Barriers and facilitators to human papillomavirus vaccination among Chinese adolescent girls in Hong Kong: A qualitative-quantitative study

Objectives: To explore perceptions towards cervical cancer, human papillomavirus (HPV) infection and HPV vaccination and to identify factors affecting the acceptability of HPV vaccination among Chinese adolescent girls in Hong Kong. Methods: Six focus groups were conducted with Chinese adolescent girls (median age 16 years, age range 13-20, n = 64) in Hong Kong in April 2007. Thematic analysis was employed to identify major themes related to cervical cancer and HPV vaccination. A supplementary questionnaire was administered to all participants before and after group discussion to assess their knowledge, attitudes and intention to be vaccinated and to collect demographic information. Results: Participants' knowledge on cervical cancer was limited and HPV was largely unheard of. They had difficulty understanding the mechanism linking cervical cancer with HPV infection. Participants held a favourable attitude towards HPV vaccination but the perceived timing of vaccination varied. Barriers to vaccination include high monetary cost, uncertain length of vaccine effectiveness, low perceived risk of HPV infection, no immediate perceived need of vaccination, anticipated family disapproval and fear of the pain of injection. Factors conducive to vaccination include perceived family and peer support and medical reassurance on safety and efficacy of vaccine. The differences on knowledge, attitudes, intention to be vaccinated now and willingness to conform to significant others before and after the discussion were statistically significant, with an increased tendency towards favouring vaccination after the focus group. Conclusions: Participants favoured HPV vaccination despite not feeling an immediate need to be vaccinated. Interventions could focus on providing professional information on HPV vaccination and raising adolescents' perceived need to take preventive measures against HPV infection.published_or_final_versio

Supporting the family as a whole: a needs assessment study on Cancer Families in Hong Kong

Powerpoint presentationConference Theme: East meets West: Expanding Frontiers and Diversitypublished_or_final_versio

Pain, fatigue and quality of life in Hong Kong Chinese women with early stage breast cancer: before-versus-after adjuvant radiotherapy

Conference theme: Innovation in Psycho-Oncology: Clinical Care, Research and AdvocacyOral Poster Session 3Background: Adjuvant radiotherapy (RT) is a common treatment for breast cancer for its benefit in reducing the risk of local recurrence. However, RT may induce substantial distress in patients and have an adverse impact on their quality of life. The purpose of this abstract was to compare the experiences of pain and fatigue, and the quality of life of Hong Kong Chinese women who had completed RT with those who were awaiting RT. Method: This analysis comprised of 70 Chinese women diagnosed with stage 0-III primary breast cancer who had joined a larger trial investigating the effects of a psychotherapy program. They were recruited consecutively from two government hospitals and three community centres in Hong Kong. The current data were collected before the program by self-administered questionnaires including the Brief Pain Inventory (BPI), Brief Fatigue Inventory (BFI) and Functional Assessment of Cancer Therapy-Breast (FACT-B). Women were age-matched and grouped by their RT status at enrollment: Pending (preRT, n=36), within a month post-RT (1-postRT, n=17), and over a month post-RT (>1-postRT, n=17, median length=91 days). Results: The three groups were similar clinically and demographically (mean age=50 years). All had breast surgery and 74% also had chemotherapy. In terms of severe pain and severe fatigue, respectively, 17% and 34% of preRT group vs. 18% and 41% of 1-postRT group vs. 29% and 29% of >1-postRT group had experienced these symptoms. The Kruskal-Wallis tests showed no significant overall group differences in the scores of BPI, BFI, Total FACT-B and subscales except for the FACT-B emotional well-being subscale (p=0.04). In all FACT-B scales, the >1-postRt group scored the highest, the preRT group slightly lower and the 1m-postRT the lowest. Conclusions: Before RT, a significant minority of women were fatigued and had experienced severe pain, suggesting the lingering effects of prior anti-cancer therapies. The occurrence of severe fatigue was more common than severe pain both before RT and shortly after RT completion. About one third of the women who had finished RT months ago still experienced fatigue and/or pain. Patients' quality of life might be undermined in the first month after treatment completion, but the longer-term quality of life after RT seemed comparable with that before RT. Research Implications: The results suggested that the potential impact of RT on quality of life might be minor and temporary. However, our small sample size implied a higher chance of a Type II error. Prospective research with a larger cohort is needed to better understand the effects of RT across the period of treatment and recovery. Research is also indicated to explore the possible causes of severe fatigue or pain in patients who have long completed treatment. Clinical Implications: Assessment of patients' symptom status prior to RT commencement is important for early intervention, if necessary, to prevent further deterioration of patients' condition as RT progresses. Such an assessment should continue into the post treatment period

