Barriers and facilitators to HPV vaccination of young women in high-income countries: a qualitative systematic review and evidence synthesis

BMC Public Health

Suzanne Audrey¹  Matthew Hickman¹  Caroline Trotter²  Harriet Batista Ferrer¹ 

[1] School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK;Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES, UK

关键词: Ethnicity;    Health inequalities;    HPV vaccine;    Decision-making;    Adolescents;   

Others  :  1129032
DOI  :  10.1186/1471-2458-14-700

 received in 2013-12-17, accepted in 2014-06-26,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Ferrer et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]World Health Organisation: Human papillomavirus vaccines. WHO position paper. Wkly Epidemiol Rec 2009, 84:118-131.
• [2]Koulova A, Tsui J, Irwin K, Van Damme P, Biellik R, Aguado MT: Country recommendations on the inclusion of HPV vaccines in national immunization programmes among high-income countries, June 2006–January 2008. Vaccine 2008, 26(51):6529-6541.
• [3]UN General Assembly: Convention on the Rights of the Child. United Nations, Treaty Ser 1989, 1577:3.
• [4]Fisher H, Trotter C, Audrey S, Macdonald-Wallis K, Hickman M: Inequalities in the uptake of human papillomavirus vaccination: A systematic review and meta-analysis. Int J Epidemiol 2013, 25:25.
• [5]Sinka K, Kavanagh K, Gordon R, Love J, Potts A, Donaghy M, Robertson C: Achieving high and equitable coverage of adolescent HPV vaccine in Scotland. J Epidemiol Community Health 2013, 68(1):57-63.
• [6]Spencer A, Roberts S, Brabin L, Patnick J, Verma A: Sociodemographic factors predicting mother’s cervical screening and daughter’s HPV vaccination uptake. J Epidemiol Community Health 2014, 68(6):571. 577
• [7]Fisher H, Audrey S, Mytton J, Hickman M, Trotter C: Examining inequalities in the uptake of the school-based HPV vaccination programme in England: A retrospective cohort study. J Public Health 2014, 36(1):36-45.
• [8]Bowyer H, Forster A, Marlow L, Waller J: Predicting human papillomavirus vaccination behaviour among adolescent girls in England: Results from a prospective survey. J Fam Plann Reprod Health Care 2014, 40(1):14-22.
• [9]National Cancer Intelligence Network: Cancer incidence and survival by major ethnic group, England, 2002–2006. 2009. http://publications.cancerresearchuk.org/downloads/product/CS_REPORT_INCSURV_ETHNIC.pdf webcite
• [10]Webb R, Richardson J, Esmail A, Pickles A: Uptake for cervical screening by ethnicity and place-of-birth: A population-based cross-sectional study. J Public Health 2004, 26(3):293-296.
• [11]Moser K, Patnick J, Beral V: Inequalities in reported use of breast and cervical screening in Great Britain: Analysis of cross sectional survey data. Br Med J 2009, 16(338):b2025.
• [12]Paavonen J, Jenkins D, Bosch FX, Naud P, Salmeron J, Wheeler CM, Chow SN, Apter DL, Kitchener HC, Castellsague X, de Carvalho NS, Skinner SR, Harper DM, Hedrick JA, Jaisamrarn U, Limson GA, Dionne M, Quint W, Spiessens B, Peeters P, Struyf F, Wieting SL, Lehtinen MO, Dubin G, HPV PATRICIA study group: Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial. Lancet 2007, 369(9580):2161-2170.
• [13]Garland S, Hernandez-Avila M, Wheeler CM, Perez G, Harper DM, Leodolter S, Tang GWK, Ferris DG, Steben M, Bryan J, Taddeo FJ, Railkar R, Esser MT, Sings HL, Nelson M, Boslego J, Sattler C, Barr E, Koutsky LA, for the Females United to Unilaterally Reduce Endo/Ectocervical Disease (FUTURE) I Investigators: Quadrivalent Vaccine against Human Papillomavirus to Prevent High-Grade Cervical Lesions. N Engl J Med 2007, 356(19):1915-1927.
• [14]Garland SM, Hernandez-Avila M, Wheeler CM, Perez G, Harper DM, Leodolter S, Tang GW, Ferris DG, Steben M, Bryan J, Taddeo FJ, Railkar R, Esser MT, Sings HL, Nelson M, Boslego J, Sattler C, Barr E, Koutsky LA, for the Females United to Unilaterally Reduce Endo/Ectocervical Disease (FUTURE) I Investigators: Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med 2007, 356(19):1928-1943.
• [15]Shepherd J, Harden A, Rees R, Brunton G, Garcia J, Oliver S, Oakley A: Young people and healthy eating: a systematic review of research on barriers and facilitators. Health Educ Res 2006, 21(2):239-257.
