitted disease [STD]). Poisson regression determined whether these experimental factors affected ad performance.

Results

The recruitment campaign reached a total of 35,646 users who viewed ads for 36,395 times. This resulted in an overall unique click-through rate of 2.01% (717/35,646) and an overall conversion rate of 0.66% (241/36,395). Reach was higher for ads that included an image of a couple (incidence rate ratio, IRR=4.91, 95% CI 2.68-8.97, P<.001) or a group (IRR=2.65, 95% CI 1.08-6.50, P=.03) compared with those that included an image of a single person. Ads that included an image of a couple also had a higher conversion rate (IRR=2.56, 95% CI 1.13-5.77, P=.02) than ads that included an image of a single person. Ads with text mentioning an STD had a higher unique click-through rate compared with ads with text mentioning cancer (IRR=1.34, 95% CI 1.06-1.69, P=.01). The campaign cost a total of US $413.72 and resulted in 150 eligible and enrolled individuals (US $2.76 per enrolled participant).

Conclusions

Facebook ads are a convenient and cost-efficient strategy for reaching and recruiting young gay and bisexual men for a Web-based HPV vaccination intervention. To help optimize ad performance among this population, researchers should consider the importance of the text and image included in the social media recruitment ads.

Health professional feedback on HPV vaccination roll-out in a developing country

BACKGROUND

Worldwide, Zambia has the highest cervical cancer incidence rates (58.4/100,000 per year) and mortality rates (36.2/100,000 per year). The human papilloma virus (HPV) vaccine is considered a vital preventative measure against cervical cancer, particularly in sub-Saharan countries, such as Zambia. Past research suggests health professionals' experiences with HPV vaccination rollout can have practical implications for effective delivery.

OBJECTIVE

To explore health professionals' perspectives on the HPV vaccination programme in Zambia.

METHODS

Researcher travelled to Zambia and conducted semi-structured interviews with fifteen health professionals working in private, government, and missionary clinics/hospitals. Observation was conducted for triangulation purposes. Thematic analysis was used to analyse the data.

FINDINGS

Five main themes emerged; medical misconceptions about the HPV vaccination, particularly with regards to infertility; fear of the unknown, including possible side effects and inadequate empirical research; need for prior desensitisation to resolve cultural barriers prior to vaccination rollout; a rural-urban divide in health awareness, particularly in relation to cancer vaccines; and economic concerns associated with access to the HPV vaccination for most of the Zambian population.

CONCLUSION

Overall, the findings indicate that an essential avenue for facilitating HPV vaccination rollout in Zambia is by implementing a pre-rollout community effort that removes or softens cultural barriers, particularly in rural areas. It is also essential to correct erroneous HPV presumptions health professionals may have around infertility. Affordability remains a seemingly intractable hindrance that hampers HPV vaccination rollout in Zambia.

Identifying Hispanic mothers' salient beliefs about human papillomavirus vaccine initiation in their adolescent daughters

Guided by the Integrative Model of Behavioral Prediction, we identify mothers' salient beliefs regarding their daughters' initiation of the human papillomavirus vaccine series. In all, 34 Hispanic mothers responded to elicitation questions. Salient beliefs included the following: (1) feeling secure, happy, relieved, concerned, and fear about vaccinating; (2) believing that vaccinating prevents and protects from human papillomavirus but may result in side effects and sexual disinhibition; (3) identifying the daughter, father, mother, aunt, friends, and grandmothers as supporters/non-supporters; and (4) affordability, transportation, clinic distance, and making appointments as facilitators/barriers. This study begins the process of building a model of human papillomavirus vaccine initiation for this population.

Provider communication about HPV vaccination: A systematic review

BACKGROUND

Improving HPV vaccination coverage in the US will require healthcare providers to recommend the vaccine more effectively. To inform quality improvement efforts, we systematically reviewed studies of provider communication about HPV vaccination.

METHODS

We searched MEDLINE, CINAHL, EMBASE, and POPLINE in August 2015 to identify studies of provider communication about HPV vaccination.

