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Essa-Hadad J, Gorelik Y, Vervoort J, Jansen D, Edelstein M. Understanding the health system barriers and enablers to childhood MMR and HPV vaccination among disadvantaged, minority or underserved populations in middle- and high-income countries: a systematic review. Eur J Public Health 2024; 34:368-374. [PMID: 38183166 PMCID: PMC10990506 DOI: 10.1093/eurpub/ckad232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Child vaccinations are among the most effective public health interventions. However, wide gaps in child vaccination remain among different groups with uptake in most minorities or ethnic communities in Europe substantially lower compared to the general population. A systematic review was conducted to understand health system barriers and enablers to measles, mumps and rubella (MMR) and human papilloma virus (HPV) child vaccination among disadvantaged, minority populations in middle- and high-income countries. METHODS We searched Medline, Cochrane, CINAHL, ProQuest and EMBASE for articles published from 2010 to 2021. Following title and abstract screening, full texts were assessed for relevance. Study quality was appraised using Critical Appraisal Skills Program checklists. Data extraction and analysis were performed. Health system barriers and enablers to vaccination were mapped to the World Health Organization health system building blocks. RESULTS A total of 1658 search results were identified from five databases and 24 from reference lists. After removing duplicates, 1556 titles were screened and 496 were eligible. Eighty-six full texts were assessed for eligibility, 28 articles met all inclusion criteria. Factors that affected MMR and HPV vaccination among disadvantaged populations included service delivery (limited time, geographic distance, lack of culturally appropriate translated materials, difficulties navigating healthcare system), healthcare workforce (language and poor communication skills), financial costs and feelings of discrimination. CONCLUSION Policymakers must consider health system barriers to vaccination faced by disadvantaged, minority populations while recognizing specific cultural contexts of each population. To ensure maximum policy impact, approaches to encourage vaccinations should be tailored to the unique population's needs. A one-size-fits-all approach is not effective.
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Affiliation(s)
- Jumanah Essa-Hadad
- Department of Population Health, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Yanay Gorelik
- Department of Population Health, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Johanna Vervoort
- Department of Health Sciences-Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Danielle Jansen
- Department of Primary- and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michael Edelstein
- Department of Population Health, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Lee PP, Chan DN, Choi K, So WK. Translation and psychometric evaluation of an instrument to assess the health beliefs of Pakistani mothers regarding human papillomavirus vaccination. Asia Pac J Oncol Nurs 2024; 11:100384. [PMID: 38495642 PMCID: PMC10940890 DOI: 10.1016/j.apjon.2024.100384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/22/2024] [Indexed: 03/19/2024] Open
Abstract
Objective Investigating mothers' health beliefs regarding human papillomavirus (HPV) vaccination is essential for understanding their decisions regarding vaccinating their daughters against HPV. There is no available validated instrument to measure the health beliefs of Pakistani mothers regarding HPV vaccination for their daughters. The purpose of this study was to translate the Human Papillomavirus Vaccination Scale - Health Belief Model (HPVS-HBM) into Urdu and to evaluate the psychometric properties of the translated Urdu version among Pakistani mothers in Hong Kong. Methods This was a descriptive correlational study for which a convenience sample of 260 Pakistani women was recruited. The original HPVS-HBM questionnaire was translated from English to Urdu according to Brislin's model. A panel of experts reviewed the translated questionnaire and assessed the content validity of the items and the scale. Face validity was assessed in a sample of five Pakistani mothers, while structural validity was examined by an exploratory factor analysis. Internal consistency and test-retest reliability were assessed to evaluate the reliability of the translated instrument. Results The translated questionnaire demonstrated good face validity and content validity (item-level content validity index: 0.83-1.00; scale-level content validity index: 0.89-1.00). Factor analysis of the 22 items in the scale revealed a three-factor structure (perceived susceptibility, perceived severity and perceived benefits), which accounted for 77.66% of the total variance. The translated questionnaire also showed good internal consistency (Cronbach's alpha: 0.93-0.98) and acceptable test-retest reliability (weighted kappa: 0.49-0.96; intra-class correlation coefficient: 0.83-0.93). Conclusions The translated Urdu version of the HPVS-HBM demonstrated desirable psychometric properties, indicating that it could be used as a valid and reliable instrument for measuring Pakistani mothers' health beliefs regarding HPV vaccination for their daughters in Hong Kong.