• [16]World Bank Classifications. http://data.worldbank.org/about/country-classifications webcite
• [17]Barbour RS: Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? Br Med J 2001, 322(7294):1115-1117.
• [18]Public Health Resource Unit: Critical Appraisal Skills Programme (CASP): appraisal tools. 1998. http://www.york.ac.uk/inst/crd/index_guidance.htm webcite
• [19]Lee A, Chan PKS, Lau LCH, Chan TTN: How would family physicians facilitate the uptake of HPV vaccination: Focus group study on parents and single women in Hong Kong. Hong Kong Pract 2011, 33(33):107-114.
• [20]Barnett-Page E, Thomas J: Methods for the synthesis of qualitative research: a critical review. BMC Med Res Methodol 2009, 9(1):59.
• [21]Ritchie J, Lewis J: Qualitative research practice: a guide for social science students and researchers. London: Sage; 2003.
• [22]Pope C, Ziebland S, Mays N: Qualitative research in health care. Analysing qualitative data. Br Med J 2000, 320(7227):114-116.
• [23]Thomas J, Harden A: Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol 2008, 8(1):45.
• [24]Estabrooks CA, Field PA, Morse JM: Aggregating qualitative findings: an approach to theory development. Qual Health Res 1994, 4(4):503-511.
• [25]McLeroy KR, Bibeau D, Steckler A, Glanz K: An ecological perspective on health promotion programs. Health Educ Q 1988, 15(4):351-377.
• [26]National Conference of State Legislatures: HPV Vaccine. 2013. http://www.ncsl.org/research/health/hpv-vaccine-state-legislationand-statutesaspx.aspx webcite
• [27]Colgrove J, Abiola S, Mello MM: HPV Vaccination Mandates - Lawmaking amid Political and Scientific Controversy. N Engl J Med 2010, 363(8):785-791.
• [28]Ford CA, English A, Davenport AF, Stinnett AJ: Increasing adolescent vaccination: barriers and strategies in the context of policy, legal, and financial issues. J Adolesc Health 2009, 44(6):568-574.
• [29]Humiston SG, Albertin C, Schaffer S, Rand C, Shone LP, Stokley S, Szilagyi PG: Health care provider attitudes and practices regarding adolescent immunizations: A qualitative study. Patient Educ Couns 2009, 75(1):121-127.
• [30]Tissot AM, Zimet GD, Rosenthal SL, Bernstein DI, Wetzela C, Kahn JA: Effective strategies for HPV vaccine delivery: the views of pediatricians. J Adolesc Health 2007, 41(2):119-125.
• [31]Quinn GP, Murphy D, Malo TL, Christie J, Vadaparampil ST: A national survey about human papillomavirus vaccination: What we didn’t ask, but physicians wanted us to know. J Pediatr Adolesc Gynecol 2012, 25(4):254-258.
• [32]Javanbakht M, Stahlman S, Walker S, Gottlieb S, Markowitz L, Liddon N, Plant A, Guerry S: Provider perceptions of barriers and facilitators of HPV vaccination in a high-risk community. Vaccine 2012, 30(30):4511-4516.
• [33]Perkins RB, Pierre-Joseph N, Marquez C, Iloka S, Clark JA: Parents’ opinions of mandatory human papillomavirus vaccination: Does ethnicity matter? Womens Health Issues 2010, 20(6):420-426.
• [34]Chan ZCY, Chan TS, Lam YM, Lau LM, Li KK, Tam WH: HPV vaccination in Hong Kong: Implications for medical education. Asian Pac J Cancer Prev 2011, 12(4):1095-1099.
• [35]Bynum SA, Wright MS, Brandt HM, Burgis JT, Bacon JL: Knowledge, beliefs, and attitudes related to human papillomavirus infection and vaccination, pap tests, and cervical intraepithelial neoplasia among adolescent girls and young women. J S C Med Assoc 2009, 105(7):267-272.
• [36]Kwan TTC, Chan KKL, Yip AMW, Tam KF, Cheung ANY, Young PMC, Lee PWH, Ngan HYS: Barriers and facilitators to human papillomavirus vaccination among Chinese adolescent girls in Hong Kong: A qualitative-quantitative study. Sex Transm Infect 2008, 84(3):227-232.
• [37]Teitelman AM, Stringer M, Nguyen GT, Hanlon AL, Averbuch T, Stimpfel AW: Social cognitive and clinical factors associated with HPV vaccine initiation among urban, economically disadvantaged women. Jognn-J Obstet Gynecol Neonatal Nurs 2011, 40(6):691-701.
