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Schools can play an important role in addressing growing concerns about adolescent mental health. Mental health of high school students has predominantly been the focus in literature with less emphasis on younger adolescents. This review identified articles published in the last decade that described evaluations of middle school-based mental health interventions and randomized participants to an intervention or control condition. Fourteen interventions met the inclusion criteria. About two-thirds of interventions were based on mindfulness or cognitive behavioral therapy. Many trials utilized racially diverse, low-income samples. All interventions were delivered to groups, and three contained a parent component. Five trials increased rigor by using an active control condition. Almost two-thirds of the interventions were effective (p < .10) in reducing at least one depression, anxiety, affect, or internalizing symptom outcome compared to a control group. This article provides information about intervention characteristics, efficacy, theoretical framework, and acceptability/feasibility.
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BACKGROUND: The Advisory Committee on Immunization Practices issued a shared clinical decision-making (SCDM) recommendation for HPV vaccination in persons aged 27-45. Since expanded eligibility for the vaccine was issued, little information has been available about HPV vaccine behaviors and intentions among women in this age group. METHODS: We conducted a cross-sectional online survey among women aged 27-45 years recruited through a Qualtrics™ respondent panel (N = 324) to answer the following questions (1) What is the prevalence of HPV vaccination among a diverse sample of adult women aged 27-45 years? (2) What are the characteristics of those who have or have not previously been vaccinated? and (3) What factors are associated with the intention to obtain the HPV vaccine among those who had never been vaccinated? Multivariable logistic regression analyses estimated adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs). RESULTS: Only 31.1% had at least one dose of the HPV vaccine. In multivariable analyses, those more likely to have been vaccinated were younger and were more likely to believe that the vaccine was effective. Of those unvaccinated or unsure, 54.8% indicated they were likely to get vaccinated in the future. Factors associated with future vaccine intention (compared to those not intending) included beliefs about vaccine testing, perceived likelihood of HPV infection, greater comfort in asking one's provider for vaccination, and prior negative healthcare experiences. CONCLUSIONS: Our findings suggest that many women in this age group are interested in HPV vaccination. While the recommendation is for SCDM rather than routine vaccination for all women in this age group, efforts to promote informed decision-making among mid-adult women may include educating women about the rigorous vaccine testing and approval process, their risk factors for HPV infection, and encouraging them to engage in SCDM with their medical providers. Targeted efforts to reach women who have had negative experiences with healthcare may also be needed.
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Intención , Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Humanos , Femenino , Vacunas contra Papillomavirus/administración & dosificación , Adulto , Estudios Transversales , Persona de Mediana Edad , Infecciones por Papillomavirus/prevención & control , Toma de Decisiones Clínicas , Conocimientos, Actitudes y Práctica en Salud , Encuestas y Cuestionarios , Aceptación de la Atención de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/psicologíaRESUMEN
INTRODUCTION: Cervical cancer disproportionately affects those who are underscreened. Human papillomavirus self-collection is a promising tool to expand screening. OBJECTIVE: Study objectives were to examine 1) factors (provider characteristics and practice type) associated with and 2) attitudes (perceived benefits and concerns) toward using human papillomavirus self-collection for cervical cancer screening in clinical practice. METHODS: This study had a mixed method design; prior to regulatory approval of self-collection, we conducted a national survey and interviews of health care providers who perform cervical cancer screening. Quantitative measures included provider and practice characteristics, willingness to recommend, and preferences related to self-collection. Qualitative interviews further elucidated provider perspectives. RESULTS: A total of 1,251 providers completed surveys, and 56 completed interviews. Among survey respondents, 33.4% reported they were likely to offer self-collection, 28.6% were unsure, and 38.0% reported they were unlikely. Most would offer self-collection either in the clinic or at home per patient preference. Male participants, advanced practice providers, internal and family physicians, and those practicing in academic medical center, hospital, or community health settings were more likely than female participants, obstetrician-gynecologist physicians, and those in private practice to indicate they were likely to offer self-collection. Concerns expressed in both surveys and interviews included the adequacy of sample collection and the ability to follow-up. Respondents felt that self-collection would be particularly beneficial for those who did not have access to clinician-collected screening, as well as for patients who may have difficulty with pelvic examinations for any reason. CONCLUSION: Providers considered human papillomavirus self-collection to be a way to expand access for patients with health care barriers and pelvic examination difficulties. They had concerns related to sample adequacy and follow-up after abnormal results.
