Prevention of Human Papillomavirus in a school-based setting

The overall aim of this thesis was to examine beliefs about human papillomavirus (HPV) prevention, especially vaccination, among parents, immigrant women, adolescents and school nurses, and to promote primary prevention among adolescents. The methods used in the thesis were focus group interviews, individual interviews, a web-based questionnaire, and finally, a randomised controlled intervention study. The immigrant women were largely in favour of HPV prevention, although barriers, such as logistic difficulties, and cultural or gender norms were found. Parents’ decision concerning vaccination of their daughters depended on several factors. Regardless of their final choice, they made the decision they believed was in the best interest of their daughter. The benefits outweighed the risks for parents choosing to vaccinate while parents declining made the opposite judgement. The majority of the school nurses reported that the governmental financial support given because of the vaccination programme had not been used for the intended purpose. Three out of four nurses had been contacted by parents who raised questions regarding the vaccine; most were related to side effects. The educational intervention had favourable effects on the adolescents’ beliefs regarding HPV prevention, especially among those with an immigrant background. Furthermore, the intention to use condom as well as actual vaccination rates among girls was slightly increased by the intervention. Trust in the governmental recommendations and the amounts of information given are important factors in the complex decision about HPV vaccination. Attention given to specific needs and cultural norms, as well as the possibility to discuss HPV vaccination with the school nurse and provision of extra vaccination opportunities at a later time are all strategies that might facilitate participation in the school-based HPV vaccination programme. School nurses need sufficient resources, knowledge and time to meet parents’ questions and concerns. The vaccinations are time-consuming and the governmental financial support needs to be used as intended, for managing the vaccination programme. A school-based intervention can have favourable effects on the beliefs and actual actions of young people and may possibly thus, in the long term, decrease the risk for HPV-related cancer

Invandrarkvinnors inställning till prevention av livmoderhalscancer : "Kan du hjälpa oss att ringa barnmorska?" - En explorativ kvalitativ studie

 SAMMANFATTNING Bakgrund: Livmoderhalscancer orsakas av humant papillomvirus (HPV). De flesta fallen inträffar bland kvinnor som inte deltar i preventionsprogram mot livmoderhalscancer. Syfte: Att undersöka invandrarkvinnors inställning till prevention av livmoderhalscancer. Metod: En explorativ kvalitativ studie. The Health Belief Model har använts som teoretisk modell. Fem fokusgruppintervjuer med 32 kvinnor ålder 18-54 år, som studerade svenska för invandrare. Data analyserades med latent innehållsanalys. Resultat: De temata som kunde urskiljas var svårigheterna med kommunikation med sjukvården, positiva till hälso- kontroll, behov av information för att fatta beslut samt ojämlikhet mellan könen. Kvinnorna i studien var mycket positiva till prevention av livmoderhalscancer och hade hög tilltro till det svenska sjukvårdssystemet. De poängterade i synnerhet kontakten med barnmorska. Deltagarna hade överlag svårigheter med information från sjukvården och saknade kunskap och information om HPV för att kunna fatta beslut om prevention av livmoderhalscancer med HPV- vaccin. Det framkom även att kulturella skillnader och ojämlikhet mellan könen påverkade inställning till prevention av livmoderhalscancer. Slutsats: Informanterna var positiva till prevention av livmoderhalscancer och vill få adekvat kunskap och information om sjukdomen men de har svårigheter med kontakten med sjukvården. Sjukvårdspersonal behöver beakta att kulturella normer påverkar kvinnors inställning till deltagande i det nationella preventionsprogrammet av livmoderhalscancer.        ABSTRACT Background: Cervical cancer is caused by Human papillomavirus (HPV). Most cases occur among women who don’t attend prevention programs. Objective: To explore immigrant women’s attitude towards prevention of cervical cancer. Method: An exploratory qualitative study. The Health Belief Model (HBM) has been used as a theoretical model. Five focus groups interviews with 32 women age 18-54, who studied Swedish for immigrants. Data was analyzed with content analysis. Results: Four main themes were found: difficulties to communicate with healthcare, positive to health control, the need of information to make a decision and inequalities among genders. The informants were positive to prevention of cervical cancer and had high confidence in the Swedish health care system. They appreciated in particular the meeting with the midwife. They had difficulty understanding the information from health care and had inadequate knowledge about HPV to make decisions about prevention of cervical cancer. Cultural differences and inequalities among genders were also related to prevention of cervical cancer. Conclusion: The informants were positive to prevention of cervical cancer and want to have adequate information about the disease. Healthcare professionals should consider that difficulties in contact with healthcare as well as inequalities in gender and cultural aspects have an impact on immigrant women’s attitude to prevention of cervical cancer.  HPV-projekte

