Article

"I Just Signed": Factors Influencing Decision-Making for School-Based HPV Vaccination of Adolescent Girls

Authors:
  • Australian centre for the prevention of cervical cancer
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Abstract

Australia was one of the first countries to implement a nationwide program providing HPV vaccination to girls at school. To date, there are no published studies describing decision-making processes and behavior postimplementation of HPV vaccination of adolescents participating in a school-based program. A purposive sample of nine schools was selected to reflect a range of vaccination coverage and school types. Semistructured focus groups with girls and interviews with parents, teachers, and immunization nurses (n = 185) were conducted until saturation was reached. Transcripts were analyzed inductively and emergent themes were subject to constant comparison. Explanatory model of decision-making in HPV vaccination. An explanatory model of decision-making and behavior was constructed from the data. Five decision-making states emerged across a continuum of vaccination behavior: active decision-vaccinated, passive decision- vaccinated, passive decision- not vaccinated, active decision- not vaccinated, and antivaccination. A range of factors influenced participants in each decision-behavior state. Adolescents were often part of the decision-making process. Where adolescents were not involved, nonagreement sometimes occurred. We have presented a variety of paths girls and their parents experience regarding decision-making and behavior in HPV vaccination. Attitudes, past experiences, and worldviews contributed to this process.

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... Teenage girls today are increasingly involved in the medical care that concerns them, and it appears useful to ask what they know about this vaccine. Few studies in France or elsewhere have examined this question [13][14][15][16][17]. All of them, however, report a lack of knowledge and information about the risk of this infection and the effectiveness and safety of the vaccine, even in countries with high vaccination coverage [15,[17][18][19]. ...
... In all, 101 teenage girls (80% of those asked to participate) completed the essay question. Their mean age was 15.5 years (range: [11][12][13][14][15][16][17][18][19]. Half were receiving outpatient care, and half were inpatients. ...
... ITW4 Criticisms and proposals ''There are posters sometimes in doctors' waiting rooms, but we don't necessarily look at them!" ITW2 ''Maybe make an ad campaign on TV, like advertising but with messages about vaccination." ITW3 ''Why not make a character or mascot based on HPV; that would be not bad at all!" ITW2 decision [13,15,17]. The other is the role of the parents, who currently must agree to their daughter's vaccination [14,26,27]. ...
Article
Objective: Vaccination coverage against HPV in France is among the lowest in the industrialized world, although the public authorities have recently become aware of this issue. Few studies have looked at teenaged girls' representations of this vaccination, even though they are the most concerned by it. This qualitative study explored the experiences and representations of HPV vaccination by adolescent girls seeing doctors at least occasionally. Study design: We used a written essay question to explore this issue among 101 adolescent girls at six urban medical centers and a semi-structured interview to discuss it in further depth with five of them. The analysis was lexicometric (ALCESTE®) and phenomenological (Interpretative Phenomenological Analysis). Results: These results are organized around four superordinate themes: the teenage girls' factual knowledge about this vaccine, their motives for and obstacles to vaccination, their involvement in this decision, and finally the need for information about and solutions to this issue. Conclusions: Teenage girls know little about this vaccine and are more sensitive to the emotional discourse that surrounds it than to rational knowledge about it. The requirement for parental authorization for this vaccine reinforces the girls' lack of investment. Vaccination programs should integrate the HPV vaccine more thoroughly into general prevention concerning sexual health and should send a strong signal by offering minors anonymous vaccination free of charge, as is already the case in France for requests for contraception, the morning-after pill, elective abortion, and screening and treatment of sexually transmitted infections.
... These findings contradicted with the finding reported by Li et al., that education may be only effective to increase specific knowledge items, specifically the most serious ones. Studies confirmed that better knowledge may be associated with greater acceptability of HPV vaccine (Kahn et al., 2003, Li et al., 2007, Scarinci et al., 2007, Ferris et al., 2007, Marshall et al., 2007, Ferris et al., 2008, Donders et al., 2008 and poor HPV knowledge have direct implications on cervical cancer screening (Cooper Robbins et al., 2010, Hilton & Smith, 2011. Although the effectiveness of the educational intervention on HPV/ HPV vaccination has been ascertained in this study, continuous education could be the most effective approach to prevent HPV related cancers in the long run (Kollar & Kahn, 2008. ...
... The reason may be possibly because the respondents were mostly from rural areas and pap screening in rural areas is still limited in Malaysia. Studies illustrate that "poor knowledge about HPV and its vaccination has direct implications on cervical screening" (Cooper Robbins et al., 2010, Hilton & Smith, 2011. A possibility may be due to the education level as half of the respondents were less educated below graduate level. ...
... The impact of knowledge on behavior change is quite complex and a variety of factors were believed to influence decisions, such as their mothers' influence, mass media campaigns and family history of 321 genital cancer. The impact of parental influence has been well recognized in other studies (Walhart, 2012, Davis et al., 2004, Oscarsson et al., 2007, Del Prete et al., 2011 and a reason against vaccination was, it will increase dangerous sexual behaviours (Bernat et al., 2009, Marlow et al., 2009, Cooper et al., 2010. Factors influencing the vaccination decision should be further explored, but lack of financial resources is recognized as the most likely cause. ...
Thesis
Baseline information on knowledge, attitude and perception towards Human Papilloma Virus (HPV) infection is crucial to establish a progressive track of practice on HPV immunization program to defeat the challenges faced by HPV related diseases and cancers. The present study aimed at developing population specific intervention tool (questionnaires) including informative educational tool (pamphlet) and to assess the impact of these tools on knowledge, attitude, perception and/or practice (KAP) changes among the three study populations (adolescents, adults and parents). A cross sectional study was conducted in urban and rural areas of Kedah state, Kedah Malaysia. The participants were selected using convenience sampling and data was collected using standardized and validated questionnaires. The participants’ demographic data, knowledge, attitude, perception/ practice about HPV infection and HPV vaccination were assessed at baseline, and after intervention and at three to six months among 2928 adolescents, 942 adults and 858 parents. The research findings showed a significant improvement in knowledge scores among adolescents from 37% at baseline to 67% (p < .001), after intervention and 66% to 88% (p < .001) at pre and post-test after 3-6 months of intervention. The median KAP score also improved significantly from [Mdn = 47 (IQR =12)] at baseline to [Mdn = 57 (IQR = 10)] at intervention and [Mdn = 47 (IQR = 12)] at post 3-6 months intervention. Among xx adults, the knowledge score improved from 63% at baseline to 89% (p < .001), after intervention and 66% to 90% (p < .001) at pre and post-test after 3-6 months of intervention. The median KAP score also improved significantly from [Mdn = 56 (IQR = 10)] at baseline to [Mdn = 88 (IQR = 18)] at intervention and [Mdn = 87 (IQR = 17)] at post 3-6 months intervention. Among parents, the knowledge score improved from 66% at baseline to 89% (p < .001), after intervention and 73% to 94% (p < .001) at pre and post-test after 3-6 months of intervention. The median KAP score also improved significantly from [Mdn = 50 (IQR = 22)] at baseline to [Mdn = 62 (IQR = 11)] at intervention and [Mdn = 73 (IQR = 5)] at post 3-6 months intervention. The protocol significantly increased knowledge and KAP scores about HPV in the study population, regardless of sociodemographic characteristics and risk behaviors. Effective, informative and appropriate educational protocols about HPV infection and HPV vaccination are particularly important and regular, booster education campaigns are required to prevent adverse psychosocial responses and promote healthy sexual practice and Pap screening behaviors in adolescents and adults. Furthermore, the research finding provides an insight into utilization of trained counselling teachers in secondary schools for prevention of health related diseases in nation’s interest.
... However, there were concerns about the potential to adversely affect young women's sexual health if young women assumed greater protection than is the case [42,43]: "I haven't heard it myself, but someone else heard from a girl that had been vaccinated that she was vaccinated against all sexually transmitted disease" [Midwife, Sweden] [42]. In addition, some parental resistance to the HPV vaccine due to connections with sexual behaviour were reported [46,47]: "We had quite a few phone calls, predominantly from [Asian] mothers, they were very concerned that by them okaying the needle, that was giving the daughters the green light to go and become sexually active" [Teacher, Australia] [47]. ...
... However, there were concerns about the potential to adversely affect young women's sexual health if young women assumed greater protection than is the case [42,43]: "I haven't heard it myself, but someone else heard from a girl that had been vaccinated that she was vaccinated against all sexually transmitted disease" [Midwife, Sweden] [42]. In addition, some parental resistance to the HPV vaccine due to connections with sexual behaviour were reported [46,47]: "We had quite a few phone calls, predominantly from [Asian] mothers, they were very concerned that by them okaying the needle, that was giving the daughters the green light to go and become sexually active" [Teacher, Australia] [47]. ...
... And one can-not… it's like offensive, I think" [School nurse, Sweden] [43]. This appeared to be an especially pertinent issue for parents with strong faith beliefs for whom sexual contact outside of marriage and multiple sexual partners were perceived to occur infrequently [47][48][49]: "Coming from a Muslim background… We don't have sex before marriage for example, so your first experience of these things are when you're married and you stay in a relationship… because of that reason I'd probably say no, I wouldn't bother with it with my two girls" [Asian Muslim mother, UK] [49]. However, other parents recognised changing cultural norms and values, suggesting that their belief systems may differ to that of their daughter [47,48]: "I went to the same school and I had a religious upbringing but a lot of my close friends who I grew up with are actually not religious now and they are living a different lifestyle than I am… my daughter may not grow up to live the way I do" [Jewish mother, UK] [48]. ...
Article
Full-text available
Background Vaccination against Human Papillomavirus (HPV) is recommended for adolescent young women prior to sexual debut to reduce cervical cancer related mortality and morbidity. Understanding factors affecting decision-making of HPV vaccination of young women is important so that effective interventions can be developed which address barriers to uptake in population groups less likely to receive the HPV vaccine. Methods We undertook a qualitative systematic review and evidence synthesis to examine decision-making relating to the HPV vaccination of young women in high-income countries. A comprehensive search of databases from inception to March 2012 was undertaken to identify eligible studies reporting the perspectives of key stakeholders including policy makers, professionals involved in programme, parents, and young women. Factors affecting uptake of the vaccine were examined at different levels of the socio-ecological model (policy, community, organisational, interpersonal and intrapersonal). Results Forty-one studies were included. Whether young women receive the HPV vaccine is strongly governed by the decisions of policy makers, healthcare professionals, and parents. These decisions are shaped by: financial considerations; social norms and values relating to sexual activity, and; trust in vaccination programmes and healthcare providers. Financial constraints may be overcome through universal healthcare systems offering the HPV vaccine free at the point of delivery. In the healthcare setting, judgements by healthcare professionals about whether to recommend the vaccine may restrict a young woman’s access to the vaccine irrespective of her own beliefs and preferences. Parents may decide not to allow their daughters to be vaccinated, based on cultural or religious perceptions about sexual activity. Conclusions Barriers to the uptake of the HPV vaccine have implications for young women’s future sexual, physical and reproductive health. Interventions to address barriers to uptake of the vaccine should target appropriate, and multiple, levels of the socio-ecological model. Issues of trust require clear, accessible, and sometimes culturally appropriate, information about the HPV vaccination programme. Although young women are central to the HPV vaccination programme, their views are underrepresented in the qualitative literature. Future research should consider young women’s perceptions of, and involvement in, consent and decision-making.
... However, there were concerns about the potential to adversely affect young women's sexual health if young women assumed greater protection than is the case [42,43]: "I haven't heard it myself, but someone else heard from a girl that had been vaccinated that she was vaccinated against all sexually transmitted disease" [Midwife, Sweden] [42]. In addition, some parental resistance to the HPV vaccine due to connections with sexual behaviour were reported [46,47]: "We had quite a few phone calls, predominantly from [Asian] mothers, they were very concerned that by them okaying the needle, that was giving the daughters the green light to go and become sexually active" [Teacher, Australia] [47]. ...
... However, there were concerns about the potential to adversely affect young women's sexual health if young women assumed greater protection than is the case [42,43]: "I haven't heard it myself, but someone else heard from a girl that had been vaccinated that she was vaccinated against all sexually transmitted disease" [Midwife, Sweden] [42]. In addition, some parental resistance to the HPV vaccine due to connections with sexual behaviour were reported [46,47]: "We had quite a few phone calls, predominantly from [Asian] mothers, they were very concerned that by them okaying the needle, that was giving the daughters the green light to go and become sexually active" [Teacher, Australia] [47]. ...
... And one can-not… it's like offensive, I think" [School nurse, Sweden] [43]. This appeared to be an especially pertinent issue for parents with strong faith beliefs for whom sexual contact outside of marriage and multiple sexual partners were perceived to occur infrequently [47][48][49]: "Coming from a Muslim background… We don't have sex before marriage for example, so your first experience of these things are when you're married and you stay in a relationship… because of that reason I'd probably say no, I wouldn't bother with it with my two girls" [Asian Muslim mother, UK] [49]. However, other parents recognised changing cultural norms and values, suggesting that their belief systems may differ to that of their daughter [47,48]: "I went to the same school and I had a religious upbringing but a lot of my close friends who I grew up with are actually not religious now and they are living a different lifestyle than I am… my daughter may not grow up to live the way I do" [Jewish mother, UK] [48]. ...
Article
Full-text available
To identify the barriers and facilitators to uptake of the HPV vaccine in an ethnically diverse group of young women in the south west of England. Three school-based vaccination sessions were observed. Twenty-three young women aged 12 to 13 years, and six key informants, were interviewed between October 2012 and July 2013. Data were analysed using thematic analysis and the Framework method for data management. The priority given to preventing cervical cancer in this age group influenced whether young women received the HPV vaccine. Access could be affected by differing levels of commitment by school staff, school nurses, parents and young women to ensure parental consent forms were returned. Beliefs and values, particularly relevant to minority ethnic groups, in relation to adolescent sexual activity may affect uptake. Literacy and language difficulties undermine informed consent and may prevent vaccination. The school-based HPV vaccination programme successfully reaches the majority of young women. However, responsibility for key aspects remain unresolved which can affect delivery and prevent uptake for some groups. A multi-faceted approach, targeting appropriate levels of the socio-ecological model, is required to address procedures for consent and cultural and literacy barriers faced by minority ethnic groups, increase uptake and reduce inequalities. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health.
... In Australia, a school-based delivery is used, and parental consent is required for the vaccination to proceed. Schools distribute parental consent forms (with an information brochure) to all eligible students to take home for signing. 1 However, students most often receive little, or no, education about HPV or HPV vaccination prior to immunisation [6,7] and there is no requirement for separate consent/assent from the adolescent. Perhaps implicit is an expectation that parents will discuss the vaccine and share information with their adolescent. ...