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Men aged 27 to 45 are eligible for human papillomavirus (HPV) vaccination as of 2019, yet relatively little is known about whether they have received or intend to receive it. We conducted a cross-sectional, online survey among fathers aged 27 to 45 between March and April 2022, to assess associations between HPV vaccination awareness, behaviors, intentions, and psychosocial constructs from the Health Belief Model. We examined the characteristics of those who had (a) heard of the HPV vaccine, (b) already received ≥ 1 dose, and (c) intentions for future vaccination among those who had never been vaccinated. Among 400 men who completed the survey, 32% were not aware of the HPV vaccine. Among those who were aware, 41% had received ≥ 1 dose. Sixty-three percent of unvaccinated men reported that they intended to get vaccinated in the future. Multivariable logistic regression analyses revealed that age and race/ethnicity were associated with having been vaccinated previously. Among the unvaccinated, multivariable logistic regression analyses revealed that those with a higher perceived risk of HPV-associated cancer had 3.73 greater odds of reporting they would seek vaccination compared to those with lower perceived risk (95% confidence interval [CI] = [1.28, 12.3]). We did not find perceived benefits, barriers, or decision self-efficacy to be related to future vaccine intentions. Since recommendations for this group include shared clinical decision-making, public health efforts should focus on raising awareness of vaccine eligibility, emphasizing risk factors for HPV-associated cancers so that individuals have an accurate perception of risk, and encouraging conversation between men and their providers.
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Padre , Conocimientos, Actitudes y Práctica en Salud , Intención , Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Humanos , Masculino , Vacunas contra Papillomavirus/administración & dosificación , Adulto , Estudios Transversales , Persona de Mediana Edad , Padre/psicología , Infecciones por Papillomavirus/prevención & control , Encuestas y Cuestionarios , Vacunación/estadística & datos numéricos , Vacunación/psicologíaRESUMEN
OBJECTIVE: To determine factors predicting emergency preparedness (EP) behaviors among Hawaii parents. METHODS: A cross-sectional online survey of parents of children (age 0-12 years) living in Honolulu, Hawaii in March 2023 examined associations with 1) having an EP kit (supplies for use during emergencies) and 2) having a family emergency plan (what to do, where to go, how to communicate during emergencies) with demographics/household characteristics and theoretical constructs of the Health Belief Model. A multivariable regression model obtained odds ratios and 95% confidence intervals. RESULTS: Participants (N=278) were mainly female (84%), college-educated (68%), and were similar in diverse racial/ethnic composure (White, 13.3%) to the overall Honolulu County. Logistic regression determined participants with lower perceived susceptibility to disasters, greater time barriers, and those who needed help to prepare for emergencies were less likely to have an EP kit. Among participants without an EP kit, a website able to create personalized instructions for household EP would be useful. Participants who needed help to prepare for emergencies were less likely to have a family emergency plan. CONCLUSION: Future interventions should focus on evidence-based strategies that improve self-efficacy associated with developing EP kits and family emergency plans.
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BACKGROUND: The 2020 American Cancer Society (ACS) guidelines are the most recent national guidelines for cervical cancer screening. These guidelines propose two major changes from current practice: initiating screening at age 25 years and using primary human papillomavirus (HPV) testing. Adoption of guidelines often occurs slowly, and therefore understanding clinician attitudes is important to facilitate practice change. METHODS: Interviews with a national sample of clinicians who perform cervical cancer screening in a variety of settings explored attitudes toward the two major changes from the 2020 ACS cervical cancer screening guidelines. Clinicians participated in 30- to 60-min interviews exploring their attitudes toward various aspects of cervical cancer screening. Qualitative analysis was performed. RESULTS: Seventy clinicians participated from across the United States. Few respondents were initiating screening at age 25 years, and none were using primary HPV testing. However, over half would be willing to adopt these practices if supported by scientific evidence and recommended by professional medical organizations. Barriers to adoption included the lack of endorsement by professional societies, lack of laboratory availability and insurance coverage, limited autonomy within large health care systems, and concerns related to missed disease. CONCLUSIONS: Few clinicians have adopted screening initiation or primary HPV testing, as recommended by the 2020 ACS guidelines, but over half were open to adopting these changes. Implementation may be facilitated via professional organization endorsement, clinician education, and laboratory, health care system, and insurance support. PLAIN LANGUAGE SUMMARY: In 2020, the American Cancer Society (ACS) released updated guidelines for cervical cancer screening. The main changes to current practices were to initiate screening at age 25 years instead of age 21 years and to screen using primary human papillomavirus (HPV) testing rather than cytology alone or in combination with HPV testing. We performed in-depth interviews with 70 obstetrics and gynecology, family medicine, and internal medicine physicians and advanced practice providers about their attitudes toward these guidelines. Few clinicians are following the 2020 ACS guidelines, but over half were open to changing practice if the changes were supported by evidence and recommended by professional medical organizations. Barriers to adoption included the lack of endorsement by professional medical organizations, logistical issues, and concerns about missed disease.
