Preparing for human papillomavirus vaccine introduction in Kenya: implications from focus-group and interview discussions with caregivers and opinion leaders in Western Kenya
Preparing for human papillomavirus vaccine introduction in Kenya: implications from focus-group and interview discussions with caregivers and opinion leaders in Western Kenya
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DOI：
10.1186/1471-2458-14-855
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发表时间：
2014-08-16
影响因子：
4.5
通讯作者：
Dunne, Eileen F.
中科院分区：
文献类型：
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作者：
Friedman, Allison L.;Oruko, Kelvin O.;Dunne, Eileen F.
背景：宫颈癌每年夺去 275,000 名女性的生命；大多数死亡发生在低收入或中等收入国家。在肯尼亚，宫颈癌是育龄妇女癌症相关死亡的主要原因。肯尼亚公共卫生和卫生部制定了一项预防宫颈癌的综合战略，其中包括到 2015 年为青春期前的女孩接种人乳头瘤病毒 (HPV) 疫苗的计划。为了确定 HPV 疫苗的沟通和动员需求，本研究旨在了解肯尼亚西部四个农村社区的男性和女性护理人员以及社区领袖对 HPV 疫苗相关的看法和担忧。方法：我们与护理人员 (n = 56) 和 12 名护理人员一起开展了 5 个焦点小组活动。与意见领袖进行关键信息访谈，探讨9-12岁女孩子宫颈癌相关知识、态度和信仰，以及HPV疫苗接种的可接受性。四名研究人员独立审查了数据，并根据访谈指南中的问题和有机出现的主题开发了代码，然后通过小组共识过程对结果进行比较和协调。 结果：宫颈癌并未得到普遍认可，尽管人们普遍了解其症状。由于与癌症和生殖/生殖器官联系在一起，宫颈癌受到人们的恐惧和污名。只要得到值得信赖的机构认可并且首先引起社区的关注，预防宫颈癌的疫苗的总体可接受性就很高。出现了一些与疫苗安全性（例如，对生育力的影响）、计划意图和健康公平相关的担忧。结论：为了在肯尼亚成功引入疫苗，需要进行沟通和动员工作，以提高宫颈癌的认识；及时要求接种疫苗；解决健康公平问题和耻辱；并尽量减少潜在的阻力。政府领导人和社区影响者的明显认可可以让女孩和社区确信疫苗的安全性、有效性和益处。社区领导、家长和倡导者的参与对于消除耻辱并使宫颈癌与肯尼亚社区相关也至关重要。这些发现强调，在引入疫苗之前，需要为信息、教育和沟通进行充分的规划和资源。提出了沟通和社交营销策略的具体建议。
Background: Cervical cancer claims the lives of 275,000 women each year; most of these deaths occur in low-or middle-income countries. In Kenya, cervical cancer is the leading cause of cancer-related mortality among women of reproductive age. Kenya's Ministry of Public Health and Sanitation has developed a comprehensive strategy to prevent cervical cancer, which includes plans for vaccinating preteen girls against human papillomavirus (HPV) by 2015. To identify HPV vaccine communication and mobilization needs, this research sought to understand HPV vaccine-related perceptions and concerns of male and female caregivers and community leaders in four rural communities of western Kenya.Methods: We conducted five focus groups with caregivers (n = 56) and 12 key-informant interviews with opinion leaders to explore cervical cancer-related knowledge, attitudes and beliefs, as well as acceptability of HPV vaccination for 9-12 year-old girls. Four researchers independently reviewed the data and developed codes based on questions in interview guides and topics that emerged organically, before comparing and reconciling results through a group consensus process.Results: Cervical cancer was not commonly recognized, though it was understood generally in terms of its symptoms. By association with cancer and genital/reproductive organs, cervical cancer was feared and stigmatized. Overall acceptability of a vaccine that prevents cervical cancer was high, so long as it was endorsed by trusted agencies and communities were sensitized first. Some concerns emerged related to vaccine safety (e.g., impact on fertility), program intent, and health equity.Conclusion: For successful vaccine introduction in Kenya, there is a need for communication and mobilization efforts to raise cervical cancer awareness; prompt demand for vaccination; address health equity concerns and stigma; and minimize potential resistance. Visible endorsement by government leaders and community influencers can provide reassurance of the vaccine's safety, efficacy and benefits for girls and communities. Involvement of community leadership, parents and champions may also be critical for combatting stigma and making cervical cancer relevant to Kenyan communities. These findings underscore the need for adequate planning and resources for information, education and communication prior to vaccine introduction. Specific recommendations for communication and social-marketing strategies are made.