RESULTS

We identified 101 qualitative and quantitative studies. Providers less often recommended HPV vaccine if they were uncomfortable discussing sex, perceived parents as hesitant, or believed patients to be low risk. Patients less often received recommendations if they were younger, male, or from racial/ethnic minorities. Despite parents' preference for unambiguous recommendations, providers often sent mixed messages by failing to endorse HPV vaccine strongly, differentiating it from other vaccines, and presenting it as an "optional" vaccine that could be delayed.

CONCLUSION

Interventions are needed to help providers deliver effective recommendations in the complex communication environment surrounding HPV vaccination.

Perceived Risk of Human Papillomavirus Infection and Cervical Cancer among Adolescent Women in Taiwan

PURPOSE

High-risk types of human papillomavirus (HPV) are a critical etiologic factor behind cervical cancer. Adolescents are a vulnerable group for HPV infection. However, the literature on adolescent women for HPV infection and cervical cancer is limited. This study was to investigate HPV-related knowledge and perceived risk of HPV infection and cervical cancer among Taiwanese adolescent women in order to assess intervention strategies for prevention of cervical cancer and maintenance of reproductive health.

METHODS

A descriptive cross-sectional study design was implemented. There were 610 adolescent women from three colleges in Southern Taiwan who participated in this study. Data were collected using an anonymous self-administered questionnaire survey.

RESULTS

The results showed that the percentage of appropriate answers to HPV-related knowledge questions was only 36.8%, and smoking as the leading cause of cervical cancer received the lowest mean score for appropriate answers among the HPV-related knowledge items. The perceived risk of HPV infection and cervical cancer were moderate, with relatively lower susceptibility to infection with HPV than to cervical cancer (p < .001). Only 11.5% of the participants reported that they had received information about HPV vaccination from healthcare professionals.

CONCLUSIONS

Participants lacked a comprehensive understanding of cervical cancer prevention and were not aware of their susceptibility to HPV infection. Adolescent women rarely obtained HPV-related information from healthcare professionals. Appropriate education strategies should be developed and conducted by healthcare professionals to reduce the risk of cervical cancer threat from adolescence.

Understanding the role of the news media in HPV vaccine uptake in the United States: Synthesis and commentary

Vaccination rates for the human papillomavirus (HPV) vaccine fall below targets and only 2 states and the District of Columbia require the vaccine for middle school-age children. Messages conveyed through news media-to parents, providers, policymakers, and the general public-may contribute to sluggish vaccination rates and policy action. In this commentary, we review the findings from 13 published studies of news media coverage of the HPV vaccine in the United States since FDA licensure in 2006. We find 2 important themes in news coverage: a rising focus on political controversy and a consistent emphasis on the vaccine as for girls, even beyond the point when the vaccine was recommended for boys. These political and gendered messages have consequences for public understanding of the vaccine. Future research should continue to monitor news media depictions of the HPV vaccine to assess whether political controversy will remain a pronounced theme of coverage or whether the media ultimately depict the vaccine as a routine public health service.

A feminist information engagement framework for gynecological cancer patients

Purpose

– The purpose of this paper is to present a three-part framework of information engagement for situated gynecological cancers. These particular cancers intertwine with medicalization of sexuality and gender power dynamics, situating information behaviors and interactions in women’s socio-health perceptions. Using Kavanagh and Broom’s feminist risk framework, the framework establishes functional and temporal parameters for sense-making and information engagement.

Design/methodology/approach

– This paper employs a structured, reiterative literature review with emergent thematic analysis. Nine indices from medicine, information studies, and sociology were searched using combinations of five terms on cervical cancer (CC) and 14 terms on information engagement in the title, abstract, and subject fields. Results were examined on a reiterative basis to identify emergent themes pertaining to knowledge development and information interactions.

Findings

– Environmentally, social stigma and gender roles inhibit information seeking; normalizing CC helps integrate medical, moral, and sexual information. Internally, living with the dichotomy between “having” a body and “being” a body requires high-trust information resources that are presented gradually. Actively, choosing to make or cede medical decision-making requires personally relevant information delivered in the form of concrete facts and explanations.