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Affiliation(s)
- Pinky P.K. Lee
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Dorothy N.S. Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - K.C. Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Winnie K.W. So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
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Vu M, Berg CJ, Pham NHT, Tiro JA, Escoffery C, Spring B, Bednarczyk RA, Ta D, Kandula NR. U.S. Vietnamese parents' trusted sources of information and preferences for intervention messaging about HPV vaccination: A mixed methods study. PEC Innov 2023; 3:100189. [PMID: 37521956 PMCID: PMC10371838 DOI: 10.1016/j.pecinn.2023.100189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/26/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023]
Abstract
Objective Assess trusted sources of information, perceived message effectiveness, and preferred dissemination strategies regarding adolescent HPV vaccination among U.S. Vietnamese parents. Methods Data came from an observational, explanatory sequential mixed-methods study with U.S. Vietnamese parents of adolescents (408 survey participants; 32 interview participants). Surveys and interviews were conducted in both Vietnamese and English. Mixed-methods data were integrated and analyzed for confirmation, expansion, or discordance. Results Both quantitative and qualitative findings confirm high trust in HPV vaccination information from providers, government agencies, and cancer organizations. Messages perceived as effective emphasize vaccine safety, experts' endorsement, importance of vaccination prior to HPV exposure, and preventable cancers. Qualitative findings expanded quantitative results, demonstrating a desire for evidence-based information in the Vietnamese language and addressing cultural concerns (e.g., effectiveness or potential side effects specific to Vietnamese adolescents, whether parents should delay HPV vaccination for Vietnamese adolescents). Quantitative and qualitative findings were incongruent about whether parents would trust information about HPV vaccination that is disseminated via social media. Conclusion We identified credible messengers, feasible strategies, and elements of impactful messages for interventions to increase adolescent HPV vaccination for U.S. Vietnamese. Innovation We focus on a high-risk, underserved population and integrate mixed-methods design and analysis.
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Affiliation(s)
- Milkie Vu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, United States of America
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, United States of America
- George Washington Cancer Center, George Washington University, United States of America
| | - Nhat-Ha T. Pham
- College of Arts and Sciences, University of Pennsylvania, United States of America
| | - Jasmin A. Tiro
- Department of Public Health Sciences, University of Chicago, United States of America
- Cancer Prevention and Population Science Program, Comprehensive Cancer Center, University of Chicago, United States of America
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, United States of America
- Emory Prevention Research Center, Emory University, United States of America
- Cancer Prevention and Control Program, Winship Cancer Institute, Emory University, United States of America
| | - Bonnie Spring
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, United States of America
| | - Robert A. Bednarczyk
- Cancer Prevention and Control Program, Winship Cancer Institute, Emory University, United States of America
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, United States of America
- Department of Epidemiology, Rollins School of Public Health, Emory University, United States of America
- Emory Vaccine Center, Emory University, United States of America
