A Mixed-Methods Analysis of Barriers to and Facilitators of Human Papillomavirus Vaccination Among Adolescents in Montana

Objectives Human papillomavirus (HPV) vaccination rates among adolescents are lower in rural areas than in urban areas of the United States. The objective of this study was to identify barriers to and facilitators of adolescent HPV vaccination in Montana, a large, primarily rural state. Methods Using a mixed-methods design, we integrated quantitative analyses of Montana’s National Immunization Survey–Teen (NIS-Teen) data from 2013-2017 with qualitative data collected at a statewide meeting in October 2018 and from stakeholder interviews conducted from October 2018 through June 2019. Using NIS-Teen data, we identified trends and estimated adjusted prevalence ratios (aPRs) to identify factors associated with vaccine uptake. Using directed content analysis of qualitative data, we identified themes related to vaccine uptake. Results In Montana, initiation of the HPV vaccine series among adolescents aged 13-17 increased from 34.4% in 2013 to 65.5% in 2017. We identified 6 themes related to HPV vaccination from qualitative analyses, including medical providers’ recommendation style as a facilitator of vaccination and parental vaccine hesitancy as a barrier to vaccination. In NIS-Teen 2017 data (n = 326 adolescents), receiving a medical provider recommendation was significantly associated with series initiation (aPR = 2.3; 95% CI, 1.5-3.6). Among parents who did not intend to initiate the vaccine series for their adolescent within 12 months (n = 71), vaccine safety was the top concern (aPR = 24.5%; 95% CI, 12.1%-36.9%). Conclusions HPV vaccination rates have increased in Montana but remain lower than rates for other adolescent vaccines. Future work should focus on reducing missed opportunities, increasing parents’ knowledge of and confidence in vaccination, and training medical providers on addressing common vaccine concerns.

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Vaccipack, A Mobile App to Promote Human Papillomavirus Vaccine Uptake Among Adolescents Aged 11 to 14 Years: Development and Usability Study

JMIR Nursing ◽

10.2196/19503 ◽

2020 ◽

Vol 3 (1) ◽

pp. e19503

Author(s):

Anne M Teitelman ◽

Emily F Gregory ◽

Joshua Jayasinghe ◽

Zara Wermers ◽

Ja H Koo ◽

...

Keyword(s):

Human Papillomavirus ◽

Technology Acceptance ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

Behavioral Model ◽

The United States ◽

Mobile App ◽

Vaccine Uptake ◽

Human Papillomavirus Vaccine ◽

Vaccination Rates

Background More than 90% of human papillomavirus (HPV)-related cancers could be prevented by widespread uptake of the HPV vaccine, yet vaccine use in the United States falls short of public health goals. Objective The purpose of this study was to describe the development, acceptability, and intention to use the mobile app Vaccipack, which was designed to promote uptake and completion of the adolescent HPV vaccine series. Methods Development of the mobile health (mHealth) content was based on the integrated behavioral model (IBM). The technology acceptance model (TAM) was used to guide the app usability evaluation. App design utilized an iterative process involving providers and potential users who were parents and adolescents. App features include a vaccine-tracking function, a discussion forum, and stories with embedded messages to promote intention to vaccinate. Parents and adolescents completed surveys before and after introducing the app in a pediatric primary care setting with low HPV vaccination rates. Results Surveys were completed by 54 participants (20 adolescents aged 11 to 14 years and 34 parents). Notably, 75% (15/20) of adolescents and 88% (30/34) of parents intended to use the app in the next 2 weeks. Acceptability of the app was high among both groups: 88% (30/34) of parents and 75% (15/20) of adolescents indicated that Vaccipack was easy to use, and 82% (28/34) of parents and 85% (17/20) of adolescents perceived the app to be beneficial. Higher levels of app acceptability were found among parents with strong intentions to use the app (P=.09; 95% CI –2.15 to 0.15). Conclusions mHealth technology, such as Vaccipack, may be an acceptable and nimble platform for providing information to parents and adolescents and advancing the uptake of important vaccines.

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Vaccipack, A Mobile App to Promote Human Papillomavirus Vaccine Uptake Among Adolescents Aged 11 to 14 Years: Development and Usability Study (Preprint)

10.2196/preprints.19503 ◽

2020 ◽

Author(s):

Anne M Teitelman ◽

Emily F Gregory ◽

Joshua Jayasinghe ◽

Zara Wermers ◽

Ja H Koo ◽

...