Research limitations/implications

– The study covers only one country.

Originality/value

– This study’s information framework and suggestions for future research encourage consideration of gender power dynamics, medicalization of sexuality, and autonomy in women’s health information interactions.

Parents' decision-making about the human papillomavirus vaccine for their daughters: I. Quantitative results

Vaccination against the human papillomavirus (HPV) is an effective primary prevention measure for HPV-related diseases. For children and young adolescents, the uptake of the vaccine is contingent on parental consent. This study sought to identify key differences between parents who obtain (acceptors) and parents who refuse (non-acceptors) the HPV vaccine for their daughters. In the context of a free, universal, school-based HPV vaccination program in Québec, 774 parents of 9-10 year-old girls completed and returned a questionnaire by mail. The questionnaire was based on the theoretical constructs of the Health Belief Model (HBM), along with constructs from other theoretical frameworks. Of the 774 parents, 88.2% reported their daughter having received the HPV vaccine. Perceived susceptibility of daughters to HPV infection, perceived benefits of the vaccine, perceived barriers (including safety of the vaccine), and cues to action significantly distinguished between parents whose daughters had received the HPV vaccine and those whose daughters had not. Other significant factors associated with daughter vaccine uptake were parents' general vaccination attitudes, anticipated regret, adherence to other routinely recommended vaccines, social norms, and positive media influence. The results of this study identify a number of important correlates related to parents' decisions to accept or refuse the HPV vaccine uptake for their daughters. Future work may benefit from targeting such factors and incorporating other health behavior theories in the design of effective HPV vaccine uptake interventions.

What are the factors that contribute to parental vaccine-hesitancy and what can we do about it?

Parental refusal or delay of childhood vaccines is increasing. Barriers to vaccination among this population have been described, yet less is known regarding motivating factors. Researchers are beginning to evaluate various approaches to address the concerns of "vaccine-hesitant" parents, but few studies have evaluated the effect of interventions on timely vaccine uptake. Several models for communicating with vaccine-hesitant parents have been reported for healthcare providers; however, the effectiveness and utility of these strategies has not been quantified. This article reviews the known barriers to vaccination reported by vaccine-hesitant parents and the current evidence on strategies to address parental vaccine hesitancy.

Update on prevention and screening of cervical cancer

Cervical cancer is the third most common cause of cancer in women in the world. During the past few decades tremendous strides have been made toward decreasing the incidence and mortality of cervical cancer with the implementation of various prevention and screening strategies. The causative agent linked to cervical cancer development and its precursors is the human papillomavirus (HPV). Prevention and screening measures for cervical cancer are paramount because the ability to identify and treat the illness at its premature stage often disrupts the process of neoplasia. Cervical carcinogenesis can be the result of infections from multiple high-risk HPV types that act synergistically. This imposes a level of complexity to identifying and vaccinating against the actual causative agent. Additionally, most HPV infections spontaneously clear. Therefore, screening strategies should optimally weigh the benefits and risks of screening to avoid the discovery and needless treatment of transient HPV infections. This article provides an update of the preventative and screening methods for cervical cancer, mainly HPV vaccination, screening with Pap smear cytology, and HPV testing. It also provides a discussion of the newest United States 2012 guidelines for cervical cancer screening, which changed the age to begin and end screening and lengthened the screening intervals.

Parents' views on human papillomavirus vaccination for sexually transmissible infection prevention: a qualitative study

Background Human papillomavirus (HPV) is the most common sexually transmissible infection (STI) in the United States (US) and an important cause of several cancers. Vaccines that prevent HPV infections are now recommended for routine use in adolescents but coverage remains suboptimal in the US. Because they are often promoted as cancer prevention vaccines, little is known about parents' views on vaccination for prevention of an STI.

METHODS

In this qualitative study, parents and caregivers of children ages 10-18 years completed an in-depth interview. Participants (n=38) were recruited from an urban hospital-based primary care centre serving a low-income population in the north-eastern US during May 2013-February 2014. Interviews were transcribed and coded using a thematic content approach.

