Taking stock and looking ahead: Behavioural science lessons for implementing the nonavalent human papillomavirus vaccine

The development and licensing of a nonavalent human papillomavirus (HPV) vaccine has the potential to reduce morbidity and mortality from HPV-related cancers beyond that of first generation HPV vaccines. However, this benefit can only be realised if the offer of vaccination is accepted. Uptake of first generation HPV vaccines is not complete and shows huge global variation. In addition to practical and financial challenges to optimising coverage, behavioural issues explain a large proportion of the variance in vaccine receipt. This commentary draws on the findings of over a decade of behavioural science research seeking to understand uptake of first generation HPV vaccines, in order to anticipate challenges to implement the nonavalent HPV vaccine. Challenges include distrust of combination vaccines, uncertainty about long-term efficacy, distrust of a new and (perceived to be) untested vaccine, cost and uncertainty regarding interchanging doses of first generation and nonavalent vaccines and the appropriateness of revaccination. We use behavioural science theory and existing evaluations of interventions to increase uptake of vaccines to identify evidence-based approaches that can be implemented by vaccine stakeholders to address parents' concerns and maximise uptake of the nonavalent HPV vaccine

Print and online newspaper coverage of the link between HPV and oral cancer in the UK: a mixed-methods study

OBJECTIVES: The role of human papillomavirus (HPV) in some oral cancers has been reported in the news press, though little is known about the content of these articles. This study aimed to examine how frequently the link between HPV and oral cancer has been reported in the news press and to examine the content of these articles. DESIGN: UK media articles were searched for articles relating to oral cancer and HPV in the database NexisUK. Of 854 articles identified by the initial search, 112 were eligible for inclusion (2002-2014) and content analysis was used to determine the main themes discussed. RESULTS: Themes included actor Michael Douglas' claim that his throat cancer was caused by HPV, the riskiness of oral sex, health information (including HPV as a cause of oral cancer) and the need to vaccinate boys against HPV. Many articles also referred to the link between HPV and cervical cancer and the increasing incidence of HPV-related oral cancer. The largest peak in articles occurred when Michael Douglas discussed his cancer (June 2013). Facts about HPV and references to research were provided in some articles. CONCLUSIONS: The link between HPV and oral cancer and the transmission of HPV via oral sex was regularly discussed, yet coverage often lacked detailed health information. This could increase awareness of the link between oral sex and HPV risk, but may also lead to public concern about oral sex as a sexual behaviour

Role of ethnicity in human papillomavirus vaccination uptake: a cross-sectional study of girls from ethnic minority groups attending London schools

OBJECTIVE: Research suggests that girls from ethnic minority groups are less likely to receive the human papillomavirus (HPV) vaccination than white British girls; however, the specific ethnic minority groups that have lower uptake have not been identified. This study aimed to examine the relationship between school-level uptake and ethnicity as well as uptake and other ethnicity-related factors, to understand which specific groups are less likely to receive the vaccination. METHODS: Aggregated uptake rates from 195 schools were obtained for each of the three recommended vaccine doses from 2008 to 2010. Census data at the lower super output area (LSOA) level for the postcode of each school were also obtained, describing the ethnic breakdown of the resident population (ethnicity, language spoken, religion, proficiency in English and duration of residency in the UK). These were used as proxy measures of the ethnic make-up of the schools. The most prevalent non-majority group for each ethnicity and ethnicity-related factor was assigned to each school. Analyses explored differences in uptake by ethnicity and ethnicity-related factors. RESULTS: No significant differences in vaccination uptake were found by ethnicity or ethnicity-related factors, although descriptive differences were apparent. Schools in areas where black ethnicities were the most prevalent non-white British ethnicities had consistently low rates of uptake for all doses. Schools in areas where some Asian ethnicities were the most prevalent non-white British ethnicities had consistently high rates of uptake for all doses. There was evidence of variability in mean uptake rates for ethnicities within ‘black’ and ‘Asian’ ethnic groups. CONCLUSIONS: Future research would benefit from focusing on specific ethnicities rather than broad ethnic categories. Replication of this study with a larger sample and using complete individual-level data, collected on a national level, would provide a clearer indication of where ethnic differences in HPV vaccination uptake exist