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American Cancer Society , Actitud del Personal de Salud , Detección Precoz del Cáncer , Infecciones por Papillomavirus , Guías de Práctica Clínica como Asunto , Investigación Cualitativa , Neoplasias del Cuello Uterino , Humanos , Neoplasias del Cuello Uterino/diagnóstico , Femenino , Estados Unidos , Detección Precoz del Cáncer/psicología , Adulto , Infecciones por Papillomavirus/diagnóstico , Persona de Mediana Edad , Pautas de la Práctica en Medicina , Tamizaje Masivo , MasculinoRESUMEN
INTRODUCTION: National guidelines recommend cervical cancer screening with Papanicolaou (Pap) testing at 3-year intervals or with human papillomavirus (HPV) testing alone or HPV/Pap cotesting at 5-year intervals for average-risk individuals aged 30-65 years. METHODS: We explored factors associated with clinician-reported guideline-concordant screening, as well as facilitators and barriers to appropriate cervical cancer screening. RESULTS: A national sample of clinicians (N = 1,251) completed surveys; a subset (n = 55) completed interviews. Most (94%) reported that they screened average-risk patients aged 30-65 years with cotesting. Nearly all clinicians who were categorized as nonadherent to national guidelines were overscreening (98%). Guideline concordant screening was reported by 47% and 82% of those using cotesting and HPV testing, respectively (5-year intervals), and by 62% of those using Pap testing only (3-year intervals). Concordant screening was reported more often by clinicians who were aged <40 years, non-Hispanic, and practicing in the West or Midwest, and less often by obstetrician-gynecologists and private practice physicians. Concordant screening was facilitated by beliefs that updated guidelines were evidence-based and reduced harms, health care system dissemination of guidelines, and electronic medical record prompts. Barriers to concordant screening included using outdated guidelines, relying on personal judgment, concern about missing cancers, inappropriate patient risk assessment, and lack of support for guideline adoption through health care systems or electronic medical records. CONCLUSIONS: Most clinicians screened with Pap/HPV cotesting and approximately one-half endorsed a 5-year screening interval. Clinician knowledge gaps include understanding the evidence underlying 5-year intervals and appropriate risk assessment to determine which patients should be screened more frequently. Education and tracking systems can promote guideline-concordant screening.