• [38]Katz ML, Reiter PL, Heaner S, Ruffin MT, Post DM, Paskett ED: Acceptance of the HPV vaccine among women, parents, community leaders, and healthcare providers in Ohio Appalachia. Vaccine 2009, 27(30):3945-3952.
• [39]Perkins RB, Pierre-Joseph N, Marquez C, Iloka S, Clark JA: Why do low-income minority parents choose human papillomavirus vaccination for their daughters? J Pediatr 2010, 157(4):617-622.
• [40]Do H, Seng P, Talbot J, Acorda E, Coronado GD, Taylor VM: HPV vaccine knowledge and beliefs among Cambodian American parents and community leaders. Asian Pac J Cancer Prev 2009, 10(3):339-344.
• [41]D’Souza C, Zyngier S, Robinson P, Schlotterlein M, Sullivan-Mort G: Health belief model: Evaluating marketing promotion in a public vaccination program. J Nonprofit Publ Sector Mark 2011, 23(2):134-157.
• [42]Oscarsson MG, Dahlberg A, Tyden T: Midwives at youth clinics attitude to HPV vaccination and their role in cervical cancer prevention. Sex Reprod Healthc 2011, 2(4):137-142.
• [43]Gottvall M, Tyden T, Larsson M, Stenhammar C, Hoglund AT: Challenges and opportunities of a new HPV immunization program Perceptions among Swedish school nurses. Vaccine 2011, 29(28):4576-4583.
• [44]Kahn JA, Rosenthal SL, Tissot AM, Bernstein DI, Wetzel C, Zimet GD: Factors influencing pediatricians’ intention to recommend human papillomavirus vaccines. Ambul Pediatr 2007, 7(5):367-373.
• [45]Hughes CC, Jones AL, Feemster KA, Fiks AG: HPV vaccine decision making in pediatric primary care: A semi-structured interview study. BMC Pediatr 2011, 11:74.
• [46]Hilton S, Hunt K, Bedford H, Petticrew M: School nurses’ experiences of delivering the UK HPV vaccination programme in its first year. BMC Infect Dis 2011, 11:226.
• [47]Cooper Robbins SC, Bernard D, McCaffery K, Brotherton JM, Skinner S: “I just signed”: Factors influencing decision-making for school-based HPV vaccination of adolescent girls. Health Psychol 2010, 29(6):618-625.
• [48]Gordon D, Waller J, Marlow LAV: Attitudes to HPV vaccination among mothers in the British Jewish community: Reasons for accepting or declining the vaccine. Vaccine 2011, 29(43):7350-7356.
• [49]Marlow LAV, Wardle J, Waller J: Attitudes to HPV vaccination among ethnic minority mothers in the UK: An exploratory qualitative study. Hum Vaccin 2009, 5(2):105-110.
• [50]Olshen E, Woods ER, Austin SB, Luskin M, Bauchner H: Parental acceptance of the human papillomavirus vaccine. J Adolesc Health 2005, 37(3):248-251.
• [51]Mays RM, Sturm LA, Zimet GD: Parental perspectives on vaccinating children against sexually transmitted infections. Soc Sci Med 2004, 58(7):1405-1413.
• [52]Toffolon-Weiss M, Hagan K, Leston J, Peterson L, Provost E, Hennessy T: Alaska Native parental attitudes on cervical cancer, HPV and the HPV vaccine. Int J Circumpolar Health 2008, 67(4):363-373.
• [53]Dempsey AF, Abraham LM, Dalton V, Ruffin M: Understanding the reasons why mothers do or do not have their adolescent daughters vaccinated against human papillomavirus. Ann Epidemiol 2009, 19(8):531-538.
• [54]Constantine NA, Jerman P: Acceptance of human papillomavirus vaccination among Californian parents of daughters: a representative statewide analysis. J Adolesc Health 2007, 40(2):108-115.
• [55]Bair RM, Mays RA, Sturm LA, Zimet GD: Acceptability of the human papillomavirus vaccine among Latina mothers. J Pediatr Adolesc Gynecol 2008, 21(6):329-334.
• [56]Waller J, Marlow LAV, Wardle J: Mothers’ attitudes towards preventing cervical cancer through human papillornavirus vaccination: A qualitative study. Cancer Epidemiol Biomark Prev 2006, 15(7):1257-1261.
• [57]Brabin L, Roberts SA, Kitchener HC: A semi-qualitative study of attitudes to vaccinating adolescents against human papillomavirus without parental consent. BMC Public Health 2007, 7:20.
• [58]Williams K, Forster A, Marlow L, Waller J: Attitudes towards human papillomavirus vaccination: A qualitative study of vaccinated and unvaccinated girls aged 17–18 years. J Fam Plann Reprod Health Care 2011, 37(1):22-25.