| | - Danny Ta
- Nell Hodgson Woodruff School of Nursing, Rollins School of Public Health, Emory University, United States of America
| | - Namratha R. Kandula
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, United States of America
- Department of Medicine, Feinberg School of Medicine, Northwestern University, United States of America
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Bloom JC, Kaufmann N, Koss S, Edwards HA, Perkins RB, Faden DL. Deciphering Knowledge and Opinions of Human Papillomavirus and Human Papillomavirus Vaccination for Facilitation of Point-of-Care Vaccination in Adults. JAMA Otolaryngol Head Neck Surg 2023; 149:870-877. [PMID: 37651109 PMCID: PMC10472267 DOI: 10.1001/jamaoto.2023.2073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/11/2023] [Indexed: 09/01/2023]
Abstract
Importance Human papillomavirus (HPV) vaccination rates remain significantly below rates for other common childhood vaccines, which has implications for future rates of HPV-associated oropharyngeal squamous cell carcinoma (OPSCC). Objective To assess whether individuals who were aware of the association between HPV and OPSCC would be more likely to have been previously vaccinated. Design, Setting, and Participants This survey study included patients aged 18 to 45 years who sought routine outpatient care at the otolaryngology clinic at Boston Medical Center from September 1, 2020, to May 19, 2021. A survey (HPV-Associated Head and Neck Cancer Epidemiology, Awareness and Demographics) [HEAD]) composed of validated questions to assess patient knowledge of HPV and HPV vaccination and barriers to vaccination was delivered to participants. The survey was paired with a novel point-of-care vaccination program housed within an otolaryngology department. Main Outcomes and Measures The main outcome was prevalence of knowledge of the relationship between HPV infection and OPSCC based on survey responses. The association of knowledge of HPV-associated OPSCC with likelihood of having been vaccinated was assessed in the overall cohort and by demographic characteristics using multivariate logistic regression. Results Of 405 patients given the survey, 288 (71.1%) responded. Of these patients, 271 (94.1%) had surveys included; 158 (58.3%) were female, and median age was 29 years (IQR, 24-35 years). The baseline vaccination rate in the surveyed population was low (26.6%; n = 72) overall (10.6% among men [12 of 113]; 37.9% among women [60 of 158]). Few participants understood the relationship between HPV infection and OPSCC (63 of 271 [23.3%]) or that HPV-associated OPSCC is the most common HPV-associated cancer type (9 of 121 [7.4%]). Compared with men, women were more likely to have been previously vaccinated (odds ratio [OR], 6.5; 95% CI, 3.0-13.9), more aware that HPV causes cancer (OR, 3.7; 95% CI, 1.9-7.1), and more likely to have heard about HPV and HPV vaccination from their health care practitioner (OR, 2.6; 95% CI, 1.2-5.7). Knowledge of the relationship between HPV infection and cancer and between HPV and OPSCC was associated with increased likelihood of having been vaccinated (HPV and cancer: OR, 4.1 [95% CI, 1.8-9.5]; HPV and OPSCC: OR, 3.7 [95% CI, 1.8-7.6]). Among 156 unvaccinated participants, 12 of 98 men (12.2%) and 7 of 131 women (5.3%) received point-of-care vaccination. Conclusions Most participants in this survey study were unaware that HPV causes OPSCC. Understanding that HPV causes OPSCC was associated with increased likelihood of having been vaccinated. However, most patients surveyed were not informed of this relationship by their health care practitioners. Targeted education aimed at unvaccinated adults establishing the relationship between HPV infection and OPSCC, paired with point-of-care vaccination, may be an innovative strategy for increasing HPV vaccination rates in adults.