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Detección Precoz del Cáncer , Adhesión a Directriz , Tamizaje Masivo , Prueba de Papanicolaou , Infecciones por Papillomavirus , Neoplasias del Cuello Uterino , Frotis Vaginal , Humanos , Femenino , Neoplasias del Cuello Uterino/diagnóstico , Persona de Mediana Edad , Adulto , Frotis Vaginal/estadística & datos numéricos , Infecciones por Papillomavirus/diagnóstico , Adhesión a Directriz/estadística & datos numéricos , Anciano , Guías de Práctica Clínica como Asunto , Encuestas y Cuestionarios , Pautas de la Práctica en Medicina/estadística & datos numéricosRESUMEN
There is a continued need for research to better understand the influence social media has on parental vaccination attitudes and behaviors, especially research capturing the effects of the COVID-19 pandemic. The goal of this study was to explore parents' perspectives related to the impact the pandemic had on 1) social media engagement, 2) vaccine messaging on social media, and 3) factors to guide future intervention development. Between February and March 2022, 6 online, synchronous, text-based focus groups were conducted with parents of adolescents aged 11 to 17 years. Participants who all utilized social media were recruited from across the United States. Qualitative data were analyzed using content analysis. A total of 64 parents participated. Average age was 47 years, and participants were predominantly White (71.9%), female (84.3%), and engaged with social media multiple times per day (51.6%). Participants (95.3%) viewed obtaining all recommended vaccines as important or very important; however, overall vaccination rates for their adolescents were varied (50% ≥1 dose HPV; 59.4% MenACWY; 78.1% Tdap; 65.6% Flu; 81.3% COVID-19). Three themes emerged highlighting the pandemic's impact on parent's (1) general patterns of social media use, (2) engagement about vaccines on social media and off-line behaviors related to vaccination, and (3) perspectives for developing a credible and trustworthy social media intervention about vaccination. Participants reported fatigue from contentious vaccine-related content on social media and desired future messaging to be from recognizable health institutions/associations with links to reputable resources. Plus, providers should continue to provide strong vaccine recommendations in clinic.
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COVID-19 , Vacunas contra Papillomavirus , Medios de Comunicación Sociales , Adolescente , Humanos , Femenino , Estados Unidos , Persona de Mediana Edad , Pandemias , COVID-19/prevención & control , Padres , Vacunación , Programas de Inmunización , Toma de Decisiones , Conocimientos, Actitudes y Práctica en SaludRESUMEN
PURPOSE: This study sought an improved understanding of household emergency preparedness (EP) among Native Hawaiian, Pacific Islander, and Filipino (Indigenous Pacific People [IPP]) parents in Hawaii. DESIGN: We conducted an exploratory qualitative descriptive study with 60-minute interviews occurring from October 2022 through March 2023. A semi-structured interview guide exploring participant household EP was employed. METHODS: Prospective participants were females who identified as IPP, caregivers of a 0-12-year-old child, spoke English, and received health services at a federally qualified health center clinic. Two researchers conducted qualitative content analysis on interview transcripts. Initial coding of transcripts identified broad categories or themes. The process was reviewed continuously to verify data and coding procedures. Three investigators independently verified final themes and subthemes. FINDINGS: Participants (N=25) were female, between 30-49 years of age (68%), had received some college education (60%), and were fully employed (68%). Major themes included: 1) Perceptions of family EP and current behaviors, 2) Barriers and challenges to family EP, and 3) Perspectives on strategies to improve family EP. Subthemes included risk perception for emergencies; family EP practices; health protection and pandemic preparedness; lack of knowledge and experience; social, cultural and economic barriers; and clinic-based, technology-driven, and community-based interventions. CONCLUSION: Factors impeding access to healthcare services also impede family EP among IPP groups and their ability to mitigate the impact of future public health emergencies. CLINICAL EVIDENCE: Targeted, innovative interventions, including ones led by health clinics and those that utilize technology, are needed to overcome common barriers faced and to facilitate the uptake of household EP behaviors among IPP families.
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Nativos de Hawái y Otras Islas del Pacífico , Investigación Cualitativa , Adulto , Femenino , Humanos , Persona de Mediana Edad , Asiático , Hawaii , Entrevistas como Asunto , Nativos de Hawái y Otras Islas del Pacífico/psicología , Estudios ProspectivosRESUMEN
BACKGROUND: Youth may be reluctant to seek health care from school health providers due to feeling embarrassed or stigmatized in the health office environment or worried about their confidentiality. The purpose of this project was to create a set of youth-centered health posters that promote youth engagement with nursing staff and to standardize health messaging across high schools in Hawaii school-based clinics. METHODS: Two community advisory boards, 1 composed of 10 youth stakeholders (mean age 17 years) and the other of 7 adult stakeholders, informed poster development utilizing web-based discussion groups. The discussions were transcribed, and additional data was collected using field notes and anonymous digital messages. Adult advisory board members also provided feedback on suggested poster text through an online survey. RESULTS: Youth and adult advisory board participants identified 4 key health concerns facing youth: confidentiality, sexual health, relationships, and mental health. Based on input from the 2 advisory boards, 4 posters were developed, each centered on 1 key health issue. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: School-based posters can convey important messages to help youth understand their health care rights and responsibilities, as well as identify important issues open for discussion with nurses. CONCLUSION: Posters are an underutilized tool for school health providers to create welcoming, inclusive health care environments and facilitate health-related conversations with youth. This paper describes participant feedback about the characteristics of a memorable poster and briefly outlines current knowledge and recommendations for school health providers regarding each of the 4 health issues.