Keyword(s):

Human Papillomavirus ◽

Technology Acceptance ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

Behavioral Model ◽

The United States ◽

Mobile App ◽

Vaccine Uptake ◽

Human Papillomavirus Vaccine ◽

Vaccination Rates

BACKGROUND More than 90% of human papillomavirus (HPV)-related cancers could be prevented by widespread uptake of the HPV vaccine, yet vaccine use in the United States falls short of public health goals. OBJECTIVE The purpose of this study was to describe the development, acceptability, and intention to use the mobile app Vaccipack, which was designed to promote uptake and completion of the adolescent HPV vaccine series. METHODS Development of the mobile health (mHealth) content was based on the integrated behavioral model (IBM). The technology acceptance model (TAM) was used to guide the app usability evaluation. App design utilized an iterative process involving providers and potential users who were parents and adolescents. App features include a vaccine-tracking function, a discussion forum, and stories with embedded messages to promote intention to vaccinate. Parents and adolescents completed surveys before and after introducing the app in a pediatric primary care setting with low HPV vaccination rates. RESULTS Surveys were completed by 54 participants (20 adolescents aged 11 to 14 years and 34 parents). Notably, 75% (15/20) of adolescents and 88% (30/34) of parents intended to use the app in the next 2 weeks. Acceptability of the app was high among both groups: 88% (30/34) of parents and 75% (15/20) of adolescents indicated that Vaccipack was easy to use, and 82% (28/34) of parents and 85% (17/20) of adolescents perceived the app to be beneficial. Higher levels of app acceptability were found among parents with strong intentions to use the app (<i>P</i>=.09; 95% CI –2.15 to 0.15). CONCLUSIONS mHealth technology, such as Vaccipack, may be an acceptable and nimble platform for providing information to parents and adolescents and advancing the uptake of important vaccines.

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Cross-Sectional Study on Perceptions Regarding Cervical Cancer Screening and Human Papillomavirus Vaccination Among Female Patients in Rural Taiwan

Journal of Global Oncology ◽

10.1200/jgo.19.23000 ◽

2019 ◽

Vol 5 (Supplement_1) ◽

pp. 14-14

Author(s):

Ruixuan J. Zhang ◽

Madeline Bach ◽

Julia Yip ◽

Athena Lin

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Hpv Vaccination ◽

The United States ◽

Asian Women ◽

Vaccination Rates ◽

Route Of Transmission ◽

Papanicolaou Smears

PURPOSE Cervical cancer remains the eighth leading cause of cancer mortality among women in Taiwan. Despite availability of a National Health Insurance program with free yearly screenings, Papanicolaou testing and human papillomavirus (HPV) vaccination rates have been historically low in Taiwan. Even in the United States, cervical cancer screening rates for Asian women are significantly lower than other ethnic groups. The goal is to direct future interventions by providing insight on barriers leading to low screening and vaccination rates among Taiwanese and Asian women. METHODS Anonymous surveys without patient identifiers were randomly administered to patients at a traditional Chinese medicine clinic in Hualien City in June 2018. Inclusion criterion was females. No exclusion criteria were defined. Participants provided written consent. Sixty-three completed surveys were received. A χ2 test was used to determine statistical significance (α = 0.05). RESULTS Formal education level correlated with increased knowledge of HPV ( P = .001), its route of transmission ( P = .044), its link to genital cancer ( P = .0024), and HPV vaccination ( P = .0039). Women were more likely to have Papanicolaou smears if they were older than 30 years of age ( P = .0033), visited the gynecologist ( P < .001), or were recommended one by their physicians ( P < .001). Although 57% of respondents knew of the HPV vaccine, only 19% were vaccinated. Among those not vaccinated, most cited reasons included an inability to find a physician providing it (23.5%), safety concerns (16.4%), belief that it encourages sexual behavior (14.5%), and high out-of-pocket expense (9.1%). CONCLUSION Knowledge of HPV does not predict a higher adherence to cervical screening guidelines. Instead, diligent physician recommendations on Papanicolaou smears can elevate adherence rates among patients. Significant contributors to low HPV vaccination rates in rural Taiwan include lack of awareness and access to the vaccine. Our study emphasizes the physician-patient relationship as a means to target vulnerable populations and increase rates of cervical cancer screening and HPV vaccination.