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Affiliation(s)
- Jacob C. Bloom
- Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts
| | - Nicole Kaufmann
- Department of Epidemiology, Harvard University School of Public Health, Boston, Massachusetts
| | - Shirley Koss
- Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts
| | - Heather A. Edwards
- Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts
| | - Rebecca B. Perkins
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts
| | - Daniel L. Faden
- Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Mass Eye and Ear, Boston, Massachusetts
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Iova CF, Badau D, Daina MD, Șuteu CL, Daina LG. Evaluation of the Knowledge and Attitude of Adolescents Regarding the HPV Infection, HPV Vaccination and Cervical Cancer in a Region from the Northwest of Romania. Patient Prefer Adherence 2023; 17:2249-2262. [PMID: 37706209 PMCID: PMC10497041 DOI: 10.2147/ppa.s421875] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/22/2023] [Indexed: 09/15/2023] Open
Abstract
Purpose In Romania, after reaching the age of 18, teenage girls can make an informed decision about vaccination. The aim of the study was to evaluate both knowledge and attitudes related to HPV infection, HPV vaccination, cervical cancer, as well as intentions, reservations, reasons that could influence the decision related to vaccination. Patients and Methods We applied an anonymized questionnaire to 690 teenage girls in the 18-19 age group, recruited from 15 high schools in Bihor County. Based on the answers to the question corresponding to item 14 of subscale 3, 2 groups were identified: the group with a hesitant behavior called the non-vaccine group (GNV) and the group with a positive behavior called the pro-vaccine group (GPV). The statistical analysis was processed by using IBM-SPSS 22. Results The analysis revealed significant differences between the groups in terms of the level of knowledge and attitudes related to vaccination, the adolescent girls in the GPV being more aware of the role and importance of HPV vaccination and more open to the idea of vaccination. For the GNV, the behavior can be explained by the fact that even if they have heard about the HPV infection being transmitted through unprotected sex and they think that vaccination in general is necessary to prevent certain diseases, they do not know if HPV vaccination would be effective in protecting them in the future. Adolescents from GPV declare they would accept HPV vaccination if it would be offered to them or they are already vaccinated. Conclusion Alongside interventions targeting parents and health-care professionals, it is necessary to improve the level of knowledge of adolescents about HPV infection, HPV vaccination and cervical cancer, by organizing information campaigns in schools, campaigns in which professionals in the field should be involved, but also by implementing education programs addressed to them.
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Affiliation(s)
- Camelia Florina Iova
- Faculty of Medicine and Pharmacy, Doctoral School, University of Oradea, Oradea, 410081, Romania
- Department of Epidemiological Surveillance and Disease Control, Directorate of Public Health of Oradea, Oradea, 410042, Romania
| | - Dana Badau
- Petru Maior Faculty of Sciences and Letters, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, 540142, Romania
- Interdisciplinary Doctoral School, Transilvania University, Brasov, 500068, Romania
| | | | - Corina Lacramioara Șuteu
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, 410081, Romania
- Department of Quality Management in Health, Emergency Clinical County Hospital of Oradea, Oradea, Romania
| | - Lucia Georgeta Daina
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, 410081, Romania
- Department of Quality Management in Health, Emergency Clinical County Hospital of Oradea, Oradea, Romania
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Gray A, Fisher CB. Factors associated with HPV vaccine acceptability and hesitancy among Black mothers with young daughters in the United States. Front Public Health 2023; 11:1124206. [PMID: 37139381 PMCID: PMC10150885 DOI: 10.3389/fpubh.2023.1124206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Compared to other-race peers, Black women are disproportionately impacted by human papillomavirus [HPV] infection, related health outcomes, and cervical cancer mortality as a result of suboptimal HPV vaccine uptake during adolescence. Few studies in the United States have examined psychosocial determinants of HPV vaccine acceptability and hesitancy among Black parents. The current study integrated the health belief model and the theory of planned behavior to evaluate the extent to which psychosocial factors are associated with pediatric HPV vaccination intentions among this population. Methods Black mothers (N = 402; age range = 25 to 69 years, M = 37.45, SD = 7.88) of daughters ages 9 to 15 years completed an online survey assessing HPV infection and vaccine beliefs and attitudes across four domains: Mother's HPV Perceptions, Mother's Vaccine Attitudes, Cues to Action, and Perceived Barriers to HPV Vaccination. Participants indicated their willingness to vaccinate their daughter on a 5-level ordinal scale ("I will definitely not have my daughter get the vaccine" to "I will definitely have my daughter get the vaccine") which was dichotomously recoded for binomial logistic regressions. Results Half of the sample (48%) intended to vaccinate their daughter. Number of daughters, mother's HPV vaccine status, perceived HPV vaccine benefits, HPV vaccine safety concerns, pediatric HPV vaccine peer norms, and doctor recommendations emerged as independent factors of Black mothers' intentions to vaccinate their daughters against HPV when controlling for all other factors. Discussion In addition to medical training to increase doctor recommendation of the HPV vaccine for Black girls, population-tailored public health messaging aimed at promoting HPV vaccine acceptance among Black mothers is urgently needed. This messaging should engage community support and emphasize the benefits of vaccination for adolescent Black girls while also addressing parental concerns regarding the safety of pediatric HPV vaccination.
