Diverse caregivers' HPV vaccine-related awareness and knowledge.

Objectives: To assess factors associated with HPV vaccine-related awareness and knowledge among caregivers of adolescents from five ethnic community groups in Utah.Design: For this community-based participatory research study, we surveyed N = 228 caregivers of teens aged 11-17 years from African American, African refugee, American Indian/Alaskan Native, Hispanic/Latino, and Native Hawaiian/Pacific Islander community groups in Utah about their HPV vaccine awareness and knowledge.Results: Participants exhibited high awareness of cervical cancer (71.05%), moderate awareness of HPV (53.95%), and low awareness of the HPV vaccine (46.49%). HPV vaccine-related knowledge was mostly worse, with fewer than half the participants reporting knowing that HPV can cause cervical cancer (46.93%), that most people are infected with HPV at some point in their lives (28.95%), that HPV is asymptomatic in females (36.40%) and males (37.28%), that the HPV vaccine is recommended for adolescent females (41.67%) and males (36.40%), and that the HPV vaccine requires more than one dose (27.19%). HPV vaccine-related awareness and knowledge were significantly associated with race/ethnicity, educational attainment, income, occupation, birthplace, parents' birthplace, English usage, health insurance coverage, type of health insurance, and child having a primary care provider (all p < 0.05). HPV vaccine-related knowledge (p < 0.05) and awareness (p < 0.05) of caregivers were associated with a child in the household receiving the HPV vaccine.Conclusion: Our findings indicate a need to develop educational interventions in collaboration with diverse communities in Utah. We underscore the importance of promoting knowledge about the existence of the HPV vaccine, as well as deeper HPV vaccine-related issues (e.g. HPV risks, treatment, and recommendations).

Diverse Families' Experiences with HPV Vaccine Information Sources: A Community-Based Participatory Approach.

Current sources of publicly available human papillomavirus (HPV) information may not adequately meet the needs of diverse families. This study sought to describe associations between sociodemographic and acculturation factors, and sources of HPV information among diverse parents and caregivers. Community organizations purposively recruited participants from African American, African refugee, Hispanic/Latino, American Indian, and Native Hawaiian and Pacific Islander communities for a 21-item survey (N = 228). Ninenty-three of these participants also participated in ten focus groups conducted in three languages. Descriptive statistics and Fishers' Exact Test for Count Data were produced and triangulated with focus group data to provide additional context. Overall, HPV vaccine awareness and knowledge in the five communities was low. This study found that a greater proportion of lower-acculturated participants had heard of HPV through personal networks (foreign-born = 50 % vs US-born = 30 %, p < 0.05; medium acculturation = 60 % vs high acculturation = 26 %, p = 0.01), while greater proportions of US-born participants reported media sources (49 % vs foreign-born = 29 %, p < 0.05). Across communities, healthcare system sources were described as important and preferred sources of HPV information. Hearing about the HPV vaccine from healthcare settings was significantly associated with increased accuracy in HPV vaccine knowledge (p < 0.05). Communities described a need for more in-depth information about the HPV vaccine, and culturally and linguistically appropriate educational materials. Culturally-competent delivery of HPV information through the healthcare system sources may be important in improving knowledge and acceptability of the HPV vaccine among diverse families.

Factors Associated with Increased HPV Vaccine Use in Rural-Frontier U.S. States.

OBJECTIVE: This study sought to examine sociodemographic factors surrounding human papillomavirus (HPV) vaccine initiation and three-dose completion rates in the Intermountain West (IW). DESIGN AND SAMPLE: Analysis of the Centers for Disease Control and Prevention's 2012 National Immunization Survey-Teen dataset was conducted with a survey-weighted Pearson chi-square test and multivariable Poisson regression to produce bivariate and multivariate analyses. Participants with daughters aged 13-17 with provider-verified immunization records were included. Dual-frame adjusted prevalence ratios (PR) and 95% confidence intervals (CI) were produced with provider-phase sampling weights. MEASURES: Factors included parents' and adolescents' sociodemographic and healthcare usage variables. Outcome measures included adolescents' receipt and completion of the HPV vaccine. RESULTS: Older parental ages (45 years and above) showed lower prevalence of adolescent HPV vaccine initiation (PR = 0.73, 95% CI = 0.59-0.87, p = .003) and completion (PR = 0.65, 95% CI = 0.44-0.96, p = .031) compared with parents younger than 35. Seventeen-year-old adolescents demonstrated highest prevalence of initiating (PR = 1.88, 95% CI = 1.47-2.39, p < .001) and completing (PR = 2.92, 95% CI = 1.97-4.33, p < .001) the vaccination series compared to 13-year olds. Those who had received meningitis vaccinations had high prevalence of initiating (PR = 1.93, 95% CI = 1.50-2.48, p < .001) and completing the HPV vaccine (PR = 2.52, 95% CI = 1.64-3.86, p < .001). CONCLUSION: This study highlights parental, adolescent, and health care characteristics related to use of the HPV vaccine. Future research to investigate specific barriers and strategies for addressing HPV vaccination use in the IW is recommended.

