Primary studies included in this systematic review

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Primary study

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An increase in HPV-related knowledge and vaccination intent among parental and non-parental caregivers of adolescent girls, age 9-17 years, in Appalachian Pennsylvania.

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Journal Journal of cancer education : the official journal of the American Association for Cancer Education
Year 2012
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This article is included in 4 Systematic reviews Systematic reviews (4 references)

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A theory and community-based educational intervention was designed to increase HPV-related knowledge and intent to vaccinate adolescent girls, against human papillomavirus (HPV) in Appalachia, a region with high cervical cancer incidence and mortality. An HPV educational session was conducted with immediate pre-/post-test questionnaires and 1-month follow-up telephone interview. McNemar tests and paired t tests evaluated change in individual knowledge variables and change in overall knowledge and intent to vaccinate against HPV, respectively. Of 117 attendees, 38 (32.5%) were parents of vaccine-eligible daughters and 79 (67.5%) non-parental caregivers. HPV-related knowledge increased for all participants (p < 0.0001) and among parents (p < 0.0001). Intent to vaccinate daughters within 1 month increased among parents (p = 0.002). Of nine (23.7%) parents who completed the follow-up interview, 100% reported the intervention as helpful and 44.4% reported that they started vaccination. Our education intervention was associated with increased HPV-related knowledge and intent to vaccinate girls in Appalachia against HPV.

Primary study

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Vaccine Policy and Arkansas Childhood Immunization Exemptions: A Multi-Year Review

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Journal American Journal of Preventive Medicine
Year 2012
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND:An increase in total vaccine exemptions (medical, philosophic, and religious) occurred in Arkansas after a 2003 legislation added a philosophic category and used a new process for vaccine exemptions. By legislative requirement, the Arkansas Department of Health monitored exemptions through the 2009–2010 school year. PURPOSE:The goal of the study was to determine the prevalence of vaccine exemption in 2003–2010 compared to the number of requests prior to the legislation enacted in 2003. METHODS:Exemptions were calculated by school-age category using raw numbers of exemptions, total estimates of the population by age level, enrollment numbers for students in public and private schools, and in enrolled college students born after 1957. Exemptions also were analyzed by school district, grade level, type of exemption, and particular vaccine exemption requested. RESULTS:Overall exemptions continued to rise each year, with an average increase of 23.1% annually. Medical exemptions declined from an average of 21.3% of all exemptions before to an average of 4.8% thereafter. The greatest increase in number of exemptions was observed among college students. The highest total rate of exemptions per precollegiate student population was <1.3%. When exemption requests were categorized, most (79%) were for exemptions from “all vaccines.” The most common single exempted vaccine was MMR (measles, mumps, rubella.)CONCLUSIONS:Since philosophic exemptions were codified in 2003 in Arkansas, the number and rate of vaccine exemptions continue to progressively increase. However, vaccine-preventable disease clusters have not yet been linked to or identified in any population with a high rate of vaccine exemptions.

Primary study

Unclassified

Designing Messages to Motivate Parents To Get Their Preteenage Sons Vaccinated Against Human Papillomavirus

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Journal Perspectives on Sexual and Reproductive Health
Year 2012
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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CONTEXT:Human papillomavirus (HPV) vaccine, licensed for use in 9-–26-year-olds, is most effective when given before sexual activity begins. HPV causes genital warts, is associated with several cancers and disproportionately affects racial and ethnic minorities. Parents are typically unaware of male HPV vaccine; messages that might motivate them to get their preteenage sons vaccinated are unexplored. METHODS: Messages promoting vaccination of preteenage boys were designed and tested in 2009 and 2010. Five focus groups were conducted with 29 black parents of 11–12-year-old boys, recruited through three churches and a middle school in North Carolina, and a racially diverse sample of 100 parents of 9–13-year-old boys in a university-based adolescent health clinic was interviewed. A constant comparison method was used to code transcripts and interpret themes. Chi-square and t tests or analyses of variance were used to assess differences in quantitative data. RESULTS:Focus group parents knew little about HPV in males. Although concerned about safety and cost, parents supported vaccination for their sons. They wanted to see racial diversity and both parents in motivational materials. In interviews, 89% of parents reported never having heard of male HPV vaccine. The largest proportion said that a message stressing the prevalence and possible consequences of HPV infection was the most motivating (32%); the design favored by the largest proportion (43%) showed two parents. CONCLUSIONS:Messages that may most motivate parents to get preteenage boys vaccinated against HPV focus on infection risk and include images of parents with their sons.

Primary study

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Vaccination Policies and Rates of Exemption from Immunization, 2005–2011

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Journal New England Journal of Medicine
Year 2012
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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We computed the annual change in the rates of nonmedical exemptions from school immunization requirements and compared these rates between states that allow philosophical exemptions and states that allow only religious exemptions. We also compared states with respect to how difficult it is to obtain nonmedical exemptions because of certain administrative procedures. We used data compiled by the Centers for Disease Control and Prevention (CDC) for school years 2005–2006 through 2010–2011.1 State-specific categories of difficulty in obtaining exemptions were based on several factors: whether completion of a standardized form was permissible, as opposed to a letter from a parent; where the parent obtained the form (i.e., school vs. health department); whether the form had to be notarized; and whether a letter from a parent, if required, needed to be worded a specific way, resulting in extra effort on the part of the parent.

