Provider perspectives on communication and dismissal policies with HPV vaccine hesitant parents.
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ABSTRACT:
SUBMITTER: Francis JKR
PROVIDER: S-EPMC8683895 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:There is concern over the increase in the number of "vaccine-hesitant" parents, which contributes to under-vaccinated populations and reduced herd immunity. Traditional studies investigating parental immunization beliefs and practices have relied on random digit dialing (RDD); however, this method presents increasing limitations. Facebook is the most used social media platform in Canada and presents an opportunity to recruit vaccine-hesitant parents in a novel manner.The study aimed to explore the use of Facebook as a tool to reach vaccine-hesitant parents, as compared with RDD methods.We recruited Canadian parents over 4 weeks in 2013-14 via targeted Facebook advertisements linked to a Web-based survey. We compared methodological parameters, key parental demographics, and three vaccine hesitancy indicators to an RDD sample of Canadian parents. Two raters categorized respondent reasons for difficulties in deciding to vaccinate, according to the model of determinants of vaccine hesitancy developed by the World Health Organization's Strategic Advisory Group of Experts on Immunization.The Facebook campaign received a total of 4792 clicks from unique users, of whom 1696 started the Web-based survey. The total response rate of fully completed unique Web-based surveys was 22.89% (1097/4792) and the survey completion rate was 64.68% (1097/1696). The total cost including incentives was reasonable (Can $4861.19). The Web-based sample yielded younger parents, with 85.69% (940/1097) under the age of 40 years as compared with 23.38% (408/1745) in the RDD sample; 91.43% (1003/1097) of the Facebook respondents were female as compared with 59.26% (1034/1745) in the RDD sample. Facebook respondents had a lower median age of their youngest child (1 year vs 8 years for RDD). When compared with the RDD sample, the Web-based sample yielded a significantly higher proportion of respondents reporting vaccines as moderately safe to not safe (26.62% [292/1097] vs 18.57% [324/1745]), partially or not at all up-to-date vaccination status of youngest child (22.06% [242/1097] vs 9.57% [167/1745]), and difficulty in making the decision to vaccinate their youngest child (21.06% [231/1097] vs 10.09% [176/1745]). Out of the Web-based respondents who reported reasons for the difficulties in deciding to vaccinate, 37.2% (83/223) reported lack of knowledge or trust due to conflicting information and 23.8% (53/223) reported the perception of the risk of the adverse effects of vaccines being higher than the risk of disease acquisition.We successfully recruited a large sample of our target population at low cost and achieved a high survey completion rate using Facebook. When compared with the RDD sampling strategy, we reached more vaccine-hesitant parents and younger parents with younger children-a population more likely to be making decisions on childhood immunizations. Facebook is a promising economical modality for reaching vaccine-hesitant parents for studies on the determinants of vaccine uptake.
| S-EPMC5547248 | biostudies-other
Project description:ObjectivesInterventions to improve health care provider communication about HPV vaccination can increase vaccine acceptance. Our objectives were to (1) identify clinics in locations with high HPV-associated cancer and low HPV-vaccination rates that would potentially benefit from dissemination of a proposed HPV Provider Communication intervention and (2) use qualitative interviews and a dissemination and implementation framework to assess readiness for change and fit of the HPV Provider Communication intervention to the context of these clinics.MethodsLocal HPV-associated cancer and HPV vaccination rates were assigned to Practice-Based Research Network clinics using data from the Colorado Central Cancer Registry, the Colorado Immunization Information System, and the American Community Survey. Staff from 38 clinics located in areas with high numbers of adolescents not up-to-date for HPV vaccine and high rates of HPV-associated cancers were recruited for qualitative interviews. Interview questions used the Promoting Action on Research Implementation in Health Services (PARIHS) conceptual framework and addressed the proposed intervention, current vaccination practices and prior quality improvement (QI) experience.ResultsTwenty-seven interviews were completed with clinicians, clinic managers, and other staff across 17 clinics (9 pediatric, 5 family medicine, 3 public/school-based health). Most clinics had some prior QI experience and there were few thematic differences between sites with more or less foundation for QI/immunization work. Participants were motivated to improve the health of their patients and valued both guidelines and local experience as important evidence to consider adopting an intervention. Interviewees were more interested in implementing the proposed intervention if it aligned with existing priorities and fit within clinic workflows. Facilitation needs included adequate time and external facilitation support for data tracking and analysis.ConclusionsQualitative interviews to understand clinic context and fit of an HPV Provider Communication intervention can inform implementation in settings with the highest potential for clinical impact.
