Systematically Developing a Web-Based Tailored Intervention Promoting HPV-Vaccination Acceptability Among Mothers of Invited Girls Using Intervention Mapping.

Background: Currently, the eHealth field calls for detailed descriptions of theory-based interventions in order to support improved design of such interventions. This article aims to provide a systematic description of the design rationale behind an interactive web-based tailored intervention promoting HPV-vaccination acceptability. Methods: The 6-step Intervention Mapping (IM) protocol was used to describe the design rationale. After the needs assessment in Step 1, intervention objectives were formulated in Step 2. In Step 3, we translated theoretical methods into practical applications, which were integrated into a coherent intervention in Step 4. In Step 5, we anticipated future implementation and adoption, and finally, an evaluation plan was generated in Step 6. Results: Walking through the various steps of IM resulted in a detailed description of the intervention. The needs assessment indicated HPV-vaccination uptake remaining lower than expected. Mothers play the most important role in decision-making about their daughter's immunization. However, they generally feel ambivalent after they made their decisions, and their decisions are based on rather unstable grounds. Therefore, intervention objectives were to improve HPV-vaccination uptake and informed decision-making, and to decrease decisional conflict among mothers of invited girls. Computer-tailoring was chosen as the main method; virtual assistants were chosen as a practical application to deliver interactive tailored feedback. To maximize compatibility with the needs of the target group, a user-centered design strategy by means of focus groups and online experiments was applied. In these, prototypes were tested and sequentially refined. Finally, efficacy, effectiveness, and acceptability of the intervention were tested in a randomized controlled trial. Results showed a significant positive effect of the intervention on informed decision-making, decisional conflict, and nearly all determinants of HPV-vaccination uptake (P < 0.001). Mothers evaluated the intervention as highly positive. Discussion: Using IM led to an innovative effective intervention for promoting HPV-vaccination acceptability. The intervention maps will aid in interpreting the results of our evaluation studies. Moreover, it will ease the comparison of design rationales across interventions, and may provide leads for the development of other eHealth interventions. This paper adds to the plea for systematic reporting of design rationales constituting the process of developing interventions

Implementation of a guideline for local health policy making by regional health services: exploring determinants of use by a web survey.

Previous evaluation showed insufficient use of a national guideline for integrated local health policy by Regional Health Services (RHS) in the Netherlands. The guideline focuses on five health topics and includes five checklists to support integrated municipal health policies. This study explores the determinants of guideline use by regional Dutch health professionals

Clustering of health and risk behaviour in immigrant and indigenous Dutch residents aged 19–40 years

Objectives\ud Studies on the co-occurrence, ‘clustering’ of health and other risk behaviours among immigrants from non-industrialised countries lack until now. The aim of this study was to compare this clustering in immigrant and indigenous adults.\ud \ud Methods\ud A representative sample (N = 2,982; response 71%) of the Dutch population aged 19–40, with 247 respondents from non-industrialized countries (Turkey, Morocco, Surinam, Netherlands Antilles), was asked about health behaviours (alcohol, smoking, drugs, unsafe sex, exercise, nutrition, sleep behaviour, traffic behaviour), and about rule-breaking behaviour and aggression. Data were collected using internet questionnaires, which excluded respondents unable to read Dutch.\ud \ud Results\ud Among indigenous adults, health and risk behaviours co-occur in three clusters (alcohol, health-enhancing behaviour, and rule-breaking behaviour), whereas among immigrant groups two clusters were found (alcohol and rule-breaking behaviour/smoking). Differences mostly concerned health-enhancing behaviours such as nutrition, which was not part of any cluster, and physical activity.\ud \ud Conclusions\ud This supports an integrated promotion of healthier lifestyles to immigrants who are able to read Dutch. Regarding potentially risky behaviours like alcohol use and rule-breaking behaviours, this could be similar to that for indigenous people\u

Clustering of health and risk behaviour in immigrant and indigenous Dutch residents aged 19-40 years

Abstract Objectives Studies on the co-occurrence, &apos;clustering&apos; of health and other risk behaviours among immigrants from non-industrialised countries lack until now. The aim of this study was to compare this clustering in immigrant and indigenous adults. Methods A representative sample (N = 2,982; response 71%) of the Dutch population aged 19-40, with 247 respondents from non-industrialized countries (Turkey, Morocco, Surinam, Netherlands Antilles), was asked about health behaviours (alcohol, smoking, drugs, unsafe sex, exercise, nutrition, sleep behaviour, traffic behaviour), and about rule-breaking behaviour and aggression. Data were collected using internet questionnaires, which excluded respondents unable to read Dutch. Results Among indigenous adults, health and risk behaviours co-occur in three clusters (alcohol, health-enhancing behaviour, and rule-breaking behaviour), whereas among immigrant groups two clusters were found (alcohol and rulebreaking behaviour/smoking). Differences mostly concerned health-enhancing behaviours such as nutrition, which was not part of any cluster, and physical activity. Conclusions This supports an integrated promotion of healthier lifestyles to immigrants who are able to read Dutch. Regarding potentially risky behaviours like alcohol use and rule-breaking behaviours, this could be similar to that for indigenous people