Primary study

Unclassified

Evaluation of a radionovela to promote HPV vaccine awareness and knowledge among Hispanic parents.

Journal Journal of community health
Year 2011
Links Pubmed DOI PubMed Central

This article is included in 5 Systematic reviews Systematic reviews (5 references)

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Hispanic women have more than a 1.5-fold increased cervical cancer incidence and mortality compared to non-Hispanic white women in the United States. The Centers for Disease Control recommends the HPV vaccine for females at ages 11 and 12 years, though it is approved for females aged 9-26 to protect against the primary types of high-risk HPV (HPV-16 and HPV-18) that cause approximately 70% of cervical cancer cases. Few culturally-tailored Spanish HPV vaccine awareness programs have been developed. This study evaluates the efficacy of a Spanish radionovela as an educational tool. Rural Hispanic parents of daughters aged 9-17 (n = 88; 78 mothers and 10 fathers) were randomized to listen to the HPV vaccine radionovela or to another public service announcement. Participants completed a 30 min pretest posttest questionnaire. Parents who listened to the HPV radionovela (intervention group) scored higher on six knowledge and belief items. They were more likely to confirm that HPV is a common infection (70% vs. 48%, P = .002), to deny that women are able to detect HPV (53% vs. 31%, P = .003), to know vaccine age recommendations (87% vs. 68%, P = .003), and to confirm multiple doses (48% vs. 26%, P = .03) than control group parents. The HPV vaccine radionovela improved HPV and HPV vaccine knowledge and attitudes. Radionovela health education may be an efficacious strategy to increase HPV vaccine awareness among Hispanic parents.

Primary study

Unclassified

HPV and HPV Vaccine Education Intervention: Effects on Parents, Healthcare Staff, and School Staff

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Journal Cancer Epidemiology Biomarkers & Prevention
Year 2011
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND:Increasing knowledge about human papillomavirus (HPV) and HPV vaccine is a potentially important way to increase vaccination rates, yet few education interventions have addressed these topics. We report the results of an education intervention targeting three key groups who have contact with adolescent females. METHODS:We conducted HPV education intervention sessions during 2008 and 2009 in Guilford County, North Carolina. Parents (n = 376), healthcare staff (n = 118), and school staff (n = 456) attended the one-time sessions and completed self-administered surveys. Analyses used mixed regression models to examine the intervention's effects on participants' self-rated HPV knowledge, objectively assessed HPV and HPV vaccine knowledge, and beliefs about HPV vaccine. RESULTS:Participants had relatively low levels of objectively assessed HPV and HPV vaccine knowledge prior to the intervention. The education intervention increased self-rated HPV knowledge among all three key groups (all P < 0.001), and objectively assessed knowledge about many aspects of HPV and HPV vaccine among healthcare and school staff members (all P < 0.05). Following the intervention, more than 90% of school staff members believed HPV and HPV vaccine education is worthwhile for school personnel and that middle schools are an appropriate venue for this education. Most parents (97%) and school staff members (85%) indicated they would be supportive of school-based vaccination clinics. CONCLUSIONS:Our education intervention greatly increased HPV and HPV vaccine knowledge among groups influential to the HPV vaccination behaviors of adolescent females. IMPACT: Education interventions represent a simple yet potentially effective strategy for increasing HPV vaccination and garnering stronger support for school-based vaccination clinics.

Primary study

Unclassified

Parental attitudes toward human papillomavirus vaccination: evaluation of an educational intervention, 2008.

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Journal Journal of health communication
Year 2011
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This article is included in 4 Systematic reviews Systematic reviews (4 references)

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The authors' objectives were to improve human papillomavirus (HPV) vaccine educational materials and to determine whether parents who received those materials had improved attitudes about the vaccine. Pretests were sent to 411 parents of girls 11-18 years of age who had not yet received the HPV vaccine. The authors then randomly assigned 270 respondents to an intervention (educational flyer and posttest) or comparison (posttest only) group. The authors conducted a mixed-method analysis of intervention group feedback on improving the flyer and used paired t tests and analysis of covariance to describe within- and between-group attitude changes. The overall posttest response rate was 76%. Among intervention group respondents (n = 131), 88% had a positive impression of the flyer, and 43% reported that it made them more likely to vaccinate their daughters with HPV vaccine in the future. Parents who received the flyer also showed a statistically significant increase in mean attitude scores regarding perceived HPV vaccine safety and access to HPV vaccine information; mean scores also increased among the comparison group, but the changes were not statistically significant. Educational materials improved HPV vaccine knowledge and attitudes among parents and might have helped motivate some parents to have their daughters vaccinated.

