Understanding Parents’ Views Toward the Newly Enacted HPV Vaccine School Entry: A Qualitative Study

Abstract Background: Human papillomavirus vaccine (HPV) is an important tool for prevention of HPV- related cancers. In Puerto Rico, the Secretary of Health established a school entry requirement of at least 1 dose of HPV vaccination in girls and boys aged 11 and 12 years taking effect in August 2018. Our study aims to examine parents’ views and opinions of the process of implementing the new HPV vaccination school entry policy in Puerto Rico, and understand barriers and facilitators related to this HPV immunization policy. Methods: Three focus group (n=12) and eight in-depth semi-structured interviews were performed, along with a survey. The interviews were recorded and transcript by our staff members. Through a thematic analysis were identified emergent themes. Results: Lack of information in relation to the policy were the theme most mentioned in the interviews. Moreover, participants expressed that previous negative experiences, from friends or family member, adverse effect and the lack of communication from school and healthcare providers deter them from the decision of vaccinated their kids. Barriers in the process of soliciting an exemption was discussed. Conclusion: Most barriers mentioned by participants who express hesitation about vaccinating their kids with the HPV vaccine, are modifiable providing parents information about the mandate’s implementation, and educational materials that address their concerns related to the vaccine’s side effects. Implementation of this efforts, however, need to consider impacting the school (teachers, principal directors, and administrative staff), the government and parents. This multilevel approach will help to improve the dissemination of information about HPV vaccination in order to clarify doubts and misinformation among hesitant parents.

Download Full-text

The Intersection of Problems, Policy, and Politics: The Adoption of an HPV Vaccine School-Entry Requirement in Puerto Rico

Qualitative Health Research ◽

10.1177/1049732321991507 ◽

2021 ◽

Vol 31 (5) ◽

pp. 859-870

Author(s):

Coralia Vázquez-Otero ◽

Ellen M. Daley ◽

Cheryl A. Vamos ◽

Nancy Romero-Daza ◽

Jason Beckstead ◽

...

Keyword(s):

Puerto Rico ◽

Nonprofit Organizations ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

School Entry ◽

Advisory Panel ◽

Policy Entrepreneurs ◽

Vaccination Rates ◽

Policy Initiatives ◽

Policy Window

Persistent human papillomavirus (HPV) infections can cause cancer (e.g., cervical/vaginal/penile/anal/oropharyngeal). The HPV vaccine prevents cancer, yet U.S. vaccination rates remain low. We explored sociopolitical factors in the adoption of Puerto Rico’s HPV vaccine school-entry requirement. Multiple streams framework explains how the intersection of problems, policy, and politics streams influence policy adoption. Policy entrepreneurs work on joining these streams. Interviews ( n = 20) were conducted with stakeholders (e.g., physicians/researchers/nonprofit organizations’ leaders). Data were analyzed using applied thematic analysis. High incidence of HPV and HPV-related cancers in Puerto Rico were indicators of problems. Focusing events included Rhaiza’s case and the HPV-Advisory Panel Report. During summer 2017, a policy window opened; the Department of Health (DOH) adopted the requirement in summer 2018. Stakeholders discussed policy initiatives. Political turnover positively influenced the process. Policy entrepreneurs created an extended period of intersection resulting in the adoption of the requirement. Findings can inform policy initiatives to improve HPV vaccination rates and reduce HPV-related cancers.

Download Full-text

Implementation of the Human Papillomavirus School-entry Requirement in Puerto Rico: Barriers and Facilitators Using the Consolidated Framework for Implementation Research

10.21203/rs.3.rs-409665/v1 ◽

2021 ◽

Author(s):

Vivian Colón-López ◽

Roxana Soto-Abreu ◽

Diana T. Medina-Laabes ◽

Olga L. Díaz-Miranda ◽

Ana P. Ortiz ◽

...