Motivational and contextual determinants of HPV-vaccination uptake:: a longitudinal study among mothers of girls invited for the HPV-vaccination

Background In the Netherlands, HPV-vaccination uptake among 12-year-old girls remains to be lower (61% in 2016) than expected. The present study is about 1) replicating the extent to which social-psychological determinants found in earlier cross-sectional studies explain HPV-vaccination intention, and 2) testing whether HPV-vaccination intention, as well as other social-psychological determinants, are good predictors of future HPV-vaccination uptake in a longitudinal design. Methods A random sample of mothers of girls invited for the vaccination in 2015 was drawn from the Dutch vaccination register (Praeventis) (N = 36,000) and from three online panels (N = 2483). Two months prior to the vaccination of girls, their mothers were requested to complete a web-based questionnaire by letter (Praeventis sample) or by e-mail (panel samples). HPV-vaccination uptake was derived from Praeventis. Backward linear and logistic regression analyses were conducted to examine most dominant predictors of HPV-vaccination intention and uptake, respectively. The total sample used for data analyses consisted of 8062 mothers. Response rates were 18% for the Praeventis sample and 47% for the panel samples. Results HPV-vaccination intention was best explained by attitude, beliefs, subjective norms, habit, and perceived relative effectiveness of the vaccination; they explained 83% of the variance in HPV-vaccination intention. Intention appeared to be the only stable predictor of HPV-vaccination uptake and explained 43% of the variance in HPV-vaccination uptake. Conclusions These results confirm what was found by earlier cross-sectional studies, and provide strong leads for selecting relevant targets in the planning of future communication strategies aiming to improve HPV-vaccination uptake

Clustering of health-compromising behavior and delinquency in adolescents and adults in the Dutch population

Objective: This study investigates the clustering of a broad range of health-compromising and delinquent behaviors. We examine whether these behaviors belong to a single but broad cluster, ‘risk-taking behavior’, and whether the nature and degree of clustering in adolescents differs from that in adults. Method: A representative sample (N = 4395) of the Dutch population aged 12 to 40 (overall response rate 67%), was asked about various health-compromising behaviors, such as alcohol consumption, smoking, illegal drug use, unsafe sexual behavior, physical inactivity, poor nutrition (such as skipping breakfast and not eating fruit and vegetables), poor sleep behavior, unlawful traffic behavior, and delinquent and aggressive behavior. Data were collected from fall 2005 to spring 2006 using internet questionnaires and face-to-face computer-assisted interviews. Results: No single broad cluster was found. Instead, there were several separate but interrelated clusters. The contents of these clusters differed between age groups. For young adolescents (12–15) two clusters were identified: Alcohol and Delinquency. For older adolescents (16–18) and adults (19–40) three clusters were identified: Alcohol, Delinquency and Health. Conclusion: The findings of this study support a more integrated approach to promoting healthier lifestyles, and suggest that the behavior targets of integrated prevention programs should be different for adolescents and adults

Human papillomavirus vaccination uptake: a longitudinal study showing ethnic differences in the influence of the intention-to-vaccinate among parent-daughter dyads

Introduction: It is unclear what role daughters play in the decision-making process regarding HPV vaccination. Therefore, we explored the impact of HPV vaccination intention among parents and their 12–13 year-old daughters on HPV vaccination uptake. Methods: In February 2014 parents/guardians and their 12–13 year-old daughters were invited to complete a questionnaire about socio-psychological determinants of the decision-making process regarding HPV vaccination. Vaccination status of the daughter was retrieved from the national vaccination database after the last possible vaccination date in 2014. The association between HPV vaccination uptake and intention, and determinants of intention, was jointly assessed using a generalized structural equation model, stratified by origin of parents (Dutch versus non-Dutch). Results: In total, 273 Dutch parent-daughter dyads and 165 non-Dutch dyads were analyzed for this study. HPV vaccination uptake was 90% (246/273) and 84% (139/165) in the Dutch and non-Dutch group, respectively. In the Dutch group, high parental intention (β = 2.3, 95%CI 1.2–3.3) and high daughters’ intention (β = 1.5, 95%CI 0.41–2.6) were significantly associated with HPV vaccination uptake. In the non-Dutch group, high daughters’ intention (β = 1.2, 95%CI 0.16–2.2) was significantly associated with HPV vaccination, but high parental intention was not (β = 0.52, 95%CI −0.47–1.5). Attitude was the most prominent socio-psychological determinant associated with vaccination intention among all groups. Conclusion: In the non-Dutch group, only daughters’ intention was significantly associated with HPV vaccination uptake, whereas in the Dutch group both the parents’ and the daughters’ intention were significantly associated with uptake. The role of the child in the decision-making process might need to be taken into account when developing new interventions focused on increasing HPV vaccination uptake, especially among individuals of non-Dutch origin