... We identified that parents face challenges discussing HPV and vaccination with their adolescents, and adolescents rarely participate in decision-making [14]. This situation is not optimal for several reasons, including: the missed opportunity for adolescents and parents to effectively communicate about important health issues and to support adolescents developing autonomy; there are important ethical reasons why adolescents should participate in consent processes regarding their own health [7,21,23]. For the school-based vaccination context, there are currently no tools to support an informed decision-making process that can be shared between parents and adolescents. ...
... We have developed and validated a questionnaire (measure) to determine changes in adolescent knowledge, attitudes, fear and anxiety, self-efficacy, and decision-making [28]. The items in this measure have been informed by a review of existing questionnaires around HPV [30][31][32][33][34], the results of our own research [6,7,8,13,23], and an expert panel of academics working in related fields. The domains of the measure include: HPV and HPV vaccine knowledge and attitudes; HPV-related fear and anxiety 'Feelings towards vaccination'; involvement in HPV vaccination decision-making; and HPV vaccination selfefficacy 'Skills inventory'. ...
Article
Full-text available
Background: The National Human Papillomavirus (HPV) Vaccination Program in Australia commenced in 2007 for females and in 2013 for males, using the quadrivalent HPV vaccine (HPV 6,11,16,18). Thus far, we have demonstrated very substantial reductions in genital warts and in the prevalence of HPV among young Australian women, providing early evidence for the success of this public health initiative. Australia has a long history of school-based vaccination programs for adolescents, with comparatively high coverage. However, it is not clear what factors promote success in a school vaccination program. The HPV.edu study aims to examine: 1) student knowledge about HPV vaccination; 2) psycho-social outcomes and 3) vaccination uptake. Methods/design: HPV.edu is a cluster randomised trial of a complex intervention in schools aiming to recruit 40 schools with year-8 enrolments above 100 students (approximately 4400 students). The schools will be stratified by Government, Catholic, and Independent sectors and geographical location, with up to 20 schools recruited in each of two states, Western Australia (WA) and South Australia (SA), and randomly allocated to intervention or control (usual practice). Intervention schools will receive the complex intervention which includes an adolescent intervention (education and distraction); a decisional support tool for parents and adolescents and logistical strategies (consent form returns strategies, in-school mop-up vaccination and vaccination-day guidelines). Careful process evaluation including an embedded qualitative evaluation will be undertaken to explore in depth possible mechanisms for any observed effect of the intervention on primary and secondary outcomes. Discussion: This study is the first to evaluate the relative effectiveness of various strategies to promote best practice in school-based vaccination against HPV. The study aims to improve vaccination-related psychosocial outcomes, including adolescent knowledge and attitudes, decision-making involvement, self-efficacy, and to reduce fear and anxiety. The study also aims to improve school vaccination program logistics including reduction in time spent vaccinating adolescents and increased number of consent forms returned (regardless of decision). Less anxiety in adolescents will likely promote more efficient vaccination, which will be more acceptable to teachers, nurses and parents. Through these interventions, it is hoped that vaccination uptake will be increased. Trial registration: Australian and New Zealand Clinical Trials Registry, ACTRN12614000404628 , 14.04.2014.
... Performing preventive health behaviours is often dependent on one's understanding of that behaviour . Without structured and effective education about HPV and HPV vaccination, young people are unlikely to learn about HPV; relying on parents to educate is unlikely to be effective as parents' knowledge can also be very limited (Marshall et al., 2007(Marshall et al., , 2013, and as with sex education more broadly (Davies and Robinson, 2010;Robinson and Davies, 2014), they experience barriers such as embarrassment about discussing the sexually transmitted nature of the virus with their child (Cooper Robbins et al., 2011a). ...
... Our earlier research found that girls wanted informational materials designed specifically for them; that it would help them to be more confident in their shared vaccination decision and in the vaccination process (Cooper Robbins et al., 2010a). We also found that girls want to participate in healthrelated decision-making processes (Cooper Robbins et al., 2011a). In 2013, in a first for any vaccine used with school-age young people, the Australian Government made available resources for schools and young people to use to support the HPV vaccination programme (http://www.hpv. ...
... Education of parents may promote vaccine acceptance through reduction of vaccine refusal as a result of misconception, as has been suggested by past research (Friedman and Shepeard, 2007). In school-based programmes, we do not know if this will result in higher coverage of the HPV vaccine overall, as many parents already passively provide consent for vaccination of their adolescent in school programmes, along with other vaccines, with limited knowledge (Cooper Robbins et al., 2011a). However, effective education of those being offered the HPV vaccine in school-based programmes has the potential to provide important benefits for students, school communities and public health more broadly, such as (1) better understanding of the importance of accessing appropriate screening services later in life, (2) less anxiety and fear and increased self-efficacy in receiving HPV vaccination, (3) less vaccine refusals on the day of vaccination and (4) more participation in shared decision-making in matters related to their health. ...
Article
Full-text available
Objective Australia has implemented a nation-wide programme providing a human papillomavirus (HPV) vaccine to girls and boys through school-based programmes. Previous research has identified three distinct areas for attention: (1) lack of understanding about HPV and HPV vaccination, (2) young people’s desire for involvement in decision-making about HPV vaccination and (3) fear of HPV vaccination. We aimed to develop an intervention to address young people’s low levels of understanding, to promote their involvement in consent and reduce vaccination-related fear and anxiety. Design, Setting, Methods Formative qualitative research was conducted in six public, private and Catholic schools in the Sydney metropolitan area. Girls who were offered the vaccine in a school programme and aged 12–13 years were interviewed in focus groups. Piloting of materials was conducted in three private schools across Sydney with both girls and boys, and changes and additions were made to the materials in accordance with feedback. Results We developed an educational intervention aimed at addressing gaps in young people’s knowledge and understanding, and offering strategies to improve confidence with vaccination and reduce needle-related anxiety. Components of the final intervention include film chapters, a magazine, a website, an app and teacher support materials. The intervention is designed for teachers and/or nurses to deliver and is linked to the school-based HPV vaccination programme. Conclusions This is the first educational intervention designed for young people in HPV school-based vaccination, to be developed from empirical data with the involvement of young people themselves.
... In Australia, a school-based delivery is used, and parental consent is required for the vaccination to proceed. Schools distribute parental consent forms (with an information brochure) to all eligible students to take home for signing. 1 However, students most often receive little, or no, education about HPV or HPV vaccination prior to immunisation [6,7] and there is no requirement for separate consent/assent from the adolescent. Perhaps implicit is an expectation that parents will discuss the vaccine and share information with their adolescent. ...
... We identified that parents face challenges discussing HPV and vaccination with their adolescents, and adolescents rarely participate in decision-making [14]. This situation is not optimal for several reasons, including: the missed opportunity for adolescents and parents to effectively communicate about important health issues and to support adolescents developing autonomy; there are important ethical reasons why adolescents should participate in consent processes regarding their own health [7,21,23]. For the school-based vaccination context, there are currently no tools to support an informed decision-making process that can be shared between parents and adolescents. ...
... We have developed and validated a questionnaire (measure) to determine changes in adolescent knowledge, attitudes, fear and anxiety, self-efficacy, and decision-making [28]. The items in this measure have been informed by a review of existing questionnaires around HPV [30][31][32][33][34], the results of our own research [6,7,8,13,23], and an expert panel of academics working in related fields. The domains of the measure include: HPV and HPV vaccine knowledge and attitudes; HPV-related fear and anxiety 'Feelings towards vaccination'; involvement in HPV vaccination decision-making; and HPV vaccination selfefficacy 'Skills inventory'. ...
Article
Introduction In the context of universal (male and female) school based HPV vaccination program, we evaluated a complex intervention to promote: 1) student knowledge about HPV vaccination; 2) psycho-social outcomes and 3) vaccination uptake. Methods We recruited a stratified random sample of schools across two Australian states, and randomly allocated to intervention or control. The intervention included adolescent education; distraction/relaxation on vaccination day; a brochure and decisional support tool for adolescents and parents; and program logistical strategies, in addition to routine state based vaccination guidelines. Both intervention and control followed routine state based guidelines. We compared intervention and control with regard to: student questionnaire data pre-dose 1, 2, 3 on HPV knowledge, vaccination decisional involvement, vaccination self-efficacy, fear and anxiety, and vaccine uptake. Immunisation data collection was ongoing in 2015. Results We recruited 21 intervention schools (3806 students) and 19 control (3159). Pre-dose 1 questionnaire student knowledge: 65% vs. 33% correct responses, (difference 32%; 95% CI: 27%, 36%); decisional involvement score: 3.7 vs. 3.6 (difference 0.11; 95% CI: 0.06, 0.16); self-efficacy score: 74 vs. 71 (difference 4; 95% CI 1, 7); fear/anxiety score: 2.6 vs. 2.7 (difference -0.11; 95% CI: -0.19, -0.02). At least one vaccine dose was given to 3277 (86.1%) students in intervention schools versus 2697 (85.4%) in control schools, difference 0.4% (95% CI: -2.6, 3.3). Conclusion Our intervention significantly improved adolescent knowledge and psycho-social outcomes, but not HPV vaccination coverage, which was high in both groups, resulting in a possible ceiling effect. Disclosure of interest statement This study was funded through a National Health and Medical Research Council Project Grant (1026765) and an investigator driven bioCSL research grant. SR. Skinner’s institution has received honoraria for Advisory Board meetings and educational symposia from GSKbiologicals and Pfizer.
... Additionally, Moreira et al. (2006) found that fear of cervical cancer influenced the decision-making process; however, this study questioned Brazilian females about their willingness to receive the vaccine prior to its introduction into the national program. Cooper Robbins et al. (2010) reported that knowledge of an individual who had received a cervical cancer diagnosis or a history of an abnormal smear, positively influenced participants' decision to be vaccinated. Such experiences are cues to action cited in the HBM, and the notion of motivation triggered by fear of cancer is also apparent. ...
... This theme focused on the anticipated and actual experience of vaccination-related pain and was identified in six studies (Bernard et al., 2011;Cooper Robbins, Brotherton, McCaffery, & Skinner, 2010;Getrich et al., 2014;Gold, Naleway, & Riedlinger, 2013;Hughes, Jones, Feemster & Fiks, 2011;Oscarsson et al., 2012;Wakimizu et al., 2015). Wakimizu et al. (2015) found an association between pain and amount of vaccinations (three intramuscular injections), with one participant reporting severe pain, causing fear of subsequent vaccinations. ...
... Hughes et al. (2011) studied 20 adolescent, mother, clinician triads where adolescents considered themselves as passive in the decision-making process; it should be noted that although they were aged from 12 to 16, half of them (n ¼ 10) were either 11 or 12 years old. Similarly, Cooper Robbins et al. (2010) found that younger participants were happy for their parents to make the decision; the study comprised of girls aged 12-16 years old. Although mutual decision-making was reported, some participants were unhappy for their parents to decide, and where disagreement occurred, parental decisions often took priority. ...
Article
The human papillomavirus (HPV) vaccine is a key intervention in the prevention of HPV infection and associated cancers. This review emphasizes the importance of understanding what influences decision-making about this vaccine. Guided by the work of Whittemore and Knafl, and Pluye and Hong, we identified 25 studies, from which four prominent themes emerged: fear and risk, pain, parental involvement, and involvement of others. Fear of cervical cancer was a strong motivation to receive the vaccine, and the extent of parental involvement also had an impact on decision-making. Recommendations to receive the vaccine by health-care providers were also an important influence. School nurses are fundamental to the promotion and delivery of the HPV vaccine and should stress the significant role that it plays in the prevention of cancer. Additionally, school nurses should ensure that discussions about HPV infection and vaccine include parents where appropriate and should distinctly recommend vaccination to those eligible.
... Education of teachers, parents and adolescents about vaccination has also been identified as important to school based vaccination program success. While ideally, adolescents should participate in an informed assent process (or consent if capable), including being aware of their own right of refusal of vaccination, this may be difficult to achieve in the setting of school based vaccination (Bernard et al., 2011;Cooper Robbins et al., 2010a, 2010c. The complex logistics of delivering mass school based vaccination, where consent for the vaccination is provided days or weeks before the actual vaccination day at the school, and where many adolescents must be vaccinated in a short time frame, challenge the feasibility of provider assessment of individual adolescent assent and/or cognitive maturity to provide consent to vaccination (Cooper Robbins et al., 2010b). ...
... In a qualitative study conducted in Sydney secondary schools, some parents reported feeling uncomfortable explaining to their adolescent why they needed the vaccine. This was related partly to a lack of knowledge in the parent and partly to embarrassment in discussing a disease which is sexually transmitted (Cooper Robbins et al., 2010c). ...
... More than two-thirds of parents of fully vaccinated girls indicated that they had their daughters vaccinated primarily for protection against cervical cancer, or because they believed that vaccines are good for health [19]. The HPV vaccine's benefit for the prevention of cervical cancer has been noted in studies done in the United Kingdom and Australia, after they introduce HPV vaccine as a part of the national immunization program [20,21]. ...
... In the previously cited study from the United Kingdom, 70 percent of girls interviewed stated that the vaccine decision was made jointly with her parents [28]. Studies from Australia [21] and Uganda [27] also found that adolescents have some independence in the decision to receive the HPV vaccine. Combined, these studies provide mounting evidence that decisionmaking for HPV vaccination has some degree of negotiation within the family, reflecting the maturation of adolescents and their increased independence from parents as they age. ...
Article
Full-text available
Objective and Method Cervical cancer is the third most common cancer affecting women worldwide and it is an important cause of death, especially in developing countries. Cervical cancer is caused by human papillomavirus (HPV) and can be prevented by HPV vaccine. The challenge is to expand vaccine availability to countries where it is most needed. In 2008 Peru’s Ministry of Health implemented a demonstration project involving 5th grade girls in primary schools in the Piura region. We designed and conducted a qualitative study of the decision-making process among parents of girls, and developed a conceptual model describing the process of HPV vaccine acceptance. Results We found a nonlinear HPV decision-making process that evolved over time. Initially, the vaccine’s newness, the requirement of written consent, and provision of information were important. If information was sufficient and provided by credible sources, many parents accepted the vaccine. Later, after obtaining additional information from teachers, health personnel, and other trusted sources, more parents accepted vaccination. An understanding of the issues surrounding the vaccine developed, parents overcome fears and rumors, and engaged in family negotiations–including hearing the girl’s voice in the decision-making process. The concept of prevention (cancer as danger, future health, and trust in vaccines) combined with pragmatic factors (no cost, available at school) and the credibility of the offer (information in the media, recommendation of respected authority figure) were central to motivations that led parents to decide to vaccinate their daughters. A lack of confidence in the health system was the primary inhibitor of vaccine acceptance. Conclusions Health personnel and teachers are credible sources of information and can provide important support to HPV vaccination campaigns.
