Exploring human papillomavirus vaccine hesitancy among college students and the potential of virtual reality technology to increase vaccine acceptance: a mixed-methods study.

Background: Human papillomavirus (HPV) can cause cancers in men and women. Despite the availability of an effective vaccine, HPV vaccination coverage remains suboptimal among college students. Literature showed that hesitancy for HPV vaccination is a leading barrier to the uptake in this group. However, prior interventions have shown limitations in reducing HPV vaccine hesitancy in college students. Thus, this study examined a conventional educational approach using a vaccine information statement (VIS), and subsequently explored college students' HPV vaccine hesitancy and the potential of virtual reality (VR) technology to overcoming the limitations of interventional efforts. Methods: We employed a mixed-methods design along with convenience sampling, constituting a one-way pre- and post-intervention (HPV VIS) survey (Study A) and individual interviews (Study B). All data collections occurred with 44 college students at an urban public university at the mid-south region of the U.S. between October 2022 and April 2023. Study A assessed changes in HPV vaccination outcomes including knowledge, beliefs/attitudes, vaccine hesitancy, and intentions. Study B measured college students' primary reasons for HPV vaccine hesitancy and preferred strategies for the vaccination promotion including VR-based education. We conducted paired t-test and Wilcoxon signed ranks test for quantitative data and framework analysis for qualitative data. Results: Participants reported significant improvements in knowledge [t(43) = 6.68, p < 0.001] regarding HPV vaccination between before and after reading the HPV VIS. No change was observed in beliefs/attitudes, vaccine hesitancy, and intentions. The framework analysis revealed college students' reasons for HPV vaccine hesitancy, needed information, and preferred strategies along with the potential of VR technology for future HPV vaccination education. Conclusion: The findings provided essential information on designing HPV vaccination information focused on vaccine hesitancy among college students. Future research should consider these findings in developing interventions including VR to increasing HPV vaccine acceptance among college students.

Factors Associated with College Students' Human Papillomavirus (HPV) Vaccination and Preferred Strategies for Catch-Up Vaccine Promotion: A Mixed-Methods Study.

Human papillomavirus (HPV) vaccination protects against six types of cancer-cervical, anal, oropharyngeal, penile, vulvar, and vaginal. In the United States (U.S.), HPV vaccination coverage in college students remains low, especially in the Mid-South region, despite the highest risk of HPV infections and disease burden. However, few studies have assessed HPV vaccination among college students here. This study examined factors associated with HPV vaccination among college students in the Mid-South and explored preferred strategies for promoting vaccination. A mixed-methods design comprising a cross-sectional, self-report online survey and dyadic virtual interviews was conducted. Simple random sampling was performed to recruit a total of 417 undergraduate students aged 18-26 from March to May 2021; convenience sampling was performed to recruit three sex-matched dyads of a total of six (four female and two male) undergraduates from survey respondents who had not completed the HPV vaccine series in May 2021. Binary logistic regression analyses showed HPV vaccine knowledge and perceived barriers to vaccination were factors contributing to coverage for both female and male students, while perceived risks of HPV and vaccine hesitancy were factors only among female students. Findings from the qualitative content analysis identified college students' perceived barriers to the vaccination at multiple levels and preferred strategies for vaccination promotion, corroborating the findings from the survey study. The findings provide implications that benefit the development of tailored interventions aimed at facilitating catch-up vaccination among college students in the Mid-South region. There is an urgent need for further research and the implementation of effective strategies that address the identified barriers and improve HPV vaccine uptake in this population.

Human Papillomavirus (HPV) Vaccination Knowledge, Beliefs, and Hesitancy Associated with Stages of Parental Readiness for Adolescent HPV Vaccination: Implications for HPV Vaccination Promotion.