Human papillomavirus vaccination uptake: a longitudinal study showing ethnic differences in the influence of the intention-to-vaccinate among parent-daughter dyads.

INTRODUCTION: It is unclear what role daughters play in the decision-making process regarding HPV vaccination. Therefore, we explored the impact of HPV vaccination intention among parents and their 12–13 year-old daughters on HPV vaccination uptake. METHODS: In February 2014 parents/guardians and their 12–13 year-old daughters were invited to complete a questionnaire about socio-psychological determinants of the decision-making process regarding HPV vaccination. Vaccination status of the daughter was retrieved from the national vaccination database after the last possible vaccination date in 2014. The association between HPV vaccination uptake and intention, and determinants of intention, was jointly assessed using a generalized structural equation model, stratified by origin of parents (Dutch versus non-Dutch). RESULTS: In total, 273 Dutch parent-daughter dyads and 165 non-Dutch dyads were analyzed for this study. HPV vaccination uptake was 90% (246/273) and 84% (139/165) in the Dutch and non-Dutch group, respectively. In the Dutch group, high parental intention (β = 2.3, 95%CI 1.2–3.3) and high daughters’ intention (β = 1.5, 95%CI 0.41–2.6) were significantly associated with HPV vaccination uptake. In the non-Dutch group, high daughters’ intention (β = 1.2, 95%CI 0.16–2.2) was significantly associated with HPV vaccination, but high parental intention was not (β = 0.52, 95%CI −0.47–1.5). Attitude was the most prominent socio-psychological determinant associated with vaccination intention among all groups. CONCLUSION: In the non-Dutch group, only daughters’ intention was significantly associated with HPV vaccination uptake, whereas in the Dutch group both the parents’ and the daughters’ intention were significantly associated with uptake. The role of the child in the decision-making process might need to be taken into account when developing new interventions focused on increasing HPV vaccination uptake, especially among individuals of non-Dutch origin

A longitudinal study on determinants of HPV vaccination uptake in parents/guardians from different ethnic backgrounds in Amsterdam, the Netherlands

Human papillomavirus (HPV) vaccination coverage in the Netherlands is low (~60%) compared to other childhood vaccinations (>90%), and even lower among ethnic minorities. The aim of this study was to explore the possible impact of ethnicity on the determinants of both HPV vaccination intention and HPV vaccination uptake among parents/guardians having a daughter that is invited for the HPV vaccination. In February 2014, parents/guardians living in Amsterdam were invited to complete a questionnaire about social-psychological determinants of their decision making process regarding the HPV vaccination of their daughter and socio-demographic characteristics. This questionnaire was sent approximately one month before the daughter was scheduled to receive her first HPV vaccine dose. Their daughters' HPV vaccination status was retrieved from the national vaccination database. We distinguished four ethnic groups: Dutch (NL), Surinamese, Netherlands Antillean, and Aruban (SNA), Middle-Eastern and North-African (MENA), and Other. To assess the impact of determinants on both intention and uptake, linear and logistic regression analyses were used respectively. Missing data were imputed using multiple imputation by chained equation. In total 1,309 parents/guardians participated (33% participation rate). In all groups we found the mothers' intention to be the strongest predictor of their daughters' HPV vaccination uptake. Explained variance of uptake was highest in the NL-group (pseudo-R(2):0.56) and lower in the other ethnic groups (pseudo-R(2) varied between 0.23 and 0.29). The lower explained variance can be attributed to the relative large proportion of participants with a positive intention that finally did not go for vaccination in the SNA-group (11%) and MENA-group (30%). Explained variance (R(2)) of intention varied between 0.66 and 0.77 across ethnic groups, and was best explained by the proximal social-psychological determinants. The strength of association of these determinants with both intention and uptake were largely similar across ethnic groups. We conclude that the same determinants should be targeted in the different ethnic groups, although the mode of delivery of the intervention needs to be tailored to the different cultural backgrounds. Further research is needed to explain the observed discrepancy between intention and uptake, especially among parents/guardians in the non-Dutch group