... Throughout the HPV vaccine implementation period, concerns have been raised by some parents, antivaccination groups, and religious groups, across a variety of ethnicities that the vaccine will encourage promiscuity and risky sexual behaviours [21][22][23][24]. A growing body of evidence suggests that, in general, these concerns are unfounded. ...
... Participant Characteristics. Participant mean age was 18.6 years (SD = 1.2; range: [17][18][19][20][21][22][23][24]. The majority reported Christianity as their religious affiliation (47%) followed by nonreligious beliefs (43%). ...
Article
Full-text available
Objectives: To date, there has been limited research on the decision-making process of HPV vaccine recipients. This study aimed to explore HPV-related knowledge, vaccination decision-making, and post-vaccination attitudes about sexual behaviour in women who participated in the Australian school- and population-based HPV vaccine program. Materials and Methods: 102 female university students who had received the HPV vaccine (<27 years) completed scales on knowledge, vaccination decision-making, and post-vaccination sexual attitudes. Results: HPV-related knowledge was low (M= 57%), and women felt moderately involved in the vaccination decision (M= 62%). Most women had not changed their sexual attitudes as a consequence of vaccination; however some reported that since vaccination they feel less concerned about sexual health (19%).There were no significant differences between school- and population-based recipients on HPV knowledge (p=.559) or post-vaccination sexual attitudes (p=.709). School-based recipients were significantly less autonomous in their decision-making (p=.001). Conclusion: Poor knowledge indicates a need for provision of information about HPV and post-vaccination sexual health. Additionally, policy makers and health professionals may benefit from reiterating the importance of continued sexual health practices to HPV vaccine recipients. Future research should assess whether young women need to be more involved in the informed decision-making process for HPV vaccination.
... Irrespective of geography and delivery setting of the HPV vaccine, cultural sensitivity was profound among women when deciding to allow their daughters to undergo vaccination for cervical cancer. Muslim and Asian mothers in the UK and Australia were concerned that giving permission their daughters to be vaccinated would be seen as a sign of approval for sex before marriage 45,46 . Some parents dismissed this viewpoint, such as Alaskan and Australian parents, when allowing their child to be vaccinated against HPV 39,46,47 . ...
... Muslim and Asian mothers in the UK and Australia were concerned that giving permission their daughters to be vaccinated would be seen as a sign of approval for sex before marriage 45,46 . Some parents dismissed this viewpoint, such as Alaskan and Australian parents, when allowing their child to be vaccinated against HPV 39,46,47 . Support from family and friends and a physician's recommendation are also important when women in the SEAR and WPR decide about having the HPV vaccine. ...
Article
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Since licensing in 2006, there has been poor uptake of the HPV vaccine among the targeted population in the South East Asia Region (SEAR) and Western Pacific Region (WPR). A systematic review was conducted to identify the studies exploring the relationship between factors and intention for HPV vaccination among women in SEAR and WPR countries. Nineteen studies were identified as suitable for qualitative synthesis, and three as suitable for meta-analysis. Most women had a positive intention to have an HPV vaccine (range 57% — 85%). Having a positive intention to vaccinate was significantly higher among women not aware of HPV infection (OR: 1.34, 95% CI: 1.02—1.76) and HPV vaccine (OR: 1.57, 95% CI: 1.26—1.96). Lower knowledge level and less confidence in safety and efficacy of the vaccine, negatively affected intention to vaccinate. Perceiving the vaccine to be expensive, low perception of contracting HPV infection and cervical cancer, and lack of concrete recommendations from healthcare providers also negatively affected intention to vaccinate. This review suggests the decision-making processes of women in SEAR and WPR is influenced by the cost of vaccination, perceived efficacy and safety of vaccine, provision of information on vaccination, and the awareness about HPV infection and the HPV vaccine
... As others have noted, past research has had an imprecise definition of vaccination hesitancy; some definitions have included attitudes, confidence, delay, and refusal (Bedford et al., 2017), a lack of precision that has hindered progress in research (Peretti-Watel, Larson, Ward, Schulz, & Verger, 2015). People demonstrate a range of motivation for being vaccinated: (a) asking for vaccination when providers do not raise the issue, (b) being open to receiving a vaccination when presented with the idea but not being especially proactive, (c) having a passive hesitancy, (d) being initially resistant to vaccination but open to persuasion; and (e) being steadfastly opposed to some or all vaccines (Benin, Wisler-Scher, Colson, Shapiro, & Holmboe, 2006;Gust et al., 2005;Cooper Robbins, Bernard, McCaffery, Brotherton, & Skinner, 2010). A study of U.S. parents identified the prevalence of five groups in relation to vaccine acceptance: "immunization advocates," strongly in favor of vaccines (33% of adults); "go along to get alongs" (26%); "health advocates," generally trusting of doctors and to some extent vaccines (25%); "fencesitters" (13%); and "worrieds" (2.6%; Gust et al., 2005). ...
... Benin et al. (2006) described people who (a) accept or do not question vaccines, (b) accept vaccines but have concerns, (c) delay or reject some vaccines, or (d) reject all vaccines. Cooper Robbins et al. (2010) proposed a two-axis taxonomy, with engagement (passive and active) on one axis and vaccination behavior (vaccinated or not) on the other axis. Most people who have not gotten vaccinated did so passively (Pearce, Marshall, Bedford, & Lynch, 2015;Samad et al., 2006). ...
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Vaccination is one of the great achievements of the 20th century, yet persistent public-health problems include inadequate, delayed, and unstable vaccination uptake. Psychology offers three general propositions for understanding and intervening to increase uptake where vaccines are available and affordable. The first proposition is that thoughts and feelings can motivate getting vaccinated. Hundreds of studies have shown that risk beliefs and anticipated regret about infectious disease correlate reliably with getting vaccinated; low confidence in vaccine effectiveness and concern about safety correlate reliably with not getting vaccinated. We were surprised to find that few randomized trials have successfully changed what people think and feel about vaccines, and those few that succeeded were minimally effective in increasing uptake. The second proposition is that social processes can motivate getting vaccinated. Substantial research has shown that social norms are associated with vaccination, but few interventions examined whether normative messages increase vaccination uptake. Many experimental studies have relied on hypothetical scenarios to demonstrate that altruism and free riding (i.e., taking advantage of the protection provided by others) can affect intended behavior, but few randomized trials have tested strategies to change social processes to increase vaccination uptake. The third proposition is that interventions can facilitate vaccination directly by leveraging, but not trying to change, what people think and feel. These interventions are by far the most plentiful and effective in the literature. To increase vaccine uptake, these interventions build on existing favorable intentions by facilitating action (through reminders, prompts, and primes) and reducing barriers (through logistics and healthy defaults); these interventions also shape behavior (through incentives, sanctions, and requirements). Although identification of principles for changing thoughts and feelings to motivate vaccination is a work in progress, psychological principles can now inform the design of systems and policies to directly facilitate action.
... The association between declining previous childhood vaccinations and the HPV vaccination is supported by previous research. 13,36 Declining parents were significantly less likely to have agreed to the vaccine against influenza A (H1N1), popularly known as swine flu. The parents declined the vaccine as they believed the risks outweighed the benefits and this backs up the results of our recent qualitative study, where parents expressed fear of side effects, especially narcolepsy, was one reason why they declined the HPV vaccination. ...
... Insufficient information from the school health service has been found previously to be a reason for not consenting to the HPV vaccination. 9,13,19,36,40 Therefore, we recommend that the information given to parents should be more focused on HPV and the HPV vaccine, including facts about the diseases HPV can cause. Most importantly, the information should clearly state that no adverse effects, such as autoimmune diseases, have been linked to the vaccine. ...
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BACKGROUND Parents' beliefs about human papillomavirus (HPV) vaccination influence whether they allow their daughters to be vaccinated. We examined the association between parents' refusal and sociodemographic background, knowledge and beliefs about HPV, and the HPV vaccination in relation to the Health Belief Model. METHODS The sample consisted of 200 (55%) parents of children aged 11‐12 years in the Swedish national vaccination program. Data were collected using a self‐reported questionnaire. Most parents (N = 186) agreed to the vaccination. Pearson's chi‐square, Fisher's exact test, and the Mann‐Whitney U test were used to analyze data. RESULTS Declining parents saw more risks and fewer benefits of HPV vaccination but no differences in beliefs regarding the severity or young girls' susceptibility to HPV were found. There was an association between refusing the HPV vaccine and lower acceptance of previous childhood vaccinations, and their main source of information was the Internet. Parents who declined the vaccine believed it could adversely affect condom use, the age of their daughter's sexual debut, and the number of sexual partners. CONCLUSION Parents should have the possibility to discuss HPV and HPV vaccine with a school nurse or other health care professionals, and should have access to evidence‐based information on the Internet.
... Parents and guardians (hereafter referred to as 'parents') play a pivotal role in ensuring vaccine uptake, given that in many countries including Australia, parental consent is required for adolescent vaccination in schools [8]. Parents' knowledge, attitudes and beliefs about vaccines in general, and HPV and HPV vaccination in particular, can influence their decision-making about HPV vaccination for their adolescent [1,[9][10][11]. Key factors influencing parental HPV decision-making include: physician recommendation, government recommendation, parents' perceived benefits of the vaccine for their adolescent, parents' concerns about vaccine safety and for some, worries about sexual risk compensation [1,[11][12][13]. ...
... Parents' knowledge, attitudes and beliefs about vaccines in general, and HPV and HPV vaccination in particular, can influence their decision-making about HPV vaccination for their adolescent [1,[9][10][11]. Key factors influencing parental HPV decision-making include: physician recommendation, government recommendation, parents' perceived benefits of the vaccine for their adolescent, parents' concerns about vaccine safety and for some, worries about sexual risk compensation [1,[11][12][13]. ...
Article
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Introduction This qualitative study aimed to explore parental attitudes, knowledge and decision-making about HPV vaccination for adolescents in the context of a gender-neutral school-based Australian National Immunisation Program (NIP). Methods Semi-structured interviews with parents of adolescents eligible for HPV vaccination were undertaken as part of an evaluation of a cluster-randomised controlled trial of a complex intervention in 40 schools (2013–2015). In this qualitative study, we purposively recruited a nested sample of parents from 11 schools across two Australian jurisdictions. Interviews explored parent knowledge and understanding of the HPV vaccine program; HPV vaccination decision-making; their adolescent’s knowledge about HPV vaccination; and their adolescent’s understanding about HPV vaccination, sexual awareness and behaviour. Transcripts were analysed using inductive and deductive thematic analysis. Results Parents’ of 22 adolescents had positive attitudes towards the program; the school-based delivery platform was the key driver shaping acceptance of and decision-making about HPV vaccination. They had difficulty recalling, or did not read, HPV vaccination information sent home. Some adolescents were involved in discussions about vaccination, with parents’ responsible for ultimate vaccine decision-making. All parents supported in-school education for adolescents about HPV and HPV vaccination. Parents’ knowledge about HPV vaccination was limited to cervical cancer and was largely absent regarding vaccination in males. Conclusions Parents’ positive attitudes towards the NIP and inclusion of the HPV vaccine is central to their vaccine decision-making and acceptance. More intensive communication strategies including school education opportunities are required to improve parents’ knowledge of HPV-related disease and to promote vaccine decision-making with adolescents.
... 8 It is impressive that despite being informed that HPV was sexually transmitted, it did not deter them from having the intention to vaccinate their adolescents. Earlier studies have consistently shown that associating HPV vaccine with the prevention of sexually transmitted infections discouraged parents who either downplay the involvement of their adolescents' sexual activities 44,46 or hold the fear that the administration of the vaccine will promote indiscriminate sex. 38,47 The reason for their departure from the conventional view require further research as earlier discussed to unravel the basis for their contrasting views about the sexuality of their adolescents. ...
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Parents have important roles to play for adolescents to get the human papillomavirus (HPV) vaccine, an effective measure in the prevention of cervical and other HPV-related cancers. It is important to understand the intention of parents to have their adolescents vaccinated for optimal uptake of the vaccine in Nigeria. This study investigated the intention of parents in five selected communities to get their adolescents vaccinated with HPV vaccine in Ibadan, Nigeria using the Integrated Behavioral Model (IBM). Cross sectional study design was employed and 678 parents were interviewed. Pearson correlation, chi-square test and multiple regression were used for data analysis at α = 0.05. Mean age of the parents was 42.5 ± 10.0 years and 230(33.9%) were males. Almost all of the parents (96.8%) had the intention to vaccinate their adolescents with HPV vaccine. This intention was significantly correlated with experiential attitude (r = 0.74, p = <.01), instrumental attitude (r = 0.33, p = <.01), injunctive norm (r = 0.39, p = <.01), descriptive norm (r = 0.32, p = <.01), perceived control (r = 0.32, p = <.01) and self-efficacy (r = 0.46, p ≤ .01). A higher proportion of parents older than 65 years significantly had no intention to vaccinate their adolescents with HPV vaccine. Intention to vaccinate adolescents with HPV vaccine was predicted by experiential attitude (OR = 0.88, 95% CI: 0.80-0.95), personal agency (OR = 0.22, 95% CI: 0.15-0.29) and injunctive norm (OR = 0.08, 95% CI: 0.02-0.13). Parental intention to vaccinate adolescents with HPV vaccine was high among the parents in this study. The reluctance of older parents about HPV vaccine for adolescents requires further investigation.
... 3 One conceptual framework for interpreting vaccination factors examines their role in passive or active decision making. 15 This framework is useful because it informs potential interventions. For example, passive decisions to forgo vaccination because of inconvenience may be amenable to evening/weekend clinics, 11 whereas active vaccination refusal due to efficacy concerns may be responsive to educational interventions. ...
Article
While influenza vaccination in the prior year is a strong predictor of subsequent vaccination, many families do not have static vaccination patterns. This study examined factors guiding influenza vaccination decisions among parents whose children sporadically received the influenza vaccination (flu-floppers). We administered surveys to 141 flu-flopper families. Surveys included 21 factors associated with vaccine decision making. A conceptual framework of “passive” and “active” decision making was used to assess parental motivators behind vaccine decisions. The most common reason for vaccinating was a desire to prevent influenza (45%). The most common reason for not vaccinating was a belief that influenza vaccination is not effective (29%). Most parents (88%) reported an active reason in years when their child was vaccinated, while only 43% reported an active reason when their child was not vaccinated (P < .00001). These findings may guide efforts to increase influenza vaccination rates in children most amenable to vaccination.