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Servicios de Enfermería Escolar , Salud Sexual , Adulto , Humanos , Adolescente , Hawaii , Salud Mental , Conducta SocialRESUMEN
One in every eight persons in Hawai'i, USA, have limited English proficiency (LEP) and are entitled to free language assistance for federally funded services under Title IV of the Civil Rights Act of 1964. They also have the right to culturally and linguistically appropriate services (CLAS) provided by professional medical interpreters (PMIs). This study's goals were to uncover barriers and facilitators of CLAS from the perspective of PMIs. PMIs for Filipino languages (n = 10) participated in an online survey and semi-structured interviews. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using conventional content analysis. Six themes emerged in the qualitative analysis: (1) cultural and social factors that can influence patient-provider communication; (2) barriers to effective patient-provider communication: patient, healthcare provider, and PMI levels; (3) facilitators of effective patient-provider communication: patient, healthcare provider, and PMI levels; (4) COVID-19 and remote interpreting barriers and facilitators; (5) strengths and weaknesses of in-person and stand-by interpreting appointments; and, (6) recommendations: system and provider levels. Proposed interventions could include advertising language services among Filipino communities and educating them about their language rights, providing additional resources for language assistance, employing more PMIs, training staff/providers, and supporting the use of PMIs versus untrained individuals.
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Comunicación , Lenguaje , Humanos , Hawaii , Técnicos Medios en Salud , Personal de Salud , Barreras de ComunicaciónRESUMEN
The World Health Organization adopted happiness as an indicator of societal progress in addressing conditions that directly affect psychological well-being and recommended communities address the determinants and obstacles to subjective well-being. Therefore, we conducted an online survey, informed by the Sustainable Happiness Model, among university employees that measured life circumstances (sociodemographics) and intentional leisure-time moderate-to-vigorous physical activity as potential predictors of subjective happiness (assessed using the Subjective Happiness Scale [SHS]). The multiethnic sample (N = 85) primarily included those who identified as White (44%), Asian (33%), and Native Hawaiian and other Pacific Islander (16%). The most prevalent age range was 41 to 50 years (31%), and 55% of the sample identified as female, 78% as faculty, and 22% as staff. Reporting a current mental health condition had significantly lower SHS scores compared to all other factors. Future research should explore interventions to support and improve university employee's mental health and overall well-being. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].
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Background: The COVID-19 pandemic led to reductions in cervical cancer screening and colposcopy. Therefore, in this mixed methods study we explored perceived pandemic-related practice changes to cervical cancer screenings in federally qualified health centers (FQHCs). Methods: Between October 2021 and June 2022, we conducted a national web survey of clinicians (physicians and advanced practice providers) who performed cervical cancer screening in FQHCs in the United States during the post-acute phase of the COVID-19 pandemic, along with a sub-set of qualitative interviews via video conference, to examine perceived changes in cervical cancer screening practices during the pandemic. Results: A total of 148 clinicians completed surveys; a subset (n=13) completed qualitative interviews. Most (86%) reported reduced cervical cancer screening early in the pandemic, and 28% reported continued reduction in services at the time of survey completion (October 2021- July 2022). Nearly half (45%) reported staff shortages impacting their ability to screen or track patients. Compared to clinicians in Obstetrics/Gynecology/Women's health, those in family medicine and other specialties more often reported reduced screening compared to pre-pandemic. Most (92%) felt that screening using HPV self-sampling would be very or somewhat helpful to address screening backlogs. Qualitative interviews highlighted the impacts of staff shortages and strategies for improvement. Conclusions: Findings highlight that in late 2021 and early 2022, many clinicians in FQHCs reported reduced cervical cancer screening and of pandemic-related staffing shortages impacting screening and follow-up. If not addressed, reduced screenings among underserved populations could worsen cervical cancer disparities in the future. Funding: This study was funded by the American Cancer Society, who had no role in the study's design, conduct, or reporting.