RESULTS

Five major themes emerged with relevance to the topic of HPV vaccination for STI prevention: (1) low awareness of HPV as an STI; (2) favourable opinions about STI prevention messages for vaccination, including at young ages; (3) salience of sexual mode of transmission, given the unpredictability of adolescent sexual behaviour and high rates of other STIs and teen pregnancy; (4) recognition that sexual health is a topic of conversation between adolescents and health care providers; and(5) relevance of personal experience.

CONCLUSIONS

Discussing STI prevention in the context of HPV vaccination appears to be well accepted by urban, low-income minority families. In addition to providing information on cancer prevention, these messages may help to raise awareness, acceptability and uptake of HPV vaccines.

Factors impacting HPV vaccination: lessons for health care professionals

HPV infection leads to significant morbidity and mortality worldwide. The HPV vaccine is currently licensed and recommended for adolescents and young adults in many countries. Nonetheless, coverage levels remain low, especially in settings using a clinic-based rather than school-based delivery model. Health care professionals (HCPs) have the potential to strongly impact HPV vaccine acceptability and uptake, yet often fail to discuss and/or strongly recommend HPV vaccination. This article reviews the myriad factors that influence HPV vaccination, focusing, in particular, on those relevant to HCP communication with patients and families. It also provides a historical framework and highlights recent evidence related to HPV vaccination that may be valuable for these conversations. Lastly, it discusses strategies targeting HCPs and their practices that may increase HPV vaccination initiation and completion rates globally.

A quality improvement initiative to increase HPV vaccine rates using an educational and reminder strategy with parents of preteen girls

INTRODUCTION

A quality improvement project was undertaken to determine if an evidence-based educational brochure and reminder system can increase human papillomavirus (HPV) vaccine uptake and dose completion rates.

METHOD

Development of a brochure to promote HPV vaccine uptake was based on predictors of parental acceptance and Health Belief Model concepts. Electronic alerts prompted telephone reminders for dose completion. This quality improvement project utilized a quasi-experimental design with 24 parents of preteen girls from a private pediatric practice and a historical control group of 29 parents. HPV vaccine rates were compared between the groups.

RESULTS

A significant difference in HPV vaccine uptake (χ(2) = 11.668, P = .001; odds ratio [OR] = 9.429, 95% confidence interval [CI] = 2.686-33.101) and dose completion (χ(2) = 16.171, P < .001; OR = 22.500, 95% CI = 4.291-117.990) rates were found between the historical control and intervention groups. Parents who received the clinical protocol were 9.4 times and 22.5 times more likely to have HPV vaccine uptake and dose completion, respectively.

DISCUSSION

Low national HPV vaccine rates demonstrate the need for theory-based vaccine delivery programs. These results show that an evidence-based educational brochure and reminder system appeared to improve HPV vaccine uptake and dose completion rates at this private pediatric practice.

Educational interventions to increase HPV vaccination acceptance: a systematic review

BACKGROUND

The Human papillomavirus (HPV) vaccine has been available for protection against HPV-associated cervical cancer and genital warts since 2006. Nonetheless, uptake has varied among countries and populations within countries. Studies have found that individuals' knowledge and attitudes toward the vaccine are associated with immunization uptake. The purpose of the current review is to summarize and evaluate the evidence for educational interventions to increase HPV vaccination acceptance.

METHODS

We searched the databases of PubMed and Web of Science for English-language articles describing educational interventions designed to improve HPV vaccination uptake, intention or attitude.

RESULTS

We identified 33 studies of HPV vaccination educational interventions: 7 tested the effectiveness of interventions with parents, 8 with adolescents or young adults, and 18 compared the effectiveness of different message frames in an educational intervention among adolescents, young adults or their parents. Most studies involved populations with higher educational attainment and most interventions required participants to be literate. The minority of studies used the outcome of HPV vaccine uptake. Well-designed studies adequately powered to detect change in vaccine uptake were rare and generally did not demonstrate effectiveness of the tested intervention.