A protocol for a cluster randomised feasibility study of an adolescent incentive intervention to increase uptake of HPV vaccination among girls

Background Uptake of the human papillomavirus (HPV) vaccine in the UK is good, but there are pockets of the community who remain unprotected. Immunisation teams usually require written parental consent for a girl to receive the vaccine. Evidence suggests that uptake of the vaccine might be improved by promoting consent form return (if returned, forms are likely to grant consent). Incentivising girls to return consent forms is a promising approach to promoting consent form return. Before testing the efficacy of an incentive intervention in a randomised controlled trial (RCT), we must first establish whether the RCT is feasible. In this randomised feasibility study, we aim to establish the feasibility of conducting a cluster RCT of an adolescent incentive intervention to increase uptake of HPV vaccination. Methods At least six schools will be randomised to either an incentive intervention arm or a standard invitation arm. Girls in standard invitation arm schools will receive the usual HPV vaccine programme invitation materials. Girls attending schools in the incentive intervention arm will receive the standard invitation and will also be told that they will receive an incentive if they return their consent form (regardless of whether consent is granted or denied). The incentive is being entered into a prize draw to win a retail voucher. Feasibility objectives include estimating the schools’ and parents’ willingness to participate in the study and be randomised; response rates to questionnaires; the extent of missing data; the girls’ and parents’ attitudes towards the incentive offered; school staff experiences of participating, fidelity to the trial procedures, data on any unintended consequences and the possible mechanisms of action, and proof-of-concept evidence of the effect of the intervention on consent form return rates and uptake of the vaccine. Analysis of feasibility outcomes will primarily be descriptive. Consent form return rates and uptake of the vaccine will be presented by trial arm without comparison. Discussion Incentivising HPV vaccine consent form return may promote HPV vaccine uptake. This study will provide the evidence needed to establish whether testing this incentive intervention using a RCT design in the future is feasible

Meta TV in practice : a study of the re-use of television texts within contemporary television programmes

This thesis considers how television reflects on its own output in the context of newly created television programmes which seek to reconsider, reframe and re-contextualise the content of television programmes that have already been broadcast. It does this by considering a range of programmes created between 2002 and 2009 as part of my work as a practice based researcher. These programmes cover some of the key genres in contemporary television and reflect the development of forms and themes within the medium. The broad focus of this work is to seek to gain an understanding of what fresh meanings can be derived from re-using existing television content in new programmes that contextualise it with the provision of newly commissioned and created visual content. More specifically the work seeks to explore the role of the implied viewer and his or her proxies on screen and how this affects the construction and delivery of these new programmes.The programmes under consideration include archive based retrospectives of television dramas, lifestyle programmes and property formats. These are viewed from the perspective of key ideas in television studies including fan studies, celebrity culture, intertextuality, hybridity and television history. Taken altogether, it is argued the work constitutes a meta-practice in television

Experiences of cervical screening and barriers to participation in the context of an organised programme: a systematic review and thematic synthesis

OBJECTIVE: As uptake of cervical screening continues to decline, this systematic review synthesises the qualitative literature on women's perceptions and experiences of cervical screening in the context of an organised call-recall programme, in order to understand the barriers to informed uptake. METHODS: We searched nine databases for English language peer-reviewed publications reporting on qualitative data from screening-eligible women, exploring barriers to cervical screening in countries that offer a nationally organised call-recall programme. Evidence was integrated using thematic synthesis. RESULTS: Thirty-nine papers from the UK, Australia, Sweden and Korea were included. The majority of participants had attended screening at least once. Two broad themes were identified: (a) should I go for screening? and (b) screening is a big deal. In considering whether to attend, women discussed the personal relevance and value of screening. Women who had previously attended described how it was a big deal, physically and emotionally, and the varied threats that screening presents. Practical barriers affected whether women translated screening intentions into action. CONCLUSIONS: The variation in women's understanding and perceptions of cervical screening suggests that interventions tailored to decisional stage may be of value in increasing engagement with the invitation and uptake of screening in those who wish to take part. There is also a need for further research with women who have never attended screening, especially those who remain unaware or unengaged, as their perspectives are lacking in the existing literature. © 2016 The Authors. Psycho-Oncology Published by John Wiley & Sons Ltd

Exploring Human Papillomavirus Vaccination Refusal Among Ethnic Minorities in England: A Comparative Qualitative Study.