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Affiliation(s)
- Aaliyah Gray
- Department of Psychology, Fordham University, Bronx, NY, United States
- Department of Epidemiology, Florida International University, Miami, FL, United States
- *Correspondence: Aaliyah Gray,
| | - Celia B. Fisher
- Department of Psychology, Fordham University, Bronx, NY, United States
- Center for Ethics Education, Fordham University, Bronx, NY, United States
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Ali RF, Arif Siddiqi D, Mirza A, Naz N, Abdullah S, Kembhavi G, Tam CC, Offeddu V, Chandir S. Adolescent girls' recommendations for the design of a human papillomavirus vaccination program in Sindh, Pakistan: a qualitative study. Hum Vaccin Immunother 2022; 18:2045856. [PMID: 35240928 PMCID: PMC9196803 DOI: 10.1080/21645515.2022.2045856] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Vaccination of adolescent girls against human papillomavirus (HPV) significantly reduces the incidence of cervical cancer. HPV vaccines are available in Pakistan but plans to develop HPV vaccination program are at a nascent stage. We conducted a formative study to explore adolescent girls' knowledge and perspectives on HPV and cervical cancer and collect their recommendations for implementing an HPV vaccination program in their community. METHODS Using qualitative exploratory study design, we conducted four focus group discussions (FGDs) with 12 adolescent girls per group in District West, Karachi. We recruited unmarried girls aged 16-19 years from schools and community settings between May-December 2020. Data analysis was done using NVivo. RESULTS Overall, participants displayed a positive attitude toward HPV vaccine. However, they were unfamiliar with basic concepts related to female reproductive health. Female relatives were indicated as girls' preferred point of contact for discussions on HPV and cervical cancer, but fathers were portrayed as decision-making authority on vaccination. Participants indicated vaccine hesitancy among parents may affect HPV vaccination uptake. Girls suggested individual household visits and community-based camps as strategies for successful implementation of HPV vaccination program. A solid foundation of trust between girls' families, program managers, and other stakeholders emerged as a key asset for the program's success. CONCLUSION Adolescent girls' suggestions of informing key decision-makers in the family (particularly fathers) of the benefits of HPV vaccination, establishing trust with vaccine providers, and increasing accessibility of vaccinations should be explored for successful implementation of an HPV vaccination program in Pakistan.