CONCLUSIONS

There is not strong evidence to recommend any specific educational intervention for wide-spread implementation. Future studies are required to determine the effectiveness of culturally-competent interventions reaching diverse populations.

Evaluation of the acceptability and feasibility of a computer-tailored intervention to increase human papillomavirus vaccination among young adult women

OBJECTIVE

To examine acceptability and feasibility of a Transtheoretical Model (TTM)-based computer-tailored intervention (CTI) for increasing human papillomavirus (HPV) vaccination in college-aged women.

PARTICIPANTS

Two hundred forty-three women aged 18-26 were recruited between February and May of 2011.

METHODS

Participants completed the intervention and a 14-item evaluation of intervention content and delivery.

RESULTS

Most participants had heard of HPV (91%), but the majority (57%) of participants were in Precontemplation for getting vaccinated. Eighty-nine percent of participants rated the CTI positively across all acceptability items, and 91% endorsed intention to get vaccinated after intervention. Although average ratings in each demographic subgroup were positive, Hispanic women and participants in more advanced stages of change rated the program more favorably than non-Hispanic and earlier-stage participants. Additionally, HPV knowledge was higher among white/non-Hispanic participants.

CONCLUSIONS

Initial acceptability and feasibility data for this intervention are promising. Its computer-based, individually tailored format is state of the art and ideal for inexpensive dissemination.

Health care professional communication about STI vaccines with adolescents and parents

Vaccination of adolescents against sexually transmitted infections (STIs) is an important prevention strategy that may reduce the global burden of disease. The World Health Organization, Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, and other national health agencies recommend the use of existing STI vaccines, and many countries have incorporated them into their routine vaccination schedule. Despite this, however, data indicate that STI vaccine uptake is suboptimal for a variety of reasons. Health care professionals (HCP) have been shown to have a strong beneficial effect on STI vaccine uptake, yet studies demonstrate that many HCPs fail to discuss or recommend them to adolescent patients. This review article focuses on HCP communication about STI vaccines with adolescents and their parents. It describes STI vaccine message content and delivery as well as the context in which HCPs formulate their messaging approach. It also examines other contextual factors that may shape communication about STI vaccines. Studies from many countries indicate that HCPs often possess misinformation about adolescents, including their sexual risk behaviors, as well as STIs, vaccine safety and efficacy, and STI vaccination recommendations. They also have misconceptions of parental barriers to STI vaccination. These may impact STI vaccine communication and have a negative influence on STI vaccine uptake. These findings highlight the critical need for improved HCP education related to adolescent health, sexuality, and STI vaccination. This may be particularly important in settings without an existing infrastructure or expertise in caring for this unique patient population.

Political and news media factors shaping public awareness of the HPV vaccine

BACKGROUND

In 2006, the U.S. Food and Drug Administration licensed a vaccine for the human papillomavirus (HPV) that prevents the strains of HPV that cause 70% of cervical cancers. Within months, many states introduced legislation requiring the vaccine for girls, prompting controversy and heightened political and media attention to the issue. Previous research has shown differences in HPV vaccine awareness by individual-level characteristics such as race/ethnicity, income, and education levels. We examined how individual political orientation and exposure to media coverage can also shape awareness of the vaccine.

METHODS

Using data from a 2009 Internet survey of 1,216 nationally representative adult respondents linked to data on state-specific news coverage, we assessed how political orientation, media exposure, and state political context predicted HPV vaccine awareness.

RESULTS

Younger people, women, and those with more education were significantly more likely to be aware of the vaccine. Even after controlling for these characteristics, we found that exposure to news media was associated with higher HPV vaccine awareness. Whereas liberals and conservatives were both more aware of the vaccine compared with moderates, the data are suggestive that liberals were more sensitive to news coverage.

CONCLUSION

These findings suggest that individual-level political identities and their interaction with the informational environment may be important factors to consider in evaluating the determinants of individuals' attitudes and behaviors related to politically charged women's health issues.

