Katz Ingrid T, Bogart Laura M, Fu Chong Min, Liu Yingna, Cox Joanne E, Samuels Ronald C, Chase Tami, Schubert Pamela, Schuster Mark A
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Massachusetts General Hospital, Center for Global Health, Boston, MassachusettsMA, USA.
BMC Public Health. 2016 Aug 25;16(1):874. doi: 10.1186/s12889-016-3529-4.
Despite recommendations that 11-12-year-olds receive the full three-shot Human papillomavirus (HPV) vaccine series, national HPV immunization coverage rates remain low. Disparities exist, with Blacks and Latinos being less likely than Whites to complete the series. We aimed to identify and compare barriers to HPV immunization perceived by healthcare providers, Black and Latino adolescents, and their caregivers to inform a clinic-based intervention to improve immunization rates.
We conducted semi-structured interviews between March and July 2014 with Black and Latino adolescents (n = 24), their caregivers (n = 24), and nurses (n = 18), and 2 focus groups with 18 physicians recruited from two pediatric primary care clinics. Qualitative protocol topics included: general perceptions and attitudes towards vaccines; HPV knowledge; and perceived individual and systems-level barriers affecting vaccine initiation and completion.
Themes were identified and organized by individual and systems-level barriers to HPV immunization. Adolescents and their caregivers, particularly Blacks, expressed concerns about HPV being an untested, "newer" vaccine. All families felt they needed more information on HPV and found it difficult to return for multiple visits to complete the vaccine series. Providers focused on challenges related to administering multiple vaccines simultaneously, and perceptions of parental reluctance to discuss sexually transmitted infections.
Optimizing HPV immunization rates may benefit from a multi-pronged approach to holistically address provider, structural, and individual barriers to care. Further research should examine strategies for providing multiple modalities of support for providers, including a routinized system of vaccine promotion and delivery, and for addressing families' concerns about vaccine safety and efficacy.
尽管建议11至12岁的儿童接种完整的三针人乳头瘤病毒(HPV)疫苗系列,但全国HPV免疫接种覆盖率仍然很低。存在差异,黑人和拉丁裔比白人完成该系列疫苗接种的可能性更小。我们旨在识别并比较医疗保健提供者、黑人和拉丁裔青少年及其照顾者所感知到的HPV免疫接种障碍,以为基于诊所的干预措施提供信息,以提高免疫接种率。
2014年3月至7月,我们对黑人和拉丁裔青少年(n = 24)、他们的照顾者(n = 24)和护士(n = 18)进行了半结构化访谈,并与从两家儿科初级保健诊所招募的18名医生进行了2次焦点小组访谈。定性协议主题包括:对疫苗的总体看法和态度;HPV知识;以及影响疫苗开始接种和完成接种的个人和系统层面的障碍。
通过HPV免疫接种的个人和系统层面障碍确定并组织了主题。青少年及其照顾者,尤其是黑人,对HPV是一种未经测试的“新型”疫苗表示担忧。所有家庭都觉得他们需要更多关于HPV的信息,并且发现很难多次返回诊所完成疫苗系列接种。提供者关注与同时接种多种疫苗相关的挑战,以及对父母不愿讨论性传播感染的看法。
优化HPV免疫接种率可能受益于多管齐下的方法,以全面解决提供者、结构和个人护理障碍。进一步的研究应考察为提供者提供多种支持方式的策略,包括常规的疫苗推广和接种系统,以及解决家庭对疫苗安全性和有效性的担忧。