Investigating Canadian parents' HPV vaccine knowledge, attitudes and behaviour: a study protocol for a longitudinal national online survey

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Abstract

Introduction

Human papillomavirus (HPV), a sexually transmitted infection, can cause anogenital warts and a number of cancers. To prevent morbidity and mortality, three vaccines have been licensed and are recommended by Canada’s National Advisory Committee on Immunisation (for girls since 2007 and boys since 2012). Nevertheless, HPV vaccine coverage in Canada remains suboptimal in many regions. This study will be the first to concurrently examine the correlates of HPV vaccine decision-making in parents of school-aged girls and boys and evaluate changes in parental knowledge, attitudes and behaviours over time.

Methods and analysis

Using a national, online survey utilising theoretically driven constructs and validated measures, this study will identify HPV vaccine coverage rates and correlates of vaccine decision-making in Canada at two time points (August–September 2016 and June–July 2017). 4606 participants will be recruited to participate in an online survey through a market research and polling firm using email invitations. Data cleaning methods will identify inattentive or unmotivated participants.

Ethics and dissemination

The study received research ethics board approval from the Research Review Office, Integrated Health and Social Services University Network for West-Central Montreal (CODIM-FLP-16–219). The study will adopt a multimodal approach to disseminate the study’s findings to researchers, clinicians, cancer and immunisation organisations and the public in Canada and internationally.

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Most cited references 56

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Human papillomavirus and cervical cancer.

Emma J Crosbie, Mark Einstein, Silvia Franceschi … (2013)

Cervical cancer is caused by human papillomavirus infection. Most human papillomavirus infection is harmless and clears spontaneously but persistent infection with high-risk human papillomavirus (especially type 16) can cause cancer of the cervix, vulva, vagina, anus, penis, and oropharynx. The virus exclusively infects epithelium and produces new viral particles only in fully mature epithelial cells. Human papillomavirus disrupts normal cell-cycle control, promoting uncontrolled cell division and the accumulation of genetic damage. Two effective prophylactic vaccines composed of human papillomavirus type 16 and 18, and human papillomavirus type 16, 18, 6, and 11 virus-like particles have been introduced in many developed countries as a primary prevention strategy. Human papillomavirus testing is clinically valuable for secondary prevention in triaging low-grade cytology and as a test of cure after treatment. More sensitive than cytology, primary screening by human papillomavirus testing could enable screening intervals to be extended. If these prevention strategies can be implemented in developing countries, many thousands of lives could be saved. Copyright © 2013 Elsevier Ltd. All rights reserved.

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Measuring vaccine hesitancy: The development of a survey tool.

Heidi Larson, Caitlin Jarrett, William Schulz … (2015)

In March 2012, the SAGE Working Group on Vaccine Hesitancy was convened to define the term "vaccine hesitancy", as well as to map the determinants of vaccine hesitancy and develop tools to measure and address the nature and scale of hesitancy in settings where it is becoming more evident. The definition of vaccine hesitancy and a matrix of determinants guided the development of a survey tool to assess the nature and scale of hesitancy issues. Additionally, vaccine hesitancy questions were piloted in the annual WHO-UNICEF joint reporting form, completed by National Immunization Managers globally. The objective of characterizing the nature and scale of vaccine hesitancy issues is to better inform the development of appropriate strategies and policies to address the concerns expressed, and to sustain confidence in vaccination. The Working Group developed a matrix of the determinants of vaccine hesitancy informed by a systematic review of peer reviewed and grey literature, and by the expertise of the working group. The matrix mapped the key factors influencing the decision to accept, delay or reject some or all vaccines under three categories: contextual, individual and group, and vaccine-specific. These categories framed the menu of survey questions presented in this paper to help diagnose and address vaccine hesitancy.

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Population-level impact and herd effects following human papillomavirus vaccination programmes: a systematic review and meta-analysis.