Applying a gender lens on human papillomavirus infection: cervical cancer screening, HPV DNA testing, and HPV vaccination

BACKGROUND

Our aim is to provide a state-of-the-art overview of knowledge on sex (biological) and gender (sociocultural) aspects of Human papillomavirus (HPV) and cervical cancer for educational purposes. Considerable disparities exist in cervical cancer incidences between different subgroups of women. We provide an outline on the crucial issues and debates based on the recent literature published in leading gender medicine journals. Intersectionality was applied in order to help categorise the knowledge.

METHODS

Key terms (HPV, cervical cancer) were screened in Gender Medicine, Journal of Women's Health and Women & Health from January 2005-June 2012. Additional searches were conducted for topics insufficiently mentioned, such as HPV vaccination of boys. In total, 71 publications were included (56 original papers, four reviews, six reports, three commentaries, one editorial and one policy statement).

RESULTS

Research reveals complexity in the way various subgroups of women adhere to cervical screening. Less educated women, older women, uninsured women, homeless women, migrant women facing language barriers, women who have sex with women and obese women participate in Pap smears less frequently. A series of barriers can act to impede decisions to vaccinate against HPV.

CONCLUSIONS

Both male and female controlled preventive methods and treatment measures should be developed in order to tackle HPV infection and different strategies are needed for different subgroups. A substantial discussion and research on alternative methods of prevention was and is lacking. In future research, sex and gender aspects of HPV-related diseases of boys and men as well as subgroup differences in HPV risk need to be addressed.

Applying a gender lens on human papillomavirus infection: cervical cancer screening, HPV DNA testing, and HPV vaccination

Background

Our aim is to provide a state-of-the-art overview of knowledge on sex (biological) and gender (sociocultural) aspects of Human papillomavirus (HPV) and cervical cancer for educational purposes. Considerable disparities exist in cervical cancer incidences between different subgroups of women. We provide an outline on the crucial issues and debates based on the recent literature published in leading gender medicine journals. Intersectionality was applied in order to help categorise the knowledge.

Methods

Key terms (HPV, cervical cancer) were screened in Gender Medicine, Journal of Women’s Health and Women & Health from January 2005-June 2012. Additional searches were conducted for topics insufficiently mentioned, such as HPV vaccination of boys. In total, 71 publications were included (56 original papers, four reviews, six reports, three commentaries, one editorial and one policy statement).

Results

Research reveals complexity in the way various subgroups of women adhere to cervical screening. Less educated women, older women, uninsured women, homeless women, migrant women facing language barriers, women who have sex with women and obese women participate in Pap smears less frequently. A series of barriers can act to impede decisions to vaccinate against HPV.

Conclusions

Both male and female controlled preventive methods and treatment measures should be developed in order to tackle HPV infection and different strategies are needed for different subgroups. A substantial discussion and research on alternative methods of prevention was and is lacking. In future research, sex and gender aspects of HPV-related diseases of boys and men as well as subgroup differences in HPV risk need to be addressed.

A serial mediation model of message framing on intentions to receive the human papillomavirus (HPV) vaccine: revisiting the role of threat and efficacy perceptions

Previous research has yielded mixed findings regarding the potential for message framing to influence HPV vaccine-related intentions. Drawing on the Extended Parallel Process Model (EPPM), the current study focuses on the role of threat and efficacy as serial mediators linking message framing and HPV vaccine-related intentions. College-age females and their parents participated in a between-subjects, posttest only experiment to investigate whether behavioral intentions to talk to a doctor about the HPV vaccine differ as a function of framing messages in terms of disease prevention. For young women, framing messages as preventing genital warts (as compared to cancer prevention) significantly increased perceptions of self-efficacy, which enhanced response efficacy perceptions that, in turn, increased intentions to talk to a doctor about the HPV vaccine. There were no effects of message framing among parents. However, response efficacy was a significant mediator of self-efficacy and behavioral intentions for both the college-age females and their parents. The results of this study suggest new approaches for considering the relationship among EPPM constructs.

