Practice-, provider-, and patient-level influences on U.S. Vietnamese parents’ decision-making about HPV vaccination for their adolescents Restricted; Files Only

Abstract

U.S. Vietnamese have high cervical cancer incidence rates and low human papillomavirus (HPV) vaccine uptake. Unfortunately, limited research has disaggregated the Asian-American population to examine mechanistic explanations for this disparity. Moreover, no prior work has leveraged a theory-guided health services framework to examine a range of health system-level factors influencing HPV vaccine uptake among U.S. Vietnamese. This dissertation study seeks to fill this gap in the literature and leverage a comprehensive health systems perspective (the P3 model) to identify practice-, provider- and patient-level determinants of U.S. Vietnamese parents’ HPV vaccine uptake for their adolescents.

We conducted three research studies. In Study 1, we conducted a systematic review of the literature to identify practice-, provider-, and patient-level determinants of HPV vaccine intention and uptake among Asian-Americans. In Study 2, we analyzed cross-sectional data from our national online survey to examine practice-, provider-, and patient-level factors impacting U.S. Vietnamese parents' HPV vaccine decision-making process. In Study 3, we analyzed qualitative semi-structured interview data to expand upon findings in Study 2, specifically by providing greater context regarding important factors for HPV vaccine acceptance and uptake and by identifying additional P3 influences on mothers' HPV vaccine decision-making.

We found low parental HPV vaccine uptake for U.S. Vietnamese adolescents. Practice-level findings indicated a desire for clinic-based materials about the HPV vaccine to be available in Vietnamese and a need for automated scheduling of HPV vaccine appointments. Provider-level findings show that provider recommendation, particularly a high-quality provider recommendation (e.g., urging same-day vaccination; emphasizing the importance of the vaccine), was critical to HPV vaccine acceptance and uptake. Moreover, we found several patient-level targets for education and programs, including a lack of knowledge about eligible ages and the number of vaccine doses, perceived child's sexual activity, and a lack of understanding about gender-neutral vaccination. The findings advance cancer health equity through exploring multilevel determinants of HPV vaccine uptake among a high-risk minority group and highlight the need for disaggregated data for Asian subgroups in order to understand disparities in health behaviors and outcomes experienced by different communities.

Table of Contents

Summary and Specific Aims ……………………………………………………………………..1

Chapter 1: Introduction …………………………………………………………………………...6

           Introduction and Literature Review ………………………………………………………6

                       Cervical Cancer Disparities Impacting U.S. Vietnamese…………………………6

                       HPV Vaccine as an Effective Method for Preventing Cancer ……………………7

                       HPV Vaccine Uptake Disparities Among Asian-Americans and U.S.

Vietnamese ………………………………………………………………………..8

           Current Limitations in the Literature ……………………………………………………..9

           Theoretical Framework ………………………………………………………………….10

                       The Need for Theoretically-Driven Research on Multilevel Determinants ……..10

                       Theoretical Framework: The P3 Model …………………………………………10

Application of the P3 Model to Identify Multilevel Factors Impacting U.S. Vietnamese Parents’ HPV Vaccine Uptake for Their Adolescents ……………..11

           Conceptual Model ……………………………………………………………………….13

           Summary ………………………………………………………………………………...14

           Figures and Tables

                       Figure 1.1 The P3 (Practice-, Provider, and Patient-Level) Model and Relevant

                       Impacting Factors on Health Behaviors (Bednarczyk et al. 2018) ……………...15

                       Figure 1.2 Conceptual Model of the Project …………………………………….16

           Chapter 1 References ……………………………………………………………………17

Chapter 2: A systematic review of practice-, provider-, and patient-level determinants impacting Asian-Asian Americans’ human papillomavirus vaccine intention and uptake ………………...29

           Introduction ……………………………………………………………………………...29

                       Theoretical Framework and Outcome Measurements …………………………..31

           Objective ………………………………………………………………………………...32

           Methods ………………………………………………………………………………….32

                       Search Strategies ………………………………………………………………...32

                       Inclusion and Exclusion Criteria ………………………………………………...33

                       Study Selection ………………………………………………………………….33

                       Data Extraction ………………………………………………………………….33

                       Data Analysis ……………………………………………………………………33

                       Quality Appraisal ………………………………………………………………..34

           Results …………………………………………………………………………………...34

                       Study Characteristics ……………………………………………………………35

                       Quality Appraisal ………………………………………………………………..36

                       Practice-Level Determinants of HPV Vaccine Intention and Uptake …………..36

                       Provider-Level Determinants of HPV Vaccine Intention and Uptake …………..36

                       Patient-Level Determinants of HPV Vaccine Intention and Uptake ……………38

           Discussion ……………………………………………………………………………….44

           Conclusions ……………………………………………………………………………...49

           Figures and Tables

Figure 2.1 PRISMA Flow Chart of the Searched, Screened, Identified, and Included Studies …………………………………………………………………51

Table 2.1 Characteristics of Studies Included in the Systematic Review

(n=26) ……………………………………………………………………………52

Table 2.2 Prevalence of HPV Vaccine Intention and/or Uptake Reported in Studies (n=26) …………………………………………………………………...56