Keyword(s):

Puerto Rico ◽

Human Papillomavirus ◽

Implementation Research ◽

Hpv Vaccine ◽

Qualitative Interviews ◽

Healthcare Providers ◽

Negative Influence ◽

Barriers And Facilitators ◽

School Entry ◽

Relative Advantage

Abstract Background: In 2018, Puerto Rico (PR) enacted a Human papillomavirus (HPV) vaccine school-entry requirement for students ages 11 to 12. Using the Consolidated Framework for Implementation Research (CFIR), we aimed to identify potential barriers and facilitators of this implementation.Methods: We conducted a total of 36 qualitative interviews with key informants who were stakeholders from different organizations (Department of Health, Schools, Healthcare Providers, and Community organizations in favor of the requirement) from July 2018 to January 2020. Three researchers performed the interview guide, data coding, and analysis according to the CFIR framework. We evaluated construct rating variability between the organizations to determine barriers and facilitators. Results: The strongest facilitators determined under the CFIR construct include the stakeholder's awareness of the parent's and student's needs to meet the HPV school-entry requirement. Other facilitators include initiatives for school-entry policies and the relative advantage of this requirement over different strategies. The strongest barriers included the cost for private providers to administer the HPV vaccine, the negative influence of social media about the vaccine, which affected parents' acceptance, and the lack of school nurses as available staff resources for the school entry requirement. Conclusions: Findings from this study can be used to improve implementation (adaptations/modifications) and inform other US states and countries in earlier stages of consideration of the adoption of similar immunization policies. Most barriers can be modifiable with the implementation of educational programs/training across schools, considering that they are the first line of response to parents of this school entry requirement.

Download Full-text

Parental decision-making on human papillomavirus vaccination for daughters in Japan

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2018-0140 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Ken-ichiro Kobayashi ◽

Charnchudhi Chanyasanha ◽

Dusit Sujirarat

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

Healthcare Providers ◽

Related Factors ◽

Human Papillomavirus Vaccination ◽

Remote Areas ◽

Parental Decision Making ◽

The Government

AbstractBackgroundIn June 2013, the fear of adverse events compelled the government to withdraw its recommendation of the Human papillomavirus (HPV) vaccine. Since then, the rate of vaccination among Japanese girls has dropped dramatically.ObjectiveThis study aims to assess how the Japanese government's policy change against HPV vaccination influenced the degree to which parents in remote areas in Japan accepted the vaccine for their daughters, and to analyze related factors.MethodsA self-administered questionnaire was distributed to parents with daughters attending secondary schools or high schools in two remote areas of the country.ResultsOut of 700 eligible parents, 246 (35%) responded. The percentage of parents in the “accept group” (those whose daughters had already been vaccinated or those who intended to have their daughters vaccinated) dropped from 54% before the government withdrew its HPV vaccine recommendation to only 4.5% after the withdrawal (1.5% of whom intended to vaccinate and 3% of whom had already had their daughters vaccinated). Vaccine acceptance was higher in parents who were employed as healthcare workers, had been educated through to the completion of high school, had good levels of knowledge about cervical cancer and the HPV vaccine, had low perceived barriers against the HPV vaccine, and received high levels of social support.ConclusionThe acceptance of HPV vaccination among parents was low overall. Higher acceptance may be possible if the government restores its recommendation and healthcare providers disseminate appropriate information about the HPV vaccination and cervical cancer.

Download Full-text

Abstract PO-040: Understanding views against the HPV vaccine school-entry requirement in Puerto Rico

10.1158/1538-7755.disp21-po-040 ◽

2022 ◽

Author(s):

Gloriany Rivas ◽

Roxana Soto-Abreu ◽

Glizette O. Arroyo-Morales ◽

Diana T. Medina-Laabes ◽

Olga L. Díaz-Miranda ◽

...