Parent-son decision-making about human papillomavirus vaccination: a qualitative analysis

BACKGROUND

Licensed for use in males in 2009, Human Papillomavirus (HPV) vaccination rates in adolescent males are extremely low. Literature on HPV vaccination focuses on females, adult males, or parents of adolescent males, without including adolescent males or the dynamics of the parent-son interaction that may influence vaccine decision-making. The purpose of this paper is to examine the decision-making process of parent-son dyads when deciding whether or not to get vaccinated against HPV.

METHODS

Twenty-one adolescent males (ages 13-17), with no previous HPV vaccination, and their parents/guardians were recruited from adolescent primary care clinics serving low to middle income families in a large Midwestern city. Dyad members participated in separate semi-structured interviews assessing the relative role of the parent and son in the decision regarding HPV vaccination. Interviews were recorded, transcribed, and coded using inductive content analysis.

RESULTS

Parents and sons focused on protection as a reason for vaccination; parents felt a need to protect their child, while sons wanted to protect their own health. Parents and sons commonly misinterpreted the information about the vaccine. Sons were concerned about an injection in the penis, while some parents and sons thought the vaccine would protect them against other sexually transmitted infections including Herpes, Gonorrhea, and HIV. Parents and sons recalled that the vaccine prevented genital warts rather than cancer. The vaccine decision-making process was rapid and dynamic, including an initial reaction to the recommendation for HPV vaccine, discussion between parent and son, and the final vaccine decision. Provider input was weighed in instances of initial disagreement. Many boys felt that this was the first health care decision that they had been involved in. Dyads which reported shared decision-making were more likely to openly communicate about sexual issues than those that agreed the son made the decision.

CONCLUSION

Parents and sons play an active role in the decision-making process, with an individual's role being influenced by many factors. The results of this study may be used to guide the messages presented by clinicians when recommending the HPV vaccine, and future vaccine uptake interventions.

Uptake of the human papillomavirus vaccine: a review of the literature and report of a quality assurance project

PURPOSE

The aims of this study were to review predictors of knowledge about human papillomavirus (HPV), HPV vaccine, and factors related to HPV vaccine uptake and report a quality assurance project that evaluated HPV vaccine uptake and three-dose completion rates.

METHODS

The setting was a small private urban pediatric practice. Chart review was used to describe HPV vaccine uptake and dose completion rates in 2007. The convenience sample included 189 girls aged 12 to 21 years with HPV vaccine uptake.

RESULTS

During 2007, 153 girls aged 12 to 17 years and 42 girls aged 18 to 21 years were seen at well-child care visits. HPV vaccine uptake was 72% (n = 110) for the younger group and 79% (n = 33) for the older group. There was no significant difference in HPV vaccine uptake by group. One quarter (24%, n = 46) received the HPV vaccine dose at an episodic visit. The dose completion rate was 64% (n = 120).

DISCUSSION

HPV vaccine uptake and dose completion rates were higher than rates reported by the Centers for Disease Control and Prevention. Effective strategies are needed to promote HPV vaccine uptake and dose completion.

Contribution of communication inequalities to disparities in human papillomavirus vaccine awareness and knowledge

OBJECTIVES

We examined the association of Internet-related communication inequalities on human papillomavirus (HPV) vaccine awareness and infection knowledge.

METHODS

We drew data from National Cancer Institute's 2007 Health Information National Trends Survey (n = 7674). We estimated multivariable logistic regression models to assess Internet use and Internet health information seeking on HPV vaccine awareness and infection knowledge.

RESULTS

Non-Internet users, compared with general Internet users, had significantly lower odds of being aware of the HPV vaccine (odds ratio [OR] = 0.42; 95% confidence interval [CI] = 0.34, 0.51) and knowing that HPV causes cervical cancer (OR = 0.70; 95% CI = 0.52, 0.95). Among general health information seekers, non-Internet seekers compared with Internet information seekers exhibit significantly lower odds of HPV vaccine awareness (OR = 0.59; 95% CI = 0.46, 0.75), and of knowing about the link between HPV infection and cervical cancer (OR = 0.79; 95% CI = 0.63, 0.99) and the sexual transmission of HPV (OR = 0.71; 95% CI = 0.57, 0.89). Among cancer information seekers, there were no differences in outcomes between Internet seekers and non-Internet seekers.