Latino Parents' Perceptions of the HPV Vaccine for Sons and Daughters.

Latinas have the highest incidence of cervical cancer. Latino parents' perceptions of the human papillomavirus (HPV) and willingness to have their sons and daughters vaccinated in Utah is largely unknown. Latino parents/guardians of children ages 11-17 years were recruited from two community organizations (N = 52) to participate in a mini-survey and focus group. Guided by the social ecological framework, a Latina facilitator conducted five focus groups that were recorded, transcribed and translated. Descriptive statistics were calculated from the mini-survey. Two members of the research team performed inductive content analysis of the focus group transcriptions separately. Discrepancies were discussed and resolved during bi-weekly meetings with group members who were present during the focus groups. Parents reported low HPV vaccine knowledge, high vaccine costs, and lack of strong provider recommendations as the main barriers to vaccine receipt. Language appropriate educational resources and consistent provider recommendations may enrich Latino parents' perceptions about the HPV vaccine.

Latinas' Colorectal Cancer Screening Knowledge, Barriers to Receipt, and Feasibility of Home-Based Fecal Immunochemical Testing.

Latinas' high colorectal cancer (CRC) mortality makes them a priority population for CRC screening. CRC screening knowledge, perceived barriers, and feasibility of using the Fecal Immunochemical Test (FIT) was assessed among Latinas in Utah. Participants aged ≥50 (n = 95) were surveyed about knowledge and barriers to CRC screening. 27 participants completed a FIT and evaluation survey. Fisher's exact tests assessed sociodemographic correlates of CRC screening outcomes. Most participants were overdue for CRC screening (n = 81, 85%). Age, acculturation, education, and employment were significantly associated with CRC screening status and/or reasons for being overdue (e.g., not knowing about the test, cost). All participants who received a FIT completed it, felt it was easy to use, and reported they would use it again. Latinas had limited awareness of CRC, CRC screenings, and experienced barriers to CRC screening (e.g., limited access, cost), but were willing to utilize a low-cost home-based FIT.

WE'RE THE EYES AND THE EARS, BUT WE DON'T HAVE A VOICE: PERSPECTIVES OF HOSPICE AIDES.

Hospice aides are integral to the delivery of home hospice care and play an essential role in the effective communication and collaboration of the hospice interdisciplinary team. Despite their critical role, little is known about hospice aides' perceptions of their role in providing hospice services. This qualitative study explores hospice aides' perspectives of their work, their relationships with patients, families and interdisciplinary team members, and their contributions to end-of-life care. Two focus groups of hospice aides (N = 13), and 16 hours of observation of in-home caregiving were conducted. Focus group data were inductively and iteratively coded, and three themes were identified: 1) "We're the eyes and ears", 2) "We're kept out of the loop", and 3) "We have no voice." Aides described themselves as front-line providers based on the close relationships they formed with patients and family members, yet felt under-recognized by members of the hospice team. Observational field notes were reexamined with themes to confirm convergence of qualitative and observational data. Better understanding of their role could enhance integration of aides into patient- and family-centered team interactions, leading to both improved patient and family outcomes and retention and support of this critical component of the hospice workforce.

Factors Associated with Human Papillomavirus Vaccination Among Diverse Adolescents in a Region with Low Human Papillomavirus Vaccination Rates.

