1. Determinants of Human Papillomavirus Vaccine Uptake by Adult Women Attending Cervical Cancer Screening in 9 European Countries
- Author
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Agnieszka Denecke, Maria Hortlund, Mette Tuxen Faber, Christian Munk, Jana Mlakar, Matti Lehtinen, Marc Arbyn, Lan Xu, Joan Carles Riera, Tiina Eriksson, Silvia de Sanjosé, Amelia Acera, Karl Ulrich Petry, Laia Bruni, Susanne K. Kjaer, Anja Oštrbenk Valenčak, Joakim Dillner, Mario Poljak, Jack Cuzick, Karolina Louvanto, Christine Clavel, Véronique Dalstein, F. Xavier Bosch, Claudia Robles, Laia Prats, Louise Cadman, Centre Hospitalier Universitaire de Reims (CHU Reims), Pathologies Pulmonaires et Plasticité Cellulaire - UMR-S 1250 (P3CELL), Université de Reims Champagne-Ardenne (URCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Reims Champagne-Ardenne (URCA), Universitat Oberta de Catalunya (UOC), Catalan Institute of Oncology, Institut Catala de la Salut, University of Ljubljana, University of Tampere, Karolinska Institutet, University of Copenhagen, Belgian Cancer Centre, Queen Mary University of London, Tampere University, Clinical Medicine, and Department of Gynaecology and Obstetrics
- Subjects
Male ,Health Knowledge, Attitudes, Practice ,Epidemiology ,Vaccination schedule ,[SDV]Life Sciences [q-bio] ,Uterine Cervical Neoplasms ,Dones ,01 natural sciences ,Adult women ,Face-to-face ,0302 clinical medicine ,Cervix cancer ,3123 Gynaecology and paediatrics ,030212 general & internal medicine ,vacunad el papil·lomavirus ,Early Detection of Cancer ,Finland ,ComputingMilieux_MISCELLANEOUS ,education.field_of_study ,Personal relationship ,Vaccination ,3. Good health ,Europe ,papillomavirus Vaccine ,Female ,France ,vacuna del papilomavirus ,papilomavirus ,Adult ,medicine.medical_specialty ,Adolescent ,Càncer de coll uterí ,Papillomaviruses ,Population ,MEDLINE ,Context (language use) ,03 medical and health sciences ,medicine ,Humans ,cervical screening ,Women ,Papillomavirus Vaccines ,0101 mathematics ,education ,Papil·lomavirus ,Sweden ,examen cervical ,business.industry ,010102 general mathematics ,Papillomavirus Infections ,Public Health, Environmental and Occupational Health ,Patient Acceptance of Health Care ,United Kingdom ,Spain ,Family medicine ,business - Abstract
Introduction: Human papillomavirus–vaccinated cohorts, irrespective of age, will likely reduce their subsequent screening requirements, thus opening opportunities for global cost reduction and program sustainability. The determinants of uptake and completion of a 3-dose human papillomavirus vaccination program by adult women in a European context were estimated. Study design: This was an intervention study. Setting/participants: Study participants were women aged 25–45 years, attending opportunistic or population-based cervical cancer screening in Belgium, Denmark, Finland, France, Germany, Slovenia, Spain, Sweden, and the United Kingdom between April 2016 and May 2018. Intervention: Study participants completed a questionnaire on awareness and attitudes on adult female human papillomavirus vaccination and were invited to receive free human papillomavirus vaccination. Main outcome measures: Main outcome measures were acceptance, uptake, and completion of vaccination schedule. Determinants of vaccine uptake were explored using multilevel logistic models in 2019. Results: Among 3,646 participants, 2,748 (range by country=50%–96%) accepted vaccination, and 2,151 (range=30%–93%) received the full vaccination course. The factors associated with higher vaccine acceptance were previous awareness of adult female (OR=1.22, 95% CI=1.00, 1.48) and male (OR=1.59, 95% CI=1.28, 1.97) vaccination. Women in stable relationships (OR=0.56, 95% CI=0.45, 0.69) or with higher educational level (OR=0.76, 95% CI=0.63, 0.93) were more likely to refuse vaccination. Recruitment by postal invitation versus personal invitation from a healthcare professional resulted in lower vaccine acceptance (OR=0.13, 95% CI=0.02, 0.76). Vaccination coverage of >70% of adolescent girls in national public programs was of borderline significance in predicting human papillomavirus vaccine uptake (OR=3.23, 95% CI=0.95, 10.97). The main reasons for vaccine refusal were vaccine safety concerns (range=30%–59%) and the need for more information on human papillomavirus vaccines (range=1%–72%). No safety issues were experienced by vaccinated women. Conclusions: Acceptance and schedule completion were largely dependent on recruitment method, achieved coverage of national vaccination programs, and personal relationship status. Knowledge of benefits and safety reassurance may be critical to expanding vaccination target ages. Study results suggest that there are no major opinion barriers in adult women to human papillomavirus vaccination, especially when vaccination is offered face to face in healthcare settings. Trial Registration: EudraCT Number 2014-003177-42. publishedVersion
- Published
- 2021
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