Keyword(s):

Puerto Rico ◽

Hpv Vaccine ◽

School Entry

Download Full-text

Predictors of Human Papillomavirus Vaccine uptake or intent among parents of preadolescents and adolescents

Journal of Nursing Education and Practice ◽

10.5430/jnep.v7n6p35 ◽

2017 ◽

Vol 7 (6) ◽

pp. 35 ◽

Cited By ~ 2

Author(s):

Kimberlee Dayal ◽

Sarah Robinson ◽

Jessica Schoening ◽

Mary Catherine Smith ◽

Son Chae Kim

Keyword(s):

Human Papillomavirus ◽

Hpv Vaccine ◽

Parental Education ◽

Hpv Vaccination ◽

College Education ◽

Vaccine Effectiveness ◽

Vaccine Uptake ◽

Human Papillomavirus Vaccine ◽

Hpv Knowledge ◽

Hpv Vaccine Uptake

Aim: The aim of this study was to examine predictors of human papillomavirus (HPV) vaccine uptake or intent among parents of pre-adolescents and adolescents.Methods: A cross-sectional descriptive study was conducted among parents of girls aged 9 to 18 years, visiting two primary care clinics in central Texas from September to November 2015. Pearson’s product-moment correlation procedures and path analyses based on Health Belief Model were performed.Results: Path analysis showed that provider recommendation for HPV vaccination (β = 0.37; p < .001) and perceived HPV vaccine harm (β = -0.48; p < .001) had statistically significant direct effects on HPV vaccine uptake or intent. The perceived HPV vaccine effectiveness was directly influenced by HPV knowledge (β = 0.39; p < .001), empowerment in parent-provider relationships (β = 0.30; p = .006) and parental college education (β = 0.23; p = .039).}Conclusions: Together with parental empowerment fostering an equal partnership with providers, targeted education to improve parental HPV knowledge may convince them of the HPV vaccine effectiveness. This, in turn, may help them put the perceived HPV vaccine harm in proper perspective and allow them to make informed decisions regarding the timely HPV vaccination of their children. Because provider recommendation is one of the most important contributing factors for HPV vaccine uptake or intent, parental education and recommendations from nurses will help reduce the knowledge gaps and empower parents to make the timely decisions to vaccinate their children.

Download Full-text

Lack of school requirements and clinician recommendations for human papillomavirus vaccination

Journal of Public Health Research ◽

10.4081/jphr.2018.1324 ◽

2018 ◽

Cited By ~ 3

Author(s):

Linda M. Niccolai ◽

Anna L. North ◽

Alison Footman ◽

Caitlin E. Hansen

Keyword(s):

Human Papillomavirus ◽

Hpv Vaccination ◽

School Entry ◽

Structured Interviews ◽

Human Papillomavirus Vaccination ◽

Strong Recommendation ◽

Entry Requirements ◽

Design And Methods ◽

Purposive Sample

Background: A strong recommendation from a clinician is one of the best predictors of human papillomavirus (HPV) vaccination among adolescents, yet many clinicians do not provide effective recommendations. The objective of this study was to understand how the lack of school entry requirements for HPV vaccination influences clinicians’ recommendations. Design and Methods: Semi-structured interviews with a purposive sample of 32 clinicians were conducted in 2015 in Connecticut USA. Data were analysed using an iterative thematic approach in 2016-2017. Results: Many clinicians described presenting HPV vaccination as optional or non-urgent because it is not required for school entry. This was noted to be different from how other required vaccines were discussed. Even strong recommendations were often qualified by statements about the lack of requirements. Furthermore, lack of requirements was often raised initially by clinicians and not by parents. Many clinicians agreed that requirements would simplify the recommendation, but that parents may not agree with requirements. Personal opinions about school entry requirements were mixed. Conclusions: The current lack of school entry requirements for HPV vaccination is an important influence on clinicians’ recommendations that are often framed as optional or non-urgent. Efforts are needed to strengthen the quality of clinicians’ recommendations in a way that remains strong and focused on disease prevention yet uncoupled from the lack of requirements that may encourage delays. Additionally, greater support for requirements among clinicians may be needed to successfully enact requirements in the future.