• [59]Brown K, Kroll J, Hudson M, Ramsay M, Green J, Long S, Vincent C, Fraser G, Sevdalis N: Factors underlying parental decisions about combination childhood vaccinations including MMR: A systematic review. Vaccine 2010, 28(26):4235-4248.
• [60]Mishra A, Graham JE: Risk, choice and the ‘girl vaccine’: Unpacking human papillomavirus (HPV) immunisation. Health, Risk Soc 2012, 14(1):57-69.
• [61]Stretch R, McCann R, Roberts SA, Elton P, Baxter D, Brabin L: A qualitative study to assess school nurses’ views on vaccinating 12–13 year old school girls against human papillomavirus without parental consent. BMC Public Health 2009, 9:254.
• [62]Hilton S, Smith E: “I thought cancer was one of those random things. I didn’t know cancer could be caught … ”: Adolescent girls’ understandings and experiences of the HPV programme in the UK. Vaccine 2011, 29(26):4409-4415.
• [63]Sussman AL, Helitzer D, Sanders M, Urquieta B, Salvador M, Ndiaye K: HPV and cervical cancer prevention counseling with younger adolescents: Implications for primary care. Ann Fam Med 2007, 5(4):298-304.
• [64]Hutson SP, Dorgan KA, Duvall KL, Garrett LH: Human papillomavirus infection, vaccination, and cervical cancer communication: the protection dilemma faced by women in southern Appalachia. Women Health 2011, 51(8):795-810.
• [65]Allen JD, De Jesus M, Mars D, Tom L, Cloutier L, Shelton RC: Decision-making about the HPV vaccine among ethnically diverse parents: Implications for health communications. J Oncol 2012, 401979. doi: 10.1155/2012/401979. Epub 2011 Nov 15
• [66]Friedman AL, Shepeard H: Exploring the knowledge, attitudes, beliefs, and communication preferences of the general public regarding HPV: Findings from CDC focus group research and implications for practice. Health Educ Behav 2007, 34(3):471-485.
• [67]Shafer A, Cates JR, Diehl SJ, Hartmann M: Asking mom: formative research for an HPV vaccine campaign targeting mothers of adolescent girls. J Health Commun 2011, 16(9):988-1005.
• [68]Cooper Robbins SC, Bernard D, McCaffery K, Brotherton J, Garland S, Skinner SR: “Is cancer contagious?”: Australian adolescent girls and their parents: making the most of limited information about HPV and HPV vaccination. Vaccine 2010, 28(19):3398-3408.
• [69]Wood F, Morris L, Davies M, Elwyn G: What constitutes consent when parents and daughters have different views about having the HPV vaccine: qualitative interviews with stakeholders. J Med Ethics 2011, 37(8):466-471.
• [70]Brabin L, Stretch R, Roberts SA, Elton P, Baxter D, McCann R: The school nurse, the school and HPV vaccination: a qualitative study of factors affecting HPV vaccine uptake. Vaccine 2011, 29(17):3192-3196.
• [71]Robbins SCC, Bernard D, McCaffery K, Skinner SR: ‘It’s a logistical nightmare!’ Recommendations for optimising human papillomavirus school-based vaccination experiences. Sex Health 2010, 7(3):271-278.
• [72]Rambout L, Tashkandi M, Hopkins L, Tricco AC: Self-reported barriers and facilitators to preventive human papillomavirus vaccination among adolescent girls and young women: a systematic review. Prev Med 2014, 58:22-32.
• [73]Holman D, Benard V, Roland K, Watson M, Liddon N, Stokley S: Barriers to human papillomavirus vaccination among US adolescents: a systematic review of the literature. JAMA Pediatr 2013, 168(1):76-82.
• [74]Polonijo AN, Carpiano RM: Social inequalities in adolescent human papillomavirus (HPV) vaccination: a test of fundamental cause theory. Soc Sci Med 2013, 82:115-125.
• [75]Humiston S, Serwint J, Szilagyi P, Vincelli P, Dhepyasuwan N, Rand C, Schaffer S, Blumkin A, Curtis CR: Increasing adolescent immunization rates in primary care: strategies physicians use and would consider implementing. Clin Pediatr 2013, 52(8):710-720.
• [76]Boyce T, Holmes A: Addressing health inequalities in the delivery of the human papillomavirus vaccination programme: examining the role of the school nurse. PLoS ONE / Public Libr Sci 2012, 7(9):e43416.
• [77]Thomas SB, Quinn SC: The Tuskegee Syphilis Study, 1932 to 1972: implications for HIV education and AIDS risk education programs in the black community. Am J Public Health 1991, 81(11):1498-1505.
• [78]National Health Service: HPV vaccine in the clear. 2010. http://www.nhs.uk/news/2009/09September/Pages/Cervical-cancer-vaccine-QA.aspx webcite