Acceptance patterns and decision-making for human papillomavirus vaccination among parents in Vietnam: an in-depth qualitative study post-vaccination

BACKGROUND: The GAVI Alliance’s decision in late 2011 to invite developing countries to apply for funding for human papillomavirus (HPV) vaccine introduction underscores the importance of understanding levels of HPV vaccine acceptance in developing country settings. In this paper, we present findings from qualitative research on parents’ rationales for vaccinating or not vaccinating their daughters (vaccine acceptance) and their decision-making process in the context of an HPV vaccination demonstration project in Vietnam (2008–2009). METHODS: We designed a descriptive qualitative study of HPV vaccine acceptability among parents of girls eligible for vaccination in four districts of two provinces in Vietnam(a). The study was implemented after each of two years of vaccinations was completed. In total, 133 parents participated in 16 focus group discussions and 27 semi-structured interviews. RESULTS: Focus group discussions and in-depth interviews with parents of girls vaccinated revealed that they were generally very supportive of immunization for disease prevention and of vaccinating girls against HPV. The involvement of the National Expanded Program of Immunization in the demonstration project lent credibility to the HPV vaccine, contributing to high levels of acceptance. For parents who declined participation, concerns about side effects, the possibility that the vaccine was experimental, and the possible impact of the vaccine on future fertility rose to the surface. In terms of the decision-making process, many parents exhibited ‘active decision-making,’ reaching out to friends, family, and opinion leaders for guidance prior to making their decision. CONCLUSION: Vietnam’s HPV vaccination experience speaks to the importance of close collaboration with the government to make the most of high levels of trust, and to reduce suspicions about new vaccines that may arise in the context of vaccine introduction in developing country settings

Continuation of injectable contraception when self-injected vs. administered by a health worker in Uganda

The purpose of this study was to compare 12-month continuation rates for subcutaneous depot medroxyprogesterone acetate (DMPA-SC) administered via self-injection and DMPA-IM administered by a facility-based health worker in Uganda. Women seeking injectable contraception at participating health facilities were offered the choice of self-injecting DMPA-SC or receiving an injection of DMPA-IM from a health worker. Those opting for self-injection were trained one-on-one. They self-injected under supervision and took home three units, a client instruction guide and a reinjection calendar. Those opting for DMPA-IM received an injection and an appointment card for the next facility visit in 3 months. We interviewed participants at baseline (first injection) and after 3 (second injection), 6 (third injection) and 9 (fourth injection) months, or upon discontinuation. Information from all interviews are included in this dataset, and can be downloaded from the files section. Information on the methods and results from this study can be found in the linked publication

The effects of fluency instruction on the literacy development of at -risk first graders

Phonological awareness and rapid serial naming are underlying processes associated with beginning reading. This first-grade study in a public school district was designed to compare the effectiveness of two supplemental instructional approaches for first graders at risk for reading failure: (a) training in phonological awareness alone and (b) training in phonological awareness and fluency. The participants were 20 at-risk first-grade students who were receiving a Title I intervention program called STeps Into Reading. This program was based on research and centered on direct instruction in phonological awareness. For this study, the intervention program was extended from 20 minutes a day to 30 minutes. The experimental group (STIR/PA + F) received fluency instruction for the extra 10 minutes. The control group (STIR/PA + PA) received additional phonological awareness instruction for the extra 10 minutes. The effects of the instruction were analyzed in two ways. First, a MANOVA was performed to determine if there was a significant difference between the STIR/PA + PA group and the STIR/PA + F group on spelling, decoding, word identification at 5 and 1 seconds and word reading fluency. There was not a significant difference found for either group on any of the dependent variables. The second analysis examined the effect of instruction on the literacy levels of the students to determine if fluency instruction gave the most at-risk students a benefit in word identification as it did in a prior feasibility study. The results of the ANOVA and independent sample t tests did show a significant advantage for the most at-risk students who received fluency instruction on word identification at 1 second and word reading fluency. There was a near significant advantage for word identification at 5 seconds. Findings support Wolf and Segal\u27s work, indicating that a neglected part of intervention may be in the area of fluency instruction for children with naming speed deficits that hinder automatic word recognition. Results are consistent with recommendations from the National Research Council (Snow, Burns, & Griffin, 1998) for instruction designed to prevent reading failure

Feasibility and acceptability of self-injected DMPA-SC in Uganda

The purpose of this study was to assess feasibility of subcutaneous depot medroxyprogesterone acetate self-injection in Uganda, with specific objectives to (a) measure the proportion of participants who self-injected competently, (b) measure the proportion who self-injected on time 3 months after training (defined conservatively as within 7 days of their reinjection date) and (c) assess acceptability. In this prospective cohort study, 380 18–45-year-old participants completed self-injection training by licensed study nurses, guided by a client instruction booklet, and practiced injection on prosthetics until achieving competence. Nurses supervised participants' self-injection and evaluated injection technique using an observation checklist. Those judged competent were given a Sayana® Press unit, instruction booklet and reinjection calendar for self-injection at home 3 months later. Participants completed an interview before and after self-injection. Nurses visited participants at home following reinjection dates; during the follow-up visit, participants demonstrated self-injection on a prosthetic, injection technique was reevaluated, and a postreinjection interview was completed. This dataset includes information from client surveys, as well as observation checklists assessing self-injection competency

Ugandan providers’ views on the acceptability of contraceptive self-injection for adolescents: A qualitative study.

Abstract Background Self-injection of subcutaneous depot medroxyprogesterone acetate may offer greater discretion and increase access to injectable contraception, particularly for those who face challenges accessing clinic services. In particular, unmarried adolescents often encounter stigma when seeking services, and may also lack the financial means to travel to clinics on the quarterly basis that injectable contraception requires. Whether self-injection is offered to women on a wide scale basis, and to adolescents specifically, will depend in part upon the willingness of providers to train clients of diverse ages and educational backgrounds. This study explores the views of providers with regard to self-injection as an option for women and adolescents in Uganda. Methods In-depth qualitative interviews were conducted with family planning providers in Gulu district, to understand their views on injectable self-injection for women, with a specific focus on unmarried adolescents ages 15 to 19 years. The in-depth interviews, which lasted up to 60 min were audio-recorded, translated and transcribed simultaneously, and analyzed using Atlas.ti software to identify key themes and common perspectives. Results A total of 40 health care providers were interviewed with equal numbers of each type (public, NGO, and private clinics, pharmacies, and community-based health workers). While most providers were receptive to self-injection for adult women, fewer than half were supportive of adolescent self-injection. Their reservations focused on age, marital status and parity concerns around adolescent use of the injectable more broadly, and concerns about the ability of adolescents to self-inject safely. Conclusions Self-injection presents an opportunity to reduce the enormous burden on the public sector health system in Uganda, which is particularly compounded by the heavy reliance on injectable contraception requiring quarterly clinic visits. The results of this study reveal a level of cautious support for self-injection among providers when it comes to self-injection by adult women. With respect to adolescent clients, family planning policymakers and program implementers should design, implement, and evaluate self-injection interventions with the needs of adolescent clients uppermost in mind, recognizing that extra attention will likely be needed to reduce provider-imposed restrictions on adolescent access to this injectable delivery modality