... Highly educated parents may resist MMR vaccine on the belief that it 'impairs the immune system' [37]. Similar 'antivaccination' attitudes have been observed among parents with respect to HPV vaccine in Australia [38]. Indeed, anti-vaccination attitudes were common enough among parents in Australia that Cooper Robbins and colleagues, employing a conceptual framework similar in many respects to the model we use, identify 'anti-vaccination' as a separate decision-making state, distinct from active and passive decision-making. ...
Article
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The GAVI Alliance's decision in late 2011 to invite developing countries to apply for funding for human papillomavirus (HPV) vaccine introduction underscores the importance of understanding levels of HPV vaccine acceptance in developing country settings. In this paper, we present findings from qualitative research on parents' rationales for vaccinating or not vaccinating their daughters (vaccine acceptance) and their decision-making process in the context of an HPV vaccination demonstration project in Vietnam (2008-2009). We designed a descriptive qualitative study of HPV vaccine acceptability among parents of girls eligible for vaccination in four districts of two provinces in Vietnama. The study was implemented after each of two years of vaccinations was completed. In total, 133 parents participated in 16 focus group discussions and 27 semi-structured interviews. Focus group discussions and in-depth interviews with parents of girls vaccinated revealed that they were generally very supportive of immunization for disease prevention and of vaccinating girls against HPV. The involvement of the National Expanded Program of Immunization in the demonstration project lent credibility to the HPV vaccine, contributing to high levels of acceptance. For parents who declined participation, concerns about side effects, the possibility that the vaccine was experimental, and the possible impact of the vaccine on future fertility rose to the surface. In terms of the decision-making process, many parents exhibited 'active decision-making,' reaching out to friends, family, and opinion leaders for guidance prior to making their decision. Vietnam's HPV vaccination experience speaks to the importance of close collaboration with the government to make the most of high levels of trust, and to reduce suspicions about new vaccines that may arise in the context of vaccine introduction in developing country settings.
... Although knowledge was low, eligible girls in this population were highly likely to receive all three doses of HPV vaccine (LaMontagne et al., 2011), suggesting that specific HPV and cervical cancer knowledge may not be a primary driver for HPV vaccine acceptance, a finding similar to that recently reported from the Australian HPV vaccination program (Cooper et al., 2010). Previous findings from childhood immunization programs have suggested that specific knowledge about immunizations and the diseases they protect against are not necessarily associated with vaccine acceptance (Nichter, 1995;Jhetta & Newell, 2008). ...
Article
Limited human papillomavirus (HPV) related knowledge might be a barrier to future vaccine acceptance. From 2008-2010, PATH conducted an HPV vaccination demonstration project in partnership with the government immunization program in Vietnam, which included awareness campaigns prior to vaccination. To assess and compare knowledge and attitudes about cervical cancer and HPV vaccines between mothers and daughters, and whether knowledge was associated with vaccination status. We analyzed HPV-related knowledge and attitude data from mother-daughter paired responses to a cross-sectional household survey. After parents completed the survey, daughters were asked the same questions. We calculated the frequency of responses for each question and devised a scaled composite measure for knowledge. Participants believed they had received enough information about cervical cancer and HPV vaccines and it was sufficient to make a decision about vaccination. Fifty percent of the participants knew HPV causes cervical cancer and 80% knew the HPV vaccine prevented cervical cancer. Mothers had more knowledge about cervical cancer and HPV infection (p<0.01), compared to daughters, who had more vaccine specific knowledge (p<0.01). However, the total mean knowledge score was similar for the groups. Girls not fully vaccinated had a lower mean knowledge score than fully vaccinated girls (p<0.001). Our results suggest that the purpose of the HPV vaccine was clearly messaged; however, some misconceptions about cervical cancer and HPV still exist. Limited knowledge about the magnitude of cervical cancer, HPV as a cause of cervical cancer, and HPV vaccines may have contributed to incomplete vaccination.
... Intentions correlate with behaviors but do not necessarily translate into behaviors. Only one study could be found that explored decision making in those who had and had not received the vaccine; however, the focus was on adolescent girls rather than college-age women (Robbins et al., 2010). ...
Article
Research on the human papillomavirus vaccine has largely focused on parents' attitudes toward vaccinating their young daughters. Yet, little is known about the factors that influence human papillomavirus vaccination in college-age women who are still eligible for the vaccine. This study examined attitudes toward the human papillomavirus vaccine in 150 college-age women who had received the vaccine and 58 who had not. The Health Belief Model was used to predict vaccine intentions and to compare vaccinated and unvaccinated women. Women's self-efficacy, social environment, and perceptions of the vaccine predicted vaccine intentions and behaviors. Interventions might include these factors to promote vaccination.
... Using Meyrick's (2006) terminology, these issues reflect the concerns with transparency (the detailed description of the research process) and systematicity (in terms of the data analysis process, using the same process throughout the analysis). All individual interviews and focus groups were analysed together to identify the recurring themes as it has been performed in previous studies (e.g., Robbins, Bernard, McCaffery, Brotherton & Skinner, 2010). Considering this strategy, the results cover all these data. ...
Article
Objectives: The main goal of this study is to explore what is meant by "quality of care" (QoC) by both health professionals and patients. This research also intends to compare the perspectives of nurses, doctors and patients in order to understand whether these different actors share similar views on what represents QoC. Design and methods: A qualitative study was conducted. The study consisted in 44 semi-structured individual interviews (11 doctors; 23 nurses; 10 patients) and in three focus groups (20 participants: doctors, nurses, patients). Participants were doctors, nurses and patients from several Hospitals in Portugal. Data were analysed using content analysis methodology with MaxQDA software. Results: The main content analysis' results revealed that all participants emphasize technical and interpersonal dimensions of QoC. Nevertheless, professionals stressed the availability of equipment and supplies and the conditions of health care indoor facilities. Patients focused more on their access to health services, namely the availability of health professionals, and on the health status outcome after care. In what the differences between doctors and nurses are concerned, the former tend to highlight the technical aspects of care more than the nurses, who tend to refer interpersonal aspects immediately. Conclusions: Although nowadays the importance of health care quality has become well-recognized, its definition is still complex. Given that specific aspects are more valued by certain groups than others, it is important to take in consideration all the stakeholder's perspectives when measuring QoC in order to continuously improve it in the 'real' settings.
... The highest uptake rates reported in this study were achieved through school-based vaccination programmes 11,17,30 which have been shown to be acceptable and convenient to parents/carers. 42,43 The observed lower uptake of the HPV vaccine in the general practice setting may be as a result of a reliance on opportunistic strategies for vaccine delivery. For a population who typically utilize healthcare infrequently, this approach may not be appropriate if high coverage is to be achieved. ...
Article
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Background The human papillomavirus (HPV) vaccine offers an opportunity to reduce health inequalities associated with cervical cancer provided the vaccine is delivered equitably at population level. Method We reviewed evidence of inequalities in HPV vaccine uptake in young women after undertaking a comprehensive search of databases from inception to March 2012. Studies that compared HPV vaccination initiation and/or completion by at least one ethnicity or socioeconomic-related variable in adolescent young women were included. There were no language restrictions. Data were extracted by two reviewers and pooled in a meta-analysis using a random-effects model; sub-analyses and meta-regression were undertaken to investigate sources of heterogeneity. Results In all, 29 publications related to 27 studies were included in the review. Black young women were less likely to initiate HPV vaccination compared with White young women (combined OR: 0.89, 95% CI: 0.82–0.97). In the USA, young women without healthcare insurance were less likely to initiate (combined OR: 0.56, 95% CI: 0.40–0.78). There was no strong evidence that lower family income (combined OR: 1.16, 95% CI: 1.00–1.34) or lower parental education (combined OR 1.06, 95% CI: 0.92–1.22) influenced HPV vaccination initiation. Conclusions We found strong evidence for differences in HPV vaccination initiation by ethnicity and healthcare coverage, but did not find a strong association with parental education or family income variables. The majority of studies originated from the USA. Population-based studies reporting both initiation and completion of the HPV vaccination programme are required to establish patterns of uptake in different healthcare contexts.
... Table 2 also contains reference to other events found not to be biologically related to vaccination, such as the occurrence of a ''mass psychogenic'' response to vaccination among girls in a school-based vaccination clinic in Australia. This report highlighted that factors other than the vaccine constituents, such as the fear of painful events, can trigger adverse reactions to vaccination [20,110]. Expert review of unusual and serious conditions that occur after vaccination, such as that conducted in specialised immunisation adverse event assessment clinics, is important [111,112]. ...
Article
Vaccination to prevent human papillomavirus (HPV)-related infection leading to cancer, particularly cervical cancer, is a major public health breakthrough. There are currently two licensed HPV vaccines, both of which contain recombinant virus-like particles of HPV types 16 and 18 (which account for approximately 70 % of cervical cancer). One vaccine also protects against HPV types 6 and 11, which cause genital warts. The safety profile of both vaccines was assessed extensively in randomised controlled clinical trials conducted prior to licensure and has been further elucidated following licensure from surveillance and specific studies in large populations. This review aims to examine current evidence regarding the safety of HPV vaccines. In summary, both vaccines are associated with relatively high rates of injection site reactions, particularly pain, but this is usually of short duration and resolves spontaneously. Systemic reactions have generally been mild and self-limited. Post vaccination syncope has occurred, but can be avoided with appropriate care. Serious vaccine-attributable adverse events, such as anaphylaxis, are rare, and although not recommended for use in pregnancy, abnormal pregnancy outcomes following inadvertent administration do not appear to be associated with vaccination. HPV vaccines are used in a three-dose schedule predominantly in adolescent females: as such case reports linking vaccination with a range of new onset chronic conditions, including autoimmune diseases, have been made. However, well-conducted population-based studies show no association between HPV vaccine and a range of such conditions. Whilst this reassuring safety profile affirms the positive risk benefit of vaccination, as HPV vaccine use expands into more diverse populations, including males, ongoing safety assessment using well-conducted studies is appropriate.
... 19,20 Parental vaccination decision-making on behalf of adolescents is influenced by physician recommendation, government recommendation, perceived benefits of the vaccine and concerns about side effects and vaccine safety. 19,[21][22][23] Social determinants of health, including socioeconomic status and ethnicity, and factors relating to patient engagement have also been found to influence vaccination uptake, although to a lesser extent in school-based programs. 24,25 Parental barriers to adolescent vaccination include not receiving a provider's recommendation, lack of information about vaccination, concerns about timing of vaccination (e.g. ...
Article
GPs are often unaware of their important role in supporting adolescent vaccination, which primarily occurs through the school-based vaccination program. Ensuring vaccinations are up to date and missed doses are completed should be considered a standard preventive health activity for the adolescent patient in general practice. As vaccination of adolescents primarily occurs through the school-based vaccination program, GPs may not see themselves as playing an important role. However, working alongside the school program, GPs are crucial in achieving the same high coverage that is seen in early childhood vaccination programs. GPs can ensure all adolescent patients in their practice are up to date with their vaccinations and provide any that have been missed in the school program. Disruption to student attendance at school from closures or restrictions during the COVID-19 pandemic may have interrupted vaccination initiation or completion, especially when more than one vaccine dose is required.
... When viewed in light of the concept of reproductive citizenship, we found that women can be grouped into a spectrum of categories: quiescent, reactive, and proactive. The concepts of active/passive vaccination behavior have arisen in previous qualitative research to explain human papillomavirus vaccine uptake by adolescent girls (Cooper Robbins, Bernard, McCaffery, Brotherton, & Skinner, 2010). Our findings indicate that women's categorization as quiescent, reactive, and proactive reproductive citizens is modified by whether the disease for prevention is influenza or pertussis. ...
Article
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Internationally, pregnant and postpartum women have been the focus of influenza and pertussis immunization campaigns, with differing levels of vaccine acceptance. We used semistructured interviews to explore pregnant women's perspectives on influenza vaccination during pregnancy and postpartum pertussis vaccination. Many women saw pregnancy as a busy time filled with advice on what they "should" and "should not" do to ensure the health of their fetus, and vaccinating themselves was regarded as just one of these tasks needing consideration. Women were more concerned about potential risks to their infants' health before their own. They saw influenza as a disease affecting the mother, whereas they viewed pertussis as a threat to the baby and therefore comparatively more risky. They were thus more likely to intend to vaccinate against pertussis to protect their infant. Framing of vaccination information toward protection of the baby might help increase vaccine uptake among pregnant women.
... One particular avenue for future research may be to incorporate models describing components beyond individual health beliefs, such as decision-making styles (e.g. active vs. passive decision making) as well as parentdaughter communication, as these have also been used to describe parental HPV decisionmaking behaviour 53 . In addition, consistent with the results of the present study, anticipated regret following vaccination has been shown in previous research to be a critical and modifiable component of HPV vaccine decision making among parents. ...
Article
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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 agree to HPV vaccine uptake by 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.
... Young people are unlikely to learn about HPV and HPV vaccination without structured and effective education (Cooper et al. 2016). Expecting parents/guardians to educate young people is also unlikely to be effective as their own knowledge about HPV and HPV vaccination can also be very limited (Marshall et al. 2007(Marshall et al. , 2013, and, as with sex education more broadly (Davies and Robinson 2010;Robinson andDavies 2014, 2017) they also experience barriers such as embarrassment about discussing the sexually transmitted nature of the virus with their child (Cooper Robbins et al. 2011). Young people's access to accurate, research-based information about HPV and HPV vaccination is a critical component of their sex education, contributing to healthy sexual citizenship and the development of their sexual literacy (Davies and Robinson 2010;Illes 2012;Robinson 2013). ...
... Most studies examining decision-making in the context of the HPV vaccine emphasize the importance of transmitting information that is fully transparent and understandable so as to enable parents to sign the informed consent forms for the vaccination [66][67][68]. Some studies indicate that people do not always read the forms to the end or do not understand what they read, so that in essence they sign the forms without their informed consent [66,69,70]. Moreover, most of the scientific literature indicates that in the case of the HPV vaccine, the parents indicate that their knowledge about the vaccine is limited [71- 74]. ...