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COVID-19 , Neoplasias del Cuello Uterino , Estados Unidos/epidemiología , Embarazo , Humanos , Femenino , Detección Precoz del Cáncer , COVID-19/diagnóstico , COVID-19/epidemiología , Pandemias , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/epidemiología , EmocionesRESUMEN
Background: The COVID-19 pandemic led to reductions in cervical cancer screening and colposcopy. Therefore, in this mixed method study we explored perceived pandemic-related practice changes to cervical cancer screenings and colposcopies. Methods: In 2021, a national sample of 1251 clinicians completed surveys, including 675 clinicians who performed colposcopy; a subset (n=55) of clinicians completed qualitative interviews. Results: Nearly half of all clinicians reported they were currently performing fewer cervical cancer screenings (47%) and colposcopies (44% of those who perform the procedure) than before the pandemic. About one-fifth (18.6%) of colposcopists reported performing fewer LEEPs than prior to the pandemic. Binomial regression analyses indicated that older, as well as internal medicine and family medicine clinicians (compared to OB-GYNs), and those practicing in community health centers (compared to private practice) had higher odds of reporting reduced screening. Among colposcopists, internal medicine physicians and those practicing in community health centers had higher odds of reporting reduced colposcopies. Qualitative interviews highlighted pandemic-related care disruptions and lack of tracking systems to identify overdue screenings. Conclusions: Reductions in cervical cancer screening and colposcopy among nearly half of clinicians more than 1 year into the pandemic raise concerns that inadequate screening and follow-up will lead to future increases in preventable cancers. Funding: This study was funded by the American Cancer Society, who had no role in the study's design, conduct, or reporting.
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COVID-19 , Neoplasias del Cuello Uterino , Estados Unidos/epidemiología , Humanos , Femenino , Embarazo , Detección Precoz del Cáncer , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/epidemiología , COVID-19/diagnóstico , COVID-19/epidemiología , Colposcopía , PandemiasRESUMEN
BACKGROUND: Updated risk-based guidelines for cervical cancer screening (CCS) allow for individualized screening that minimizes unnecessary testing. However, these guidelines are complex and may not be easily understandable to patients. PURPOSE: To describe women's perceptions and preferences about CCS in light of recent guideline changes. METHODOLOGY: This qualitative study conducted in February 2020 used online, text-based focus groups with a sample of US women ( n = 49) ages 27-45. After participants completed a short demographic survey, an experienced moderator used a semistructured guide to solicit participants' perceptions of routine gynecologic care and CCS. We summarized survey data using descriptive statistics. Two authors analyzed transcripts using conventional content analysis and met with other team members to resolve discrepancies and determine final themes. RESULTS: Most participants were non-Hispanic White (65%), had health insurance (90%), and reported having a routine gynecologic examination in the past year (70%). We identified four common themes: (1) low perceived risk of human papillomavirus (HPV) coupled with low knowledge about HPV as a causative factor for cervical cancer, (2) confusion about-and mistrust of-recent individual risk-based guidelines that determine the indicated timing and type of CCS test (Pap or HPV testing), (3) mixed opinions about performing a self-swab for HPV testing, and (4) conflicting perceptions of trust toward providers and the health care industry. CONCLUSIONS: Findings highlight women's uncertainty and hesitancy about updated CCS guidelines. IMPLICATIONS: Provider-patient communication strategies should consider women's gaps in knowledge about HPV, include the rationale for guidelines and types of tests, and build trust between patients and providers.
