Ford Carol A, English Abigail, Davenport Amy F, Stinnett Amy J
University of North Carolina; CB 7225, Chapel Hill, NC 27599-7225, USA.
J Adolesc Health. 2009 Jun;44(6):568-74. doi: 10.1016/j.jadohealth.2008.11.015. Epub 2009 Feb 12.
To increase understanding of the policy, legal, and financial issues influencing efforts to achieve high rates of adolescent vaccination.
We conducted semistructured telephone interviews with 49 key informants in nine states, five jurisdictions, and at the national level. We elicited: (a) experiences with human papillomavirus (HPV) and meningococcal vaccine programs; (b) perspectives on policy, legal, and financing issues influencing adolescent vaccine program effectiveness; and (c) strategies to increase rates of adolescent vaccination. Common and informative themes were identified by content analyses.
Participants reported that barriers to adolescent vaccination included: public concerns (insufficient knowledge, negative attitudes, safety concerns, controversy); practitioner concerns (insufficient knowledge or ambivalence about recommendations); delivery issues (insufficient access to or use of healthcare, vaccines not at healthcare site or part of routine care); minor consent issues; cost/financing issues; and lack of coordination in timing of vaccine recommendations, supply, and financing. Many barriers and promising strategies for overcoming them vary depending on adolescent age. For example, concerns about providing vaccines to prevent sexually transmitted diseases are less frequent with respect to older adolescents; issues of consent vary widely between 11 and 25 years of age; and financial barriers/potential solutions vary by age. We develop a framework to address policy, legal, and financial issues influencing adolescent vaccination based on adolescent age.
A comprehensive description of factors influencing adolescent vaccination reveals variation based on age. A framework that incorporates this complexity may enhance strategies to increase rates of vaccine delivery to adolescent populations.
增进对影响实现青少年高疫苗接种率努力的政策、法律和财务问题的理解。
我们对九个州、五个司法管辖区以及国家层面的49名关键信息提供者进行了半结构化电话访谈。我们了解到：(a) 人乳头瘤病毒（HPV）和脑膜炎球菌疫苗计划的经验；(b) 对影响青少年疫苗计划有效性的政策、法律和融资问题的看法；以及(c) 提高青少年疫苗接种率的策略。通过内容分析确定了常见且有参考价值的主题。
参与者报告称，青少年疫苗接种的障碍包括：公众担忧（知识不足、态度消极、安全担忧、争议）；从业者担忧（对建议的知识不足或态度矛盾）；实施问题（获得或使用医疗保健服务不足、疫苗不在医疗保健场所或不是常规护理的一部分）；未成年人同意问题；成本/融资问题；以及疫苗建议、供应和融资时间安排缺乏协调。许多障碍以及克服这些障碍的有前景策略因青少年年龄而异。例如，对于年龄较大的青少年，对提供预防性传播疾病疫苗的担忧较少；同意问题在11至25岁之间差异很大；财务障碍/潜在解决方案因年龄而异。我们基于青少年年龄制定了一个框架，以解决影响青少年疫苗接种的政策、法律和财务问题。
对影响青少年疫苗接种因素的全面描述揭示了基于年龄的差异。一个纳入这种复杂性的框架可能会增强提高青少年人群疫苗接种率的策略。
