Introduction of School-Based HPV Vaccination in Sweden : Knowledge and Attitudes among Youth, Parents, and Staff

The overall aim of this thesis is to provide a better understanding of knowledge, attitudes, consent, and decision-making regarding Human papillomavirus (HPV) vaccination, seen from the perspectives of concerned parties – high school students, school nurses, and parents. Two quantitative studies were performed: one descriptive cross-sectional study and one quasi-experimental intervention study. Qualitative studies using focus group interviews and individual interviews were also performed. High school students’ knowledge about HPV and HPV prevention was low but their attitudes toward HPV vaccination were positive. An educational intervention significantly increased the students’ knowledge regarding HPV and HPV prevention. Their already positive attitudes toward condom use and HPV vaccination remained unchanged. The students wanted to receive more information about HPV from school nurses. The school nurses were also positive to HPV vaccination but identified many challenges concerning e.g. priorities, obtaining informed consent, culture, and gender. They saw an ethical dilemma in conflicting values such as the child’s right to self-determination, the parents’ right to make autonomous choices on behalf of their children, and the nurse’s obligation to promote health. They were also unsure of how, what, and to whom information about HPV should be given. Parents, who had consented to vaccination of their young daughters, reasoned as follows: A vaccine recommended by the authorities is likely to be safe and effective, and the parents were willing to do what they could to decrease the risk of a serious disease for their daughter. Fear of unknown adverse events was overweighed by the benefits of vaccination. Parents also saw the school nurse as an important source of HPV information. Conclusions: Positive attitudes toward HPV vaccination despite limited knowledge about HPV, are overarching themes in this thesis. School nurses have a crucial role to inform about HPV prevention. It is important that the concerned parties are adequately informed about HPV and its preventive methods, so that they can make an informed decision about vaccination. A short school-based intervention can increase knowledge about HPV among students. From a public health perspective, high vaccination coverage is important as it can lead to a reduced number of HPV-related disease cases.

Kunskap väger tungt men är lätt att bära : en studie om osynliga mellanchefers fortbildningsbehov

Datum: 2007-06-21 Författare: Gottvall, Maria Holmqvist, Elin Nivå/utbildning: D-nivå (Magisternivå) Företagsekonomi Handledare: Nils Wåhlin, Niklas Wahlström Titel: Kunskap väger tungt men är lätt att bära – en studie om osynliga mellanchefers fortbildningsbehov Problem: ”Hur väl möter stora företag inom verkstadsindustrin de osynliga mellanchefernas behov av fortbildning?” Syfte: Syftet med denna uppsats är att uppmärksamma och öka förståelsen för osynliga mellanchefers fortbildningsbehov vid Scania AB i Södertälje, genom att: Identifiera osynliga mellanchefer. Utveckla förståelsen för de osynliga mellanchefernas profiltillhörighet. Jämföra de osynliga mellanchefernas syn på dess fortbildningsbehov med deras chefs syn på detta behov. Identifiera eventuella skillnader mellan två avdelningar angående osynliga mellanchefers fortbildningsbehov. Utveckla förståelsen för brister och möjligheter i den nuvarande fortbildningen. Metod: För att kunna besvara problemformuleringen och uppfylla uppsatsens syften har vi använt oss av både en kvalitativ och kvantitativ ansats. Vi har sammanlagt genomfört fjorton semistrukturerade intervjuer samt genomfört en elektronisk enkät med nio av dessa respondenter. Tanken med denna uppsats är att försöka utveckla förståelsen för och om möjligt generera ny kunskap om osynliga mellanchefers fortbildningsbehov, vilket även innebär att vårt teoretiska ramverk främst ligger till grund för att ge läsaren en bakgrund och förståelse till det problem vi studerar. Vårt angreppssätt kommer såtillvida att till största delen vara fokuserat på ett induktivt angreppssätt med svaga deduktiva inslag, vilket även stämmer väl överens med vårt val av en hermeneutisk kunskapssyn. Resultat/slutsatser: Den slutsats vi kommit fram till angående hur väl stora företag inom verkstadsindustrin möter de osynliga mellanchefernas behov till fortbildning anser vi att Scania AB, i detta fall, inte möter behoven till den grad som kan anses vara önskvärt. Viss obalans har identifierats hos Scania AB gällande denna fråga, vilken måste åtgärdas om de om möjligt ska kunna tillgodose de osynliga mellanchefernas behov. Sökord: Mellanchef, osynlig mellanchef, decentralisering, fortbildning, matchning, arbetsprofiler, aktivitetsprofiler Omfång, sidor: 87 numrerade sidor + 6 bilagor Antal ref/källor: 5 Internetkällor, 22 litteraturkällor (böcker), 15 intervjuer, 16 vetenskapliga artiklar, 3 övriga tryckta källor samt ett manus för licentiatuppsats (otryckt