Download Full-text

The Ethical Case for Mandating HPV Vaccination

The Journal of Law Medicine & Ethics ◽

10.1177/1073110518782957 ◽

2018 ◽

Vol 46 (2) ◽

pp. 501-510 ◽

Cited By ~ 5

Author(s):

Michelle J. Bayefsky

Keyword(s):

Cervical Cancer ◽

Health Equity ◽

Hpv Vaccine ◽

Final Section ◽

Hpv Vaccination ◽

School Entry ◽

Best Interests ◽

Moral Imperative

When the HPV vaccine was released over a decade ago, there was intense opposition to mandating the vaccine, including among bioethics and legal scholars. Some of the original concerns are now obsolete, while other objections continue to present an obstacle to mandating the vaccine. This essay responds to earlier critiques of mandatory HPV vaccination and offers a series of arguments in support of a vaccine mandate. The first section briefly addresses initial concerns that are no longer relevant. The second section makes the ethical case for mandating HPV vaccination, based on three principles: 1) the best interests of children, 2) solidarity, and 3) health equity. The final section addresses concerns related to implementation of the vaccine, including the validity of linking vaccination to school entry. The essay concludes that we have a moral imperative to protect children from the leading cause of cervical cancer, and that mandating HPV vaccination is the best way to ensure that children of all backgrounds receive the vaccine before they have been exposed to the virus.

Download Full-text

Challenges to Human Papillomavirus Vaccine Acceptability among Women in South India: An Exploratory Study

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.20-1650 ◽

2021 ◽

Author(s):

Pooja Shah ◽

Veena Shetty ◽

Maithri Ganesh ◽

Avinash K. Shetty

Keyword(s):

Human Papillomavirus ◽

Hpv Vaccine ◽

Exploratory Study ◽

Social Stigma ◽

Hpv Vaccination ◽

Scale Up ◽

Vaccine Safety ◽

Vaccine Uptake ◽

Human Papillomavirus Vaccine ◽

Barriers And Challenges

Cervical cancer is the second leading cause of cancer and one of the leading causes of cancer-related death in women in India. Human papillomavirus (HPV) vaccine uptake in India is low due to cost, low awareness of HPV, social stigma, and other factors. We assessed the awareness, attitudes, and beliefs regarding HPV and HPV vaccination and explored the barriers and challenges to HPV vaccine intent among women in Mangalore, India. An exploratory study was conducted using two focus group discussions (FGDs) and six in-depth one-on-one interviews. FGD-1 comprised nine women aged 18 to 26 years, and FGD-2 comprised seven women aged 27 to 45 years. The FGDs were recorded, transcribed, and analyzed using thematic content analysis. Themes identified were limited knowledge of HPV and vaccine, stigma associated with receiving HPV vaccine, vaccine safety concerns, and cost as a barrier to receiving vaccine. Participants expressed desire for physician and government recommendation of the HPV vaccine to validate vaccine intent. Contrasting themes between the two FGDs include support for vaccination at a younger age and lower perception of stigma and judgment in the 18- to 26-year-old group; however, participants in the 27- to 45-year-old group support vaccination at an older age and endorse greater fear of stigma and judgment associated with obtaining vaccination. Education regarding HPV-associated diseases and the HPV vaccine for the general public, physicians, and government officials in conjunction with lowering vaccine cost, improving vaccine access, and encouraging strong physician recommendations are key strategies to scale up HPV vaccine implementation in India.

Download Full-text

Using Intervention Mapping to Develop a Provider Intervention to Increase HPV Vaccination in a Federally Qualified Health Center

Frontiers in Public Health ◽

10.3389/fpubh.2020.530596 ◽

2020 ◽

Vol 8 ◽

Author(s):

Jessica D. Austin ◽

Serena A. Rodriguez ◽

Lara S. Savas ◽

Tina Megdal ◽

Lois Ramondetta ◽

...