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Changing the Narrative: Structural Barriers and Racial and Ethnic Inequities in COVID-19 Vaccination

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18189904 ◽

2021 ◽

Vol 18 (18) ◽

pp. 9904

Author(s):

Anuli Njoku ◽

Marcelin Joseph ◽

Rochelle Felix

Keyword(s):

Minority Groups ◽

Ethnic Disparities ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Structural Barriers ◽

Structural Racism ◽

Vaccination Rates ◽

Promising Solution ◽

The Impact

The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups in the United States. Although a promising solution of the COVID-19 vaccination offers hope, disparities in access again threaten the health of these communities. Various explanations have arisen for the cause of disparate vaccination rates among racial and ethnic minorities, including discussion of vaccine hesitancy. Conversely, the role of vaccine accessibility rooted in structural racism as a driver in these disparities should be further explored. This paper discusses the impact of structural barriers on racial and ethnic disparities in COVID-19 vaccine uptake. We also recommend public health, health system, and community-engaged approaches to reduce racial disparities in COVID-19 disease and mortality.

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Barriers and Facilitators of Human Papillomavirus (HPV) Vaccination During the Implementation of the School-Based HPV Vaccine Program in Manizales, Colombia

Journal of Global Oncology ◽

10.1200/jgo.18.11000 ◽

2018 ◽

Vol 4 (Supplement 1) ◽

pp. 18s-18s

Author(s):

Verónica Cordoba ◽

Olga Lucía Tovar-Aguirre ◽

Sandra Franco ◽

María del Pilar Escobar ◽

Nelson Enrique Arias ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Hpv Vaccine ◽

Pap Smear ◽

Hpv Vaccination ◽

Barriers And Facilitators ◽

Vaccine Uptake ◽

Socioeconomic Level ◽

Vaccination Rates ◽

School Based

Abstract 43 Purpose Colombia implemented a school-based human papillomavirus (HPV) vaccination program that consisted of a three-dose series in girls age 9 years in 2012. In 2014, the program included girls up to the last grade of high school, and the second and third doses were scheduled at 6 and 60 months. After a mass psychogenic response after vaccination that occurred from May to October 2014 in Carmen de Bolivar, vaccination rates dropped from 80% in 2012 and 2013 to 18% in 2014. The aim of the current study was to identify barriers and facilitators of HPV vaccine uptake in Colombia. Methods To develop quantitative instruments for a population-based survey, we conducted 19 qualitative interviews and 18 focus groups between September 2016 and February 2017. Participants were girls who were eligible to receive vaccination between 2012 and 2014 and their parents or legal representatives. Results Forty-nine girls who were selected from six schools of low (n = 2), medium (n = 2), and high (n = 2) socioeconomic level and 58 of their parents participated in the study. Eighty-one percent (40 of 49) of girls were age 12 to 15 years at the time of interview. No girls from schools of a low socioeconomic level and only two of 20 of their parents knew the etiology of cervical cancer. Pap smear cytology and condom use were the methods of cervical cancer prevention that were most often mentioned by parents. Only vaccinated girls from schools of a high socioeconomic level considered the HPV vaccine to be a good prevention alternative. Facilitators in adults were the desire to prevent disease in general and HPV. For both girls and their parents, listening to positive information about the vaccine facilitated vaccine uptake. Negative media information about the effects of the vaccine from the 2014 psychogenic event was the main barrier for vaccine uptake or series completion. Fifty-seven percent of girls and 30% of parents mentioned that, at the time of vaccination, information about the HPV vaccine was received mainly through government massive media campaigns, whereas approxiamtely one half of both parents and girls did not receive information from schools or health care services. Conclusion Our results suggest that improving HPV vaccination rates in Colombia will require a comprehensive education program, including mass media information about the HPV vaccine. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

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Human papillomavirus (HPV) infection and vaccination: a cross-sectional study of college students’ knowledge, awareness, and attitudes in Villanova, PA

10.1101/2020.12.21.20248626 ◽

2020 ◽

Author(s):

Jennifer A. Goldfarb ◽

Joseph D. Comber

Keyword(s):

