Impact of a shared medical decision-making aid on patient decisional conflict regarding human papillomavirus vaccination: a mixed-methods study.

In the United States, human papillomavirus (HPV) vaccination among 27- to 45-y-olds (mid-adults) is recommended based on shared clinical decision making with a health care provider. We developed a patient decision aid tool to support the implementation of this mid-adult HPV vaccination guideline. The purpose of this study was to evaluate the effect of a patient decision aid tool for HPV vaccination, HPV DECIDE, compared with an information fact sheet among mid-adults who have not received the HPV vaccine. Participants were recruited between December 2023 and January 2024. We used a randomized Solomon, 4-group, pretest/posttest design with mid-adults aged 27 to 45 y who were unvaccinated for HPV and balanced based on sex (n = 612). The primary outcome was decisional conflict. Intermediate outcomes included knowledge, behavioral expectancies, self-efficacy, and perceived risk. Variables were measured using validated scales. Pretest sensitization was not present; intervention and control groups were compared. Fixed-effects inverse-variance weighting was used to pool effect estimates and determine meta-analytic statistical significance across tests with and without pretest controls. Participants in the intervention group had significantly lower total decisional conflict scores (B = -3.58, P = 0.007) compared with the control group. Compared with the control group, participants in the intervention group showed higher knowledge (B = 0.48, P = 0.020), greater intention to receive (B = 0.196, P = 0.049) and discuss the HPV vaccine (B = 0.324, P ≤ 0.001), and greater self-efficacy about HPV vaccine decision making (B = 3.28, P = 0.043). There were no statistically significant results for perceived risks of HPV infection. The HPV DECIDE tool for mid-adult HPV vaccination shows promise for immediate reductions in decisional conflict and improvement in knowledge, intentions, and self-efficacy about the HPV vaccine. Future studies are warranted to evaluate the effectiveness of this patient decision aid tool in real-world settings. Shared clinical decision making is recommended for HPV vaccination with mid-adults.A patient decision aid for HPV vaccination reduced decisional conflict for mid-adults.The HPV vaccine patient decision aid was acceptable to mid-adults.

Does the use of an online decision aid (DA) about fertility preservation (FP), in addition to standard counselling by a specialist in reproductive medicine, reduce decisional conflict compared to standard counselling alone? Female cancer patients who could make use of the online DA had a significantly lower short-term decisional conflict score. Nowadays, female cancer patients have several options for preserving fertility, but having to decide whether to opt for FP within a short time frame after cancer diagnosis and before the start of treatment is challenging. According to previous studies focussing mainly on breast cancer patients, decisional conflict among these women is high, and they have expressed the need for additional support. The study was a randomized controlled trial including female cancer patients who were referred by their treating oncologist to a specialist in reproductive medicine for fertility counselling. Participants were randomly assigned to the control group (counselling only) or to the intervention group (counselling and additional use of the online DA immediately after counselling). Recruitment was ongoing from July 2016 to December 2017 at eight fertility centres in Switzerland and Germany. The online DA was developed by an interdisciplinary team of specialists in reproductive medicine, gynaecologists, oncologists and psychologists. Of 79 recruited participants, 59 completed the first assessment and could therefore be enrolled in the study. They were asked to complete an online questionnaire at three time points: at T1, after counselling (control group, n = 27) or after counselling and the additional use of the DA (intervention group, n = 24); at T2, 1month later (N = 41: control group, n = 23; intervention group, n = 18); and at T3, 12months later (N = 37: control group, n = 20; intervention group, n = 17). The survey comprised questions about fertility-related knowledge, attitude towards FP, willingness to undergo FP and socio-demographic data, as well as the decisional conflict and decisional regret scales. All participants showed low decisional conflict scores. Women who used the online DA in addition to counselling (intervention group) showed a significantly lower total score on the Decisional Conflict Scale (DCS) compared to the control group at T1 (P = 0.008; M = 12.15, SD = 4.38; 95% CI, 3.35-20.95) and at T2 (P = 0.043; M = 9.35, SD = 4.48; 95% CI, 0.31-18.38). At T3, the mean total score of the DCS was still lower in the intervention group compared to the control group; however, this group difference was no longer significant (P = 0.199, M = 6.86, SD = 5.24; 95% CI, -3.78 to 17.51). The majority of participants had already made a decision regarding FP (yes or no) at T1 (72.5%): 91.7% in the intervention group compared to 55.6% in the control group (P = 0.014). Those who had decided already at T1 showed significantly lower decisional conflict (P = 0.007; M = 13.69, SD = 4.89; 95% CI, 3.86-23.52). The average number of DA sessions per user was 2.23, and 80.8% of the participants completed the DA's value clarification exercises. Participants in the intervention group were satisfied with the DA and would recommend it to other patients. The recruitment of participants was challenging because of the emotionally difficult situation patients were in. This led to the limited sample size for final analysis. Education levels were high in two-thirds of the participants. It is difficult to say whether the DA would be equally effective in women with a lower educational background. There is evidence that the DA served as a helpful complement to the decision-making process for young female cancer patients qualifying for FP. This is, to our knowledge, the first randomized controlled trial evaluating a DA targeted at patients with several cancer types and in a language other than English (i.e. German). This study contributes to extending the range of the still limited number of DAs in the context of FP. The study was supported by a research grant of the Swiss Cancer Research. The authors declare that no competing interests exist. Clinicaltrials.gov, trial no. NCT02404883. 19 March 2015. 4 July 2016.