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Infecciones por Papillomavirus , Neoplasias del Cuello Uterino , Femenino , Humanos , Prueba de Papanicolaou , Neoplasias del Cuello Uterino/diagnóstico , Detección Precoz del Cáncer , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/prevención & control , Grupos Focales , Virus del Papiloma Humano , Tamizaje Masivo , Conocimientos, Actitudes y Práctica en SaludRESUMEN
OBJECTIVE: To examine associations among women's preferred locations for human papillomavirus (HPV) self-sampling in relation to their demographic, social, and health characteristics and their perceived benefits and concerns regarding this procedure. DESIGN: Cross-sectional, descriptive survey. SETTING: Online distribution between March 2022 and April 2022. PARTICIPANTS: People who were assigned female sex at birth and were eligible for cervical cancer screening (N = 367: cis-gender women, n = 364; another gender identity, n = 3). METHODS: We used quota sampling to obtain a racially and ethnically diverse sample. We conducted bivariate analyses to examine differences in participants' preferred locations for HPV self-sampling by sociodemographic and health characteristics. We used a multinomial logistic regression model to examine the associations between preferred HPV self-sampling location, characteristics of participants, and perceived benefits and concerns regarding this procedure. RESULTS: In our sample, 43% (n = 158) of participants preferred HPV self-sampling at the office of a health care provider, 50% (n = 182) preferred HPV self-sampling anywhere (office or home), and 7% (n = 27) did not feel comfortable with HPV self-sampling anywhere. Participants 39 to 45 years of age were more likely to prefer HPV self-sampling anywhere (office or home) than participants 27 to 32 years of age, OR = 2.47, 95% confidence interval (CI) [1.21, 5.06]. Participants who preferred HPV self-sampling anywhere perceived greater benefit related to limited geographic access to a clinic compared to those who preferred office only, OR = 1.82, 95% CI [1.08, 3.07]. Participants who preferred HPV self-sampling anywhere had less concern related to performing the procedure accurately than those who preferred office only, OR = 0.44, 95% CI [0.31, 0.62]. CONCLUSION: HPV self-sampling is an alternative strategy to increase cervical cancer screening. As providers consider implementation of HPV self-sampling, our findings suggest that office and home-based collection strategies should be considered to increase access to cervical cancer screening.
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Infecciones por Papillomavirus , Neoplasias del Cuello Uterino , Masculino , Recién Nacido , Femenino , Humanos , Adulto , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/prevención & control , Virus del Papiloma Humano , Infecciones por Papillomavirus/diagnóstico , Detección Precoz del Cáncer/métodos , Autocuidado/métodos , Estudios Transversales , Aceptación de la Atención de Salud , Papillomaviridae , Identidad de Género , Manejo de Especímenes/métodos , Tamizaje Masivo/métodosRESUMEN
BACKGROUND: The 2019 American Society for Colposcopy and Cervical Pathology (ASCCP) risk-based management consensus guidelines are the most recent national guidelines for the management of abnormal cervical cancer screening tests. These guidelines benefit patients by concentrating testing and treatment in those at highest cervical cancer risk. Adoption of guidelines often occurs slowly, with few studies examining the factors associated with guideline-adherent management of abnormal results. METHODS: To elucidate the factors associated with the use of the 2019 ASCCP guidelines among clinicians who perform cervical cancer screening, physicians and advanced practice professionals who perform cervical cancer screening were cross-sectionally surveyed. Clinicians responded to screening vignettes with differing recommendations for management between the 2019 and prior management guidelines. Screening vignette 1 involved reduction of invasive testing on a low-risk patient; screening vignette 2 involved increased surveillance testing on a high-risk patient. Binomial logistic regression models determined the factors associated with the use of the 2019 guidelines. RESULTS: A total of 1251 clinicians participated from across the United States. For screening vignettes 1 and 2, guideline-adherent responses were given by 28% and 36% of participants, respectively. Management recommendations differed by specialty and were incorrect in different situations: there was inappropriate invasive testing by obstetrics and gynecology physicians (vignette 1) and inappropriate discontinuation of screening by family and internal medicine physicians (vignette 2). Regardless of their chosen response, over half erroneously believed they were guideline adherent. CONCLUSIONS: Many clinicians who believe they are following appropriate guidelines may not realize their management strategy is inconsistent with the 2019 guidelines. Education initiatives tailored to clinician specialty could address the understanding of current guidelines, encourage the use of updated guidelines, maximize patient benefits, and minimize harms. PLAIN LANGUAGE SUMMARY: The 2019 American Society for Colposcopy and Cervical Pathology risk-based management consensus guidelines are the most recent national guidelines for abnormal cervical cancer screening test management. We surveyed over 1200 obstetrics and gynecology (OB/GYN), family medicine, and internal medicine physicians and advanced practice providers about their screening and abnormal results follow-up practices in relation to guidelines. Few clinicians are following the 2019 guidelines. Management recommendations differed by clinician specialty and were incorrect in different situations: there was inappropriate invasive testing by OB/GYN physicians and inappropriate screening discontinuation by family and internal medicine physicians. Education tailored by clinician specialty could address the understanding of current guidelines, encourage the use of updated guidelines, maximize patient benefits, and minimize harms.