| S-EPMC10575754 | biostudies-literature
Project description:BackgroundParents use alternative protective methods instead of having their children vaccinated because of their various concerns.AimsThe aim of this study is to examine the processes by which the parents preferred alternative methods rather than the vaccines to strengthen their child's immune system.MethodsSemi-structured, qualitative interviews were conducted with 22 parents who had vaccine hesitancy. The study sample consisted of parents whose children were between the ages of 0 and 18 years and who experienced vaccine hesitancy and lived in Turkey. The interviews with individuals were conducted online and aimed to be representative of the population of Turkey.ResultsThe factors that caused parental vaccine hesitancy were various, such as vaccine contents, distrust of healthcare workers and false information about vaccines. Because of these factors, parents resorted to natural nutrition, vitamin support and some other precautions, such as avoiding takeaway food or preparing homemade food, rather than having their children vaccinated.ConclusionsIn recent years, it is thought that parents need education about vaccination; outbreaks may be caused by immigrant children who cannot be registered, and therefore cannot be vaccinated, in Turkey, which has received immigration at a high rate.
| S-EPMC8899307 | biostudies-literature
Project description:IntroductionDespite over 15 years of real-world data that supports the safety and efficacy of the human papillomavirus (HPV) vaccine, in the United States vaccine hesitancy persists. Many studies have focused on vaccine-hesitant parents, but fewer have examined provider perspectives on how to address HPV vaccine hesitancy.MethodsBetween July 2021-April 2022, we recruited providers in Maryland and the broader Mid-Atlantic region who practiced pediatrics, primary care, family medicine, or adolescent medicine and who provided outpatient care for children ages 10-17. Semi-structured virtual interviews focused on provider-reported strategies to address HPV vaccine-hesitant parents, as well as perceived barriers to successful vaccination and provider perspectives on specific interventions to address parental hesitancy. Audio recordings were transcribed and analyzed via a combination of deductive and inductive coding. Higher-level themes within the domains of strategies, barriers, and perspectives on specific proposed interventions were identified.Results and discussionA total of sixteen providers completed an interview. Within the domain of provider-reported strategies, the following themes emerged: 1) leveraging continuity of care and established parental trust, 2) supporting parental autonomy, 3) tailoring the approach to specific concerns of vaccine-hesitant parents, 4) normalizing the HPV vaccine, and 5) focusing on health prevention and cancer prevention. Barriers providers identified were: 1) limited time, 2) lack of common ground with parents, 3) parent-child decision discordance, 4) availability of misinformation, and 5) parental concerns such as safety and necessity. In the domain for proposed interventions, providers favored interventions that saved time or were not resource-intense, that did not single out the HPV vaccine as different, were patient friendly, and leveraged efficiency through the electronic medical record. The insights from this study can help inform the development of provider-acceptable and feasible tools and interventions to address parental HPV vaccine hesitancy.