CONCLUSIONS

Use of a communication channel, such as the Internet, whose use is already socially and racially patterned, may widen observed disparities in vaccine completion rates.

Mental representations of HPV in Appalachia: gender, semantic network analysis, and knowledge gaps

Media coverage has emphasized human papillomavirus (HPV) as a vaccine-preventable, sexually transmitted virus causing cervical cancer. Appalachian undergraduate students (N = 309, 50% female) were surveyed on their knowledge of HPV; analyses of mental representations were similar to content analyses of media coverage of HPV, suggesting media cultivation. Semantic network analysis revealed linkages between vaccine, disease causation and prevention, women's centrality in the representations, and structural differences that varied between vaccinated women, unvaccinated women, and men. The findings provided insights into gaps in the public's understanding of HPV, potential stigmatization of those testing HPV+, and future challenges in vaccinating men.

Human papillomavirus vaccine delivery strategies that achieved high coverage in low- and middle-income countries

OBJECTIVE

To assess human papillomavirus (HPV) vaccination coverage after demonstration projects conducted in India, Peru, Uganda and Viet Nam by PATH and national governments and to explore the reasons for vaccine acceptance or refusal.

METHODS

Vaccines were delivered through schools or health centres or in combination with other health interventions, and either monthly or through campaigns at fixed time points. Using a two-stage cluster sample design, the authors selected households in demonstration project areas and interviewed over 7000 parents or guardians of adolescent girls to assess coverage and acceptability. They defined full vaccination as the receipt of all three vaccine doses and used an open-ended question to explore acceptability.

FINDINGS

Vaccination coverage in school-based programmes was 82.6% (95% confidence interval, CI: 79.3-85.6) in Peru, 88.9% (95% CI: 84.7-92.4) in 2009 in Uganda and 96.1% (95% CI: 93.0-97.8) in 2009 in Viet Nam. In India, a campaign approach achieved 77.2% (95% CI: 72.4-81.6) to 87.8% (95% CI: 84.3-91.3) coverage, whereas monthly delivery achieved 68.4% (95% CI: 63.4-73.4) to 83.3% (95% CI: 79.3-87.3) coverage. More than two thirds of respondents gave as reasons for accepting the HPV vaccine that: (i) it protects against cervical cancer; (ii) it prevents disease, or (iii) vaccines are good. Refusal was more often driven by programmatic considerations (e.g. school absenteeism) than by opposition to the vaccine.

CONCLUSION

High coverage with HPV vaccine among young adolescent girls was achieved through various delivery strategies in the developing countries studied. Reinforcing positive motivators for vaccine acceptance is likely to facilitate uptake.

Asking mom: formative research for an HPV vaccine campaign targeting mothers of adolescent girls

Vaccination against the types of human papillomavirus (HPV) that cause about 70% of cervical cancers is approved for use in girls and women between 9 and 26 years of age and recommended routinely in 11-12-year-old girls. This article reports on the systematic theory-based formative research conducted to develop HPV vaccine messages for a campaign targeting racially diverse mothers of nonvaccinated 11-12-year-old girls in rural Southeastern United States. A consortium of 13 county health departments concerned about high rates of cervical cancer in their region relative to state and national averages initiated the campaign. The research examined behavioral determinants for vaccination decisions as well as mothers' reactions to message frames and emotional appeals. On the basis of focus groups and intercept interviews (n = 79), the authors demonstrated how preproduction message research and production message testing were used to develop messages that would motivate mothers of preteen girls. Core emotional truths that emerged were a mother's instinct to protect her daughter from harm and to embrace aspirations for her daughter's future. Mothers also reacted more positively to text about preventing cervical cancer than about preventing HPV, a sexually transmitted disease. Mothers preferred message concepts with photos of minorities and Caucasian mothers and daughters.