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Affiliation(s)
- Rozina Feroz Ali
- Maternal & Child Health Program, IRD Pakistan, Karachi, Pakistan
| | | | - Amna Mirza
- Maternal & Child Health Program, IRD Pakistan, Karachi, Pakistan
| | - Nowshaba Naz
- Maternal & Child Health Program, IRD Pakistan, Karachi, Pakistan
| | - Sara Abdullah
- Maternal & Child Health Program, IRD Pakistan, Karachi, Pakistan
| | - Gayatri Kembhavi
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Clarence C Tam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | | | - Subhash Chandir
- Maternal & Child Health Program, IRD Pakistan, Karachi, Pakistan.,IRD Global, Singapore, Singapore
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Browne S, Feemster KA. Human papillomavirus: optimizing opportunities for prevention. Curr Opin Pediatr 2022; 34:132-139. [PMID: 35152231 DOI: 10.1097/mop.0000000000001119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Human papillomavirus (HPV) infection is one of the most common sexually transmitted infections worldwide and is a precursor to anogenital and oropharyngeal cancers. Effective prevention is available through HPV vaccination and emerging evidence demonstrates the potential to significantly impact HPV-associated disease through reductions in the incidence of genital warts, precancerous cervical lesions, and cervical cancer. Indications have also recently expanded to include the prevention of oropharyngeal cancer, an outcome that has been increasing in incidence for men and women. Yet despite demonstrated effectiveness, the potential for broader impact and well-established routine recommendations for administration to adolescents, barriers to vaccine uptake persist. The purpose of this review is to provide an update on HPV prevention in the US, including trends in disease burden, HPV vaccine effectiveness, evolving vaccine recommendations and opportunities and barriers to their implementation. RECENT FINDINGS Several studies have demonstrated that HPV vaccination has the potential to prevent most HPV-attributable cancers. Ongoing research addresses questions related to duration of protection, effectiveness in vulnerable populations, vaccine schedules and strategies to improve access and optimize uptake. SUMMARY To ensure continued impact on the prevention of HPV-associated disease and subsequent cancer, it is crucial to address gaps in vaccine uptake. A strong recommendation for all persons for whom HPV vaccines are indicated, alongside initiatives to increase awareness of HPV vaccination and address specific concerns, can improve uptake among hesitant populations. Globally, efforts to bolster immunization programs are needed to broaden access to HPV vaccination.
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Affiliation(s)
- Safa Browne
- Vaccine Education Center, The Children's Hospital of Philadelphia
| | - Kristen A Feemster
- Vaccine Education Center, The Children's Hospital of Philadelphia
- Department of Pediatrics, Division of Infectious Disease, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Global Medical and Scientific Affairs, Merck Research Laboratories, Merck & Co., Inc., Kenilworth, New Jersey, USA
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Mitchell H, Lim R, Gill PK, Dhanoa J, Dubé È, Bettinger JA. What do adolescents think about vaccines? Systematic review of qualitative studies. PLOS Glob Public Health 2022; 2:e0001109. [PMID: 36962668 PMCID: PMC10022047 DOI: 10.1371/journal.pgph.0001109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/02/2022] [Indexed: 11/19/2022]
Abstract
Adolescence presents a key opportunity to build vaccine-related health literacy and promote vaccine confidence and uptake. Although adolescents are central to vaccination programs, their views around vaccines are frequently underrepresented in qualitative literature. We reviewed qualitative studies to systematically identify and summarize existing evidence on adolescents' own understanding of vaccines and experiences with vaccine decision-making, including self-consent when applicable. CINAHL; Embase; Ovid Medline; and Psych Info database searches were last updated on May 28, 2022. Data pertaining to general study characteristics, participant demographics, and qualitative content were extracted independently by two reviewers and analyzed using textual narrative synthesis. Out of 3559 individual records, 59 studies were included. The majority of the studies were conducted in high-income countries and 75% focused on human papilloma virus vaccines, with the remaining studies looking at COVID-19, meningococcal, hepatitis B and influenza vaccines or adolescent experiences with vaccines in general. Adolescent self-consent was explored in 7 studies. Perspectives from sexual and gender minorities were lacking across studies. Adolescents often had limited understanding of different vaccines and commonly perceived vaccine information to be directed towards their parents rather than themselves. Many adolescents felt school-based vaccine education and information available through healthcare providers were insufficient to make informed decisions about vaccines. While adolescents described obtaining vaccine information from traditional and online media, face-to-face interactions and opinions from trusted adults remained important. Adolescents generally relied on their parents for vaccine-decision making, even when self-consent was an option. A notable exception to this included marginalized adolescents who could not rely on parents for health-related advice. Qualitative literature about adolescent vaccines would be enriched by studies examining vaccines other than the HPV vaccine, studies examining adolescent vaccine programs in low and middle-income countries, and by deliberately eliciting vaccine experiences of adolescent with diverse sexual orientation and gender identities.