Kunskap väger tungt men är lätt att bära : en studie om osynliga mellanchefers fortbildningsbehov

Datum: 2007-06-21 Författare: Gottvall, Maria Holmqvist, Elin Nivå/utbildning: D-nivå (Magisternivå) Företagsekonomi Handledare: Nils Wåhlin, Niklas Wahlström Titel: Kunskap väger tungt men är lätt att bära – en studie om osynliga mellanchefers fortbildningsbehov Problem: ”Hur väl möter stora företag inom verkstadsindustrin de osynliga mellanchefernas behov av fortbildning?” Syfte: Syftet med denna uppsats är att uppmärksamma och öka förståelsen för osynliga mellanchefers fortbildningsbehov vid Scania AB i Södertälje, genom att: Identifiera osynliga mellanchefer. Utveckla förståelsen för de osynliga mellanchefernas profiltillhörighet. Jämföra de osynliga mellanchefernas syn på dess fortbildningsbehov med deras chefs syn på detta behov. Identifiera eventuella skillnader mellan två avdelningar angående osynliga mellanchefers fortbildningsbehov. Utveckla förståelsen för brister och möjligheter i den nuvarande fortbildningen. Metod: För att kunna besvara problemformuleringen och uppfylla uppsatsens syften har vi använt oss av både en kvalitativ och kvantitativ ansats. Vi har sammanlagt genomfört fjorton semistrukturerade intervjuer samt genomfört en elektronisk enkät med nio av dessa respondenter. Tanken med denna uppsats är att försöka utveckla förståelsen för och om möjligt generera ny kunskap om osynliga mellanchefers fortbildningsbehov, vilket även innebär att vårt teoretiska ramverk främst ligger till grund för att ge läsaren en bakgrund och förståelse till det problem vi studerar. Vårt angreppssätt kommer såtillvida att till största delen vara fokuserat på ett induktivt angreppssätt med svaga deduktiva inslag, vilket även stämmer väl överens med vårt val av en hermeneutisk kunskapssyn. Resultat/slutsatser: Den slutsats vi kommit fram till angående hur väl stora företag inom verkstadsindustrin möter de osynliga mellanchefernas behov till fortbildning anser vi att Scania AB, i detta fall, inte möter behoven till den grad som kan anses vara önskvärt. Viss obalans har identifierats hos Scania AB gällande denna fråga, vilken måste åtgärdas om de om möjligt ska kunna tillgodose de osynliga mellanchefernas behov. Sökord: Mellanchef, osynlig mellanchef, decentralisering, fortbildning, matchning, arbetsprofiler, aktivitetsprofiler Omfång, sidor: 87 numrerade sidor + 6 bilagor Antal ref/källor: 5 Internetkällor, 22 litteraturkällor (böcker), 15 intervjuer, 16 vetenskapliga artiklar, 3 övriga tryckta källor samt ett manus för licentiatuppsats (otryckt

School Nurses' Perceptions and Experiences of Delivering a School-Based Intervention to Improve Primary Prevention of Human Papillomavirus Among Adolescents - A Focus Group Study Following a Randomized Controlled Trial