... It is likely that aspects of the environment or setting influence ones experience (eg, consider a 10-y-old boy who is vaccinated in a private, calm room in comparison to being vaccinated in a gymnasium where he is surrounded by staring peers and can witness his friends cry and potentially faint). Unfortunately, beyond focus groups and descriptive research, [19][20][21][22][23][24][25][26][27][28] no trials were identified that systematically studied relevant environmental factors such as: privacy, presence of peers, ventilation, use of separate entrances and exits to the vaccination area, and concealing distress-provoking items. Consideration of setting and situational factors in future research is important, perhaps particularly for school-based vaccination. ...
Article
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The HELPinKids&Adults knowledge synthesis for the management of vaccination-related pain and high levels of needle fear updated and expanded upon the 2010 HELPinKIDS knowledge synthesis and clinical practice guideline for pain mitigation during vaccine injections in childhood. Interventions for vaccine pain management in adults and treatment of individuals with high levels of needle fear, phobias, or both were included, thereby broadening the reach of this work. The present paper outlines the overarching limitations of this diverse evidence base and provides recommendations for future research. Consistent with the framing of clinical questions in the systematic reviews, the Participants, Intervention, Comparison, Outcome, Study design (PICOAS) framework was used to organize these predominant issues and research directions. The major limitations we identified across systematic reviews were an overall dearth of trials on vaccination, lack of methodological rigor, failure to incorporate important outcomes, poor study reporting, and various sources of heterogeneity. Future research directions in terms of conducting additional trials in the vaccination context, improving methodological quality and rigor, assessment of global acceptability and feasibility of interventions, and inclusion of outcomes that stakeholders consider to be important (eg, compliance) are recommended. Given concerns about pain and fear are known contributors to vaccine hesitancy, improving and expanding this evidence base will be integral to broader efforts to improve vaccine compliance and public health worldwide.
... It is likely that aspects of the environment or setting influence ones experience (eg, consider a 10-y-old boy who is vaccinated in a private, calm room in comparison to being vaccinated in a gymnasium where he is surrounded by staring peers and can witness his friends cry and potentially faint). Unfortunately, beyond focus groups and descriptive research, [19][20][21][22][23][24][25][26][27][28] no trials were identified that systematically studied relevant environmental factors such as: privacy, presence of peers, ventilation, use of separate entrances and exits to the vaccination area, and concealing distress-provoking items. Consideration of setting and situational factors in future research is important, perhaps particularly for school-based vaccination. ...
... At the time of this study there was little research that measured expatriate (expat) parents knowledge of HPV and the HPV vaccine, or tested health-information dissemination tools specifically designed to address the gaps in health-related knowledge of transient populations such as expats. Research on parents' vaccination-related knowledge of HPV is important, as some countries require parental consent to vaccinate young people who are below the legal age [9], [14], [15]. Without parental consent it is difficult to vaccinate young people who are below the legal age [14], [16]. ...
Article
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Expatriates face a unique set of determinants to health which may influence their level of knowledge, perception of available preventative health care alternatives and their health seeking behaviors. The objective of this study is to understand the effect of an email communication intervention on expatriate parents’ level of knowledge of the Human Papillomavirus (HPV). Repeated measurement of knowledge was conducted pre- and post-intervention among parents who received the study intervention (group 1) and those who received standard care (group 2). Intervention effect was measured by any change in knowledge within and between groups. The group 1 had a significant rise in knowledge mean from baseline to first and then second follow-up ( m = 0.57 (SD 0.39), m = 0.84 (SD 0.16) and m = 0.87 (SD 0.11), respectively). In addition, after receiving the intervention, group 1 felt they had sufficient information to make an informed decision of whether to vaccinate their child(ren), with a significant difference from baseline to first post test, (χ² (1) = 8.50, p < 0.05). Based on an increase in knowledge, the study’s email intervention proved effective mode to disseminating HPV-related information.
... 20 We found that while some adolescents were involved in this decision, a significant proportion were not. 21 Shared decision-making was particularly hindered by parent/adolescent discomfort with talking about sex together. Australian girls have said that they would be more involved in the decision to be vaccinated if they were equipped with knowledge about the vaccine. ...
Article
OBJECTIVES: We describe the development and validation of measures of human papillomavirus (HPV)/HPV vaccination knowledge, fear/anxiety about vaccination, involvement in HPV vaccine decision-making, and self-efficacy with regard to getting the vaccine, designed to evaluate the efficacy of an intervention to affect these domains (collectively termed the HAVIQ: HPV Adolescent Vaccine Intervention Questionnaire). STUDY DESIGN: Literature search, cognitive interviews and cross-sectional survey. METHODS: A literature search identified existing items that were modified for the present measures. Experts reviewed draft measures for face and content validity. Cognitive interviews with adolescents were also used to assess content validity. Adolescents completed the measures and an internal reliability analysis of each measure was performed. RESULTS: The four experts concurred that the measures had face validity. Cognitive interviews identified items requiring refinement. Content validity was examined with ten experts and was deemed acceptable. There were 1800 adolescents who completed the measures; Cronbach's alpha was >0.6 for three of the four measures. The four final measures are brief, comprising 25 items in total. CONCLUSIONS: The measures are robustly developed and validity-tested. The HAVIQ may be used in research settings to evaluate adolescents' knowledge and experiences of the process of HPV vaccination in a school-based vaccination programme.
... The point at which adolescents have meaningful agency regarding vaccine decisions is ambiguous. Some parents (or providers) welcome adolescent input during the HPV vaccine decision-making process, but others do not consider their adolescent child's attitudes on this topic [15,16,30,31], particularly if the adolescents are younger and/or their attitudes do not align with the parents' own [32,33]. Future studies should consider exploring the concordance of HPV vaccine attitudes among adolescent and parent dyads, as well as peer-social norms, and how that may influence vaccination decisions. ...
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Few studies have assessed adolescent human papillomavirus (HPV) vaccine attitudes and whether they are associated with vaccination uptake. This study characterized HPV vaccine attitudes among male and female adolescents, identified factors associated with attitude changes, and examined associations between attitudes and vaccination receipt. Surveys were administered to adolescents aged 15-16 years who had not completed the HPV vaccine series. A modified version of the Carolina HPV Immunization Attitudes and Beliefs Scale (CHIAS) was employed to assess barriers, harms, ineffectiveness, and uncertainties scores. Surveys were available from 108 participants; 63% were male and 33% had initiated the HPV vaccine series at baseline. CHIAS scores significantly decreased (i.e., became more favorable) between baseline and follow-up for barriers (p = 0.01) and uncertainties (p < 0.01). At least one sociodemographic/clinical factor was associated with changes in each score. Attitude changes were not associated with receipt of HPV vaccine, although adolescents with higher baseline harms scores were significantly less likely to receive an HPV vaccine dose (OR = 0.67). Adolescents' HPV vaccine attitudes slightly improved over a one-year period during which an intervention was implemented. More research is needed to learn how parent and adolescent HPV vaccine attitudes form, and how best to address concerns about vaccine harms.
... Most studies examining decision-making in the context of the HPV vaccine emphasize the importance of transmitting information that is fully transparent and understandable so as to enable parents to sign the informed consent forms for the vaccination [66][67][68]. Some studies indicate that people do not always read the forms to the end or do not understand what they read, so that in essence they sign the forms without their informed consent [66,69,70]. Moreover, most of the scientific literature indicates that in the case of the HPV vaccine, the parents indicate that their knowledge about the vaccine is limited [71- 74]. ...
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Background: Designing online informational materials regarding the human papilloma virus (HPV) vaccine has become a challenge for designers and decision-makers in the health authorities due to the scientific and public controversy regarding the vaccine's safety and effectiveness as well as the sexual and moral concerns related to the vaccine. Objective: To investigate how cultural sensitivity is articulated in the informational materials explaining the HPV vaccine that are posted online on the websites of the Israeli health authorities. In addition, the study strives to examine the effect of transparency on the expression of cultural sensitivity in the informational materials. Methods: Quantitative and qualitative content analysis of the texts of explanatory informational materials published on the online Arabic and Hebrew websites of the Israel Ministry of Health and the Clalit HMO. Results: The findings reveal differences in the dimensions of cultural sensitivity (based on Resnicow's cultural sensitivity model) between the informational materials targeting the majority Jewish population and those targeting the minority Arab population. Indeed, the research findings point to a paradox. On the one hand, the materials appealing to the conservative Arab population exhibited cultural sensitivity in that the sexual context of the vaccine was missing. On the other hand, analysis of Resnicow's deep dimensions shows that disregarding the sexual context does not allow the relevant target audience to reflect on the barriers and concerns. In addition, the way the information was provided exhibited a lack of transparency regarding the cultural sensitivity dimensions (surface and deep). Conclusions: The public health authorities have two main objectives in the context of vaccinations. One is to raise the vaccination rates and the other is to provide full and culturally sensitive information to give the public the tools to make intelligent decisions. The findings of this study indicated that despite the high uptake rate for HPV vaccination in the Arab population, the health authorities did not exercise full transparency and cultural sensitivity in transmitting the association between engaging in sexual relations and necessity of the vaccination. Thus, the major challenge for the health authorities is to find ways to implement the objective of communicating information about the vaccination in a way that is transparent and culturally sensitive, even if this raises questions and fears among the public deriving from their culture.
... Most studies examining decision making in the context of the HPV vaccine emphasize the importance of transmitting information that is fully transparent and understandable to enable parents to sign the informed consent forms for the vaccination [66][67][68]. Some studies indicate that people do not always read the forms to the end or do not understand what they read, so, in essence, they sign the forms without their informed consent [66,69,70]. Moreover, most of the scientific literature indicates that in the case of the HPV vaccine, the parents indicate that their knowledge about the vaccine is limited [71][72][73][74]. ...
Article
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Background: Designing web-based informational materials regarding the human papillomavirus (HPV) vaccine has become a challenge for designers and decision makers in the health authorities because of the scientific and public controversy regarding the vaccine’s safety and effectiveness and the sexual and moral concerns related to its use. Objective: The study aimed to investigate how cultural sensitivity (CS) is articulated in the explanatory informational materials on the HPV vaccine that are posted on the websites of the Israeli health authorities. In addition, the study examined the effect of transparency on the expression of CS in the informational materials. Methods: The study employed a quantitative and qualitative content analysis of the texts of explanatory informational materials published on the Arabic and Hebrew websites of the Israel Ministry of Health and the Clalit health maintenance organization (HMO). Results: The findings revealed the differences in the dimensions of CS (based on the CS model by Resnicow) between the informational materials targeting the majority Jewish population and those targeting the minority Arab population. Indeed, the research findings point to a paradox. On the one hand, the materials appealing to the conservative Arab population exhibited CS, in that the sexual context of the vaccine was missing. On the other hand, analysis of Resnicow's deep dimensions showed that disregarding the sexual context does not allow the relevant target audience to reflect on the barriers and concerns. In addition, the way the information was provided exhibited a lack of transparency regarding the CS dimensions (surface and deep). Conclusions: The public health authorities have 2 main objectives in the context of vaccinations. One is to raise the vaccination rates and the other is to provide full and culturally sensitive information to give the public the tools to make intelligent decisions. The findings of this study indicated that despite the high uptake rate for HPV vaccination in the Arab population, the health authorities did not exercise full transparency and CS in transmitting the association between engaging in sexual relations and the necessity of the vaccination. Thus, the major challenge for the health authorities is to find ways to implement the objective of communicating information about the vaccination in a way that is transparent and culturally sensitive, even if this raises questions and fears among the public deriving from their culture.
... Knowledge and understanding of HPV infection and HPV vaccination are important factors affecting decision-making about the vaccine [19][20][21]. In 2020, our systematic review involving 13 studies revealed that parent immigrants and refugees in western countries had limited knowledge about HPV infection and vaccination. ...
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Background: Little is known about acceptability of the human papillomavirus (HPV) vaccine among parents of adolescents from culturally and linguistically diverse backgrounds in Australia. This study aimed to explore the knowledge and attitudes of parents from Arabic backgrounds towards HPV vaccination offered to their children in the national school-based vaccination program. Methods: Qualitative interviews were conducted in Western Sydney, with parents of adolescents from Arabic backgrounds. Recruitment was via informal personal contacts and passive snowballing. Face-to-face semi-structured interviews were conducted in Arabic. These were audio-recorded, transcribed, and translated into English. Thematic analysis was used to identify emerging themes. Results: Commonly identified themes across fifteen interviews included: (1) lack of awareness and knowledge of HPV and its vaccination, (2) awareness and understanding of the government vaccination information sheet, (3) parents' preferences for information provision, (4) the role of parents' religious beliefs in forming attitudes about HPV vaccination, and (5) lost opportunities to educate parents about HPV vaccination during general practitioner (GP) visits. Conclusion: The findings point to the need to address cultural, language, and communication barriers to improve awareness and acceptability of HPV vaccination in the Arabic community. Educational strategies should be tailored to this community based on their specific information needs and preferences.
... Chaque pays élabore sa propre stratégie vaccinale en considérant des critères de coût, de faisabilité et d'acceptabilité culturelle. Les programmes de vaccination mis en oeuvre par différents pays se distinguent par le caractère obligatoire ou recommandé ainsi que par la prise en charge publique ou privée.Par exemple, en Australie, le vaccin contre le HPV est proposé aux jeunes filles de 7 à 12 ans de la même manière qu'un vaccin faisant partie d'un programme d'immunisation obligatoire en milieu scolaire(Juraskova et al., 2012 ;Robbins, Bernard, McCaffery, 2010). Selon les dernières données le taux de la couverture vaccinale est supérieur à 70 % dans ce pays avec une réduction de la prévalence du HPV de 28,7 % à 6,7 %(Tabrizi et al., 2013).De même au Royaume-Uni, grâce au programme de vaccination des jeunes filles à l'école, la couverture a dépassé les 80 % et la prévalence de l'infection au HPV chez les jeunes filles âgées de 16-18 ans a diminué de 19,1 % en 2008 à 6,5 % en 2010-2012(Mesher et al., 2013). ...