Invandrarkvinnors inställning till prevention av livmoderhalscancer : "Kan du hjälpa oss att ringa barnmorska?" - En explorativ kvalitativ studie

 SAMMANFATTNING Bakgrund: Livmoderhalscancer orsakas av humant papillomvirus (HPV). De flesta fallen inträffar bland kvinnor som inte deltar i preventionsprogram mot livmoderhalscancer. Syfte: Att undersöka invandrarkvinnors inställning till prevention av livmoderhalscancer. Metod: En explorativ kvalitativ studie. The Health Belief Model har använts som teoretisk modell. Fem fokusgruppintervjuer med 32 kvinnor ålder 18-54 år, som studerade svenska för invandrare. Data analyserades med latent innehållsanalys. Resultat: De temata som kunde urskiljas var svårigheterna med kommunikation med sjukvården, positiva till hälso- kontroll, behov av information för att fatta beslut samt ojämlikhet mellan könen. Kvinnorna i studien var mycket positiva till prevention av livmoderhalscancer och hade hög tilltro till det svenska sjukvårdssystemet. De poängterade i synnerhet kontakten med barnmorska. Deltagarna hade överlag svårigheter med information från sjukvården och saknade kunskap och information om HPV för att kunna fatta beslut om prevention av livmoderhalscancer med HPV- vaccin. Det framkom även att kulturella skillnader och ojämlikhet mellan könen påverkade inställning till prevention av livmoderhalscancer. Slutsats: Informanterna var positiva till prevention av livmoderhalscancer och vill få adekvat kunskap och information om sjukdomen men de har svårigheter med kontakten med sjukvården. Sjukvårdspersonal behöver beakta att kulturella normer påverkar kvinnors inställning till deltagande i det nationella preventionsprogrammet av livmoderhalscancer.        ABSTRACT Background: Cervical cancer is caused by Human papillomavirus (HPV). Most cases occur among women who don’t attend prevention programs. Objective: To explore immigrant women’s attitude towards prevention of cervical cancer. Method: An exploratory qualitative study. The Health Belief Model (HBM) has been used as a theoretical model. Five focus groups interviews with 32 women age 18-54, who studied Swedish for immigrants. Data was analyzed with content analysis. Results: Four main themes were found: difficulties to communicate with healthcare, positive to health control, the need of information to make a decision and inequalities among genders. The informants were positive to prevention of cervical cancer and had high confidence in the Swedish health care system. They appreciated in particular the meeting with the midwife. They had difficulty understanding the information from health care and had inadequate knowledge about HPV to make decisions about prevention of cervical cancer. Cultural differences and inequalities among genders were also related to prevention of cervical cancer. Conclusion: The informants were positive to prevention of cervical cancer and want to have adequate information about the disease. Healthcare professionals should consider that difficulties in contact with healthcare as well as inequalities in gender and cultural aspects have an impact on immigrant women’s attitude to prevention of cervical cancer.  HPV-projekte

Barriers towards HPV vaccinations for boys and young men : a narrative review

BACKGROUND: HPV vaccination of both girls and boys can protect against infection and eliminate the risk for HPV-associated cancer. Due to a common misconception that the virus only poses risks to women, vaccine coverage is suboptimal among men in many countries. It is urgent to identify barriers to vaccination of boys and men. METHODS: We conducted a narrative review of publications examining attitudes and beliefs regarding HPV vaccination for boys and young men. The electronic databases searched were PubMed, PsychInfo and Scopus (December 2020; last update July 2021). A total of 103 original articles were included in the final analysis. RESULTS: The central barriers against vaccination of boys and men are: (1) lack of knowledge, (2) vaccine hesitancy in general, (3) lack of recommendation from and/or discussions with healthcare providers, (4) cost and logistics, and (5) the idea that HPV vaccination may promote promiscuity. Men who have sex with men and families belonging to ethnic minorities express a need for information tailored to their situation. CONCLUSIONS: Boys should be included in national immunization programs and men should also be offered catch-up vaccinations. Future studies should focus on addressing vaccine hesitancy and developing interventions to promote pan-gender HPV vaccination

