Information needs of young women vaccinated against HPV attending colposcopy: a qualitative study

Perspectives of HPV vaccine decision-making among young adults: A qualitative systematic review and evidence synthesis

BACKGROUND

Despite the demonstrated safety and effectiveness of HPV vaccines in preventing HPV-related cancers, global vaccine coverage remains low. The suboptimal adolescent HPV vaccine coverage rate leaves many young adults at increased risk for developing vaccine preventable HPV-related cancers. This qualitative evidence synthesis (QES) aims to examine the HPV vaccination perspectives of young adults globally and identify the barriers and facilitators to HPV vaccine uptake and decision-making processes.

METHODS

A comprehensive search was conducted on October 2023 across seven databases to identify studies that reported on HPV vaccination among young adults aged 18-26 years and used qualitive study methods or analysis techniques.

RESULTS

Forty-two studies were purposively sampled for inclusion, presenting 29 findings across 10 thematic categories. Vaccine eligible young adults believed that they had aged out of eligibility for HPV vaccination. There was also a perspective that condom use, and regular screenings were alternatives to vaccination in preventing HPV infections. Challenges included scheduling appointments, requirements for multiple shots, and vaccine cost. There was also concern for the gendered nature of vaccine promotion. Lastly, despite being at the age to make autonomous decisions, parents were still influential and active in the vaccine decision-making process for their children.

CONCLUSION

The novelty of this study, as one of the principal QES on catch-up HPV vaccination, presents findings that underscore the complexity of factors across multiple ecological levels which may aid or impede vaccination uptake among young adults and provide important considerations for interventions, programs, and policies aimed at addressing HPV vaccination disparities among young adults.

Colposcopy non-attendance following an abnormal cervical cancer screening result: a prospective population-based cohort study

Background

A considerable proportion of cervical cancer diagnoses in high-income countries are due to lack of timely follow-up of an abnormal screening result. We estimated colposcopy non-attendance, examined the potential factors associated and described non-attendance reasons in a population-based screening study.

Methods

Data from the MARZY prospective cohort study were analysed. Co-test screen-positive women (atypical squamous cells of undetermined significance or worse [ASC-US+] or high-risk human papillomavirus [hrHPV] positive) aged 30 to 65 years were referred to colposcopy within two screening rounds (3-year interval). Women were surveyed for sociodemographic, HPV-related and other data, and interviewed for non-attendance reasons. Logistic regression was used to examine potential associations with colposcopy attendance.

Results

At baseline, 2,627 women were screened (screen-positive = 8.7%), and 2,093 again at follow-up (screen-positive = 5.1%; median 2.7 years later). All screen-positives were referred to colposcopy, however 28.9% did not attend despite active recall. Among co-test positives (ASC-US+ and hrHPV) and only hrHPV positives, 19.6% were non-attendees. Half of only ASC-US+ screenees attended colposcopy. Middle age (adjusted odds ratio [aOR] = 1.55, 95% CI 1.02, 4.96) and hrHPV positive result (aOR = 3.04, 95% CI 1.49, 7.22) were associated with attendance. Non-attendance was associated with having ≥ 3 children (aOR = 0.32, 95% CI 0.10, 0.86). Major reasons for non-attendance were lack of time, barriers such as travel time, need for childcare arrangements and the advice against colposcopy given by the gynaecologist who conducted screening.

Conclusions

Follow-up rates of abnormal screening results needs improvement. A systematic recall system integrating enhanced communication and addressing follow-up barriers may improve screening effectiveness.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01851-6.

"I'm neither here, which would be bad, nor there, which would be good": the information needs of HPV+ women. A qualitative study based on in-depth interviews and counselling sessions in Jujuy, Argentina

The objective of this qualitative study was to explore the information needs of HPV+ women. We conducted 38 in-depth interviews with HPV+ women in the province of Jujuy, Argentina. The interviews included a counselling session to respond to women’s concerns and questions. Women perceived the information provided as good, despite having several doubts and misconceptions after receiving results of an HPV+ test. They expressed difficulties in formulating questions during the consultation due to shame, excess of information provided or lack of familiarity with technical language. They valued emotional support and being treated kindly by professionals. The perceived information needs that emerged as most important were: (1) the meaning of an HPV+ result and its relationship with cervical cancer evolution and severity; (2) continuity and timing of the care process; (3) information on the sexual transmission of the virus; (4) explanation of the presence or absence of symptoms. Women’s primary unperceived information needs were: (1) detailed information about colposcopy, biopsy and treatments and their effects (including fertility consequences); and (2) deconstructing the association of sexual transmission with infidelity. Sources of information included: (1) the health care system; (2) the internet; and (3) social encounters (close friends and relatives). It is crucial to strengthen the processes for delivering results, with more thorough information, improved emotional support and active listening focused on the patient, as well as to conceive new formats to provide information in stages and/or gradually, in order to facilitate women’s access to the health care system and the information they need.