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Colposcopía , Neoplasias del Cuello Uterino , Femenino , Embarazo , Humanos , Estados Unidos , Colposcopía/métodos , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/terapia , Neoplasias del Cuello Uterino/patología , Estudios Transversales , Detección Precoz del Cáncer/métodos , ActitudRESUMEN
BACKGROUND: Improving household emergency preparedness (EP) is a public health priority, yet little is known about what influence the COVID-19 pandemic had on families' EP. This study aimed to explore current EP attitudes and behaviors. METHODS: We conducted online focus groups in Winter 2022 with a nationwide sample of parents of adolescents. We held six 90-min focus groups of 9-15 participants using a semi-structured interview script that elicited parental knowledge and attitudes related to household EP. Two researchers conducted qualitative content analysis on focus group transcripts. First-level coding within and across scripts was used to identify broad categories or themes regarding EP. The process was reviewed continuously to verify data and coding procedures. Three investigators independently verified the final themes that emerged. RESULTS: Participants (N = 64) were mostly female (n = 54, 84.3%), white (n = 46, 71.9%), and college-educated (n = 49, 76.6%). Major themes included: 1) Expanded awareness and behavioral change related to EP due to the COVID-19 pandemic, 2) Reconceptualization of planning for family health as part of EP, 3) Changing perspectives related to vaccination as a component of EP, and 4) Perspectives related to discussing EP with their health care provider. CONCLUSIONS: EP was described as a healthcare issue and healthcare providers were identified as trusted sources of EP information. Interventions to support providers' ability to assist with individual EP health action plans, including discussing vaccination as part of preparedness are needed.
Asunto(s)
COVID-19 , Defensa Civil , Adolescente , Humanos , Femenino , Masculino , Pandemias , COVID-19/epidemiología , Conocimientos, Actitudes y Práctica en Salud , PadresRESUMEN
Clinician recommendation remains a critical factor in improving HPV vaccine uptake. Clinicians practicing in federally qualified health centers were surveyed between October 2021 and July 2022. Clinicians were asked how they recommended HPV vaccination for patients aged 9-10, 11-12, 13-18, 19-26, and 27-45 y (strongly recommend, offer but do not recommend strongly, discuss only if the patient initiates the conversation, or recommend against). Descriptive statistics were assessed, and exact binomial logistic regression analyses were utilized to examine factors associated with HPV vaccination recommendation in 9-10-y-old patients. Respondents (n = 148) were primarily female (85%), between the ages of 30-39 (38%), white, non-Hispanic (62%), advanced practice providers (55%), family medicine specialty (70%), and practicing in the Northeast (63%). Strong recommendations for HPV vaccination varied by age: 65% strongly recommended for ages 9-10, 94% for ages 11-12, 96% for ages 13-18, 82% for age 19-26, and 26% for ages 27-45 y. Compared to Women's Health/OBGYN specialty, family medicine clinicians were less likely to recommend HPV vaccination at ages 9-10 (p = .03). Approximately two-thirds of clinicians practicing in federally qualified health centers or safety net settings strongly recommend HPV vaccine series initiation at ages 9-10. Additional research is needed to improve recommendations in younger age groups.
Asunto(s)
Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Humanos , Femenino , Adulto , Infecciones por Papillomavirus/prevención & control , Vacunación , Conocimientos, Actitudes y Práctica en Salud , Pautas de la Práctica en Medicina , Encuestas y CuestionariosRESUMEN
BACKGROUND: COVID-19 vaccines are now available under Emergency Use Authorization for children ages 6 months to 5 years. We examined parents' intentions to vaccinate their children under the age of 5 years and assessed whether their confidence in making an informed decision about vaccination (decision self-efficacy) was associated with these intentions. METHOD: We conducted a cross-sectional online survey of U.S. parents between 23 March and 5 April 2022. We examined associations between parental intention to vaccinate their young children (