Barriers and facilitators to HPV vaccination of young women in high-income countries: a qualitative systematic review and evidence synthesis
Barriers and facilitators to HPV vaccination of young women in high-income countries: a qualitative systematic review and evidence synthesis
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DOI：
10.1186/1471-2458-14-700
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发表时间：
2014-07-09
影响因子：
4.5
通讯作者：
Audrey, Suzanne
中科院分区：
文献类型：
--
作者：
Ferrer, Harriet Batista;Trotter, Caroline;Audrey, Suzanne
背景资料：建议青春期年轻女性在初次性行为前接种人乳头瘤病毒（HPV）疫苗，以降低宫颈癌相关的死亡率和发病率。了解影响年轻女性HPV疫苗接种决策的因素是很重要的，这样就可以制定有效的干预措施，解决不太可能接受HPV vaccine.Methods的人群中摄取的障碍：我们进行了一个定性的系统评价和证据合成，以研究高收入国家年轻女性HPV疫苗接种相关的决策。对从成立到2012年3月的数据库进行了全面搜索，以确定报告关键利益攸关方（包括决策者、参与方案的专业人员、父母和年轻妇女）观点的合格研究。在不同层次的社会生态模型（政策，社区，组织，人际和个人内部）的影响因素的疫苗摄取进行了检查。年轻女性是否接受HPV疫苗接种主要取决于政策制定者，医疗保健专业人员和父母的决定。这些决定是由以下因素决定的：财务考虑;与性活动有关的社会规范和价值观，以及对疫苗接种计划和医疗保健提供者的信任。财政限制可以通过全民医疗保健系统在交付点免费提供HPV疫苗来克服。在卫生保健环境中，卫生保健专业人员关于是否推荐疫苗的判断可能会限制年轻妇女获得疫苗，而不管她自己的信仰和偏好如何。父母可能会决定不允许他们的女儿接种疫苗，基于文化或宗教观念的性activity.Conclusions：的HPV疫苗的摄取的障碍有影响年轻女性未来的性，身体和生殖健康。解决接种疫苗障碍的干预措施应针对社会生态模式的适当和多层次。信任问题需要关于HPV疫苗接种计划的明确、可获得、有时在文化上适当的信息。虽然年轻女性是HPV疫苗接种计划的核心，但她们的观点在定性文献中代表性不足。今后的研究应考虑青年妇女对同意和决策的看法和参与情况。
Background: Vaccination against Human Papillomavirus (HPV) is recommended for adolescent young women prior to sexual debut to reduce cervical cancer related mortality and morbidity. Understanding factors affecting decision-making of HPV vaccination of young women is important so that effective interventions can be developed which address barriers to uptake in population groups less likely to receive the HPV vaccine.Methods: We undertook a qualitative systematic review and evidence synthesis to examine decision-making relating to the HPV vaccination of young women in high-income countries. A comprehensive search of databases from inception to March 2012 was undertaken to identify eligible studies reporting the perspectives of key stakeholders including policy makers, professionals involved in programme, parents, and young women. Factors affecting uptake of the vaccine were examined at different levels of the socio-ecological model (policy, community, organisational, interpersonal and intrapersonal).Results: Forty-one studies were included. Whether young women receive the HPV vaccine is strongly governed by the decisions of policy makers, healthcare professionals, and parents. These decisions are shaped by: financial considerations; social norms and values relating to sexual activity, and; trust in vaccination programmes and healthcare providers. Financial constraints may be overcome through universal healthcare systems offering the HPV vaccine free at the point of delivery. In the healthcare setting, judgements by healthcare professionals about whether to recommend the vaccine may restrict a young woman's access to the vaccine irrespective of her own beliefs and preferences. Parents may decide not to allow their daughters to be vaccinated, based on cultural or religious perceptions about sexual activity.Conclusions: Barriers to the uptake of the HPV vaccine have implications for young women's future sexual, physical and reproductive health. Interventions to address barriers to uptake of the vaccine should target appropriate, and multiple, levels of the socio-ecological model. Issues of trust require clear, accessible, and sometimes culturally appropriate, information about the HPV vaccination programme. Although young women are central to the HPV vaccination programme, their views are underrepresented in the qualitative literature. Future research should consider young women's perceptions of, and involvement in, consent and decision-making.