Thesis
Le taux de couverture vaccinale contre le papillomavirus humain (HPV) reste faible en France autour de 20%. Ce travail porte sur l’attitude adoptée par la population française afin de comprendre les motivations et les freins à la vaccination HPV.Une série d’études, qualitatives et quantitatives, a été réalisée en 2014-2016 sur deux populations, la première de jeunes filles de 15 à 25 ans et la deuxième de mères ayant des filles âgées de 11 à 16 ans. Notre approche méthodologique est essentiellement basée sur le modèle combiné issu de la théorie du comportement planifié (Theory of Planned Behavior, TPB, Ajzen, 1991) et du modèle des croyances relatives à la santé (Health Beliefs Model, HBM, Rosenstock, 1974). Parmi les modérateurs de la décision les deux systèmes de motivation décrits par Carver et White (1994) ont été retenus. En complément, une étude expérimentale a été conduite basée sur la Théorie des perspectives (Prospect Theory) de Kahneman et Tversky (1979). Les analyses statistiques ont été effectuées avec les logiciels R et SPSS. Plusieurs traitements statistiques ont été opérés sur les données : analyse des comparaisons, analyse en composantes principales (ACP), régressions linéaires multiples, ANCOVA etc.Les résultats apportent de nouveaux éclairages quant au processus de décision d’acceptation ou de refus de vaccination. Le modèle mis en évidence par ces études fait apparaître des facteurs caractéristiques tels que l'attitude favorable à la vaccination, la sécurité du vaccin, le contrôle perçu ainsi que le regret anticipé, qui jouent un rôle déterminant dans le processus de décision. L’environnement médical et familial proche jouent également un rôle essentiel.
... This is not surprising, since individual beliefs about HPV vaccination surely influence the decision to take the vaccine. It should also be noted that parents have to consent to vaccination for children and parental beliefs are thus important as well [4,43,[46][47][48][49]. This fits well with our finding in the bivariate analyses that HPV vaccination was associated both with discussions with parents or others and the presence of vaccinated friends. ...
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In 2012, human papillomavirus (HPV) vaccination was introduced free of charge in the Swedish national school-based vaccination programme for 10-12-year-old girls, and as catch-up vaccination for young women. In Sweden, there is an ongoing discussion about including boys in the national vaccination programme. Few studies are undertaken about adolescents' knowledge, beliefs and HPV vaccination status in relation to socioeconomic status and sexual experience. Thus, the aim was to examine HPV catch-up vaccination status in adolescents in relation to 1) socioeconomic factors, 2) beliefs and knowledge about HPV prevention, and 3) sexual behaviour. The Health Belief Model was used as a theoretical framework. Upper secondary school students (n = 832) aged 16, randomly chosen from a larger sample, were invited to participate in conjunction with the general health interview with the school nurse. A total of 751/832 (90.3%), girls (n = 391, 52%) and boys (n = 360, 48%) completed the questionnaire. HPV vaccination was associated with ethnicity and the mothers' education level; i.e. girls with a non-European background and girls with a less educated mother were less likely to have received the vaccine (p
... Young people are unlikely to learn about HPV and HPV vaccination without structured and effective education (Cooper et al. 2016). Expecting parents/guardians to educate young people is also unlikely to be effective as their own knowledge about HPV and HPV vaccination can also be very limited (Marshall et al. 2007(Marshall et al. , 2013, and, as with sex education more broadly (Davies and Robinson 2010;Robinson andDavies 2014, 2017) they also experience barriers such as embarrassment about discussing the sexually transmitted nature of the virus with their child (Cooper Robbins et al. 2011). Young people's access to accurate, research-based information about HPV and HPV vaccination is a critical component of their sex education, contributing to healthy sexual citizenship and the development of their sexual literacy (Davies and Robinson 2010;Illes 2012;Robinson 2013). ...
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The National Human Papillomavirus (HPV) Vaccination Program in Australia commenced in 2007 for girls and in 2013 for boys, using the quadrivalent HPV [4vHPV] vaccine. In Australia, students are primarily vaccinated en masse, on school grounds, after parental/ guardian consent is obtained. Students most often receive little, or no, education at school about HPV or HPV vaccination prior to immunisation. There is also some uncertainty about where young people can and should obtain reliable information about the vaccine, outside of school. We conducted a cluster randomised controlled trial of a complex intervention in schools. This study aimed to improve: (1) student knowledge about HPV vaccination; (2) psycho-social outcomes and (3) vaccination uptake. In this paper, we brie y outline our educational intervention and discuss its implementation by educators including facilitators and barriers. We also discuss the study ndings pertaining to student knowledge about HPV and HPV vaccination and their attitudes to vaccination across control and intervention schools. Study results showed students in intervention schools demonstrate greater knowledge and understanding of HPV and HPV vaccination. Greater knowledge and understanding of HPV and HPV vaccination appeared to promote positive attitudes towards vaccination and supported con dence with vaccination.
... The impact of knowledge on behavior is complex and a variety of factors were seen to influence the young women's decisions, such as their mothers' influence, mass media campaigns, and family history of genital cancer. The strong impact of parental influence on young people has been recognized in other studies [52][53][54][55][56]and a reason against vaccination for parents concerns the risk that vaccine will increase dangerous sexual behaviours [57][58][59]. Factors influencing the decision to take the HPV vaccination should be further explored, but we recognized that the most likely cause for the low uptake of HPV vaccine is lack of financial resources: lowering the price of the vaccine (e.g. by reimbursement) might improve vaccination rates. Enforcing vaccination for children in universal programs and implementing schoolbased vaccine mandates, rather than trying to improve vaccination rates among adolescents, is an effective way of spreading the method of primary prevention. ...
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Background: Despite knowledge about HPV may be an important determinant for vaccine acceptance and uptake, only few studies have assessed HPV-related knowledge in young females. The aim of this study was to assess the reliability and validity of the questionnaire, in Italian women ≥18 years old, as a tool to examine knowledge, attitudes and behaviors towards screening and vaccination against HPV and reliable source of information. Methods: The questionnaire was administered to 30 girls in anonymous, voluntary and self -administered form with close-ended type of questions, except for the socio-demographic characteristics. It was composed in 3 sections for a total of 69 items. Participation in the study was entirely voluntary and anonymous. Descriptive analyses were performed using frequencies, percentages, and frequency table for categorical variables. Reliability analysis was tested and content validity was evaluated using Cronbach's alpha to check internal consistency and avoid misinterpretation of the results. The study was conducted in 4 Italian cities: Ferrara, Rome, Cassino and Palermo, to represent the different Italian geographical areas and knowledge, attitudes and behaviors towards screening and vaccination against HPV and reliable source of information. Data were collected in October 2010. Statistical analysis was performed with the statistical software for Windows SPSS, version 19.0. Results: The highest value of Cronbach's alpha resulted on 24 items (alpha= 0,774); the addition of other items, one at a time, decreased the value. Cronbach's alpha on all the 3 sections together resulted in a value of 0, 059. Young women generally knew that HPV can cause cervical cancer (93.3%) and genital warts (16.7%) and 76.7% of them recognized Pap-test as a screening tool. The main sources of information about HPV vaccination are represented by magazines / books (33.3%), TV (26.7%), and gynecologists (23.3%). Conclusions: This pilot study demonstrated that a short version of the questionnaire has very good reliability properties in the study and this needs to be taken into account for future studies.
... 20 We found that while some adolescents were involved in this decision, a significant proportion were not. 21 Shared decision-making was particularly hindered by parent/adolescent discomfort with talking about sex together. Australian girls have said that they would be more involved in the decision to be vaccinated if they were equipped with knowledge about the vaccine. ...
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Objectives: We describe the development and validation of measures of human papillomavirus (HPV)/HPV vaccination knowledge, fear/anxiety about vaccination, involvement in HPV vaccine decision-making, and self-efficacy with regard to getting the vaccine, designed to evaluate the efficacy of an intervention to affect these domains (collectively termed the HAVIQ: HPV Adolescent Vaccine Intervention Questionnaire). Study design: Literature search, cognitive interviews and cross-sectional survey. Methods: A literature search identified existing items that were modified for the present measures. Experts reviewed draft measures for face and content validity. Cognitive interviews with adolescents were also used to assess content validity. Adolescents completed the measures and an internal reliability analysis of each measure was performed. Results: The four experts concurred that the measures had face validity. Cognitive interviews identified items requiring refinement. Content validity was examined with ten experts and was deemed acceptable. There were 1800 adolescents who completed the measures; Cronbach's alpha was >0.6 for three of the four measures. The four final measures are brief, comprising 25 items in total. Conclusions: The measures are robustly developed and validity-tested. The HAVIQ may be used in research settings to evaluate adolescents' knowledge and experiences of the process of HPV vaccination in a school-based vaccination programme.
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The University of North Carolina's Self-management and Transition to Adulthood with Rx=therapies Program (UNC STARx) was created in 2006. This manuscript describes the program's evolution from a nephrology-centric intervention to addressing multipleconditions in an institution-wide interdisciplinary program. We illustrate the lessons and insight informed by youth with chronic conditions/disabilities, their parents, health provider and community partners across the continuum of health care transition (HCT). Specifically, we describe lessons relate to program sustainability, including the importance of a dedicated program coordinator, inter and intra-institutional collaboration to validate tools that promote and assess patient self-management skills and HCT, strategies to improve youth, provider (pediatric and adult-focused) and parent communication, and the important role for peer volunteers (in person or through social media) addressed. The UNC STARx Program's collaboration has produced IRB-approved tools that promote communication between youth with chronic conditions and providers, while outlining customized interventions based on patient's level of knowledge and mastery of HCT skills. Two private foundations provided initial funding and it now has become an institution-wide collaborative funded primarily by the North Carolina Children's Hospital. The UNC STARx partners include youth with chronic conditions and disabilities, families and researchers from several disciplines and institutions in our state, nation and the world. Our innovative program holds great promise and it already appears to improve health outcomes and quality of life for youth and their families (based on participation rate and user satisfaction both at >95%). Our lessons from the field may assist other institutions as they strive to improve adolescents'/young adults' health outcomes through evidence-based and cost-effective interventions.
Human papillomavirus (HPV) vaccination is becoming routine in many countries, and Australia has achieved high levels of uptake by implementing a school-based program. School-based delivery of the vaccine to adolescents is highly efficient, when compared with general practitioner or private provider delivery of vaccine to a population, in the absence of legislative mandates. However, challenges exist in implementing a complex health promotion initiative in the school setting. As we demonstrate in this article, knowledge and understanding of HPV and the HPV vaccine is very low among vaccinated and unvaccinated adolescents alike in Australia, and efforts to address this gap are only just beginning. This article explores some of the data on Australian young people’s knowledge and attitudes towards HPV vaccination, as well as some of the implications and possible changes that could be implemented in routine provision of HPV vaccination, both in Australia and internationally.
Article
Background: Nova Scotia has the highest rate of cervical cancer in Canada, and most of these cases are attributed to the Human Papillomavirus (HPV). In 2007, Gardasil(®) was approved and implemented in a successful school-based HPV immunization program. Little is known, however, which strategies (if any) used within a school-based program help to improve vaccine uptake. Methods: A retrospective, exploratory correlation study was conducted to examine the relationship between school-based strategies and uptake of HPV vaccine. Data was analyzed through Logistic regression, using PASW Statistics 17 (formerly SPSS 17). Results: HPV vaccine initiation was significantly associated with Public Health Nurses providing reminder calls for: consent return (p=0.017) and missed school clinic (p=0.004); HPV education to teachers (p<0.001), and a thank-you note to teachers (p<0.001). Completion of the HPV series was associated with vaccine consents being returned to the students' teacher (p=0.003), and a Public Health Nurse being assigned to a school (p=0.025). Conclusions: These findings can be used to help guide school-based immunization programs for optimal uptake of the HPV vaccine among the student population.
Article
Introduction Human papillomavirus (HPV) vaccination is offered in Australia through school-based programs. While HPV vaccination coverage is high, coverage of the full course of vaccination is suboptimal in Australia and there is a drop in coverage between the first and third doses. This study aimed to describe the drivers of low HPV vaccination coverage in Western Australian (WA) schools and barriers and enablers to improving vaccine coverage. This paper focusses on process and system-level factors. Materials and methods This was a mixed methods study. We analysed WA vaccination coverage data by school, undertook an online survey targeting the individuals responsible for the HPV vaccination program in their schools and school nurses, and compared survey findings and HPV vaccine dose three coverage in schools with 50 or more students in the eligible cohort. We also conducted focus groups with students and interviews with parents in schools with low HPV vaccine coverage. Results Schools with low HPV vaccine coverage had low coverage for the first dose of HPV vaccine as well as a higher drop off between first and third doses compared to schools with higher HPV vaccine coverage. Respondents from low and middle HPV vaccine coverage schools reported more issues with return of consent forms, low parental literacy, language barriers, absenteeism and difficulty contacting parents compared to schools with high coverage. Parents and students raised a number of challenges in relation to HPV vaccination including student absenteeism, language barriers, and issues with the return of consent forms. Conclusions A multifaceted approach to improving HPV vaccination coverage should be targeted at schools with low coverage. Based on our findings, these actions should include a range of approaches to obtaining parental consent and intensive follow up with students who are absent on vaccination days.
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Objective To explore parents' views of extending the human papillomavirus (HPV) vaccination programme to also include boys. Design Explorative qualitative design using individual, face-to-face, interviews and inductive thematic analysis. Setting 11 strategically chosen municipalities in central Sweden. Participants Parents (n=42) who were offered HPV vaccination for their 11–12 years old daughter in the national school-based vaccination programme. Results The key themes were: equality from a public health perspective and perception of risk for disease. Parents expressed low knowledge and awareness about the health benefits of male HPV vaccination, and they perceived low risk for boys to get HPV. Some parents could not see any reason for vaccinating boys. However, many parents preferred gender-neutral vaccination, and some of the parents who had not accepted HPV vaccination for their daughter expressed that they would be willing to accept vaccination for their son, if it was offered. It was evident that there was both trust and distrust in authorities' decision to only vaccinate girls. Parents expressed a preference for increased sexual and reproductive health promotion such as more information about condom use. Some parents shared that it was more important to vaccinate girls than boys since they believed girls face a higher risk of deadly diseases associated with HPV, but some also believed girls might be more vulnerable to side effects of the vaccine. Conclusions A vaccine offered only to girls may cause parents to be hesitant to vaccinate, while also including boys in the national vaccination programme might improve parents' trust in the vaccine. More information about the health benefits of HPV vaccination for males is necessary to increase HPV vaccination among boys. This may eventually lead to increased HPV vaccine coverage among both girls and boys.
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This chapter explores how the concept of wellbeing is operationalized in policy and practice, constituted as health’s more flexible and well-rounded counterpart. Drawing on Foucault’s (1991) analytics of governmentality, we argue that “health-as-wellbeing” is mobilized as a modality of neoliberal government. Taking the Australian Human Papillomavirus (HPV) vaccination program as a case study, we explore how discourses of healthy citizenship, HPV and HPV vaccination are produced and consumed through conjoining discourses of health and wellbeing. We analyze the initial televisual and online promotional materials that targeted girls and young women alongside data from a qualitative research study about the school-based HPV vaccination program. We argue that the shift from health to health-as-wellbeing produces and manages contemporary subjectivities through a range of pedagogies and consumptive practices that position individuals as free-choosing agents and managers-of-the-self. We illustrate how the discourse of health-as-wellbeing is employed to mediate knowledge about HPV and HPV related cancer, and to construct the norms of healthy and gendered citizenship.
