Peterson Caryn E, Silva Abigail, Holt Hunter K, Balanean Alexandrina, Goben Abigail H, Dykens Jon Andrew
School of Public Health, University of Illinois at Chicago, Chicago, IL, USA.
University of Illinois Cancer Center, Chicago, IL, USA.
Cancer Causes Control. 2020 Sep;31(9):801-814. doi: 10.1007/s10552-020-01323-y. Epub 2020 Jun 14.
Compared to US urban populations, rural residents have a higher incidence of HPV-related cancer and lower HPV vaccine coverage. This study determined what is known about barriers and facilitators to vaccine uptake in US rural settings.
A scoping review was conducted to describe individual, interpersonal, organizational, and community/societal barriers and facilitators to HPV vaccine initiation and completion among US rural populations and to identify gaps in the current research. A systematic search was conducted using PubMed/MEDLINE and CINAHL databases.
A total of 1,083 abstracts were reviewed and 13 articles met the inclusion criteria. Major themes at the individual-level included caregiver and vaccine-recipient demographics, other immunizations received, pap test history, awareness/knowledge of cervical cancer, HPV vaccine, or HPV infection, attitudes and motivation to vaccinate, STD diagnosis, sexual behavior, cervical cancer history, contraceptive use, and cancer fatalism. Interpersonal themes focused on provider influence and communication, caregiver and peer influence, and social support for the caregiver. At the organizational-level, themes included health insurance, provider characteristics, school-based interventions, and provider/practice-based interventions. The only community/societal factor examined related to a social marketing campaign.
Additional research is needed on interpersonal, organizational, and community/societal factors, as well as an expanded focus on rural males. Future studies should account for rural heterogeneity by expanding the geographic areas studied. Our findings detailing factors found to be associated with HPV vaccine uptake will help inform future clinical, health services, and community research, as well as interventions and policy efforts.
与美国城市人口相比，农村居民人乳头瘤病毒（HPV）相关癌症的发病率更高，HPV疫苗接种率更低。本研究确定了美国农村地区HPV疫苗接种的障碍和促进因素。
进行了一项范围综述，以描述美国农村人口中HPV疫苗接种开始和完成的个人、人际、组织以及社区/社会层面的障碍和促进因素，并找出当前研究中的差距。使用PubMed/MEDLINE和CINAHL数据库进行了系统检索。
共审查了1083篇摘要，13篇文章符合纳入标准。个人层面的主要主题包括照顾者和疫苗接种者的人口统计学特征、接受的其他免疫接种、巴氏试验史、对宫颈癌、HPV疫苗或HPV感染的认识/了解、接种疫苗的态度和动机、性传播疾病诊断、性行为、宫颈癌病史、避孕措施使用以及癌症宿命论。人际层面的主题集中在医疗服务提供者的影响和沟通、照顾者和同伴的影响以及对照顾者的社会支持。在组织层面，主题包括医疗保险、医疗服务提供者特征、基于学校的干预措施以及基于医疗服务提供者/医疗机构的干预措施。唯一审查的社区/社会因素与一项社会营销活动有关。
需要对人际、组织和社区/社会因素进行更多研究，同时扩大对农村男性的关注。未来的研究应通过扩大研究地理区域来考虑农村地区的异质性。我们详细阐述与HPV疫苗接种相关因素的研究结果将有助于为未来的临床、卫生服务和社区研究以及干预措施和政策努力提供信息。