Anne M. Johnson, Erich V. Kliewer, Louise Baandrup … (2015)

Human papillomavirus (HPV) vaccination programmes were first implemented in several countries worldwide in 2007. We did a systematic review and meta-analysis to assess the population-level consequences and herd effects after female HPV vaccination programmes, to verify whether or not the high efficacy reported in randomised controlled clinical trials are materialising in real-world situations. We searched the Medline and Embase databases (between Jan 1, 2007 and Feb 28, 2014) and conference abstracts for time-trend studies that analysed changes, between the pre-vaccination and post-vaccination periods, in the incidence or prevalence of at least one HPV-related endpoint: HPV infection, anogenital warts, and high-grade cervical lesions. We used random-effects models to derive pooled relative risk (RR) estimates. We stratified all analyses by age and sex. We did subgroup analyses by comparing studies according to vaccine type, vaccination coverage, and years since implementation of the vaccination programme. We assessed heterogeneity across studies using I(2) and χ(2) statistics and we did trends analysis to examine the dose-response association between HPV vaccination coverage and each study effect measure. We identified 20 eligible studies, which were all undertaken in nine high-income countries and represent more than 140 million person-years of follow-up. In countries with female vaccination coverage of at least 50%, HPV type 16 and 18 infections decreased significantly between the pre-vaccination and post-vaccination periods by 68% (RR 0·32, 95% CI 0·19-0·52) and anogenital warts decreased significantly by 61% (0·39, 0·22-0·71) in girls 13-19 years of age. Significant reductions were also recorded in HPV types 31, 33, and 45 in this age group of girls (RR 0·72, 95% CI 0·54-0·96), which suggests cross-protection. Additionally, significant reductions in anogenital warts were also reported in boys younger than 20 years of age (0·66 [95% CI 0·47-0·91]) and in women 20-39 years of age (0·68 [95% CI 0·51-0·89]), which suggests herd effects. In countries with female vaccination coverage lower than 50%, significant reductions in HPV types 16 and 18 infection (RR 0·50, 95% CI 0·34-0·74]) and in anogenital warts (0·86 [95% CI 0·79-0·94]) occurred in girls younger than 20 years of age, with no indication of cross-protection or herd effects. Our results are promising for the long-term population-level effects of HPV vaccination programmes. However, continued monitoring is essential to identify any signals of potential waning efficacy or type-replacement. The Canadian Institutes of Health Research. Copyright © 2015 Elsevier Ltd. All rights reserved.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2017

Publication date (Electronic): 11 October 2017

Volume: 7

Issue: 10

Electronic Location Identifier: e017814

Affiliations

[1 ] departmentDepartment of Psychology , McGill University , Montreal, Quebec, Canada

[2 ] departmentLady Davis Institute for Medical Research , Jewish General Hospital , Montreal, Quebec, Canada

[3 ] departmentDepartment of Community Health Sciences, Faculty of Medicine , University of Calgary , Calgary, Alberta, Canada

[4 ] departmentSection of Adolescent Medicine, Department of Pediatrics , Indiana University School of Medicine , Indianapolis, Indiana, USA

[5 ] Louise Granofsky Psychosocial Oncology Program, Segal Cancer Center, Jewish General Hospital , Montreal, Quebec, Canada

[6 ] departmentDepartment of Psychiatry , McGill University , Montreal, Quebec, Canada

[7 ] departmentDepartment of Oncology , McGill University , Montreal, Quebec, Canada

Author notes

[Correspondence to ] Gilla K Shapiro; gilla.shapiro@ 123456mail.mcgill.ca

Author information

Gilla K Shapiro http://orcid.org/0000-0002-2214-8263

Ovidiu Tatar http://orcid.org/0000-0003-1886-6390

Article

Publisher ID: bmjopen-2017-017814

DOI: 10.1136/bmjopen-2017-017814

PMC ID: 5652458

PubMed ID: 29025844

SO-VID: 1792e86b-5133-4839-939b-510d9c063bf0

License:

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

History

Date received : 18 May 2017

Date revision received : 27 July 2017

Date accepted : 01 August 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000015, Canadian Cancer Society Research Institute;

Funded by: FundRef http://dx.doi.org/10.13039/501100000024, Canadian Institutes of Health Research;

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ScienceOpen disciplines: Medicine

Keywords: attitudes,behaviour,canada,cancer prevention,decision-making,human papillomavirus,knowledge,sexually transmitted infections,parents,vaccination

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ScienceOpen disciplines: Medicine

Keywords: attitudes, behaviour, canada, cancer prevention, decision-making, human papillomavirus, knowledge, sexually transmitted infections, parents, vaccination

Investigating Canadian parents' HPV vaccine knowledge, attitudes and behaviour: a study protocol for a longitudinal national online survey

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Abstract

Introduction

Methods and analysis

Ethics and dissemination

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Point-Of-Care Testing for STIs

Most cited references 56

Human papillomavirus and cervical cancer.

Measuring vaccine hesitancy: The development of a survey tool.

Population-level impact and herd effects following human papillomavirus vaccination programmes: a systematic review and meta-analysis.

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