Social and cultural construction processes involved in HPV vaccine hesitancy among Chinese women: a qualitative study.

BACKGROUND: HPV vaccine is a prophylactic vaccine to prevent HPV infections. Recommended by the World Health Organization, this vaccine is clinically proven to be one of the most effective preventive measures against the prevalence of cervical cancer and other HPV-associated cancers and chronic genital conditions. However, its uptake rate among women in Hong Kong is insignificant-only approximately 2.9% adolescent girls and 9.7% female university students received HPV vaccination in 2014. With the notion of Critical Medical Anthropology, we aimed to identify if different influential factors, ranging from individual, societal, and cultural, are involved in the decision-making process of whether to receive HPV vaccination. METHODS: We adopted a qualitative approach and conducted in-depth individual semistructured interviews with 40 women in Hong Kong between May and August 2017. RESULTS: We noted that the following factors intertwined to influence the decision-making process: perceptions of HPV and HPV vaccine; perceived worthiness of HPV vaccines, which was in turn influenced by vaccine cost, marriage plans, and experiences of sexual activities; history of experiencing gynecological conditions, stigma associated with HPV vaccination, acquisition of information on HPV vaccines, distrust on HPV vaccines, and absence of preventive care in the healthcare practice. CONCLUSIONS: HPV vaccination is promoted in a manner that is "feminized" and "moralized" under the patriarchal value system, further imposing the burden of disease on women, and leading to health inequality of women in pursuing the vaccination as a preventive health behaviour as a result. We believe that this ultimately results in an incomplete understanding of HPV, consequently influencing the decision-making process. The "mixed-economy" medical system adopting capitalist logic also molds a weak doctor-patient relationship, leading to distrust in private practice medical system, which affects the accessibility of information regarding HPV vaccination for participants to make the decision.

Barriers to Receiving HPV Vaccination Among Men in a Chinese Community: A Qualitative Study in Hong Kong.

Human papillomavirus (HPV) can cause various diseases; low-risk strains can cause genital warts, whereas high-risk strains can cause cervical cancer and cancer of the vulva in women and cancers of the penis, anus, and oropharynx in men. Although HPV affects men, literature has reported that the prevalence of HPV vaccination is far lower among men than among women. Few studies have examined perceptions and acceptability of the HPV vaccine among men, particularly in Chinese communities. In this study, the acceptability of the HPV vaccine to men was investigated using Hong Kong men as a case group. A qualitative research approach was adopted. Thirty-nine men were purposively sampled for the in-depth individual semistructured interviews from June to October 2017 to investigate their perceptions of the HPV vaccine and the barriers for them to receive the vaccination. Limited knowledge and awareness of HPV-related issues, low perceived risk of HPV infection, perceived association between HPV vaccine and promiscuity, and lack of accessible official information on HPV-related topics were identified as the key barriers. These barriers intermingled with the sociocultural environment, cultural values of sexuality, and patriarchal gender values. HPV vaccine is shown to be socially constructed as a vaccine for women exclusively and for promiscuity. The participants were discouraged from receiving HPV vaccination because of its signaling of socially deviant promiscuity. Cultural taboo on sex served as a social oppression of open discussion about HPV vaccine and affected the participants' perceived need of vaccination. Perceived insignificance of reproductive organs also influenced the participants' perceived need of vaccination.

The Role of Counterfactual Thinking in Narrative Persuasion: Its Impact on Patients' Adherence to Treatment Regimen.

