Practice-, provider-, and patient-level influences on U.S. Vietnamese parents’ decision-making about HPV vaccination for their adolescents Open Access
Vu, Ha (Summer 2021)
Published
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
| School | |
|---|---|
| Department | |
| Degree | |
| Submission | |
| Language |
|
| Research Field | |
| Keyword | |
| Committee Chair / Thesis Advisor | |
| Committee Members |
Primary PDF
| Thumbnail | Title | Date Uploaded | Actions |
|---|---|---|---|
|
|
Practice-, provider-, and patient-level influences on U.S. Vietnamese parents’ decision-making about HPV vaccination for their adolescents () | 2021-06-22 12:57:15 -0400 |
|
Supplemental Files
| Thumbnail | Title | Date Uploaded | Actions |
|---|