The vaccination against human papillomavirus (HPV) has shown effectiveness in preventing six different types of cancer. Despite a safe, effective HPV vaccine, vaccination coverage for adolescents remains suboptimal, especially in the Memphis, Tennessee metropolitan area. Parents/Guardians have a substantial influence on adolescent vaccination, but little is known about parental cognitive factors contributing to intent on adolescent HPV vaccination in this region. Thus, this study examined factors associated with stages of parental readiness for adolescent HPV vaccination by applying the transtheoretical model. A cross-sectional, online survey was conducted to collect quantitative data on sociodemographic characteristics; health-related information; HPV vaccination knowledge, beliefs, and hesitancy; and stages of readiness for adolescent HPV vaccination among parents. Convenience sampling was performed to recruit a total of 497 parents of adolescents aged 11-17 years in Shelby and Tipton Counties in Tennessee and DeSoto County in Mississippi. Binary logistic regression analyses showed that greater knowledge of HPV vaccination, greater perceived susceptibility to HPV, and lower levels of HPV vaccination hesitancy, respectively, distinguished higher from lower stages of parental readiness for adolescent HPV vaccination after controlling for other variables. The findings provide implications for developing readiness for stage-specific interventions targeted to effectively influence the parental decision-making process regarding HPV vaccination for adolescents.

Medical and public health professionals' perceived facilitators and barriers of human papillomavirus (HPV) vaccination among African American adolescents in Shelby County, Tennessee.

Human papillomavirus (HPV) infects nearly 85% of sexually active Americans during their lifetime, causing most cervical and five other cancers. Routine HPV vaccination is recommended for adolescents to prevent HPV-attributable cancers, but HPV vaccination coverage remains low, especially in Tennessee. In 2021, 54.6% of the population in Shelby County, Tennessee was Black or African American, reporting higher rates of new cervical cancer cases than other counties in Tennessee. While medical and public health professionals (HPs) play a critical role in promoting vaccination coverage, little is known about the factors HPs perceive to influence HPV vaccination for this population. This study sought to explore HPs' perceived facilitators and barriers of HPV vaccination among African American adolescents. Qualitative individual interviews with 26 HPs in Shelby County were conducted between October 2019 and February 2020. Interpretive content analysis of the interview data guided by the socio-ecological model revealed several important themes regarding the facilitators and barriers across the individual, interpersonal, and community levels. At the individual level, parental vaccine hesitancy emerged as a leading barrier to HPV vaccination, while appropriate education facilitated the vaccination. At the interpersonal level, a lack of strong provider recommendations impeded HPV vaccination, whereas improved communication skills with patients facilitated the vaccination. Finally, the community-level barriers included a lack of education and social/religious norms; the community-level facilitators included community outreach efforts. HPs should consider development of comprehensive community-based approaches that leverage the facilitators and barriers at multiple levels to increase HPV vaccination among African American adolescents in this region.

Predicting adoption of colorectal cancer screening among Korean Americans using a decision tree model.

BACKGROUND: Colorectal cancer screening (CRCS) rates remain suboptimal among Korean Americans despite recommendations from health organizations. Little is known about the mechanism underlying their CRCS adoption within complex systems. This study aimed to examine the multi-level predictors of CRCS adoption among Korean Americans using a decision tree model. METHODS: A cross-sectional survey was performed to assess CRCS adoption and multiple levels of influence - individual (i.e. CRCS self-efficacy, CRCS attitudes, risk of colorectal cancer, psychological distress, health status), interpersonal (i.e. social support, social networks, CRCS recommendations), and organizational/community (i.e. health insurance, primary doctor, primary clinic) factors. A total of 433 Korean Americans aged 50-75 in a metropolitan area in the Southeastern U.S. completed a self-report questionnaire. To determine the important variables that predict CRCS adoption, the study generated a decision tree predictive model using R statistical software. RESULTS: The results indicated that CRCS self-efficacy and CRCS attitudes at the individual level and CRCS recommendations and social support at the interpersonal level differentiate adopting or not adopting CRCS. Furthermore, CRCS recommendations (n = 138, 56%, prob = 0.64) and CRCS self-efficacy (n = 51, 21%, prob = 0.88) were the most powerful predictors of CRCS adoption. CONCLUSION: The findings highlight the critical roles of CRCS recommendations from healthcare providers and family/friends and patients' confidence in performing screening-related tasks in influencing CRCS adoption among Korean Americans. Practice efforts should target individual and interpersonal characteristics when developing interventions for promoting CRCS among Korean Americans, especially who are not adherent to screening guidelines.

Analyzing factors associated with decisional stage of adopting breast cancer screening among Korean American women using precaution adoption process model.