The present qualitative study is a part of the process evaluation of a complex intervention, the randomized controlled trial, "Prevention of human papillomavirus (HPV) in a school-based setting." We aimed to explore participating school nurses' perceptions and experiences of delivering the educational HPV intervention to adolescents aged 16. Focus group interviews were conducted with school nurses (n = 20) and analyzed with inductive qualitative content analysis. The overall theme Easily adapted into the existing role as a school nurse permeated the participants' views. The nurses were in favor of delivering an intervention that increased the HPV vaccination rates and improved beliefs and awareness about HPV prevention. It suits their work and health-promoting aspect of their role well and can easily be adapted into the current school health consultant curriculum. Having material in different languages to share with adolescents and their parents to promote equal health was deemed important

Parents' views of including young boys in the Swedish national school-based HPV vaccination programme : a qualitative study

Objective: To explore parents' views of extending the human papillomavirus (HPV) vaccination programme to also include boys. Design: Explorative qualitative design using individual, face-to-face, interviews and inductive thematic analysis. Setting: 11 strategically chosen municipalities in central Sweden. Participants: Parents (n= 42) who were offered HPV vaccination for their 11-12 years old daughter in the national school-based vaccination programme. Results: The key themes were: equality from a public health perspective and perception of risk for disease. Parents expressed low knowledge and awareness about the health benefits of male HPV vaccination, and they perceived low risk for boys to get HPV. Some parents could not see any reason for vaccinating boys. However, many parents preferred gender-neutral vaccination, and some of the parents who had not accepted HPV vaccination for their daughter expressed that they would be willing to accept vaccination for their son, if it was offered. It was evident that there was both trust and distrust in authorities' decision to only vaccinate girls. Parents expressed a preference for increased sexual and reproductive health promotion such as more information about condom use. Some parents shared that it was more important to vaccinate girls than boys since they believed girls face a higher risk of deadly diseases associated with HPV, but some also believed girls might be more vulnerable to side effects of the vaccine. Conclusions: A vaccine offered only to girls may cause parents to be hesitant to vaccinate, while also including boys in the national vaccination programme might improve parents' trust in the vaccine. More information about the health benefits of HPV vaccination for males is necessary to increase HPV vaccination among boys. This may eventually lead to increased HPV vaccine coverage among both girls and boys

Social support attenuates the link between torture exposure and post-traumatic stress disorder among male and female Syrian refugees in Sweden

BACKGROUND: The aim of this study is threefold: (i) to establish the psychometric properties and gender invariance of ENRICHD Social Support Inventory (ESSI), which was used for the first time in the present study in the population of Syrian refugees resettled in Sweden; (ii) to assess whether gender moderates the associations between social support, exposure to torture and PTSD; (iii) to assess whether social support mediates the association between exposure to torture and PTSD, and whether this mediation is in turn moderated by gender. METHODS: Data from a cross-sectional and population-based study of a random sample of Syrian refugees (n = 1215) resettled in Sweden 2011-2013 was analyzed within a Structural Equation Modeling (SEM) framework. RESULTS: Our results indicate adequate fit and gender invariance for a unidimensional model of ESSI. Exposure to torture was associated with lower social support (B = -0.22, p < 0.01) and with higher odds ratio (OR) for PTSD (OR 2.52, 95% Confidence interval (CI) 1.83-3.40). Furthermore, higher social support was associated with less likelihood for PTSD (B = -0.56, p < 0.001). Social support partially mediated the effect of torture exposure on PTSD (OR 1.13, 95% bias corrected bootstrap CI 1.06-1.26). Gender did not moderate this pattern. CONCLUSION: The results indicate that social support attenuates the link between torture exposure and PTSD, and may function as a protective factor for PTSD among both torture-exposed refugee men and women

Physical activity, post-traumatic stress disorder, and exposure to torture among asylum seekers in Sweden : a cross-sectional study