Keyword(s):

Health Center ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

Intervention Mapping ◽

Healthcare Providers ◽

Skills Training ◽

Clinical Settings ◽

Strong Recommendation ◽

Federally Qualified Health Center ◽

Planning Group

Introduction: A healthcare provider's ability to give a strong recommendation for the HPV vaccine is of utmost importance in increasing HPV vaccination. To reduce the burden of HPV-related cancers, there is a critical need to develop and implement theory-based interventions aimed at strengthening healthcare providers' communication about the HPV vaccine.Methods: We used Intervention Mapping (IM) steps 1–5 to develop and implement a provider-level intervention that aligns with the priorities and needs of a large, urban Federally Qualified Health Center (FQHC).Results: In step 1, a diverse planning group identified barriers to HPV vaccination in clinical settings and generated process maps and a logic model of the problem. Step 2 outlined outcomes and provider performance objectives of the intervention and identified knowledge, skills, self-efficacy, outcome expectations, and normative beliefs as modifiable targets that need to change for providers to deliver strong recommendations for the HPV vaccine to parents and patients. In step 3, the planning group mapped the methods of persuasive communication, information, and modeling and skills training to behavioral targets and outlined the program practical applications (strategies) components, scope, and sequence. In steps 4 and 5, the planning group produced the intervention and planned for program implementation. The iterative and participatory process of IM resulted in modifications to the initial intervention that aligned with the needs of the FQHC.Discussion: IM provided a systematic, participatory, and iterative approach for developing a theory-based provider-level intervention aimed at strengthening healthcare providers' ability to provide a strong recommendation for the HPV vaccine to eligible patients and parents served by a large FQHC. IM assisted with the identification of behavioral targets and methods that move beyond HPV knowledge and reminders to create behavior change. IM can help researchers and planners describe the processes and rational behind developing interventions and may help to facilitate implementation in real-world clinical settings by tailoring intervention components to the needs of the population.

Download Full-text

Knowledge, Attitude and Practice of Main Stakeholders towards Human Papilloma Virus Infection and Vaccination in Mombasa and Tana-River Counties in Kenya: A Qualitative Study

Vaccines ◽

10.3390/vaccines9101099 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1099

Author(s):

Diana Wangeshi Njuguna ◽

Nour Mahrouseh ◽

Osarugue Victory Isowamwen ◽

Orsolya Varga

Keyword(s):

Human Papilloma Virus ◽

Hpv Vaccine ◽

Health Workers ◽

Hpv Vaccination ◽

Significant Proportion ◽

Human Papilloma Virus Infection ◽

Hpv Infection ◽

Structured Interviews ◽

Papilloma Virus ◽

Tana River

Following a successful Human Papilloma Virus (HPV) vaccination pilot in 2013–2015 in Kitui county, Kenya introduced the HPV vaccine in October 2019 with a goal to immunize approximately 800,000 girls annually against HPV. Our study assessed the knowledge, attitudes, and practice of affected groups towards HPV infection and vaccination in two counties of Kenya. Semi-structured interviews from children aged between nine and thirteen years and key informants comprising of parents, head teachers, community leaders and health workers involved in HPV vaccination in health facilities from Mombasa and Tana-River counties were conducted. Content was analyzed thematically and coded for emerging themes using the QRS Nvivo 12 Plus software package. From our findings, a significant proportion of participants, especially children, have limited knowledge of the subject. Vaccination of boys was opposed by most participants. Parents and the community members are not in favor of HPV vaccination, as compared to the other groups. A similar pattern of inadequate knowledge and strongly opposed attitudes was observed in Tana-River and Mombasa. Active community involvement in primary prevention strategies may promote the uptake of the vaccine which can be achieved by robust awareness, modifying the negative beliefs about HPV vaccine and encouraging the perceptibility of HPV vaccination.

Download Full-text