OBJECTIVES: In England, uptake of human papillomavirus (HPV) vaccination to prevent HPV-related cancer is lower among girls from ethnic minority backgrounds. We aimed to explore the factors that prevented ethnic minority parents from vaccinating, compared to White British non-vaccinating parents and vaccinating ethnic minority parents. METHODS: Interviews with 33 parents (n = 14 ethnic minority non-vaccinating, n = 10 White British non-vaccinating, n = 9 ethnic minority vaccinating) explored parents' reasons for giving or withholding consent for HPV vaccination. Data were analysed using Framework Analysis. RESULTS: Concerns about the vaccine were raised by all non-vaccinating ethnic minority parents, and they wanted information to address these concerns. External and internal influences affected parents' decisions, as well as parents' perceptions that HPV could be prevented using means other than vaccination. Reasons were not always exclusive to non-vaccinating ethnic minority parents, although some were, including a preference for abstinence from sex before marriage. Only ethnic minority parents wanted information provided via workshops. CONCLUSIONS: Ethnic differences in HPV vaccination uptake may be partly explained by concerns that were only reported by parents from some ethnic groups. Interventions to improve uptake may need to tackle difficult topics like abstinence from sex before marriage, and use a targeted format

Information needs among women taking part in primary HPV screening in England: a content analysis

Objectives: Introducing primary human papillomavirus (HPV) testing to cervical screening programmes means changes to the results women receive. We explored additional information needs among women undergoing HPV primary screening. / Design: Women were sent a postal questionnaire shortly after receiving their results and 6 and 12 months later. Each questionnaire asked if women had any unanswered questions about cervical screening or HPV testing. Free-text responses constituted the data. Themes were identified using content analysis. / Setting: National Health Service (NHS) Cervical Screening Programme, England. / Participants: 381 women who recorded one or more free-text responses. / Results: The most common theme represented women’s emotional responses and attempts to understand their results. This theme was raised by 45% of women overall, but was as high as 59% in the HPV cleared group. General questions about the cause and epidemiology of HPV were raised by 38% of women and were more common among those testing HPV positive with normal cytology (52%). Questions about the purpose and procedure for HPV testing were most common among HPV-negative women (40%, compared with 16%–24% of the other results groups). Questions about future implications of test results were raised by 19% of women, and this theme was most common among those with persistent HPV. / Conclusions: Despite provision of information alongside screening invitations, women can still have unanswered questions following receipt of their results. Details about the epidemiology of HPV and why cervical screening procedures are changing should be included with screening invitations. Some results groups may benefit from additional tailored information with their results letter

Anticancer activity and DNA interaction of bis(pyridyl)allene-derived metal complexes

The constant need for novel drugs has prompted the scientific community to explore alternative structures to natural products and small and medium size organic compounds used in classic medicinal and pharmaceutical chemistry. Since the discovery of cisplatin, organometallic compounds have revealed great potential as metallodrugs and their development has exponentially grown in recent years. In this manuscript, we describe our efforts towards the synthesis of new metallodrugs by reaction of bis(pyridyl)allenes and metal complexes. Two classes of compounds are presented: one in which the allene structure is intact and the metal (Pd(II), Pt(IV) or Au(III)) coordinates to the pyridine-nitrogens; and another, in which one of the pyridines cyclises into a gold-activated allene to form β-N-stabilised gold carbenes. Both classes of compounds are active catalysts in important organic reactions, and are also promising antimicrobial, antifungal and anticancer agents. In this work, we describe the promising anticancer activity, against breast cancer cells, of the gold carbene complexes, and preliminary studies of their interaction with DNA, including non-canonical DNA structures. Our results have revealed an unusual selective stabilisation of hTeloC i-motif by one of the Au(III) carbene complexes, that opens up exciting opportunities for further development of novel DNA-binding metallodrugs