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Introduction In response to a significant increase of measles cases and a high percentage of unvaccinated adolescents in New South Wales, Australia, a measles high school catch-up vaccination programme was implemented between August and December 2014. This study aimed to explore the factors affecting school-based supplementary immunization activities (SIAs) and to inform future SIA and routine school-based vaccination programme implementation and service provision. Methods Focus group analysis was conducted among public health unit (PHU) staff responsible for implementing the SIA catch-up programme. Key areas discussed were pre-programme planning, implementation, resources, consent materials, media activity and future directions for school vaccination programme delivery. Sessions were audio recorded, transcribed verbatim and reviewed. Thematic analysis was conducted to identify the major themes. Results Two independent focus groups with 32 participants were conducted in January 2015. Barriers to the SIA implementation included lead time, consent processes, interagency collaboration, access to the targeted cohort and the impact of introducing a SIA to an already demanding curriculum and school programme immunization schedule. A positive PHU school coordinator rapport and experience of PHU staff facilitated the implementation. Consideration of different approaches for pre-clinic vaccination status checks, student involvement in the vaccination decision, online consent, workforce sharing between health districts and effective programme planning time were identified for improving future SIA implementation. Conclusion Although many barriers to school programme implementation have been identified in this study, with adequate resourcing and lead time, SIAs implemented via a routine school vaccination programme are an appropriate model to target adolescents.
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Vaccinations against sexually transmitted infections (STIs) are a critical strategy for preventing STIs, but are limited by their acceptance in the general population. This chapter discusses the acceptability of current and future vaccinations against STIs, including licensed vaccines for human papillomavirus (HPV) and hepatitis B (HBV), as well as potential vaccines for HIV and genital herpes. Despite a high level of documented acceptability, there continues to be a gap between intention to vaccinate and vaccine acceptance. Prophylactic STI vaccination will only reach its complete potential if it is widely accepted by parents of adolescents before they are sexually active. Social, behavioral, and attitudinal factors that have been associated with acceptance or acceptability are identified for parents, adolescents, and healthcare providers. Potential structural, public health, and clinical strategies that may be implemented to increase uptake of current and future STI vaccines are discussed.
Chapter
The uses of mobile apps (application software) in health interventions to affect health behaviour change and/or disease management has become increasingly popular with the rise of mobile technologies. Young people’s ubiquitous use of technology and new media provides opportunities to educate them about a variety of health issues, including human papillomavirus (HPV), HPV vaccination, and also management of needle-related fear and anxiety. Young people’s use of mobile and new media technologies are frequently constructed through discourses of risk, especially in relation to their interactions with sexual content, too much screen time and lack of physical activity. However, in this discussion we focus on the innovative capacity of mobile and new media technologies to educate, engage, and make accessible accurate health information and relaxation/distraction techniques to assist young people to become informed, agentic citizens.
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Abstract Background The first vaccine to prevent human papillomavirus (HPV) and cervical cancer has been licensed, and in future, vaccination may be routinely offered to 10–14 year old girls. HPV is a sexually transmitted virus and some parents may refuse consent for vaccination. Under-16s in the UK have a right to confidential sexual health care without parental consent. We investigated parents' views on making available HPV vaccination to adolescent minors at sexual health clinics without parental consent. Methods This was a semi-qualitative analysis of views of parents of 11–12 year old school children collected as part of a population-based survey of parental attitudes to HPV vaccination in Manchester. Parents were firstly asked if they agreed that a well-informed child should be able to request vaccination at a sexual health clinic without parental consent, and secondly, to provide a reason for this answer. Ethical perspectives on adolescent autonomy provided the framework for descriptive analysis. Results 307 parents answered the question, and of these, 244 (80%) explained their views. Parents with views consistent with support for adolescent autonomy (n = 99) wanted to encourage responsible behaviour, protect children from ill-informed or bigoted parents, and respected confidentiality and individual rights. In contrast, 97 parents insisted on being involved in decision-making. They emphasised adult responsibility for a child's health and guidance, erosion of parental rights, and respect for cultural and moral values. Other parents (n = 48) wanted clearer legal definitions governing parental rights and responsibilities or hoped for joint decision-making. Parents resistant to adolescent autonomy would be less likely to consent to future HPV vaccination, (67%) than parents supporting this principle (89%; p < 0.001). Conclusion In the UK, the principle of adolescent autonomy is recognised and logically should include the right to HPV vaccination, but this may concern parents who would otherwise approve vaccination.
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Approximately 73 million adults in the United States report using the Internet as a source for health information. This study examines the quality, content, and scope of human papillomavirus (HPV) vaccine Internet news coverage starting on the day of its licensure. Information about the HPV vaccine in the media may influence personal attitudes and vaccine uptake. Using four search engines and six search terms, a sample of 250 Internet articles on the HPV vaccine were identified between June 8, 2006, and September 26, 2006. The coding instrument captured how the headline was depicted and how the vaccine was labeled in addition to information about HPV, cervical cancer, the HPV vaccine, and current social issues and concerns about the vaccine. Analysis revealed balanced Internet news coverage; 52.4% of Internet news stories were coded as neutral toward the vaccine. Eighty-eight percent of articles labeled the vaccine as a cervical cancer vaccine; 73.5% explained the link between HPV and cervical cancer, although without providing background information on HPV or cervical cancer. Vaccine affordability was the most cited social concern (49.2%). Information about vaccine safety and side effects, duration of vaccine protection, and availability of the catchup vaccine for females aged 13-26 was repeatedly missing. The HPV vaccine is being marketed as a vaccine to prevent cervical cancer. Comprehensive information on the vaccine, HPV, and cervical cancer continues to be missing from media coverage. Public health educators should monitor online media in an effort to respond to inaccurate information. Barriers to vaccine cost and funding mechanisms need to be addressed more effectively by states. Knowledge of particular media messages could provide a starting point for tackling opposition and uptake issues for future sexually transmitted infection (STI) vaccines.
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The relationship between cancer patients' desire for information and their preference for participation in decision making has been examined. Approximately 77% of the 52 patients reported that they had participated in decision making to the extent that they wished, while most of the remaining 23% would have preferred an opportunity to have greater input. Although many of the patients actively sought information, a majority preferred the physician to assume the role of the primary decision maker. Ethically, the disclosure of information has been assumed to be necessary for autonomous decision making. Nevertheless, the results of this study indicate that patients may actively seek information to satisfy an as yet unidentified aspect of psychological autonomy that does not necessarily include participation in decision making.
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The first vaccine to prevent human papillomavirus (HPV) and cervical cancer has been licensed, and in future, vaccination may be routinely offered to 10-14 year old girls. HPV is a sexually transmitted virus and some parents may refuse consent for vaccination. Under-16s in the UK have a right to confidential sexual health care without parental consent. We investigated parents' views on making available HPV vaccination to adolescent minors at sexual health clinics without parental consent. This was a semi-qualitative analysis of views of parents of 11-12 year old school children collected as part of a population-based survey of parental attitudes to HPV vaccination in Manchester. Parents were firstly asked if they agreed that a well-informed child should be able to request vaccination at a sexual health clinic without parental consent, and secondly, to provide a reason for this answer. Ethical perspectives on adolescent autonomy provided the framework for descriptive analysis. 307 parents answered the question, and of these, 244 (80%) explained their views. Parents with views consistent with support for adolescent autonomy (n = 99) wanted to encourage responsible behaviour, protect children from ill-informed or bigoted parents, and respected confidentiality and individual rights. In contrast, 97 parents insisted on being involved in decision-making. They emphasised adult responsibility for a child's health and guidance, erosion of parental rights, and respect for cultural and moral values. Other parents (n = 48) wanted clearer legal definitions governing parental rights and responsibilities or hoped for joint decision-making. Parents resistant to adolescent autonomy would be less likely to consent to future HPV vaccination, (67%) than parents supporting this principle (89%; p < 0.001). In the UK, the principle of adolescent autonomy is recognised and logically should include the right to HPV vaccination, but this may concern parents who would otherwise approve vaccination.
Book
Most writing on sociological method has been concerned with how accurate facts can be obtained and how theory can thereby be more rigorously tested. In The Discovery of Grounded Theory, Barney Glaser and Anselm Strauss address the equally Important enterprise of how the discovery of theory from data--systematically obtained and analyzed in social research--can be furthered. The discovery of theory from data--grounded theory--is a major task confronting sociology, for such a theory fits empirical situations, and is understandable to sociologists and laymen alike. Most important, it provides relevant predictions, explanations, interpretations, and applications. In Part I of the book, "Generation Theory by Comparative Analysis," the authors present a strategy whereby sociologists can facilitate the discovery of grounded theory, both substantive and formal. This strategy involves the systematic choice and study of several comparison groups. In Part II, The Flexible Use of Data," the generation of theory from qualitative, especially documentary, and quantitative data Is considered. In Part III, "Implications of Grounded Theory," Glaser and Strauss examine the credibility of grounded theory. The Discovery of Grounded Theory is directed toward improving social scientists' capacity for generating theory that will be relevant to their research. While aimed primarily at sociologists, it will be useful to anyone Interested In studying social phenomena--political, educational, economic, industrial-- especially If their studies are based on qualitative data.
Article
Australia has implemented a nation-wide program providing HPV vaccination to girls at school. To date, there are no published studies that explore knowledge about HPV and HPV vaccine post-implementation of the national school-based HPV vaccination program. A purposive sample of schools was selected to reflect a range of vaccination coverage (high versus lower uptake), and different school types (Catholic, Independent or Government). Semi-structured focus groups and interviews were conducted with girls and their parents respectively, until saturation was reached. Transcripts were analysed, letting themes emerge from the data. A core theme from both girls and parents was lack of knowledge. Supporting themes were lack of knowledge of HPV, lack of knowledge of vaccine, and realisation of their lack of knowledge. Their lack of knowledge was common in three areas: what HPV is, how HPV is transmitted, and the HPV and cervical cancer connection. The lack of knowledge about HPV vaccination was reflected in what the vaccine protects against, how the vaccine works, HPV vaccination recommendations, the vaccine and Pap smear connection, and myths about HPV vaccination. Both girls and parents wanted more information, had a tendency to defer responsibility, and parents expressed judgment of themselves as parents. Low levels of knowledge and understanding about HPV vaccination among adolescents and parents have implications for adolescents' future health practices, including sexual risk behaviour, condom usage, and cervical screening. Reasons for the low levels of knowledge are explored, as are implications for school-based educational interventions.
Article
This article presents the findings of parents' views on the human papillomavirus vaccine from one area of England. The authors outline that many parents have strong views about the vaccine particularly in relation to safety and effectiveness, age, and medical and moral concerns. This article presents an analysis of some of the issues. The authors conclude that nurses should provide up-to-date advice to help allay concerns.
Article
Though many studies have documented correlates of HPV vaccine acceptability, our study is one of the first to examine correlates of vaccine initiation. The current study aimed to identify modifiable correlates of HPV vaccine initiation among adolescent girls in high risk communities and whether correlates varied by race and urban/rural status. In 2007, we conducted a cross-sectional survey of 889 parents of adolescent girls aged 10-18 living in areas of North Carolina, USA with high cervical cancer rates. We analyzed data using logistic regression. Health Belief Model constructs were associated with HPV vaccine initiation in multivariate analyses, including doctor's recommendation to get HPV vaccine, perceived barriers to obtaining HPV vaccine, and perceived potential vaccine harms. While exploratory stratified analyses suggested that many of the same parent beliefs were important correlates of HPV vaccine initiation regardless of racial group or urban/rural status, a few differences did exist. These potentially modifiable beliefs offer well-defined targets for future interventions designed to increase HPV vaccine coverage. However, the beliefs' relative importance may differ between racial groups and regions.
Article
The objective of this study was to compare the reasons why mothers do or do not have their adolescent daughters vaccinated against HPV. Mothers of vaccinated and unvaccinated 11- to 17-year-old girls seen during preventive care visits in outpatient family medicine or pediatric clinics underwent an audiotaped structured telephone interview that used open-ended questions to assess the reasons underlying maternal decisions about HPV vaccination. Qualitative methods categorized maternal responses into themes. Interviews of 52 mothers (19 declining vaccination, 33 accepting) identified several distinct factors underlying their decisions about HPV vaccination. Lack of knowledge about HPV, age-related concerns, and low perceived risk of infection were commonly cited reasons for declining vaccination. Desire to prevent illness, physician recommendation, and a high perceived risk of infection were commonly identified motivating factors. Both groups of mothers had significant concerns about vaccine safety. Locus of control (e.g., mother or daughter) of health-related decisions arose as a novel factor influencing this decision that had not been previously described in the context of HPV vaccination. Addressing safety concerns, educating parents about the age-specific risk of HPV infection, and promoting strong physician recommendation for vaccination may be the most useful targets for future interventions to increase HPV vaccine utilization.
Article
To assess HPV vaccine acceptability, focus groups of women (18-26 years), parents, community leaders, and healthcare providers were conducted throughout Ohio Appalachia. Themes that emerged among the 23 focus groups (n=114) about the HPV vaccine were: barriers (general health and vaccine specific), lack of knowledge (cervical cancer and HPV), cultural attitudes, and suggestions for educational materials and programs. Important Appalachian attitudes included strong family ties, privacy, conservative views, and lack of trust of outsiders to the region. There are differences in HPV vaccine acceptability among different types of community members highlighting the need for a range of HPV vaccine educational materials/programs to be developed that are inclusive of the Appalachian culture.
Article
To examine the prevalence and predictors of the belief that human papillomavirus (HPV) vaccination will result in "risk compensation," that is, will increase risky sexual behavior. Two surveys were carried out: with 332 mothers (Study 1) and 360 adolescent girls (Study 2). The outcome measure was the score on a risk compensation scale tapping beliefs that HPV vaccination would increase risky sexual behavior. Among mothers, those from the lowest income group (F = 4.38, p < .01), from ethnic minority backgrounds (F = 7.41, p < .01), and who did not attend cervical screening (F = 9.96, p < .01), had the highest risk compensation scores. Among adolescents, girls with lower educational attainment (F = 4.14, p < .05), from ethnic minority backgrounds (F = 6.60, p < .001), and who felt themselves to be less sexually experienced than their peers (F = 3.31, p < .05), had the highest scores. Girls showed lower belief in risk compensation in relation to their own behavior (personal compensation) than for "girls in general" (general compensation; t = 13.68, p < .001). Lower knowledge of HPV was associated with higher personal risk compensation beliefs (F = 4.26, p < .05). A significant minority of mothers and adolescents themselves say that HPV vaccination would increase the chance of risky sexual behavior. Because risk compensation beliefs are likely to predict HPV vaccine acceptance, identifying the basis for these beliefs and providing appropriate information and education to parents and adolescents will be vital. Following the introduction of vaccination, it will be important to discover whether risk compensation actually takes place, and every effort should be made to ensure it does not.