Table 2.3 Practice-Level Determinants of HPV Vaccine Intention and Uptake ...................................................................................................................61

Table 2.4 Provider-Level Determinants of HPV Vaccine Intention and

Uptake …………………………………………………………………………...62

Table 2.5 Patient-Level Determinants of HPV Vaccine Intention and

Uptake …………………………………………………………………………...63

           Appendix 2.A Search Terms …………………………………………………………….70

           Appendix 2.B Details of Results in Reviewed Studies Organized by P3 Factors ………73

           Chapter 2 References ……………………………………………………………………93

Chapter 3: U.S. Vietnamese parents’ HPV vaccine decision-making for their adolescents: An exploration of practice-, provider-, and patient-level influences ………………………………106

           Introduction …………………………………………………………………………….106

           Methods ………………………………………………………………………………...109

                       Recruitment and Data Collection ………………………………………………109

                       Measurements ………………………………………………………………….110

                       Statistical Analysis ……………………………………………………………..114

           Results ………………………………………………………………………………….114

                       HPV Vaccine Initiation ………………………………………………………...115

                       HPV Vaccine Completion ……………………………………………………...116

                       Willingness to Initiate HPV Vaccine …………………………………………..116

                       Provider Recommendation for HPV Vaccine …………………………………117

           Discussion ……………………………………………………………………………...118

                       Strengths and Limitations ……………………………………………………...121

           Conclusions …………………………………………………………………………….121

           Tables and Figures

                       Table 3.1 Sociodemographic characteristics in relation to HPV vaccine

initiation ………………………………………………………………………..122

Table 3.2 Healthcare practice-, provider-, and patient-level characteristics in relation to HPV vaccine initiation ……………………………………………...124

Table 3.3 Most common reasons underlying HPV vaccine initiation, non-initiation, or initiation but non-completion …………………………………….126

Table 3.4 Healthcare practice-, provider-, and patient-level predictors of HPV vaccine initiation ……………………………………………………………….127

Table 3.5 Healthcare practice-, provider, and patient-level predictors of HPV vaccine completion & willingness to initiate …………………………………..128

           Appendix 3.A Recruitment Procedures ………………………………………………..129

                       Supplementary Figure 3.1 Recruitment Process with CBOs …………………..129

                       Supplementary Figure 3.2 Recruitment Flow Chart …………………………...132

                       Supplementary Table 3.1 ………………………………………………………134

           Chapter 3 References …………………………………………………………………..135

Chapter 4: A qualitative study of U.S. Vietnamese mothers’ HPV vaccine decision-making for their adolescents ………………………………………………………………………………..143

           Abstract ………………………………………………………………………………...143

           Introduction …………………………………………………………………………….144

           Methods ………………………………………………………………………………...147

                       Study Design and Participants …………………………………………………147

                       Data Collection ………………………………………………………………...148

                       Data Analysis …………………………………………………………………..149

           Results ………………………………………………………………………………….151

                       Sample Characteristics …………………………………………………………151

                       Practice-Level Influences ………………………………………………………151

                       Provider-Level Influences ……………………………………………………...153

                       Patient-Level Influences ……………………………………………………….155

           Discussion ……………………………………………………………………………...158

                       Strengths and Limitations ……………………………………………………...162

           Conclusions …………………………………………………………………………….163

           Tables and Figures

                       Table 4.1 Selected examples of interview questions and probes ………………164

Table 4.2 Sociodemographic and acculturations-related characteristics of U.S. Vietnamese mothers and their adolescents …………………………………….166

Table 4.3 Healthcare practice-, provider-, and patient-level influences on U.S. Vietnamese mothers’ HPV vaccine decision-making for their adolescents …...168

Supplementary Table 4.1 Information about adolescents ……………………...169

           Chapter 4 References …………………………………………………………………..170

Chapter 5: Conclusion ………………………………………………………………………….180

           Summary of Findings …………………………………………………………………..180

           Implications of Practice-Level Findings ……………………………………………….182

           Implications of Provider-Level Findings ………………………………………………183

           Implications of Patient-Level Findings ………………………………………………...184

           Strengths and Limitations ……………………………………………………………...186

           Conclusions …………………………………………………………………………….187

           Chapter 5 References …………………………………………………………………..188

About this Dissertation

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Laney Graduate School
Department	Behavioral Sciences and Health Education
Degree	Ph.D.
Submission	Dissertation
Language	English
Research Field	Health Sciences, Public Health
Keyword	Vietnamese cancer prevention HPV vaccine
Committee Chair / Thesis Advisor	Carla Berg, George Washington University Cam Escoffery, Emory University
Committee Members	Robert Bednarczyk, Emory University

Last modified

Primary PDF

Thumbnail	Title	Date Uploaded	Actions
	File download under embargo until 20 August 2023	2021-06-22 12:57:15 -0400	File download under embargo until 20 August 2023

Supplemental Files

Thumbnail	Title	Date Uploaded	Actions