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Prevention of Human Papillomavirus in a school-based setting
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. (Sexual and Reproductive Health)
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to examine beliefs about human papillomavirus (HPV) prevention, especially vaccination, among parents, immigrant women, adolescents and school nurses, and to promote primary prevention among adolescents.

The methods used in the thesis were focus group interviews, individual interviews, a web-based questionnaire, and finally, a randomised controlled intervention study.

The immigrant women were largely in favour of HPV prevention, although barriers, such as logistic difficulties, and cultural or gender norms were found. Parents’ decision concerning vaccination of their daughters depended on several factors. Regardless of their final choice, they made the decision they believed was in the best interest of their daughter. The benefits outweighed the risks for parents choosing to vaccinate while parents declining made the opposite judgement. The majority of the school nurses reported that the governmental financial support given because of the vaccination programme had not been used for the intended purpose. Three out of four nurses had been contacted by parents who raised questions regarding the vaccine; most were related to side effects. The educational intervention had favourable effects on the adolescents’ beliefs regarding HPV prevention, especially among those with an immigrant background. Furthermore, the intention to use condom as well as actual vaccination rates among girls was slightly increased by the intervention.

Trust in the governmental recommendations and the amounts of information given are important factors in the complex decision about HPV vaccination. Attention given to specific needs and cultural norms, as well as the possibility to discuss HPV vaccination with the school nurse and provision of extra vaccination opportunities at a later time are all strategies that might facilitate participation in the school-based HPV vaccination programme. School nurses need sufficient resources, knowledge and time to meet parents’ questions and concerns. The vaccinations are time-consuming and the governmental financial support needs to be used as intended, for managing the vaccination programme. A school-based intervention can have favourable effects on the beliefs and actual actions of young people and may possibly thus, in the long term, decrease the risk for HPV-related cancer.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. , 85 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1138
Keyword [en]
Human papillomavirus, HPV, vaccination, cervical cancer, school nurse, school health, immigrants, parents, adolescents, belief, attitude, decision, prevention, public health, randomised controlled trial, intervention, focus group interviews, vaccine hesitancy
National Category
Nursing
Research subject
Medical Science; Caring Sciences
Identifiers
URN: urn:nbn:se:uu:diva-263252ISBN: 978-91-554-9354-7 (print)OAI: oai:DiVA.org:uu-263252DiVA: diva2:858043
Public defence
2015-11-20, Gustavianum, Auditorium Minus, Akademigatan 3, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Funder
Swedish Cancer Society, 130744
Available from: 2015-10-29 Created: 2015-09-29 Last updated: 2015-11-10
List of papers
1. Immigrant women’s experiences and views on the prevention of cervical cancer: a qualitative study
Open this publication in new window or tab >>Immigrant women’s experiences and views on the prevention of cervical cancer: a qualitative study
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2015 (English)In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 18, no 3, 344-354 p.Article in journal (Refereed) Published
Abstract [en]

Background

Many Western countries have cervical cancer screening programmes and have implemented nation-wide human papillomavirus (HPV) vaccination programmes for preventing cervical cancer.

Objective

To explore immigrant women's experiences and views on the prevention of cervical cancer, screening, HPV vaccination and condom use.

Design

An exploratory qualitative study. The Health Belief Model (HBM) was used as a theoretical framework.

Setting and participants

Eight focus group interviews, 5–8 women in each group (average number 6,5), were conducted with 50 women aged 18–54, who studied Swedish for immigrants. Data were analysed by latent content analysis.

Results

Four themes emerged: (i) deprioritization of women's health in home countries, (ii) positive attitude towards the availability of women's health care in Sweden, (iii) positive and negative attitudes towards HPV vaccination, and (iv) communication barriers limit health care access. Even though the women were positive to the prevention of cervical cancer, several barriers were identified: difficulties in contacting health care due to language problems, limited knowledge regarding the relation between sexual transmission of HPV and cervical cancer, culturally determined gender roles and the fact that many of the women were not used to regular health check-ups.