BackgroundEnsuring vaccine access is a prerequisite for promoting human papilloma virus (HPV) vaccination. Although HPV vaccination efforts in China have primarily focused on young females, little research has examined the difficulties they face in accessing the HPV vaccine and its impact on vaccine uptake and intention. This study analyzed the overall perception of access difficulties to HPV vaccines, as well as three specific vaccine access difficulties, and examined their influencing factors among female university students in China. We also examined the associations between overall and specific vaccine access difficulties and HPV vaccination intention and uptake.MethodsA cross-sectional study was conducted among female university students from eight universities or colleges in Zhejiang Province, China, from December 2020 to January 2021. Logistic regressions were used to identify factors associated with both overall and specific perceptions of vaccine access difficulties. A multivariable logistic regression model and a multiple linear regression model were used to explore factors influencing HPV vaccine uptake and vaccine intention by controlling for potential confounding factors, respectively.ResultsA total of 3176 female university students were included in this study. The proportion of female students perceiving overall difficulty in obtaining HPV vaccine, as well as difficulties in accessing the desired type of HPV vaccine, HPV vaccination centers, and HPV vaccination information, were 60.6%, 57.7%, 60.7%, and 54.0%, respectively. Perceived overall difficulty in obtaining HPV vaccine, as well as difficulties in accessing the desired type of HPV vaccine, HPV vaccination centers, and HPV vaccination information were associated with HPV vaccine uptake and intention.ConclusionsChinese female university students generally perceived various difficulties in accessing HPV vaccine. It is crucial to improve access to HPV vaccine, optimize the layout and service quality of HPV vaccination centers, and enhance the dissemination and transparency of HPV vaccine information. More efforts are needed to provide a strong guarantee for HPV vaccination uptake among female university students.

Differences in knowledge, attitudes and intentions towards HPV vaccination among young adults from diverse socio-cultural groups in Israel: A cross-sectional study

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S. Cervical cancer (CC) is the most common HPV-associated cancer, and Korean Americans (KAs) experience one of the highest CC incidence and mortality rates among Asian Americans. Awareness and knowledge of HPV and HPV vaccine are essential in preventing HPV-associated cancers; however, studies emphasize low HPV awareness and knowledge among KAs. Although HPV causes cancers in both men and women, there exist misconceptions that the HPV vaccine is only for women and not for men. Furthermore, research on HPV vaccination among KAs has been conducted mostly among women. The health belief model (HBM) is a value-expectancy theory that is used to explain and predict individual changes in health behaviors and has been used in multiple studies that aimed to understand HPV vaccination behavior. Purpose: The purpose of this study is to develop an HBM guided text messaging program to increase HPV awareness, knowledge, and HPV vaccination among Korean young adults in the U.S. Methods: A total of 10 Korean young adults between the ages of 18 and 26 completed the mixed methods study. The survey examined HPV, HPV vaccine, and cervical cancer awareness and knowledge, beliefs, and vaccination intention. The qualitative interview with cognitive response testing (CRT) of the text messages, which were preconstructed based on previous literature and six constructs of HBM, allowed participants to provide feedback on the comprehension and emotional response to the messages, and any other recommendations to improve the content and delivery of the messages. Results: All participants (N=10) indicated to have never received the HPV vaccine and most participants had no intention to receive the HPV vaccine within one year. Although most of the participants were aware of HPV and HPV vaccine, overall knowledge of HPV, HPV vaccine, and cervical cancer were low. The interviews revealed that reasons for vaccine hesitancy and non-vaccination included cost, inconvenience, and low perceived susceptibility. Especially, there was low perception of the importance of HPV vaccination for males. Overall, findings from the CRT showed that there was a clear understanding of the preconstructed text messages. There was a consensus on the duration and timing of the messages and participants provided recommendations on the content, tone, and structure of the messages. Using the HBM, participants’ feedback on HPV awareness, knowledge, and vaccination intention, the text messaging library was revised and includes a total of 9 text messages over the four days. Conclusions: This study provides important insights into the development of an educational text messaging program among Korean young adults in the U.S. Current study will build a foundation for an educational mobile health program to help increase awareness and knowledge of HPV and HPV-associated cancers, as well as HPV vaccination intention, and impact HPV-associated cancer rates among KAs through vaccination in the long term. Citation Format: Min Jeong Jeon, Daisy Le. Development of an educational text messaging program to improve human papillomavirus awareness, knowledge, and vaccination intention among Korean young adults in the U.S. [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C101.

