Barriers to HPV immunization among blacks and latinos: a qualitative analysis of caregivers, adolescents, and providers.
Barriers to HPV immunization among blacks and latinos: a qualitative analysis of caregivers, adolescents, and providers.
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DOI：
10.1186/s12889-016-3529-4
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发表时间：
2016-08-25
影响因子：
4.5
通讯作者：
Schuster MA
中科院分区：
文献类型：
--
作者：
Katz IT;Bogart LM;Fu CM;Liu Y;Cox JE;Samuels RC;Chase T;Schubert P;Schuster MA
尽管建议11-12岁的儿童接受完整的三针人乳头瘤病毒（HPV）疫苗系列，但全国HPV免疫接种率仍然很低。存在差异，黑人和拉丁美洲人比白人更不可能完成这个系列。我们的目的是确定和比较卫生保健提供者，黑人和拉丁美洲青少年及其护理人员对HPV免疫接种的障碍，以提供基于临床的干预措施，以提高免疫接种率。我们在2014年3月至7月期间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，并从两个儿科初级保健诊所招募了18名医生。定性方案主题包括：对疫苗的一般看法和态度; HPV知识;以及影响疫苗启动和完成的个人和系统层面障碍。主题被确定和组织的个人和系统层面的HPV免疫接种的障碍。青少年和他们的照顾者，特别是黑人，对HPV是一种未经测试的“更新”疫苗表示担忧。所有家庭都认为他们需要更多关于HPV的信息，并发现很难返回多次访问以完成疫苗系列。提供者重点关注与同时接种多种疫苗有关的挑战，以及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，结构和个人的护理障碍。进一步的研究应审查为提供者提供多种形式支持的战略，包括疫苗推广和提供的系统，以及解决家庭对疫苗安全性和有效性的关切。
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.