Conclusion

The women wanted to participate in cervical cancer prevention programmes and would accept HPV vaccination for their daughters, but expressed difficulties in understanding information from health-care providers. Therefore, information needs to be in different languages and provided through different sources. Health-care professionals should also consider immigrant women's difficulties concerning cultural norms and pay attention to their experiences.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-166329 (URN)10.1111/hex.12034 (DOI)000353956900006 ()23252449 (PubMedID)
Available from: 2012-01-11 Created: 2012-01-11 Last updated: 2017-12-08Bibliographically approved
2. Trust versus concerns: how parents reason when they accept HPV vaccination for their young daughter
Open this publication in new window or tab >>Trust versus concerns: how parents reason when they accept HPV vaccination for their young daughter
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2013 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 118, no 4, 263-270 p.Article in journal (Refereed) Published
Abstract [en]

Background. From spring of 2012, human papillomavirus (HPV) vaccine against cervical cancer is offered free of charge to all girls aged 10-12 years through a school-based vaccination programme in Sweden. The aim of this study was to explore how parents reason when they accept HPV vaccination for their young daughter and also their views on HPV-related information. Methods. Individual interviews with parents (n = 27) of 11-12-year-old girls. The interviews were recorded, transcribed verbatim, and analysed using thematic content analysis. Results. Three themes emerged through the analysis: Trust versus concern, Responsibility to protect against severe disease, and Information about HPV and HPV vaccination is important. The parents expressed trust in recommendations from authorities and thought it was convenient with school-based vaccination. They believed that cervical cancer was a severe disease and felt a responsibility to protect their daughter from it. Some had certain concerns regarding side effects and vaccine safety, and wished for a dialogue with the school nurse to bridge the information gaps. Conclusions. Trust in the recommendations from authorities and a wish to protect their daughter from a severe disease outweighed concerns about side effects. A school-based vaccination programme is convenient for parents, and the school nurse has an important role in bridging information gaps. The findings from this qualitative study cannot be generalized; however, it can provide a better understanding of how parents might reason when they accept the HPV vaccination for their daughter.

Keyword
Decision-making, HPV vaccination, parents, school-based vaccination, school nurses
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-210566 (URN)10.3109/03009734.2013.809039 (DOI)000325527300009 ()23777602 (PubMedID)
Note

De två första författarna delar förstaförfattarskapet.

Available from: 2013-11-13 Created: 2013-11-11 Last updated: 2017-12-06Bibliographically approved
3. Not the right time: why parents refuse to let their daughters have the human papillomavirus vaccination
Open this publication in new window or tab >>Not the right time: why parents refuse to let their daughters have the human papillomavirus vaccination
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2014 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 4, 436-441 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To explore why parents refused to allow their 10- to 12-year-old daughters to receive the human papillomavirus (HPV) vaccination from the Swedish school-based vaccination programme.

Methods: Individual interviews with 25 parents who had been offered, but not consented to, their daughters receiving the HPV vaccination.

Results: Five themes emerged through the interviews: 1) she is just a little girl, 2) inadequate information, 3) not compatible with our way of life, 4) scepticism about the vaccination and 5) who can you trust? The parents made their decisions with their child’s best interests in mind. This was not considered the right time, and the vaccine as perceived as unnecessary and different from other vaccines. Mistrust in Government recommendations and a lack of evidence or information were other reasons to decline.

Conclusion: The decision-making process was complex. These parents preferred to wait until their daughter was older and believed the information they received from the school health system was insufficient. The results indicate that a more flexible HPV vaccination schedule may improve vaccine uptake. This includes more transparent information about the virus and the vaccine and information about who to contact to get the daughter vaccinated at a later date.

Keyword
Decision-making, Human papillomavirus, Parents, School, Vaccination programmes
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-214970 (URN)10.1111/apa.12545 (DOI)000332694700025 ()
Available from: 2014-01-09 Created: 2014-01-09 Last updated: 2017-12-06Bibliographically approved
4. School nurses’ attitudes and experiences regarding the human papillomavirus vaccination programme in Sweden: a population-based survey
Open this publication in new window or tab >>School nurses’ attitudes and experiences regarding the human papillomavirus vaccination programme in Sweden: a population-based survey
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2014 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, no 540, 1-9 p.Article in journal (Refereed) Published
Abstract [en]