College Students ◽

Hpv Vaccination ◽

The United States ◽

Hpv Infection ◽

Cross Sectional Study ◽

Human Papillomaviruses ◽

Vaccine Uptake ◽

Cross Sectional ◽

Vaccination Rates ◽

Almost All

AbstractHuman papillomaviruses are major causative agents of multiple cancers including cervical, penial, and oropharyngeal cancers. Almost all sexually active individuals are exposed to HPV in their lifetime and although not all HPV subtypes are capable of causing cancers, several high-risk subtypes widely circulate. Several HPV vaccines have been developed and successfully utilized to limit the spread of these viruses and reduce rates of associated cancers. Despite their success, HPV vaccination rates remain low. Studies estimate the highest prevalence of HPV in the United States is among college students. This makes college students an ideal target for interventions that promote HPV vaccination and prevention. To this end, we were interested in investigating the relationship between low HPV vaccine uptake and attitudes and awareness about HPV vaccination among college aged students. We designed a survey to assess knowledge and perception of HPV and HPV vaccination that could help pinpoint correlations between this knowledge and vaccination status. We find that more robust education focusing on the benefits of HPV vaccination could be utilized to improve vaccination rates.

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Addressing Parental Vaccine Hesitancy and Other Barriers to Childhood/Adolescent Vaccination Uptake During the Coronavirus (COVID-19) Pandemic

Frontiers in Immunology ◽

10.3389/fimmu.2021.663074 ◽

2021 ◽

Vol 12 ◽

Author(s):

Olufunto A. Olusanya ◽

Robert A. Bednarczyk ◽

Robert L. Davis ◽

Arash Shaban-Nejad

Keyword(s):

Public Health ◽

Healthcare Providers ◽

Policy Decision ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Surveillance Systems ◽

Health Crisis ◽

Children And Adolescent ◽

Vaccination Rates

Routine childhood immunizations are proven to be one of the most effective public health interventions at controlling numerous deadly diseases. Therefore, the CDC recommends routine immunizations for children and adolescent populations against vaccine-preventable diseases e.g., tetanus, pertussis, diphtheria, etc. This current review sought to examine barriers to pediatric vaccine uptake behaviors during the COVID-19 pandemic. We also explored the implications for parental vaccine hesitancy/delay during an ongoing health crisis and proposed recommendations for increasing vaccine confidence and compliance. Our review determined that the receipt for vaccinations steadily improved in the last decade for both the United States and Tennessee. However, this incremental progress has been forestalled by the COVID-19 pandemic and other barriers i.e. parental vaccine hesitancy, social determinants of health (SDoH) inequalities, etc. which further exacerbate vaccination disparities. Moreover, non-compliance to routine vaccinations could cause an outbreak of diseases, thereby, worsening the ongoing health crisis and already strained health care system. Healthcare providers are uniquely positioned to offer effective recommendations with presumptive languaging to increase vaccination rates, as well as, address parental vaccine hesitancy. Best practices that incorporate healthcare providers’ quality improvement coaching, vaccination reminder recall systems, adherence to standardized safety protocols (physical distancing, hand hygiene practices, etc.), as well as, offer telehealth and outdoor/drive-through/curbside vaccination services, etc. are warranted. Additionally, a concerted effort should be made to utilize public health surveillance systems to collect, analyze, and interpret data, thereby, ensuring the dissemination of timely, accurate health information for effective health policy decision-making e.g., vaccine distribution, etc.

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Challenges related to human papillomavirus (HPV) vaccine uptake in Minnesota: clinician and stakeholder perspectives

Cancer Causes & Control ◽

10.1007/s10552-021-01459-5 ◽

2021 ◽

Author(s):

Nicholas Yared ◽

Molly Malone ◽

Estee Welo ◽

Inari Mohammed ◽

Emily Groene ◽

...

Keyword(s):