How to educate the public on human papillomavirus and cervical cancer prevention

Session 17: Plenary - AOGIN Education Session: abstract no. I -17.2The association between HPV and cervical cancer is well established. Our previous studies showed that public knowledge about HPV and cervical cancer was generally poor. Furthermore, public awareness of the sexual transmission of HPV was associated with a stigmatized attitude towards HPV infected individuals owing largely to the lay stereotypical belief linking a person who bears a sexually transmitted infection with promiscuity or sexual deviation. Correcting this misconception is necessary as women or adolescents who consider themselves “sexually proper” may see little need to take preventive measures against HPV or cervical cancer. In our recent study, we noted that apart from giving factual information, a public HPV message consisting of explicit anti-stereotypic contents targeting specific lay sexual beliefs reduced the stigma associated with high risk HPV. Furthermore, excluding low risk HPV in the context of cervical cancer control helped to avoid the potential stigmatizing effect of genital warts from tainting perceptions about high risk HPV infection. Utilizing multiple channels in public education is necessary to reach different populations. Newspaper, magazine, television and other mass media channels enable a one-way dissemination of information on HPV and cervical cancer to a wide spectrum of audiences. Public health talks allow for tailoring of the contents to meet the particular information needs of a target group as well as chances of interaction to aid understanding. For instance, we collaborated with local secondary schools to implement an educational program on cervical cancer prevention for their female students. A substantial knowledge gain and positive attitude towards HPV vaccination were found among the adolescent participants after attending the program. In public HPV and cervical cancer education, tailoring the contents and channels of delivery are crucial to impart knowledge to a variety of audiences without drawing backfire.The 4th Biennial Conference of the Asia Oceania research organisation on Genital Infections Neoplasis (AOGIN 2010), New Delhi, India, 26-28 March 2010

Assessment of knowledge and stigmatizing attitudes related to human papillomavirus among Hong Kong Chinese healthcare providers

Objective: To assess knowledge and stigmatizing attitudes related to human papillomavirus (HPV) and HPV testing among Chinese healthcare providers in Hong Kong. Methods: Between May and September 2010, an anonymous self-administered questionnaire was sent to 247 doctors, nurses, and smear-taking trainees providing cervical screening in Hong Kong. Results: In total, 137 questionnaires were returned. Most participants had basic knowledge about HPV infection and HPV vaccination. Only about 33% knew that high-risk HPV does not cause genital warts, infection is most common among young women, or infected individuals might not have any identifiable sexual risk factors. Regarding HPV testing, 6 of 7 knowledge items were answered incorrectly by many participants (≥ 50%), highlighting a lack of understanding of the indications for HPV testing and the implications of a positive result. About 30% of participants agreed that individuals with HPV infection were sexually easy, responsible for their infection, or had more than 1 sexual partner. More knowledge about HPV infection predicted less stigmatizing attitudes. Conclusion: Continued education on HPV and HPV testing is needed for frontline healthcare providers of screening in Hong Kong. The stigmatizing attitudes toward HPV-infected individuals warrant further exploration of the impact of HPV infection on patient care and interventions. © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.link_to_subscribed_fulltex

The effect of school-based cervical cancer education on perceptions towards human papillomavirus vaccination among Hong Kong Chinese adolescent girls

Objective: To evaluate the effects of school-based cervical cancer education on Hong Kong Chinese adolescent girls. Methods: Adolescent girls (n=953) in local secondary schools attended a tailored educational program on cervical cancer prevention. Self-administered questionnaires were used before and after the program to measure its effects on participants' knowledge, attitude and perceived social norms towards human papillomavirus (HPV) vaccination and their intention to be HPV vaccinated. Results: Before the program, HPV vaccine acceptance was favorable but relevant knowledge was low. After the program, participants had greater knowledge and a more positive attitude (both p<0.001), with more girls anticipating family (41.6% before vs. 58.9% after) and peer support (32.8% before vs. 56.9% after). There were 11.3% more girls who indicated an intention to accept the vaccine afterward. More knowledge, a more positive attitude and perceived support from significant others predicted a stronger intention to be HPV vaccinated. Conclusion: The educational program had a positive impact on participants' perceptions towards HPV vaccination and their intention to be vaccinated. Practice implications: School-based cervical cancer education is a viable means to meet the substantial educational needs of adolescents. Promotion of HPV vaccination should also include educating and influencing perceptions of families and peers. © 2010 Elsevier Ireland Ltd.link_to_subscribed_fulltex