Parent-Level Barriers and Facilitators to HPV Vaccine Implementation in Santo Domingo, Dominican Republic

Liebermann, Erica; Devanter, Nancy Van; Gúzman, Natalia Frías; Ompad, Danielle C.; Shirazian, Taraneh; Healton, Cheryl

doi:10.1007/s10900-020-00830-y

Cited by 8 publications

(20 citation statements)

References 9 publications

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“…Participants were concerned about the information available through the internet (unreliable sources), which are often the most common source accessible and in uential to this population of young parents. These ndings were consistent with other studies using CFIR expressing frustration about messages of opposition from religious groups because linked sexuality with young girls [31], the sources of information and in uences such as the internet [40].…”

Section: Discussionsupporting

confidence: 91%

“…Another factor mentioned was the high cost of the vaccine for those who were uninsured, although in Puerto Rico the health insurances are required to cover this vaccine and almost all are eligible for vaccine for children program. The cost of the vaccine as a barrier to patients was also mentioned in previous studies using CFIR [31,40]. Other studies also mentioned the barrier of the cost associated with the infrastructure, storage, and administration [22,30].…”

Section: Discussionmentioning

confidence: 97%

“…Participants demonstrated their knowledge and awareness about the factors that promote vaccine hesitancy in parents. Some of the factors documented by key informants interviewed and mentioned in previous articles by Hispanic and African American parent-level focus groups included: unawareness [39] and misinformation about the bene ts [40] of the HPV vaccine, stigma attributed to an STI-vaccine related [30,39], vaccine distrust due to long-term effects [39][40][41], effectiveness [41], among others. Additionally, this facilitator is consistent with what has been found in a previous study using CFIR [29]; however, the reasons identi ed were not the same.…”

Section: Discussionmentioning

confidence: 99%

“…Especially in those in the rst line of contact (school and clinical nurses, pediatricians) documented that they know their population, know their barriers to upto-date vaccination. These qualities make them a strong source of in uence to parents [40,42].…”

Section: Discussionmentioning

confidence: 99%

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Implementation of the human papillomavirus school-entry requirement in Puerto Rico: barriers and facilitators using the consolidated framework for implementation research

Colón‐López

Soto-Abreu

Medina-Laabes

et al. 2021

Human Vaccines & Immunotherapeutics

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Background: In 2018, Puerto Rico (PR) enacted a Human papillomavirus (HPV) vaccine school-entry requirement for students ages 11 to 12. Using the Consolidated Framework for Implementation Research (CFIR), we aimed to identify potential barriers and facilitators of this implementation.Methods: We conducted a total of 36 qualitative interviews with key informants who were stakeholders from different organizations (Department of Health, Schools, Healthcare Providers, and Community organizations in favor of the requirement) from July 2018 to January 2020. Three researchers performed the interview guide, data coding, and analysis according to the CFIR framework. We evaluated construct rating variability between the organizations to determine barriers and facilitators.Results: The strongest facilitators determined under the CFIR construct include the stakeholder's awareness of the parent's and student's needs to meet the HPV school-entry requirement. Other facilitators include initiatives for school-entry policies and the relative advantage of this requirement over different strategies. The strongest barriers included the cost for private providers to administer the HPV vaccine, the negative in uence of social media about the vaccine, which affected parents' acceptance, and the lack of school nurses as available staff resources for the school entry requirement.Conclusions: Findings from this study can be used to improve implementation (adaptations/modi cations) and inform other US states and countries in earlier stages of consideration of the adoption of similar immunization policies. Most barriers can be modi able with the implementation of educational programs/training across schools, considering that they are the rst line of response to parents of this school entry requirement. Contributions To The LiteratureThis study is one of the few that explored the barriers and facilitators of the HPV school-entry vaccine requirement using the CFIR framework. This valuable tool leads us to evaluate the implementation process from multiple settings and stages.Results have shown the importance of capacity training to school staff and health stakeholders to boost parents' capacity and engage parents who are unaware or hesitant to vaccinate. These ndings provide new information about challenges that emerged in the implementation. These factors that support or impede the process will help guide other implementers that want to replicate HPVschool entry policies in other jurisdictions or countries.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Implementation of the human papillomavirus school-entry requirement in Puerto Rico: barriers and facilitators using the consolidated framework for implementation research