| S-EPMC11334775 | biostudies-literature
Project description:Vaccine hesitancy (VH) is an issue of global concern. The quality of communication between healthcare providers and parents can influence parental immunization acceptance. We aimed to describe immunization uptake following specialist immunization clinic (SIC) consultation for Australian children of VH parents as a cohort, and according to pre-clinic parental position on immunization. At a single tertiary pediatric SIC (RCH, Melbourne) a retrospective descriptive study classified VH families according to 3 proposed parental positions on immunization at initial clinic attendance. Immunization status at follow up was ascertained via the Australian Children's Immunization Register and National HPV Program Register and compared between groups. Of the VH cohort, 13/38 (34%) families were classified as hesitant, 21 (55%) as late/selective vaccinators and 4 (11%) as vaccine refusers. Mean follow up post-SIC attendance was 14.5 months. For the overall VH cohort, the majority chose selective immunization (42%) following SIC consultation. When analyzed by pre-clinic parental position on immunization, there was a trend for hesitant families to proceed with full immunization, selective families to continue selective immunization and refusing families to remain unimmunised (p < 0.0001). The most commonly omitted vaccines were hepatitis B (66%) and Haemophilus influenzae type B (55%), followed by the meningococcal C conjugate vaccine (53%) and measles, mumps and rubella vaccine (53%). Immunization outcome appears to correlate with pre-clinic parental position on immunization for the majority of families attending a SIC in Australia, with selective immunization the most common outcome. Tailored communication approaches based on parental position on immunization may optimise clinic resources and engagement of families, but require prospective research evaluation.
| S-EPMC5054782 | biostudies-literature
Project description:ObjectivesResearch has shown that physicians are encountering an increase in vaccine-hesitant parents (VHPs) numbers. This study examined physicians' vaccination knowledge, vaccine-related discussions with VHPs, beliefs about and responses to vaccine hesitancy, and challenges faced while discussing immunization with VHPs.MethodsThis cross-sectional, descriptive study was performed at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia, in September 2020. The data were collected through a questionnaire distributed via email. The sample comprised 90 physicians who routinely treat children and reported they frequently have appropriate vaccine discussions when encountering VHPs.ResultsNinety participants (59% were females) completed the questionnaire. Of these, 37.8% were from family medicine, 7.8% from primary care, and 54.4% from paediatrics. The most discussed topics were vaccine necessity, reasons for vaccine refusal, and vaccine safety. Seventeen participants (18.8%) reported being extremely confident, and (42.2%) were confident in their vaccine-specific knowledge. Regarding confidence in communication skills, 22.2% reported being extremely confident and (45.6%) were confident. Determinants of higher confidence in the knowledge and communication skills were physician age (p = 0.001 and p = 0.0001, respectively), years of practice (p = 0.002 and (p = 0.005), and patients seen per workday (p = 0.0001 and p = 0.024). Other factors such as physician sex (p = 0.062), the field of practice (p = 0.329), and hours of work per week (p = 0.061) were not significantly different. Forty-six (51%) physicians sometimes find it challenging to conduct appropriate vaccine-related discussions because of having too many other issues to discuss during the consultation. Furthermore, 53 (59%) participants agreed/strongly agreed that parental refusal to vaccinate would raise suspicions of negligence. On the other hand, 59 (65%) disagreed/strongly disagreed that parental refusal of vaccines is a parental right. Participants expressed the need to refer VHPs to a specialised advisory clinic with excellent experience and negotiation skills to overcome the challenges.ConclusionVaccine safety and necessity are the topics of most concern to VHPs, and a knowledgeable physician with competent communication skills is critical in responding to such situations. This study highlights the most reported barriers to successful vaccine-related discussions. It raises underlying ethical principles such as parental autonomy and the need to train physicians in VHPs. To train physians for succucful vaccine counceling of VHPs.
| S-EPMC10478439 | biostudies-literature
Project description:U.S. Vietnamese have high cervical cancer incidence and low human papillomavirus (HPV) vaccine initiation. Using the P3 model, we explored practice-, provider-, and patient-level determinants of U.S. Vietnamese parents' HPV vaccine decision-making for their adolescents. We conducted a cross-sectional, online survey (04/2020-12/2020) with U.S. Vietnamese parents who had ≥ 1 adolescent ages 9-18. We assessed HPV vaccination outcomes (initiation, willingness to initiate, completion) and provider recommendation. Modified Poisson regressions were used to identify practice-, provider- and patient-level correlates of outcomes. The sample (n = 408) was 44 years old on average; 83% were female and 85% had a Bachelor's degree. Around half of adolescents were female (51%) and 13-18 year old (54%). Only 41 and 23% of parents had initiated and completed the HPV vaccine series for their child, respectively. Initiation was associated with receiving provider recommendation (either low- or high-quality), while willingness to initiate was associated with receiving high-quality recommendation. Both initiation and willingness to initiate was negatively associated with parental perception that their child was too young for a "sexually transmitted infection (STI)-preventing vaccine." Provider recommendation was associated with higher parental U.S. acculturation and the child being older and female. Provider-facing interventions should promote high-quality, age-based, gender-neutral HPV vaccine recommendation. These and population- and individual-facing interventions should recognize the need for additional parental education, particularly related to misconceptions regarding STI prevention.