Background: Sweden introduced a school-based human papillomavirus (HPV) vaccination programme in 2012, andschool nurses are responsible for managing the vaccinations. The aim of the present study was to investigate theattitudes and experiences of school nurses regarding the school-based HPV vaccination programme 1 year after itsimplementation.Methods: Data were collected using a web-based questionnaire in the spring of 2013, and 83.1% (851/1024) ofnurses responded.Results: There were strong associations between the nurses’ education about the HPV vaccine and their perceivedknowledge about the vaccine and a favourable attitude towards vaccination (both p < 0.001). School nurses whoreceived a high level of education were more likely to have a positive attitude to HPV vaccination compared withnurses with little education about HPV vaccination (adjusted odds ratio [OR] = 9.8; 95% confidence interval [CI]:3.797–25.132). Nurses with high perceived knowledge were more likely to have a positive attitude compared withthose with a low level of perceived knowledge (OR = 2.5; 95% CI: 1.299–4.955). If financial support from thegovernment was used to fund an additional school nurse, nurses were more likely to have a positive attitude thanif the financial support was not used to cover the extra expenses incurred by the HPV vaccination (OR = 2.1; 95% CI:1.051–4.010). The majority, 648 (76.1%), had been contacted by parents with questions about the vaccine, mostlyrelated to adverse effects. In addition, 570 (66.9%) stated that they had experienced difficulties with thevaccinations, and 337 (59.1%) of these considered the task to be time-consuming.Conclusions: A high level of education and perceived good knowledge about HPV are associated with a positiveattitude of school nurses to the HPV vaccination programme. Thus, nurses require adequate knowledge, education,skills and time to address the questions and concerns of parents, as well as providing information about HPV.Strategic financial support is required because HPV vaccination is a complex and time-consuming task.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keyword
Attitude, Experience, Human papillomavirus, School health, School nurse, Vaccination
National Category
Health Sciences
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-229189 (URN)10.1186/1471-2458-14-540 (DOI)000338959600002 ()24886332 (PubMedID)
Funder
Swedish Cancer Society, 130744
Available from: 2014-08-05 Created: 2014-08-05 Last updated: 2017-12-05Bibliographically approved
5. School-based intervention for the prevention of HPV among adolescents: a cluster randomised controlled study
Open this publication in new window or tab >>School-based intervention for the prevention of HPV among adolescents: a cluster randomised controlled study
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2016 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 1, e009875Article in journal (Refereed) Published
Abstract [en]

Objective: To improve primary prevention of human papillomavirus (HPV) infection by promoting vaccination and increased condom use among upper secondary school students. Design: Cluster randomised controlled trial. Setting: 18 upper secondary schools in Sweden. Participants: Schools were first randomised to the intervention or the control group, after which individual classes were randomised so as to be included or not. Of the 832 students aged 16 years invited to participate during the regular individual health interview with the school nurse, 751 (90.2%) agreed to participate and 741 (89.1%) students completed the study. Interventions: The intervention was based on the Health Belief Model (HBM). According to HBM, a person's health behaviour can be explained by individual beliefs regarding health actions. School nurses delivered 30 min face-to-face structured information about HPV, including cancer risks and HPV prevention, by propagating condom use and HPV vaccination. Students in the intervention and the control groups completed questionnaires at baseline and after 3 months. Main outcome measures: Intention to use condom with a new partner and beliefs about primary prevention of HPV, and also specifically vaccination status and increased condom use. Results: All statistical analyses were performed at the individual level. The intervention had a significant effect on the intention to use condom (p=0.004). There was also a significant effect on HBM total score (p=0.003), with a 2.559 points higher score for the intervention group compared to the controls. The influence on the HBM parameters susceptibility and severity was also significant (p<0.001 for both variables). The intervention also influenced behaviour: girls in the intervention group chose to have themselves vaccinated to a significantly higher degree than the controls (p=0.02). No harms were reported. Conclusions: The school-based intervention had favourable effects on the beliefs about primary prevention of HPV, and increased the HPV vaccination rates in a diverse population of adolescents.

Keyword
adolescents, HPV, prevention, randomised control trial, school-based
National Category
Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-263257 (URN)10.1136/bmjopen-2015-009875 (DOI)000369993900136 ()
Funder
Swedish Cancer Society, 130744
Available from: 2015-09-30 Created: 2015-09-29 Last updated: 2017-12-01Bibliographically approved

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Citation style
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  • Other locale
More languages
Output format
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