BackgroundIn France, human papillomavirus (HPV) vaccination coverage varies across socioeconomic levels.AimWe aimed at assessing HPV vaccine awareness, uptake and vaccination intention among adolescents in France.MethodsIn a cluster-randomised study, 13–15-year-old students in 61 French middle schools completed a web-based questionnaire. We used multivariable logistic regression to evaluate determinants of HPV vaccine awareness, self-reported uptake and vaccination intention among unvaccinated students and interaction terms to explore effects of visits to family physician and remembering school lessons on vaccination. The French deprivation index of school municipalities served as proxy for socioeconomic levels.ResultsAmong 6,992 participants, awareness was significantly associated with parental education (odds ratio (OR) = 0.82; 95% confidence interval (CI): 0.71–0.95), language spoken at home (OR = 0.59; 95% CI: 0.52–0.66) and deprivation level (OR = 0.57; 95% CI: 0.44–0.71), regardless of physician visit or school lessons. Vaccine uptake was associated with parental education without a recent physician visit (OR = 0.31; 95% CI: 0.16–0.59, vs OR = 0.64; 95% CI: 0.52–0.78 with a visit, interaction p = 0.045). Vaccination intention among unvaccinated was associated with deprivation level (moderate-low vs low) among students not remembering school lessons on vaccination (OR = 0.17; 95% CI: 0.05-0.62, vs OR = 0.93; 95% CI: 0.51–1.67 remembering school lessons, interaction p = 0.022). Parental education was associated with vaccination intention among students reporting a physician visit (OR = 0.41; 95% CI: 0.26–0.64 vs OR = 1.05; 95% CI: 0.50–2.20 without a visit, interaction p = 0.034).ConclusionOur results suggest that healthcare and school could promote vaccination and mitigate social inequalities in HPV vaccination coverage.

Decision aids are useful adjuncts to clinical consultations for women considering breast reconstruction. This study compared the impact of two online decision aids, the Breast RECONstruction Decision Aid (BRECONDA) and the Alberta Health Services (AHS) decision aid, on decisional conflict, decisional satisfaction, and decisional regret. This randomized controlled trial included 60 women considering whether or not to undergo breast reconstruction. Two online decision aids, the AHS and the BRECONDA, were compared using randomized two-arm equal allocation. Participants responded to questionnaires at baseline, after the first and second consultations, and at 6 weeks and 6 months after deciding to, or not to, undergo reconstruction. Change in decisional conflict scores was compared between the BRECONDA and the AHS decision aid. Secondary outcomes included decisional regret and decisional satisfaction. Both groups were similar in demographic, clinical, and behavioral characteristics. Women spent more time consulting the BRECONDA in comparison to women using the AHS decision aid (56.7 ± 53.8 minutes versus 28.4 ± 27.2 minutes; P < 0.05). Decisional conflict decreased (P < 0.05), and decisional satisfaction improved over time in both groups (P < 0.05). However, there were no differences based on the type of decision aid used (P > 0.05). Both decision aids had a similar reduction in decisional regret (P > 0.05). Decision aids decrease decisional conflict and improve decisional satisfaction among women considering breast reconstruction. Physicians should therefore offer patients access to decision aids as an adjunct to breast reconstruction consultations to help patients make an informed decision. Therapeutic, I.