The purpose of this study is twofold: (1) to explicate the underlying process of how narratives, accompanied with counterfactual thinking, exert cognitive and affective influence on audiences and (2) to examine how counterfactual thinking and regulatory focus, as story characteristics, enhance the persuasiveness of the narrative. Participants in the experiment were exposed to animated narratives in which the protagonist described her nonadherence to the peritoneal dialysis treatment regimen that resulted in her hospitalization. One hundred thirty-six patients undergoing peritoneal dialysis participated in a 2 (Goal failure framing: promotion-framed failure versus prevention-framed failure) by 2 (Counterfactual thinking: additive counterfactuals versus subtractive counterfactuals) between-subject factorial experiment. The analyses showed that narratives with additive counterfactuals, as opposed to those with subtractive counterfactuals, elicited greater anticipated regret and mental simulation, and, in turn, influenced the audience's attitude toward and intention of adherence. More important, promotion-/prevention-framed failure and additive/subtractive counterfactuals jointly influenced the audience's anticipated regret and mental simulation. Specifically, in the prevention-framed goal failure condition, narratives with additive counterfactuals elicited greater anticipated regret and mental simulation; however, in the promotion-framed goal failure condition, there was no significant difference on anticipated regret and mental simulation between narratives with subtractive counterfactuals and those with additive counterfactuals. The theoretical and practical implications were discussed.

Psychosocial Factors Predict Nonadherence to PD Treatment: A Hong Kong Survey.

♦ BACKGROUND: Nonadherence to hand hygiene and aseptic regimen, dialysis environment guidelines, and catheter and exit-site care guidelines are risk factors of peritonitis. However, little is known about the psychosocial factors that account for the nonadherent behavior of patients undergoing peritoneal dialysis (PD). Applying the health belief model, this study seeks to enhance the understanding of psychosocial influences on patients' nonadherent behavior to the 3 regimen components. ♦ METHODS: Through referrals by 7 Hong Kong renal patient support groups, we surveyed patients undergoing PD treatment. ♦ RESULTS: A total of 244 Hong Kong PD patients completed the questionnaires. About 90% of the patients reported no deviation from catheter and exit-site care guidelines. However, the nonadherence rates of hand hygiene and aseptic regimen and of dialysis environment guidelines were 30.3% and 23%, respectively. Longer time on PD treatment and lower family monthly income were associated with nonadherence to dialysis environment guidelines. Employed patients tended toward nonadherence to catheter and exit-site care guidelines twice as much as unemployed patients. Of the 5 health beliefs, perceived benefits, perceived barriers, and efficacy belief were significant predictors of nonadherence to the 3 regimen components. ♦ CONCLUSIONS: The findings of this study inform the design of intervention to change patients' behavior in regimen nonadherence for preventing peritonitis. To identify the target audience for adherence intervention based on the 3 regimen components, the results suggest dividing patients into subgroups according to their sociodemographic background. To foster behavioral change, health communicators should address patients' health beliefs when formulating intervention strategies.

Perception of acupuncture among users and nonusers: A qualitative study.

This study uses a qualitative methodology to examine the perception of acupuncture among users and nonusers. Altogether 37 participants, age 35 or older, were interviewed. Participants' perception of advantages and disadvantages of adopting acupuncture, and their criteria in selecting acupuncturists, were collected. Results found that among the user group, acupuncture was perceived as being effective, having little side effects, and generating lasting impact. Among nonusers, acupuncture was perceived as lacking a clinical base, high risk, and nonstandardized. Nonusers had less confidence in acupuncture than biomedicine. Participants relied on social communication and the practitioner's professional qualifications in choosing acupuncturists. Marketing implications are discussed.

Media, social proximity, and risk: a comparative analysis of newspaper coverage of Avian Flu in Hong Kong and in the United States.

This study uses the psychometric paradigm (Renn & Rohrmann, 2000; Slovic, 1992) as an analytic framework to analyze the risk dimensions being conveyed in media coverage of Avian flu in Hong Kong and in the United States between 2003 and 2007. A quantitative content analysis of The New York Times and South China Morning Post stories showed different patterns of avian flu related risk content coverage. The differences revealed that dimensions related to dreadfulness, catastrophic potential, uncertainty, and unfamiliarity were more emphasized in The New York Times than in South China Morning Post. The authors discuss the implications.