Background: Korean American (KA) women have experienced higher prevalence and lower survival rates of breast cancer (BC) than other ethnic groups in the United States. However, BC screening rates for KA women remain significantly lower than the national target (81.1%) specified by Healthy People 2020. Few studies have explained how the decision to adopt BC screening occurs and progresses and what factors contribute to this decision among KA women. This study used Weinstein's Precaution Adoption Process Model (PAPM) as a theoretical framework to examine characteristics and factors associated with the decisional stage of mammography adoption.Methods: A cross-sectional self-report survey was administered among KA women (N = 308) ages 50-80 from the Atlanta metropolitan area. A total of 281 KA women completed the survey, answering questions about socio-demographics, health-related information, mammography history, doctor recommendation, BC screening knowledge, self-efficacy for BC screening, decisional balance scores on attitudes and beliefs pertaining to mammography, and the seven-stage PAPM.Results: KA women reported a low rate of mammography uptake with about 24% and 35% of the participants undergoing mammography within the last year and two years, respectively. KA women in stages 5 (decided yes), 6 (action), and 7 (maintenance) were likely to have increased screening-related knowledge, positive decisional balance, and regular medical check-up compared to those in stages 1 (unaware), 2 (unengaged), and 3 (deciding).Conclusion: This study highlights important factors that could potentially facilitate BC screening among KA women in Georgia. The findings also provide implications for interventions and practice for increasing mammography screening among medically underserved populations.

Is Colorectal Cancer Screening Associated with Stages of Weight Control Among Korean Americans Aged 50-75 Years Old?: Implications for Weight Control Practice.

OBJECTIVE: To examine the associations of colorectal cancer (CRC) screening with stages of weight control among Korean Americans (KAs) using the transtheoretical model and provide implications for their weight control practice. METHODS: A quantitative, cross-sectional survey was employed to collect data on current weight control behaviors and intentions, CRC screening history, previous cancer diagnosis, body mass index, number of chronic conditions, perceived health status, health insurance, and sociodemographics. Purposive sampling was implemented to recruit KA participants in the Atlanta metropolitan area in the USA from May 2015 to February 2016. A total of 433 KAs aged 50 to 75 years completed a self-report survey questionnaire. Descriptive and bivariate analyses and multiple logistic regressions were performed using Stata Version 14/MP software. RESULTS: Applying the stages of the transtheoretical model 53% were positioned in the first two stages (precontemplation and contemplation) of weight control with 47% being in the last two stages (action and maintenance). Participants who had been screened for CRC were more likely to be in the last two stages of weight control compared with those who had not been screened (OR = 2.49; p = 0.003). CONCLUSIONS: The findings suggest that preventive healthcare such as CRC screening may provide the opportunity for health education interventions to help encourage weight control efforts and behaviors in the KA community. Future research is warranted to investigate the underlying mechanism behind the link between CRC screening and weight control to guide the development of interventions for eliminating health disparities.

Barriers and facilitators to colorectal cancer screening among older Korean Americans: A focus group study.

A qualitative study was undertaken to explore the barriers and facilitators to colorectal cancer (CRC) screening among older Korean Americans (KAs). Four focus groups with 25 male and female KA participants and one focus group comprising five KA health professionals were conducted in the Atlanta Metropolitan area. Interpretive analyses of the interview data revealed barriers regarding CRC screening for KAs included a lack of CRC knowledge, embarrassment during the screening tests, CRC-related fatalism, and modesty, no perceived need for the screening, poor English proficiency, and mistrust of the American healthcare system. The results also indicated that doctors' screening recommendations and access to Korean doctors positively influence KAs' decision to participate in CRC screening. Public health social workers should consider integrating age- and gender-specific cultural contexts when developing interventions and programs for CRC screening targeted to older KAs.

Analyzing factors enabling colorectal cancer screening adherence in Korean Americans using the Andersen's Behavioral Model of Health Services Utilization.