This study examined associations between general attitudes toward seeking medical care, attitudes about vaccines/fear of shots, and human papillomavirus (HPV) vaccine uptake and intentions in college women. Hypothesized associations were framed by the Theory of Planned Behavior (TPB). Participants (N = 330, mean age = 18.9 years, 75% White) completed a one-time survey. The majority (61%; n = 201) had received ≥1 HPV vaccine dose. Hierarchical logistic regression examined relationships between attitudes and vaccine uptake. Pearson correlation coefficients and Kruskal-Wallis tests examined associations between attitudes and vaccine intentions. Results were partially consistent with the TPB. In the final model, perceived benefits, but not fear of shots, were associated with vaccine uptake. Among the unvaccinated, perceived benefits, but not fear of shots, were associated with vaccine intentions. Provider recommendation was the strongest predictor of vaccine uptake. Findings suggest interventions incorporating discussion of perceived benefits and provider recommendation may improve HPV vaccine receipt among college women.

The purpose of the current study was to identify predisposing, enabling, and need-based factors associated with human papillomavirus (HPV) or HPV vaccination intentions among ethnoracial minority men who have sex with men (MSM) and gender expansive natal males. This was a secondary analysis of survey data from 299 Black and Hispanic MSM and gender expansive young (aged 18–30 years) adults living in the USA. Variable selection was informed by Anderson’s model of healthcare utilization. Outcomes were self-reported HPV vaccination and vaccine intentions. Less than half of the sample (45.5%) reported initiating (i.e., receiving at least 1 dose) HPV vaccination. Hierarchical multiple regression was used to identify relevant theoretical predictors. Among those who were unvaccinated, 14.2% were unlikely, 56.3% were undecided, and 29.4% likely to initiate HPV vaccination within the next 12 months. More favorable vaccine attitudes (adjusted prevalence ratio [aPR] = 1.55; 95% CI: 1.12–2.15), past year routine check-up (aPR = 1.50; 95% CI: 1.14–1.97), and ever being diagnosed with anogenital warts (aPR = 1.55; 95% CI: 1.12–2.15) were independently associated with the probability of HPV vaccination. Several enabling factors (e.g., testing for sexually transmitted infections) were not associated with HPV vaccination, suggesting routine missed opportunities. There were no associations between predictor variables and HPV vaccine intentions. Targeted efforts are needed to decrease anal cancer disparities experienced by ethnoracial minority MSM. Leveraging enabling factors already present this population (e.g., STI testing and pre-exposure prophylaxis use) are potential targets for interventions to increase the reach of HPV vaccination.

Female students in tertiary vocational institutions, particularly in regions with limited medical resources, play a crucial role in grassroots healthcare and cervical cancer prevention. Understanding their awareness of human papillomavirus (HPV), willingness to receive the HPV vaccine, and perceived barriers is essential for promoting vaccination equity. A cross-sectional study was conducted from March to April 2023 among female vocational students in southern Xinjiang, China, using a standardized electronic questionnaire. The collected data included sociodemographic characteristics, HPV-related knowledge, vaccination willingness, and barriers. Descriptive statistics and logistic regression analyses were performed. Among 1,157 participants, only 37.0% had heard of HPV, and 28.9% were aware of the HPV vaccine. Univariate analysis revealed that non-medical majors and students from rural areas had significantly lower odds of having adequate knowledge (OR = 0.450, 95% CI: 0.360-0.563, p < 0.001; and OR = 0.458, 95% CI: 0.350-0.600, p < 0.001; respectively). In contrast, higher parental education (junior college/bachelor's degree or above) was associated with 58% greater odds of higher awareness (OR = 1.576, 95% CI: 1.119-2.219, p = 0.009). Additionally, students who had not heard of HPV or the HPV vaccine were significantly less likely to possess sufficient awareness (OR = 0.230, 95% CI: 0.181-0.293, p < 0.001; and OR = 0.194, 95% CI: 0.150-0.250, p < 0.001; respectively). Further, multivariate analysis confirmed that major, residence, prior HPV awareness, and vaccine awareness were independent predictors of knowledge level (all p < 0.001). Specifically, medical students demonstrated greater knowledge regarding HPV typing (41.8% vs. 25.6%) and optimal vaccination timing (16.7% vs. 7.9%) than non-medical students. Regarding vaccination attitudes, only 32.1% of the overall students expressed willingness to receive the HPV vaccine, with higher willingness rates observed among medical students (44.6% vs. 19.7%), urban residents (47.8% vs. 27.9%), and individuals who were aware of HPV (50.5%) or the HPV vaccine (59.3%). Actual uptake of HPV vaccine, however, remained low (1.1%-4.5%). Regression analysis showed that medical students had 2.4 times higher vaccination intent, and urban residents exhibited 1.7 times higher intent, compared to their counterparts. Furthermore, awareness was positively correlated with willingness to vaccinate, whereas an earlier age at sexual debut was linked to reduced vaccination intent (OR = 0.57, 95% CI: 0.37-0.89; p = 0.02). The main barrier to vaccination was the low perceived risk associated with young age (45.4%); medical students reported greater concerns about access and cost, whereas psychological barriers, such as worries about side effects and doubts about safety and efficacy, were common across all groups. HPV awareness and vaccination uptake among female vocational students in southern Xinjiang remain low. Targeted health education initiatives should focus on non-medical students, rural populations, and individuals from lower socioeconomic backgrounds. Enhancing vaccine accessibility and affordability through institutional and governmental efforts is critical to improving vaccination coverage in this population.