Primary study

Unclassified

Attitudes and Beliefs of Parents Concerned About Vaccines: Impact of Timing of Immunization Information

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Journal Pediatrics
Year 2011
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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OBJECTIVES:To determine if giving vaccine-information materials before the 2-month vaccination visit to mothers with concerns about vaccine safety positively changed their attitudes and beliefs about vaccine safety. METHODS:Mothers who indicated concerns about infant vaccinations were recruited from 2 separate sites in Tennessee and California and were given vaccine information at 1 of 3 times: during a prenatal visit; a 1-week postpartum well-child visit; or a 2-month vaccination visit. A separate group of concerned mothers was assigned to be followed longitudinally at all 3 time points and was analyzed separately. The mothers reviewed a new vaccine-information pamphlet and Vaccine Information Statements (VIS) from the Centers for Disease Control and Prevention. Attitudes and beliefs about immunization were assessed both before and after the review of materials with written surveys. RESULTS:A total of 272 mothers with immunization concerns participated in the study. After review of the materials, mothers in all groups were significantly more likely to respond positively to questions and statements supporting the safety and importance of vaccines. Mothers who received this information at earlier visits were not significantly more likely to respond positively than mothers who received the information at the child's 2-month vaccination visit; however, participating mothers did indicate a preference for receiving vaccine information before the first vaccination visit. CONCLUSIONS:Distribution of the vaccine-information pamphlet and Vaccine Information Statements significantly improved attitudes about vaccination regardless of at what visit they were provided. Allowing adequate time to review vaccine information, even if done at the vaccination visit, may benefit concerned mothers.

Primary study

Unclassified

Rural parents' vaccination-related attitudes and intention to vaccinate middle and high school children against influenza following educational influenza vaccination intervention.

Journal Human vaccines
Year 2011
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This article is included in 3 Systematic reviews Systematic reviews (3 references)

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OBJECTIVE: This study examined changes in parental influenza vaccination attitudes and intentions after participating in school-based educational influenza vaccination intervention. METHODS: Participants were drawn from three counties participating in a school-based influenza vaccination intervention in rural Georgia (baseline N=324; follow-up N=327). Data were collected pre- and post-intervention from phone surveys with parents' with children attending middle- and high-school. Attitudes, beliefs, vaccination history, and intention to vaccinate were assessed. RESULTS: Parents who participated in the intervention conditions reported significantly higher influenza vaccination rates in their adolescents, relative to a control group, as well as increased vaccination rates post-intervention participation relative to their baseline rates. Intervention participants reported greater intention to have their adolescent vaccinated in the coming year compared to control parents. Significant differences were observed post intervention in perceived barriers and benefits of vaccination. CONCLUSIONS: These findings suggest that a school-delivered educational influenza vaccination intervention targeting parents and teens may influence influenza vaccination in rural communities. Future influenza vaccination efforts geared toward the parents of rural middle- and high-school students may benefit from addressing barriers and benefits of influenza vaccination.

Primary study

Unclassified

Randomised cluster trial to support informed parental decision-making for the MMR vaccine.

Journal BMC public health
Year 2011
Links Pubmed DOI PubMed Central

This article is included in 3 Systematic reviews Systematic reviews (3 references)

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BACKGROUND: In the UK public concern about the safety of the combined measles, mumps and rubella [MMR] vaccine continues to impact on MMR coverage. Whilst the sharp decline in uptake has begun to level out, first and second dose uptake rates remain short of that required for population immunity. Furthermore, international research consistently shows that some parents lack confidence in making a decision about MMR vaccination for their children. Together, this work suggests that effective interventions are required to support parents to make informed decisions about MMR. This trial assessed the impact of a parent-centred, multi-component intervention (balanced information, group discussion, coaching exercise) on informed parental decision-making for MMR. METHODS: This was a two arm, cluster randomised trial. One hundred and forty two UK parents of children eligible for MMR vaccination were recruited from six primary healthcare centres and six childcare organisations. The intervention arm received an MMR information leaflet and participated in the intervention (parent meeting). The control arm received the leaflet only. The primary outcome was decisional conflict. Secondary outcomes were actual and intended MMR choice, knowledge, attitude, concern and necessity beliefs about MMR and anxiety. RESULTS: Decisional conflict decreased for both arms to a level where an 'effective' MMR decision could be made one-week (effect estimate = -0.54, p < 0.001) and three-months (effect estimate = -0.60, p < 0.001) post-intervention. There was no significant difference between arms (effect estimate = 0.07, p = 0.215). Heightened decisional conflict was evident for parents making the MMR decision for their first child (effect estimate = -0.25, p = 0.003), who were concerned (effect estimate = 0.07, p < 0.001), had less positive attitudes (effect estimate = -0.20, p < 0.001) yet stronger intentions (effect estimate = 0.09, p = 0.006). Significantly more parents in the intervention arm reported vaccinating their child (93% versus 73%, p = 0.04). CONCLUSIONS: Whilst both the leaflet and the parent meeting reduced parents' decisional conflict, the parent meeting appeared to enable parents to act upon their decision leading to vaccination uptake.