Human papillomavirus (HPV) is a critical factor in the development of cervical cancer and can lead to genital warts and other clinical sequelae. Two vaccines against HPV have been developed recently that have shown to be safe and effective. The use of HPV vaccines holds promise for alleviating the burden of illness related to HPV infection. However, barriers specific to HPV vaccines, as well as barriers related to adolescent vaccination in general, may pose challenges to widespread implementation. Among these are: (1) lack of knowledge among the US population about HPV transmission and its relation to cervical cancer and other anogenital diseases; (2) parental concerns about vaccines in general and about vaccinating minors against sexually transmitted diseases; (3) financing by the government and private insurers for newly recommended vaccines; (4) challenges related to adolescents' healthcare-seeking behavior and health insurance coverage; and (5) barriers related to the dynamics of HPV infection (eg, protection against only certain types of HPV, duration of immunity, immunization schedules). Addressing these concerns will be critical in effective implementation of HPV vaccines and, potentially, vaccines, against other sexually transmitted diseases.
"French health authorities recommended HPV vaccination for girls reaching 14 years with catch-up vaccination for girls aged 15–23 within their first year of sexual activity
. Since parental consent is required for vaccination of adolescent girls, parents, and especially mothers, are key decision-makers and potentially a major source of information for their daughters
[Show abstract][Hide abstract] ABSTRACT: Background
In France, it is recommended that girls and women aged 14–23 are vaccinated against the human papillomavirus (HPV). However, French women’s knowledge of and attitude towards the vaccine has been little studied.
Thirty-nine general practitioners, representative of those working in the large Rhône-Alpes region, offered a self-administered questionnaire on cervical cancer (CC) prevention to all 18–65 year-old women who came for consultation during June and July 2008. In addition, semi-structured interviews were undertaken with a sample of those who had daughters aged 14–18.
Of the 1,478 women who completed the questionnaire, only 16.9% mentioned HPV as the cause of CC, even though 76.2% knew of the vaccine. 210 women had daughters aged 14–18, and 32 were interviewed. Compared with the wider group, more of these women were aware of the HPV vaccine (91.4%). 44.8% knew the target population and 17.1% the recommended ages for vaccination. 54.3% favoured HPV vaccination; 37.2% were undecided and only 0.9% were opposed. The main barrier to acceptance was the recency of the vaccine’s introduction and concern about possible side effects (54.9%); 14.1% preferred to rely on their GP’s decision. Factors associated with acceptance of the HPV vaccine were having previously vaccinated a child against pneumococcus (OR=3.28 [1.32-8.11]) and knowing the target population for HPV vaccination (OR=2.12 [1.15-3.90]). Knowing the recommended frequency of Papanicolaou smear testing (Pap test) screening was associated with lower acceptance (OR=0.32 [0.13-0.82]).
Few mothers are opposed to HPV vaccination. Factors associated with acceptability were knowledge about the vaccine, acceptance of other vaccines and, unexpectedly, lack of knowledge about the recommended frequency of Pap testing. On multivariate analysis, compliance with recommendations for Pap test screening and socioeconomic factors had no effect on views about HPV vaccination. Given that concern about possible side effects is the major barrier to wider acceptance of the HPV vaccine in France, GPs have a key role in providing information.
BMC Public Health 11/2012; 12(1):1034. DOI:10.1186/1471-2458-12-1034 · 2.26 Impact Factor
"Barriers to vaccination, including cost and health insurance coverage, should be addressed in future initiatives. Other barriers have previously been reported, including lack of knowledge about HPV transmission and associated risks for cervical cancer and other genital diseases, parental concerns about the vaccine and vaccinating minors against sexually transmitted infections, lack of knowledge about financial assistance programs, challenges related to health care–seeking behavior of young women, and barriers specific to HPV infection (eg, protection against only certain types of HPV) (13). "
[Show abstract][Hide abstract] ABSTRACT: The incidence of cervical cancer in Appalachia exceeds the national rate; rural Appalachian women are at especially high risk. We assessed the attitudes and practices related to human papillomavirus vaccination among providers in primary care practices in a contiguous 5-county area of Appalachian Pennsylvania.
In December 2006 and May 2007, all family medicine, pediatric, and gynecology practices (n = 65) in the study area were surveyed by 2 faxed survey instruments.
Of the 65 practices, 55 completed the first survey instrument. Of these 55, 44 offered the vaccine to their patients. Forty of the 44 practices offered it to girls and women aged 9 to 26 years, and 11 were willing to accept referrals from other practices for vaccination. The average reported charge for each of the 3 required injections was $150. Of the 55 practices that responded to the first survey instrument, 49 responded to the second survey instrument, 46 of which recommended the vaccine to their patients.
The prevalence of offering the vaccine against human papillomavirus was high in this area of Appalachian Pennsylvania. Future interventions may focus on community education because the vaccine is available from most providers.
"A fourth potential barrier to HPV vaccine provision is parents who are unaware of the HPV vaccine or their daughters' eligibility for the VFC or other healthcare service programs. For example, some parents of VFC-eligible adolescents may be unaware that they can receive low-cost and free vaccines . A fifth potential barrier is parents' lack of motivation to have their adolescents vaccinated against HPV. "
[Show abstract][Hide abstract] ABSTRACT: Potential barriers to widespread vaccination of adolescent girls against human papillomavirus (HPV) infection are poorly understood. We provide an overview of potential barriers to provision of HPV vaccine and empirical data on the concerns of medical practices that may inhibit HPV vaccine provision.
We conducted phone interviews with medical practices in rural areas in southeastern North Carolina with high rates of cervical cancer to assess 10 potential concerns about HPV vaccine provision.
Concerns most commonly reported by medical practices (N = 71) were inadequate reimbursement (68%), high cost of the vaccine to patients (66%), and burden of determining insurance coverage (66%). Practices that were not providing the vaccine reported more concerns about HPV vaccine provision on average than practices providing the vaccine (6.0 vs. 4.5 concerns, p < .05).
Medical practices' concerns about the HPV vaccine may be barriers to stocking it and, thus, to providing it to adolescents. Even providers who stock the vaccine reported concerns. Research is needed to address ways to ameliorate these medical practices' concerns and also to understand other potential barriers to vaccine coverage.
Journal of Adolescent Health 10/2008; 43(4 Suppl):S61-7. DOI:10.1016/j.jadohealth.2008.06.015 · 3.61 Impact Factor
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