Educational interventions may be a strategy to increase human papillomavirus (HPV) vaccination among female university students, but studies to date have shown mixed results. This study evaluated the effect of MeFirst, an individually tailored, online educational intervention, on HPV vaccine-related knowledge, vaccination intention, and uptake among previously unvaccinated female university students. All female students aged 18-26 years who reported being unvaccinated against HPV at a midwestern university were invited via email to enroll. Participants completed an online survey that assessed baseline HPV vaccine-related knowledge, attitudes and vaccination intention. Participants (n = 661) were then randomized to receive either an educational website automatically tailored to their baseline survey responses (MeFirst intervention) or a standard CDC information factsheet on HPV vaccine (control). Vaccine uptake and repeat knowledge and attitude measures were assessed with online surveys 3 months following the intervention and analyzed using logistic regression models. HPV vaccine uptake was similar in both the MeFirst and control groups at 3 months following the intervention (p = 0.98). Three months after the intervention, the proportion of participants with high knowledge regarding HPV vaccination increased from baseline (32% to 50%; p < 0.0001) but the proportion with favorable intention was unchanged. We found that an individually tailored, online educational tool had similar effects as a nontailored factsheet on HPV-related knowledge, intention to HPV undergo vaccination, and HPV vaccine uptake among previously unvaccinated female university students.

ABSTRACTWe developed and tested the acceptability and utility of a novel HPV vaccination decision aid (DA) among Chinese young women aged 18–26 years and parents of adolescent girls aged 9–17 years. From March to May 2016, a total of 101 parents plus 109 young women completed baseline surveys assessing their HPV vaccination knowledge, decision self-efficacy, decision conflict, and HPV vaccination intention. Two weeks after receiving the DA, 84 (83.2%) parents and 92 (84.4%) young women completed re-assessments. Chi-square tests or t-tests were performed to compare the before-and-after differences. Cohen’s d was calculated to indicate the effect size. After reading the DA, both participating young women’s and parents’ knowledge of HPV vaccination (Cohen’s d = 0.62 among young women and d = 0.59 among parents) and decision self-efficacy (d = 0.38 among young women and d = 0.59 among parents) significantly increased. Both young women’s and parents’ decision conflict (d = −0 · 98 and −1.06) significantly decreased. The proportion of young women intending to receive HPV vaccination and parents deciding to vaccinate daughters against HPV significantly increased (p < 0 · 0001). The DA showed good acceptability and utility facilitating HPV vaccination decision-making for most Chinese young women and parents of adolescent girls. Further randomized controlled trials of this tool are essential.

BackgroundHuman papillomavirus (HPV) poses a significant public health concern, being linked to various serious health conditions such as cancer and genital warts. Despite the vaccine’s safety, efficacy, and availability through...

Objective: To examine human papillomavirus (HPV) vaccine intent and the effect of an educational intervention on vaccine uptake among female college students. Participants: Females aged 18 to 26 attending a university health service gynecology clinic (n = 256). Methods: Participants were randomized to receive either HPV-specific education with a mailed reminder or standard care. Predictors of HPV vaccine intent and uptake at 6 months following enrollment were identified. Results: At baseline, 41% intended to undergo HPV vaccination. Participants who were currently sexually active and lacked supplemental health insurance had decreased intent. Perceived parental approval regarding HPV vaccination, perceived vulnerability to HPV infection, and belief in health benefits of HPV vaccine were associated with increased intent. HPV vaccine uptake was low (5.5%) and did not differ by study group. However, baseline intent was significantly associated with HPV vaccine uptake. Conclusions: Interventions to increase HPV vaccine uptake in college students should address HPV-related beliefs and broader barriers to vaccination.

IntroductionThe human papillomavirus (HPV) causes the most common sexually transmitted infection globally. Vaccination can prevent persistent infections of certain genotypes, linked to increased cancer risks, including cervical cancer. However, vaccine...