Purpose/objectives: Korean Americans (KAs) report suboptimal colorectal cancer (CRC) screening adherence. This study investigated factors that enable KAs to adhere to CRC screening guidelines using the Andersen's Behavioral Model of Health Services Utilization. Design: Cross-sectional survey using self-reported measures of CRC screening behaviors. Sample and methods: Purposive sampling was used to recruit 433 KAs aged 50-75 from the Atlanta metropolitan area who completed questionnaires measuring predisposing (i.e., gender, age, marital status, and educational attainment), enabling (income, health insurance, regular annual health checkups, doctor's recommendation English proficiency, CRC knowledge, self-efficacy for CRC screening, and decisional balance in CRC screening), and need (family cancer history and self-reported health status) factors associated with CRC screening. Findings: A multiple logistic regression model including all 14 predictor variables revealed that several enabling factors (i.e., income, regular annual health checkups, doctor's recommendation, self-efficacy, and decisional balance) independently predicted increased CRC screening adherence in KAs. No predisposing or need factors independently predicted CRC screening. Conclusions and implications for psychosocial providers or policy: To increase CRC screening adherence among KAs, psychosocial interventions should target on improving their self-efficacy and decisional balance regarding CRC screening, while policy interventions should focus on promoting health providers' CRC screening recommendations during routine health checkups.

Analyzing Factors of Breast Cancer Screening Adherence among Korean American Women Using Andersen's Behavioral Model of Healthcare Services Utilization.

Objectives: Regular uptake of mammography screening reduces the risk of advanced stage diagnosis of breast cancer (BC). However, BC screening rates remain suboptimal among Korean American (KA) women. Using the Andersen's Behavioral Model of Healthcare Services Utilization, this study examined factors associated with mammography screening among KA women aged 50 to 80 years in the state of Georgia, USA. Methods: We used purposive sampling to recruit study participants in the Atlanta metropolitan area from May 2015 to February 2016. A total of 303 KA women completed a cross-sectional, self-report survey about their sociodemographics, health care access information, knowledge, self-efficacy, decisional balance, and mammography history. Results: Descriptive analyses confirmed low rates of mammography screening in the participants. Multiple logistic regression analyses showed that having a mammogram within the past year was associated with greater BC knowledge, higher scores of decisional balance and fewer annual health check-ups among KA women without any cancer history. Conclusions: The findings offer implications for health policy aimed at increasing BC screening by leveraging enabling factors among medically underserved KA women at both structural and cultural levels.

Analyzing paths from online health information seeking to colorectal cancer screening using health literacy skills frame and cognitive mediation model.

OBJECTIVE: To test the hypothesized paths for Online Health Information Seeking (OHIS) behaviors in developing health literacy, leading to colorectal cancer (CRC) screening among Korean Americans (KAs) using Health Literacy Skills Frameworks (HLSF) and Cognitive Mediation Model (CMM). METHODS: A total of 433 KAs aged 50 through 75 in a metropolitan area in the Southeastern U.S. completed a cross-sectional survey regarding sociodemographics, OHIS behaviors, information overload, health literacy, decisional balance, and CRC screening history. Path analyses were implemented to assess the hypothesized causal models by examining the relationships among these variables. RESULTS: OHIS was positively associated with information overload and health literacy; information overload was negatively associated with health literacy. Health literacy was positively associated with decisional balance; decisional balance was positively associated with uptake of sigmoidoscopy and colonoscopy. CONCLUSION: The findings supported both theoretical frameworks, HLSF and CMM, for OHIS to develop health literacy, leading to CRC screening. These findings highlight the significant roles of information overload and attitudes and beliefs about screening in enhancing health literacy and CRC screening among KAs. PRACTICE IMPLICATIONS: Practice efforts for facilitating CRC screening among medically underserved older KAs should target improving access to and use of OHIS and culturally-tailored health information delivery.

Analyzing Factors Associated With Decisional Stage of Adoption for Colorectal Cancer Screening Among Older Korean Americans Using Precaution Adoption Process Model.

Introduction: For Korean Americans (KAs), colorectal cancer (CRC) screening rates remain lower than the national target. This study aimed to examine factors predicting decisional stage of CRC screening adoption among older KAs using the precaution adoption process model. Method: Convenience sampling was employed to recruit KAs aged 50 to 75 years from the Atlanta metropolitan area in the United States. A total of 433 KAs completed a cross-sectional survey that collects information on sociodemographics, CRC screening history, a physician's recommendation, knowledge, self-efficacy, and decisional balance pertaining CRC screening, and precaution adoption process model stage. Results: Higher scores of decisional balance (odds ratio [OR] = 1.34), having a physician's recommendation (OR = 8.61), and having regular annual medical checkups (OR = 4.44) were significantly associated with higher decisional stage compared with lower stage, controlling for other variables. Discussion: Intervention research should incorporate consideration of individuals' decisional stage to move KAs forward from not engaging the screening to maintaining regular participation in CRC screening.