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

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

‘To be on the safe side’ : a qualitative study regarding users’ beliefs and experiences of internet-based self-sampling for Chlamydia trachomatis and Neisseria gonorrhoeae testing

 Objectives:  In Sweden, an increasing number of tests for sexually transmitted infections are conducted. Self-sampling services are provided free of charge at the national eHealth website. Our aim was to obtain a deeper understanding of users' beliefs and experiences of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) self-sampling services.  Methods:  This qualitative study is part of the national project 'Internet-based chlamydia and gonorrhoea self-sampling test', conducted in Sweden. Individuals ordering a CT/NG self-sampling test at home from the eHealth website were invited to participate. Of the 114 individuals who agreed, a purposeful sample including 20 women and men aged 18-49 years (mean, 30.8 years) participated in a telephone interview in 2019.  Results:  The test service for CT/NG was highly appreciated by men and women of different ages. Round-the-clock accessibility, avoiding clinical visits, ease of use, confidentiality and a rapid test result were reasons for this appreciation. Language, uncertainty about the correct sampling procedure, unreliable postal services and concerns about handling of personal data were mentioned as barriers. Reasons for testing were checking after unprotected sex, symptoms, checking a partner's fidelity or a regular routine-'to be on the safe side'. Knowledge about the infections and their consequences was limited; some considered them severe, especially if they could threaten fertility, and others were less concerned. Disclosing an infection was described as emotionally stressful. Participants had high self-efficacy in relation to the test and would not hesitate to use the service again, even if it involved a cost.  Conclusions:  Internet-based CT/NG self-sampling at home was highly appreciated and was used for individual health reasons, but also out of concern for others' health and for society as a whole. The benefits seem to outweigh the barriers, and the service may therefore continue to be widely offered

In everybody's interest but no one's assigned responsibility : midwives' thoughts and experiences of preventive work for men's sexual and reproductive health and rights within primary care

BACKGROUND: Sexual and reproductive health and rights (SRHR) have historically been regarded as a woman's issue. It is likely that these gender norms also hinder health care providers from perceiving boys and men as health care recipients, especially within the area of SRHR. The aim of this study was to explore midwives' thoughts and experiences regarding preventive work for men's sexual and reproductive health and rights in the primary care setting. METHODS: An exploratory qualitative study. Five focus group interviews, including 4-5 participants in each group, were conducted with 22 midwives aged 31-64, who worked with reproductive, perinatal and sexual health within primary care. Data were analysed by latent content analysis. RESULTS: One overall theme emerged, in everybody's interest, but no one's assigned responsibility, and three sub-themes: (i) organisational aspects create obstacles, (ii) mixed views on the midwife's role and responsibility, and (iii) beliefs about men and women: same, but different. CONCLUSIONS: Midwives believed that preventive work for men's sexual and reproductive health and rights was in everybody's interest, but no one's assigned responsibility. To improve men's access to sexual and reproductive health care, actions are needed from the state, the health care system and health care providers

Important but far away : adolescents' beliefs, awareness and experiences of fertility and preconception health

Objectives: The aim was to explore adolescents' beliefs and awareness regarding fertility and preconception health, as well as their views and experiences of information about fertility and preconception health directed at their age group. Methods: We performed seven semi-structured focus group interviews among upper secondary school students (n = 47) aged 16-18 years in two Swedish counties. Data were analysed by qualitative content analysis. Results: One theme ('important but far away') and five categories ('starting a family far down on the list'; 'high awareness but patchy knowledge of fertility and preconception health'; 'gender roles influence beliefs about fertility and preconception health'; 'wish to preserve fertility and preconception health in order to keep the door to procreation open'; 'no panacea - early and continuous education about fertility and preconception health') emerged from the interviews. Participants recognised the importance of preconception health and were highly aware of the overall importance of a healthy lifestyle. Their knowledge, however, was patchy and they had difficulties relating to fertility and preconception health on a personal and behavioural level. Participants wanted more information but had heterogeneous beliefs about when, where and how this information should be given. Conclusion: The adolescents wanted information on fertility and preconception health to be delivered repeatedly as well as through different sources