Ecole des Hautes Etudes en Santé Publique, 15 Av. du professeur Léon Bernard, 35043 Rennes, France.
CNRS, Université Paris-Sorbonne, GEMASS, 57 rue Pouchet, Paris 75017, France; Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, 19-21 Bd. Jean Moulin 13005, Marseille, France.
Vaccine. 2021 Jan 15;39(3):521-528. doi: 10.1016/j.vaccine.2020.12.019. Epub 2020 Dec 13.
The contemporary crisis of trust in vaccines has severely impaired acceptance of the HPV vaccine, especially in France, where its uptake culminated at 23.7% in 2018 (complete course at age 16). Physicians' recommendations strongly influence its acceptance/refusal. Our study sought to understand the decision processes leading physicians to recommend this vaccine (or not).
Qualitative interviews of French physicians (general practitioners, gynecologists, and pediatricians). We first randomly selected doctors in a national register of medical professionals and then resorted to snowballing to build a convenience sample. We coded the interviews in a thematic analysis built both inductively and deductively from our research questions and data.
Two thirds of the participants (19/28) were favorable to HPV vaccination, some (4) opposed it, while the others were hesitant about recommending it. In explaining their opinions, most participants mentioned that they trusted the stakeholders within the vaccination system: the less trust they had, the more critical they were of the vaccine and the more importance they attributed to patients' opinions. We identified three different ways they interacted with patients on this topic: informing and convincing; adapting to patients' opinions; refusing compromise about vaccination. Crossing these various themes, we found 5 types of physicians: dissidents (mistrustful of the healthcare system and HPV vaccine), hesitant (finding it difficult to make up their minds about this vaccination), laissez-faire (letting patients decide by themselves, but very favorable to HPV vaccination), educator (very favorable), and uncompromising vaccinators (refusing debate). Pediatricians were overrepresented among the latter two types.
Physicians' judgment was influenced by their trust in the stakeholders involved in designing and implementing the HPV vaccination strategy. In this sense, doctors did not differ substantially from laypeople. They were, nonetheless, strongly influenced by their professional style and ethos.
当前，人们对疫苗的信任危机严重影响了 HPV 疫苗的接种率，尤其是在法国，其接种率在 2018 年达到顶峰，为 23.7%（16 岁时完成全程接种）。医生的建议强烈影响着 HPV 疫苗的接种/拒绝率。本研究旨在了解促使医生推荐（或不推荐）该疫苗的决策过程。
对法国医生（全科医生、妇科医生和儿科医生）进行定性访谈。我们首先从国家医疗专业人员登记处随机选择医生，然后通过滚雪球的方式构建方便样本。我们采用主题分析法对访谈进行编码，该方法从我们的研究问题和数据中同时进行归纳和演绎。
三分之二的参与者（19/28）赞成 HPV 疫苗接种，有些（4 人）反对，而其他人则对推荐该疫苗犹豫不决。在解释他们的意见时，大多数参与者提到他们信任疫苗接种系统中的利益相关者：他们对疫苗的信任度越低，对疫苗的批评就越严厉，对患者意见的重视程度就越高。我们确定了他们在这个话题上与患者互动的三种不同方式：告知和说服；适应患者的意见；拒绝在疫苗接种问题上妥协。交叉这些主题，我们发现了 5 种类型的医生：反对者（不信任医疗保健系统和 HPV 疫苗）、犹豫不决者（对这种疫苗犹豫不决）、放任自流者（让患者自己决定，但非常赞成 HPV 疫苗）、教育者（非常赞成）和不妥协的疫苗接种者（拒绝辩论）。儿科医生在后面两种类型中占比较大。
医生的判断受到他们对设计和实施 HPV 疫苗接种策略的利益相关者的信任程度的影响。从这个意义上说，医生与普通大众并没有太大区别。然而，他们强烈受到他们的专业风格和职业道德的影响。