Article
Vaccines for the human papillomavirus (HPV) are currently licensed for females, ages 9 through 26 years old in the U.S., and for adult women up to 45 years in some countries such as Australia. As licensure for adult women, over 26 years, is sought in other countries, it will be important to determine the acceptability to them. We reviewed the available articles on adult opinions and acceptability of vaccinating women against HPV. Predictors of acceptability included barriers, knowledge, risk, age, and marital status. Overall, acceptability rates were high, if adequate information was given and the cost was affordable.
Article
To assess immunization levels for children of employees of a large corporation. A mail survey of a random sample of employees on the immunization history of one child per family. US employees of Johnson & Johnson. 1500 employees with children born between 1984 and 1991. Coverage rates for recommended vaccines at different ages up to 6 years. Only 45.2% and 55.3% of the study children at ages 2 and 6 years were current for all recommended immunizations (65.1% and 70.3%, respectively, excluding the Haemophilus influenzae type b vaccine). Using the minimum standard required by many states for school entry, the coverage level at age 6 years was 90.4%. Factors associated with higher immunization rates at age 2 years were the corporate health plan (choices), higher pay level, greater parental formal education, white race, and knowing when to initiate immunization. Lower immunization rates at age 2 years were associated with delayed receipt of the first dose of diphtheria, tetanus, and pertussis vaccine, use of city or county clinics, employee-reported barriers of difficulty leaving work, and provider access problems, but not cost of services. After adjusting for the effects of other variables through logistic regression, race, pay level, and plan choice were no longer significant. Modeling with the remaining variables predicted rates of adequate immunization at age 2 years from 15% to 81%. Even in this relatively affluent group with good insurance (including immunizations), preschool immunization rates did not reach public health goals. Changing modifiable factors, such as knowing when to initiate immunization, enabling parents to leave work more easily, and improving provider access, might improve preschool immunization rates.
Article
This research study explored mothers' decision-making processes regarding health care for their children. Identifying how decisions are made by mothers about health care for their children will assist health care professionals to be appropriate advocates for mothers, to improve quality of life, and to contain costs of health care for children. A sample of 114 rural mothers (51 with one child, 63 with more than one child) completed questionnaires identifying demographics, social support, client and professional interaction elements, self-determinism, competence in problem-solving skills, and relationships to responses to health care scenarios. Qualitative data were also gathered by structured in-depth interviews of 7 subjects. ANOVA, correlations, and factor analysis were completed to analyze data. Most of the mothers' decisions were based on the perceived degree of seriousness, mother's degree of fear of the child's condition, attitude of the health care provider, previous experience with the situation, and social support for the mother. There were no significant differences in decision-making processes by first time mothers and by mothers with more than one child. Implications include teaching mothers assessment skills to identify serious versus nonserious situations and to utilize other social supports.
Article
The purpose of this article is to describe the similarities and differences between two approaches to grounded theory research: grounded theory as espoused by Glaser and grounded theory as espoused by Strauss and Corbin. The focus of the article is the controversy surrounding the use of axial coding. The author proposes a resolution to the controversy by suggesting that one does not need to view either approach as right or wrong; rather, the qualitative and grounded theory researcher can choose an approach, and that choice is based on the goal of the researcher's study. Examples of both approaches, from the author's research study on the experiences of living in a family with a child with attention deficit hyperactivity disorder (ADHD), are provided.
Article
As healthcare technology and medical therapies proliferate, healthcare providers have more options to offer and patients have more options from which to choose. Active patient participation in healthcare decision making is a relatively new phenomenon that has been born of sociocultural, ethical, and legal influences. Patients, however, often find healthcare decisions bewildering, stressful, and anxiety-provoking. The purpose of this review is to provide a framework for those interested in pursuing patient decision-making investigations and suggest ways in which current knowledge can be extended to develop a scientific platform upon which to build decision support interventions. Literature review. This review (a) provides a context for understanding patient decision making; (b) explicates the state of the science of patient decision making; (c) identifies significant theoretical, methodological, and measurement issues; and, (d) identifies gaps in patient decision-making knowledge and propose areas for further investigation.
Article
Several vaccines for sexually transmitted infections (STI) are presently in development and the eventual availability of such vaccines is expected to result in the prevention of a significant number of burdensome conditions. Young adolescents are presumed to be likely targets for these vaccines since adolescents' risk for STI increases as they age and become sexually active. It is unclear, however, to what extent parents will agree to having adolescents receive STI vaccines. Inasmuch as acceptance is the foundation for effective immunization programs, an understanding of parental perspectives about this issue is required to inform future STI vaccine program strategies. This paper presents findings from a qualitative study that used in-depth interviews to elicit attitudes from 34 parents about accepting vaccines for genital herpes, human immunodeficiency virus, human papillomavirus and gonorrhea for their children (aged 8-17). Data were collected from parents bringing their children for care at an urban clinic and a suburban private office. Content analysis of the responses revealed that most parents (>70%) approved the administration of all four of the STI vaccines proposed. Parents' reasons for acceptance included wanting to protect their children, being concerned about specific disease characteristics, and previous experience with the infections. Parents who declined the vaccines did so primarily because they perceived their children to be at low risk for the infections or they had low concern about features of the diseases. Most parents thought they should be the decision-maker regarding children receiving an STI vaccine. Results from this study will be used to plan subsequent investigations of the determinants of STI vaccine acceptance by parents.
Article
Lack of information has been associated with patient anxiety or concern in a number of healthcare areas. (1) Identify the proportion of parents who agreed, were neutral, and disagreed that they had access to enough information to make a decision about immunizing their child; (2) examine how parents who agreed and disagreed differed with respect to sociodemographic characteristics, and their attitudes about immunizations, their child's healthcare provider, immunization requirements/exemptions, and immunization policymakers; and (3) identify if differences exist in specific immunization concerns. A sample of parents with at least one child aged < or =6 years (n=642) was analyzed using data from the HealthStyles survey conducted during July and August 2003. Odds ratios and the Mantel-Haenszel chi-square test were used for analysis. Response rate for HealthStyles was 69% (4035/5845). The largest proportion of parents agreed they had access to enough information (67%) compared to parents who were neutral (20%) or who disagreed (13%). Compared to parents who agreed, parents who disagreed were more likely to be less confident in the safety of childhood vaccines (odds ratio [OR]=5.4, 95% confidence interval [CI]=3.3-8.9), and to disagree that their child's main healthcare provider is easy to talk to (OR=10.3, 95% CI=3.7-28.1). There was a significant linear trend in the percentage of parents expressing immunization concerns among those who agreed, were neutral, and who disagreed they had access to enough information (p<0.05; df=1). While most parents agreed that they had access to enough immunization information, approximately a third did not. Perceived lack of information was associated with negative attitudes about immunizations and toward healthcare providers. Basic information about the benefits and risks of vaccines presented by a trusted provider could go a long way toward maintaining and/or improving confidence in the immunization process.
Article
Prophylactic vaccines against human papillomavirus (HPV) are expected to be available for public use by 2007 and likely will be targeted to preadolescent children. Parental acceptance of these vaccines will be critical for their success. The objectives of this study were (1) to determine the overall acceptance of HPV vaccines for preadolescent children by parents, (2) to evaluate the influence of written educational information about HPV on parental acceptability of HPV vaccines, and (3) to identify independent predictors associated with HPV vaccine acceptability by parents. A randomized intervention study within a cross-sectional survey was conducted. Parental HPV vaccine acceptability was measured under 3 different hypothetical scenarios. A self-administered survey on the knowledge, attitudes, and beliefs about HPV and HPV vaccines was sent to 1600 parents of 8- to 12-year-old children. In addition to a baseline paragraph about HPV that was received by all study participants, a random half of the study participants received a detailed "HPV Information Sheet" outlining the epidemiology and potential clinical sequelae of HPV infection. Independent predictors of parental HPV vaccine acceptability were determined using multivariate linear regression models. Parents who received the HPV information sheet had higher mean scores on the HPV knowledge assessment tool than the control group. However, despite this apparent improvement in knowledge, there was not a statistically significant difference in HPV vaccine acceptability between the 2 groups. Providing parents with an HPV information sheet did seem to improve knowledge about HPV, but this increased knowledge had little effect on the acceptability of these vaccines by parents for their children. Instead, attitudes and life experiences seemed to be more important factors influencing HPV vaccine acceptability among parents.
Article
To determine the acceptability of childhood HPV vaccination and examine demographic, cultural, and psychosocial predictors of vaccine acceptance. School-based survey. Questionnaires sent to 1205 mothers of 8-14-year-old girls. Responses from 684 were included in the analyses. Ten schools (seven primary, three secondary) in four areas of England. Seventy-five percent of mothers would accept the vaccine for their daughter. Vaccine acceptance was higher in mothers who had experience of cancer in the family (OR=1.61, CI: 1.14-2.29), had older daughters (OR=1.15, CI: 1.04-1.27), perceived approval from husband/partner (OR=14.51, CI: 6.15-34.25) and believed vaccine acceptance would be more normative (OR=1.78, CI: 1.59-2.01). Having concerns about too many vaccinations (OR=0.22, CI: 0.15-0.31) or vaccine side effects (OR=0.37, CI: 0.28-0.50) and worry about increasing promiscuity (OR=0.47, CI: 0.36-0.62) emerged as deterrents. The modal preferred age was 12 years. Endorsing vaccination at earlier ages was predicted by feeling able to discuss related topics, including sex, at younger ages (OR=1.37, CI: 1.24-1.51) and concern about increasing promiscuity (OR=0.61, CI: 0.47-0.78). Overall, there was a favourable response to HPV vaccination. Emphasising the widespread acceptance of the vaccine might promote acceptance further, as would information on immunological and social benefits of earlier vaccination.
Article
To inform future human papillomavirus (HPV) vaccination programs, we systematically reviewed studies of HPV-related beliefs and HPV vaccine acceptability, organizing the findings using health behavior theory and cervical cancer risk factors. We searched Medline, CINAHL, and PsycINFO from 1995 to January, 2007 for studies of HPV beliefs and HPV vaccine acceptability among adolescents, young adults, and parents of adolescents in the United States. We identified 28 studies. Most were small, cross-sectional studies of parents and adults. Most parents reacted positively to the possibility of vaccinating their daughters against HPV. Vaccination acceptability was higher when people believed the vaccine was effective, a physician would recommend it, and HPV infection was likely. Cost and, for 6% to 12% of parents, concerns that vaccination would promote adolescent sexual behavior were barriers to vaccination. African American, Hispanic, and white respondents were equally accepting of the HPV vaccine. Parents with lower levels of education reported higher vaccine acceptability. Many studies inadequately reported on other variables associated with cervical cancer mortality. HPV vaccine programs in the United States should emphasize high vaccine effectiveness, the high likelihood of HPV infection, and physicians' recommendations, and address barriers to vaccination.
Article
A vaccine to prevent human papilloma virus (HPV) infection has been licensed recently in the United States of America and Australia. The aim of this study was to assess community attitudes to the introduction of HPV vaccine in the State of South Australia. A cross-sectional survey was conducted by computer-aided telephone interviews in February 2006. The survey assessed adult and parental attitudes to the introduction of HPV vaccine to provide protection against a sexually transmitted disease caused by HPV and against cervical cancer. Two thousand interviews were conducted in metropolitan and rural households. Two per cent of respondents knew that persistent HPV infection caused cervical cancer and a further 7% were aware that the cause was viral. The majority of adults interviewed (83%) considered that both men and women should receive HPV vaccine and 77% of parents agreed that they would have their child/children immunised. Parents were mainly concerned about possible side effects of the vaccine (66%), with only 0.2% being concerned about discussing a sexually transmitted disease with their children and 5% being concerned that use of the vaccine may lead to promiscuity. Our findings suggest that public health education campaigns for HPV vaccination will find a majority of parents receptive to their children being vaccinated, but attention must be paid to appropriate explanation about HPV infection as the cause of cervical cancer and education about the safety of the HPV vaccine.
Article
This qualitative study explored parental decision-making about the DTaP/IPV/Hib 'five-in-one' vaccine. Semi-structured interviews were conducted with 22 parents of babies aged between 4 and 13 weeks old, recruited from four practices in southern England. A modified Grounded Theory approach identified that although parents had some concerns, most complied with the recommended programme rather than making an informed decision. Other themes related to perceived importance of immunisation; beliefs about how immunisation works; trust; perceptions of vulnerability; feelings of guilt and responsibility; and practicalities. It is important to explore how parents' attitudes change over the preschool years and to develop ways of addressing uncertainties about immunisation, including the safety of combining antigens and the need for boosters.
Article
Cellular and humoral immune responses of dogs to a candidate vaccine, composed of Leishmania braziliensis promastigote protein plus saponin as adjuvant, have been investigated as a pre-requisite to understanding the mechanisms of immunogenicity against canine visceral leishmaniasis (CVL). The candidate vaccine elicited strong antigenicity related to the increases of anti-Leishmania IgG isotypes, together with higher levels of lymphocytes, particularly of circulating CD8(+) T-lymphocytes and Leishmania chagasi antigen-specific CD8(+) T-lymphocytes. As indicated by the intense cell proliferation and increased nitric oxide production during in vitro stimulation by L. chagasi soluble antigens, the candidate vaccine elicited an immune activation status potentially compatible with effective control of the etiological agent of CVL.
Australian newspaper coverage of HPV vaccination
  • Cooper Robbins
  • S C Pang
  • C Leask
Cooper Robbins, S. C., Pang, C., & Leask, J. (in press). Australian newspaper coverage of HPV vaccination, October 2006-December 2009. Journal of Health Communication.
Qualitative research and evaluation methods
  • Nsw Html
  • Website
National Vaccine Advisory Committee. (1991). http://www.hhs.gov/nvpo/ nvac/adult4.html NSW DET Website. (2009). http://www.schools.nsw.edu.au/gotoschool/ a-z/immunisation.php Patton, M. Q. (2002). Qualitative research and evaluation methods, 3rd edition. Thousand Oaks, CA: Sage.