Introduction: This study assesses the sociodemographic facilitators and barriers to human papillomavirus (HPV) vaccination for diverse teens in a region with low HPV vaccination rates. Materials and Methods: In this community-based participatory research study, we surveyed adult family members of teens aged 11-17 years from African American, African refugee, American Indian/Alaskan Native, Hispanic/Latino, and Native Hawaiian/Pacific Islander community groups in Salt Lake City, Utah. Bivariate analyses assessed associations between sociodemographic characteristics and, respectively, HPV vaccine receipt and intentions for vaccination. Barriers to vaccination were also investigated. Results: Only 20% of participants had vaccinated at least one of their children with at least one dose of the HPV vaccine. HPV vaccination was significantly related to caregiver age (p=0.035), race/ethnicity (p=0.001), educational attainment (p=0.006), annual household income (p=0.0454), years in the United States (p=0.023), and caregiver parent birthplace (p=0.008). Among caregivers with unvaccinated children, intention to vaccinate was significantly related to race/ethnicity (p=0.048 for daughters; p=0.003 for sons), caregiver parent birthplace (p=0.023 for sons), health insurance coverage (p=0.028 for daughters; p=0.047 for sons), and type of health insurance coverage (p=0.008 for sons). The most frequently cited barriers to HPV vaccination were lack of knowledge about the HPV vaccine, costs, side effects, and child not being sexually active. Conclusions: Our results show substantially lower HPV vaccine coverage than both national and state rates, signaling the urgent need for multipronged HPV vaccination interventions within these communities; strategies are discussed.

Younger Age and Health Beliefs Associated with Being Overdue for Pap Testing among Utah Latinas who were Non-Adherent to Cancer Screening Guidelines.

Factors associated with being overdue for Papanicoloau (Pap) testing in a Latina community were examined. Female participants aged ≥ 21 years, who were overdue for one or more cancer screenings (N = 206), were purposively recruited. Descriptive statistics, Fisher's Exact Tests for count data, and multivariable logistic regressions were conducted. Participants overdue for cancer screening, aged 38-47 years demonstrated lower odds of being overdue for Pap testing compared with those 21-37 years old (OR = 0.11, 95% CI = 0.01-0.49, p = 0.01). Lower perceived susceptibility to cervical cancer (OR = 3.21, p = 0.02), and poorer perceived health (OR = 3.74, p < 0.01) was associated with being overdue for Pap testing. Cost/lack of insurance was the most common barrier reported among those overdue for Pap testing. Among an underserved population of Latinas, cost or a lack of health insurance persist as barriers to Pap testing. Evaluation of systematic barriers to accessing Pap testing for lower-income, uninsured individuals is recommended.

Caregiver Activation and Home Hospice Nurse Communication in Advanced Cancer Care.

BACKGROUND: Activated patients have the skills, knowledge, and confidence to manage their care, resulting in positive outcomes such as lower hospital readmission and fewer adverse consequences due to poor communication with providers. Despite extensive evidence on patient activation, little is known about activation in the home hospice setting, when family caregivers assume more responsibility in care management. OBJECTIVE: We examined caregiver and nurse communication behaviors associated with caregiver activation during home hospice visits of patients with advanced cancer using a prospective observational design. METHODS: We adapted Street's Activation Verbal Coding tool to caregiver communication and used qualitative thematic analysis to develop codes for nurse communications that preceded and followed each activation statement in 60 audio-recorded home hospice visits. RESULTS: Caregiver communication that reflected activation included demonstrating knowledge regarding the patient/care, describing care strategies, expressing opinions regarding care, requesting explanations of care, expressing concern about the patient, and redirecting the conversation toward the patient. Nurses responded by providing education, reassessing the patient/care environment, validating communications, clarifying care issues, updating/revising care, and making recommendations for future care. Nurses prompted caregiver activation through focused care-specific questions, open-ended questions/statements, and personal questions. CONCLUSIONS: Few studies have investigated nurse/caregiver communication in home hospice, and, to our knowledge, no other studies focused on caregiver activation. The current study provides a foundation to develop a framework of caregiver activation through enhanced communication with nurses. IMPLICATIONS FOR PRACTICE: Activated caregivers may facilitate patient-centered care through communication with nurses in home hospice, thus resulting in enhanced outcomes for patients with advanced cancer.