Colón‐López

Soto-Abreu

Medina-Laabes

et al. 2021

Human Vaccines & Immunotherapeutics

View full text Add to dashboard Cite

show abstract

“…22,23 However, similar to our findings, the main barrier reflected to explain the participants' position has been the lack of information. 12,24,25 Participants in this study were most interested to know about : the pros and cons of the HPV vaccine, duration of vaccine effectiveness and potential side effects in order to make an informed decision about vaccinating against HPV.…”

Section: Discussionmentioning

confidence: 99%

Understanding Parents’ Views Toward the Newly Enacted HPV Vaccine School Entry: A Qualitative Study

Colón‐López¹,

Medina-Laabes²,

Abreu³

et al. 2021

Preprint

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Background: Human papillomavirus vaccine (HPV) is an important tool for prevention of HPV- related cancers. In Puerto Rico, the Secretary of Health established a school entry requirement of at least 1 dose of HPV vaccination in girls and boys aged 11 and 12 years taking effect in August 2018. Our study aims to examine parents’ views and opinions of the process of implementing the new HPV vaccination school entry policy in Puerto Rico, and understand barriers and facilitators related to this HPV immunization policy. Methods: Three focus group (n=12) and eight in-depth semi-structured interviews were performed, along with a survey. The interviews were recorded and transcript by our staff members. Through a thematic analysis were identified emergent themes. Results: Lack of information in relation to the policy were the theme most mentioned in the interviews. Moreover, participants expressed that previous negative experiences, from friends or family member, adverse effect and the lack of communication from school and healthcare providers deter them from the decision of vaccinated their kids. Barriers in the process of soliciting an exemption was discussed. Conclusion: Most barriers mentioned by participants who express hesitation about vaccinating their kids with the HPV vaccine, are modifiable providing parents information about the mandate’s implementation, and educational materials that address their concerns related to the vaccine’s side effects. Implementation of this efforts, however, need to consider impacting the school (teachers, principal directors, and administrative staff), the government and parents. This multilevel approach will help to improve the dissemination of information about HPV vaccination in order to clarify doubts and misinformation among hesitant parents.

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User Engagement on a Novel Educational Health Intervention Aimed at Increasing HPV Vaccine Uptake in Hong Kong: a Qualitative Study

Chau

Butt

et al. 2022

J Canc Educ

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HPV vaccine uptake rates are suboptimal in Hong Kong. A multi-disciplinary school-based HPV health-promotion programme (MDL-SHPVP) aimed at raising HPV knowledge levels and increasing vaccine uptake has therefore been developed to address vaccine hesitancy. This qualitative study was conducted to collect user feedback and identify the strengths and limitations of the educational resources developed for the programme among key vaccination stakeholders including adolescent girls and their mothers. Twenty-six participants including eight mother-daughter dyads, four teachers, three social workers, two school principals and one school nurse were recruited. To cater to the diverse audience, ten educational videos, three animations, a digital game and one booklet were developed for the programme and distributed to the participants for viewing. Semi-structured interviews were then conducted to collect feedback on the acceptability and effectiveness of the resources. Interviews were audio-recorded, transcribed verbatim, and resulting data were thematically analysed. Three themes and six sub-themes emerged. The educational materials were well-received and effective in raising HPV-knowledge levels, generating confidence in vaccine safety and effectiveness, and boosting vaccination intention. Some doubts regarding vaccine necessity remained, and recommendations for improving resource presentation and accessibility were provided. Our findings suggest that the MDL-SHPVP has the potential to boost HPV vaccine uptake. Future studies may explore educational interventions which target to increase not only HPV vaccination intention but also the sense of urgency so as to encourage timely vaccination for adolescents at the ideal age. Study findings may also provide directions for the development of future health education interventions.

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Parent-Level Barriers and Facilitators to HPV Vaccine Implementation in Santo Domingo, Dominican Republic

Cited by 8 publications

References 9 publications

Implementation of the human papillomavirus school-entry requirement in Puerto Rico: barriers and facilitators using the consolidated framework for implementation research

Implementation of the human papillomavirus school-entry requirement in Puerto Rico: barriers and facilitators using the consolidated framework for implementation research

Understanding Parents’ Views Toward the Newly Enacted HPV Vaccine School Entry: A Qualitative Study

User Engagement on a Novel Educational Health Intervention Aimed at Increasing HPV Vaccine Uptake in Hong Kong: a Qualitative Study

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