Background: Forced migrant populations have high rates of trauma-related ill health, including post-traumatic stress disorder (PTSD). Physical activity (PA) is well-established as an effective stress reliever, while insufficient PA is associated with adverse effects on both mental and physical health. The aim of this study was to examine the prevalence of different levels of PA and its association with PTSD symptom severity, controlled for exposure to torture, among asylum seekers in Sweden. Methods: A cross-sectional survey study, with data from 455 asylum seekers, originating from Afghanistan, Eritrea, Iraq, Somalia, and Syria, residing at large housing facilities across Sweden. Level of PA was assessed by the Exercise Vital Sign and categorized as; Inactive, Insufficient PA, and Sufficient PA. Prevalence estimates for proportions of different levels of PA were calculated. Analysis of variance were conducted to determine the association between levels of PA and PTSD symptom severity, measured by the Harvard Trauma Questionnaire. Multivariable logistic regression analysis was performed to determine the contribution of PA on PTSD beyond sex, age, and exposure to torture. Results: About half of the participants (53.3, 95% CI: 48.6-58.1) met the recommendations for Sufficient PA. One third of the participants (33.3, 95% CI: 28.7-37.8) were insufficiently engaged in PA, and 13.4% (95% CI: 10.1-16.7) were inactive. There was a significant difference in PTSD symptom severity between groups of asylum seekers with different levels of PA (F-(2,F- 316) = 23.15, p < .001). When controlling for sex, age, and exposure to torture, Sufficient PA was found to be associated with less PTSD symptom severity compared to both Insufficient PA (B = 0.297, SE = 0.086, p < .001) and Inactive (B = 0.789, SE = 0.104, p < .001). Conclusions: Insufficient PA was common among the asylum seekers and our findings suggest that more PA is highly associated with lower PTSD symptom severity. An increased focus on assessment and promotion of PA is justified and discussed as particularly pertinent considering the much extended time of asylum-seeking processes. The results support previous evidence of PA as a potentially important factor in the context of PTSD and forced migrants' health

Health-related quality of life among Syrian refugees resettled in Sweden

Purpose The main purpose of this study was to assess health-related quality of life (HRQoL) among Syrian refugees resettled in Sweden. Further, we wanted to investigate whether sex, age, education, area of residence, cohabitation and social support were associated with HRQoL in this population. Methods This is a cross-sectional study including 1215 Syrian refugees from a randomly selected sample frame resettled in Sweden between the years 2011 and 2013. HRQoL was measured by the EQ-5D-5L descriptive system, and EQ-5D-5L index values were calculated. Associations between sex, age, education, area of residence, cohabitation, social support and EQ-5D-5L were investigated using multiple linear regression analysis. Results Depression/anxiety was the most commonly (61.9%) reported EQ-5D-5L problem among the group of Syrian refugees. The mean EQ-5D-5L index value was found to be 0.754. Male sex, younger age, cohabitation and social support were found associated with a higher EQ-5D-5L index score. Conclusions Our results concerning long-lasting health problems among the study population indicate that there is a profound need for policies and interventions promoting refugees' health. Our results also show that social support, a modifiable factor, is relevant to refugees' overall health, pointing to the importance of public health interventions and policies targeting the facilitation, mobilization and enhancing of refugees' social support

Including a discussion forum in a web-based intervention on fertility and sexuality following cancer - Usage and content

Aim: The aim of the study was to investigate how young adult survivors of childhood cancer used an online discussion forum as part of a web-based psycho-educational intervention. Specifically, we aimed to characterize users of the discussion forum, investigate how they used the discussion forum (type of usage) and content of the posted messages. Methods: This study is a part of a randomized controlled trial, Fex-Can Childhood RCT. Participants with self-reported sexual dysfunction or fertility-related distress were drawn from a population-based national cohort. Sociodemographic and clinical characteristics of the intervention group (n = 322) and data on usage of the discussion forum were analysed with descriptive statistics and compared between subgroups. Messages posted in the online discussion forum were analysed with qualitative thematic analysis. Results: Approximately half (48 %) of participants in the intervention group accessed the discussion forum and most of them (76 %) without writing own posts. Users of the discussion forum did not statistically differ in sociodemographic or clinical characteristics from the rest of the intervention group. The 97 written posts, written by 38 individuals, were mainly descriptions of own experiences and thoughts and concerned three themes: A changed body, Concerns around family building and Longing for support. Peer-support and interaction between participants were seen in some forum threads and the 'like'-function was frequently used, demonstrating engagement and activity. Participants expressed that they felt affinity with and appreciated sharing own experiences and to recognize themselves in others' stories. Conclusions: A discussion forum as part of a web-based intervention appears to be a valuable component by giving participants an opportunity to share intimate experiences and concerns related to surviving cancer