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Affiliation(s)
- Hana Mitchell
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Rebecca Lim
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Prubjot K Gill
- University of British Columbia Library, University of British Columbia, Vancouver, BC, Canada
| | - Joban Dhanoa
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Ève Dubé
- Institut National de Santé Publique du Québec, Québec City, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
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Colón-López V, Medina-Laabes DT, Abreu RS, Díaz Miranda OL, Ortiz AP, Fernández ME, Hull PC. Understanding parents' views toward the newly enacted HPV vaccine school entry policy in Puerto Rico: a qualitative study. BMC Public Health 2021; 21:1938. [PMID: 34696745 PMCID: PMC8544631 DOI: 10.1186/s12889-021-11952-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/28/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Human papillomavirus vaccine (HPV) is an essential tool for the prevention of HPV-related cancers. In Puerto Rico, the Secretary of Health established a school entry requirement of at least one dose of HPV vaccination in girls and boys aged 11 and 12 years, taking effect in August 2018. Our study aimed to examine parents' and guardians' views of unvaccinated children about the process of implementation of the new HPV vaccination school entry policy in Puerto Rico and identify potential barriers and facilitators related to the implementation of this requirement. METHODS During April through November 2019, we conducted three focus groups (n = 12) and eight in-depth semi-structured interviews with parents of children aged 11 and 12 who had not yet initiated the HPV vaccine series. The interview topics addressed were: perception of vaccination, HPV vaccine and it is inclusion as new school entry requirement practice, procedure of the sources of information, influencers, and willingness to change. The interviews were recorded and transcribed by our staff members. We identified emergent themes through thematic analysis. RESULTS The participants' perspective on the HPV vaccine school requirement was mixed. Lack of information of the HPV vaccines and lack of communication about the school-entry requirement were the themes most mentioned in the interviews. Moreover, previous negative experiences from friends or family members and adverse effects deterred some participants from vaccinating their kids. We discussed barriers in the process of soliciting an exemption. CONCLUSION Most barriers mentioned by study participants are modifiable. Information about the HPV vaccine mandate's implementation and educational materials regarding HPV vaccine safety need to be provided to address parents' concerns related to the vaccine's side effects. Schools (teachers, principal directors, and administrative staff), the government, and parent organizations need to be part of these efforts. This multilevel approach will help to improve disseminating information about HPV vaccination to clarify doubts and misinformation among parents.
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Affiliation(s)
- Vivian Colón-López
- Comprehensive Cancer Center-University of Puerto Rico, Cancer Control and Population Sciences, San Juan, Puerto Rico.
- Department of Health Services Administration, Graduate School of Public Health, University of Puerto Rico Medical Science Campus, San Juan, Puerto Rico.
| | - Diana T Medina-Laabes
- Comprehensive Cancer Center-University of Puerto Rico, Cancer Control and Population Sciences, San Juan, Puerto Rico
| | - Roxana Soto Abreu
- Comprehensive Cancer Center-University of Puerto Rico, Cancer Control and Population Sciences, San Juan, Puerto Rico
| | - Olga L Díaz Miranda
- Comprehensive Cancer Center-University of Puerto Rico, Cancer Control and Population Sciences, San Juan, Puerto Rico
| | - Ana P Ortiz
- Comprehensive Cancer Center-University of Puerto Rico, Cancer Control and Population Sciences, San Juan, Puerto Rico
- Department of Epidemiology and Biostatistics, Graduate School of Public Health, University of Puerto Rico Medical Science Campus, San Juan, Puerto Rico
| | - María E Fernández
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center, Houston, Texas, United States
| | - Pamela C Hull
- The University of Kentucky, Department of Behavioral Science, College of Medicine, Markey Cancer Center, Lexington, Kentucky, United States
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