| S-EPMC8600911 | biostudies-literature
Project description:BackgroundEfforts to reduce opioid overdose fatalities have resulted in tapering (i.e., reducing or discontinuing) opioid prescriptions despite a limited understanding of patients' experiences.ObjectiveTo explore patients' perspectives on opioid taper experiences to ultimately improve taper processes and outcomes.DesignQualitative study.ParticipantsPatients on long-term opioid therapy for chronic pain who had undergone a reduction of opioid daily prescribed dosage of ≥50% in the past 2 years in two distinct medical systems and regions.ApproachFrom 2019 to 2020, we conducted semi-structured interviews that were audio-recorded, transcribed, systematically coded, and analyzed to summarize the content and identify key themes regarding taper experiences overall and with particular attention to patient-provider relationships and provider communication during tapers.Key resultsParticipants (n=41) had lived with chronic pain for an average of 17.4 years (range, 3-36 years) and described generally adverse experiences with opioid tapers, the initiation of which was not always adequately justified or explained to them. Consequences of tapers ranged from minor to substantial and included withdrawal, mobility issues, emotional distress, exacerbated mental health symptoms, and feelings of social stigmatization for which adequate supports were typically unavailable. Narratives highlighted the consequential role of patient-provider relationships throughout taper experiences, with most participants describing significant interpersonal challenges including poor provider communication and limited patient engagement in decision making. A few participants identified qualities of providers, relationships, and communication that fostered more positive taper experiences and outcomes.ConclusionsFrom patients' perspectives, opioid tapers can produce significant physical, emotional, and social consequences, sometimes reducing trust and engagement in healthcare. Patient-provider relationships and communication influence patients' perceptions of the quality and outcomes of opioid tapers. To improve patients' experiences of opioid tapers, tapering plans should be based on individualized risk-benefit assessments and involve patient-centered approaches and improved provider communication.
| S-EPMC9130417 | biostudies-literature
Project description:BackgroundHuman papillomavirus (HPV) infections and associated diseases remain a serious burden worldwide. It is now clear that HPV serves as the etiological factor and biologic carcinogen for HPV-associated lesions and cancers. Although preventative HPV vaccines are available, these vaccines do not induce strong therapeutic effects against established HPV infections and lesions. These concerns create a critical need for the development of therapeutic strategies, such as vaccines, to treat these existing infections and diseases.Main bodyUnlike preventative vaccines, therapeutic vaccines aim to generate cell-mediated immunity. HPV oncoproteins E6 and E7 are responsible for the malignant progression of HPV-associated diseases and are consistently expressed in HPV-associated diseases and cancer lesions; therefore, they serve as ideal targets for the development of therapeutic HPV vaccines. In this review we revisit therapeutic HPV vaccines that utilize this knowledge to treat HPV-associated lesions and cancers, with a focus on the findings of recent therapeutic HPV vaccine clinical trials.ConclusionGreat progress has been made to develop and improve novel therapeutic HPV vaccines to treat existing HPV infections and diseases; however, there is still much work to be done. We believe that therapeutic HPV vaccines have the potential to become a widely available and successful therapy to treat HPV and HPV-associated diseases in the near future.
| S-EPMC5096309 | biostudies-literature
Project description: Not available
| S-EPMC9258752 | biostudies-literature