Motivating underserved Vietnamese Americans to obtain colorectal cancer screening: evaluation of a culturally tailored DVD intervention.

BACKGROUND: Colorectal cancer (CRC) is a leading cause of cancer death among Vietnamese Americans, yet screening remains underutilized. We investigated the effectiveness of a culturally tailored DVD intervention in promoting CRC screening among unscreened Vietnamese Americans age 50 and over. MATERIALS AND METHODS: Using a community-based participatory research approach, we conducted a trial comparing twenty-eight subjects who received a mailed DVD in Vietnamese, with twenty-eight subjects who received a mailed brochure in Vietnamese. Subjects completed telephone surveys at baseline, One-month, and one-year. The primary outcome was receipt of screening. Secondary measures were participants' knowledge, attitudes, and beliefs about CRC screening. Two focus groups explored the intervention's acceptability and effectiveness. RESULTS: At one year, CRC screening rates of 57.1% and 42.9% were observed in experimental and control group respectively (p=0.42), Subjects in both groups showed increased knowledge about CRC after one month. Focus group findings revealed that the DVD was an effective method of communicating information and would help promote screening. CONCLUSIONS: The findings suggest that culturally tailored, linguistically appropriate content is more important than the type of media used. This relatively low intensity, low cost intervention utilizing a DVD can be another useful method for outreach to the often hard-to-reach unscreened population.

Older Korean cancer survivors' depression and coping: directions toward culturally competent interventions.

Studies have consistently shown cancer diagnosis and treatment to be associated with increased depression. However, research that directly examines the depression and coping strategies of older minority cancer survivors is sparse. Addressing that gap, this study examines depression and coping strategies among older Korean immigrant cancer survivors. A qualitative method approach was utilized by interviewing 15 survivors from the state of New York (NY) and nine from Minnesota (MN). Each interview was digitally audio-recorded and transcribed verbatim in Korean. Grounded theory was employed to analyze the data, using Atlas ti 5.0. Analysis of the MN interviews showed two depression factors: (1) physical deterioration and (2) fear of death. For the NY interviews, analysis highlighted the following factor: loneliness due to disconnectedness from community. Analysis of the MN and the NY interviews for depression coping strategies revealed two primary internal coping strategies: (1) reliance on religion through prayer and (2) psychological strength by avoiding negative thoughts. For external strategies, analysis suggested three shared strategies: (1) social and religious support, (2) medical service utilization, and (3) health management by exercise. Regional differences related to depression factors imply that survivors living in the NY area may need more social support, whereas survivors living in the MN area may need more knowledge around physical changes that follow cancer treatment. Regional similarities across results indicate that availability of social support is a critical factor relieving depression. Thus, specialized intervention programs for reducing depression among cancer survivors should consider regional features.

The contribution of culture to Korean American women's cervical cancer screening behavior: the critical role of prevention orientation.

BACKGROUND: Despite the proven benefits of Pap testing, Korean American women have one of the lowest cervical cancer screening rates in the United States. This study examined how cultural factors are associated with Pap test utilization among Korean American women participants. METHODS: Quota sampling was used to recruit 202 Korean American women participants residing in New York City. Hierarchical logistic regression was used to assess the association of cultural variables with Pap test receipt. RESULTS: Overall, participants in our study reported significantly lower Pap test utilization; only 58% reported lifetime receipt of this screening test. Logistic regression analysis revealed one of the cultural variables--prevention orientation--was the strongest correlate of recent Pap test use. Older age and married status were also found to be significant predictors of Pap test use. CONCLUSION: Findings suggest cultural factors should be considered in interventions promoting cervical cancer screening among Korean American women. Furthermore, younger Korean American women and those not living with a spouse/partner should be targeted in cervical cancer screening efforts.