Social Media ◽

Human Papillomavirus ◽

Cancer Prevention ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

Negative Influence ◽

Vaccine Uptake ◽

Related Factors ◽

Vaccination Rates ◽

Hpv Vaccine Uptake

Abstract Background Human papillomavirus (HPV) vaccination rates among adolescents are increasing in Minnesota (MN) but remain below the Healthy People 2020 goal of 80% completion of the series. The goal of this study was to identify messaging and interventions impacting HPV vaccine uptake in MN through interviews with clinicians and key stakeholders. Methods We conducted semi-structured key participant interviews with providers and stakeholders involved in HPV vaccination efforts in MN between 2018 and 2019. Provider interview questions focused on messaging around the HPV vaccine and clinic-based strategies to impact HPV vaccine uptake. Stakeholder interview questions focused on barriers and facilitators at the organizational or state level, as well as initiatives and collaborations to increase HPV vaccination. Responses to interviews were recorded and transcribed. Thematic content analysis was used to identify themes from interviews. Results 14 clinicians and 13 stakeholders were interviewed. Identified themes were grouped into 2 major categories that dealt with messaging around the HPV vaccine, direct patient–clinician interactions and external messaging, and a third thematic category involving healthcare system-related factors and interventions. The messaging strategy identified as most useful was promoting the HPV vaccine for cancer prevention. The need for stakeholders to prioritize HPV vaccination uptake was identified as a key factor to increasing HPV vaccination rates. Multiple providers and stakeholders identified misinformation spread through social media as a barrier to HPV vaccine uptake. Conclusion Emphasizing the HPV vaccine’s cancer prevention benefits and prioritizing it among healthcare stakeholders were the most consistently cited strategies for promoting HPV vaccine uptake. Methods to combat the negative influence of misinformation about HPV vaccines in social media are an urgent priority.

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Digital Gaming Interventions– Utilizing Theories and Evaluation to Increase HPV Vaccination among Young Males (Preprint)

10.2196/preprints.21303 ◽

2020 ◽

Author(s):

Gabrielle Darville ◽

Jade Burns ◽

Tanaka Chavanduka ◽

Charkarra Anderson - Lewis

Keyword(s):

Hpv Vaccine ◽

Game Design ◽

Hpv Vaccination ◽

Intervention Mapping ◽

Health Belief ◽

Theoretical Models ◽

The United States ◽

Vaccine Uptake ◽

Transmitted Infection ◽

Vaccination Rates

UNSTRUCTURED The Human Papillomavirus (HPV) is the most common sexually transmitted infection in the US. HPV attributes to most cancers including anal, oral, cervical and penile. Despite infection rates in the United States recommendations and communication campaigns have traditionally focused on females. Because of this, males lack knowledge of reasons for vaccination, the benefits of being vaccinated and their risks overall. Gaming as a health education strategy can be beneficial for this key demographic because of the popularity and gaming mechanism that can promote behavior change. Objective: This study sought to explore the relationship between gamification and HPV vaccine uptake. Materials and Methods: In total twenty two (n=22) interviews were conducted with experts in the fields of cancer prevention, sexual and reproductive health, public health, game design, technology and health communication on how a game should be developed to increase HPV vaccination rates among males. Results: Overwhelmingly theoretical models such as the health belief model (HBM) were identified with key constructs such as self-efficacy and risk perception. Experts also suggested using intervention mapping and logic models as planning tools for health promotion interventions utilizing a digital game as a medium. Lastly, in game and out of game measures were discussed as assessments for quality and impact by our expert panel. Conclusion: This study shows that interventions should focus on whether greater utilization of serious games and the incorporation of theory and standardized methods can impact the need of young men to vaccinate and complete the series of the HPV vaccine.

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COVID-19 and Historic Influenza Vaccinations in the United States: A Comparative Analysis

Vaccines ◽

10.3390/vaccines9111284 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1284

Author(s):

Pranav Mirpuri ◽

Richard A. Rovin

Keyword(s):

Influenza Vaccination ◽

The United States ◽

Vaccination Rate ◽

Primary Objective ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

County Level ◽

Vaccination Rates ◽

Global Challenge ◽

Us Counties

The COVID-19 vaccination effort is a monumental global challenge. Recognizing and addressing the causes of vaccine hesitancy will improve vaccine uptake. The primary objective of this study was to compare the COVID-19 vaccination rates in US counties to historical vaccination rates for influenza in persons aged 65 and older. The secondary objective was to identify county-level demographic, socioeconomic, and political factors that influence vaccination rates. County level data were obtained from publicly available databases for comparison and to create predictive models. Overall, in US counties the COVID-19 vaccination rate exceeded influenza vaccination rates amongst those aged 65 or older (69.4.0% vs. 44%, p < 0.0001). 2690 (83.4%) of 3224 counties had vaccinated 50% or more of their 65 and older residents in the first seven months of the COVID-19 vaccination roll out. There were 467 (14.5%) of 3223 counties in which the influenza vaccination rate exceeded the COVID-19 vaccination rate. Most of these counties were in the Southern region, were considered politically “red” and had a significantly higher non-Hispanic Black resident population (14.4% vs. 8.2%, p < 0.0001). Interventions intended to improve uptake should account for nuances in vaccine access, confidence, and consider factual social media messaging, especially in vulnerable counties.

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