These findings suggest that unique educational strategies need to be developed, based on the needs and perceptions of the targeted audience, in order to achieve wide-spread acceptability of this vaccine.

Armed conflict disproportionately affects women, newborns, children, and adolescents. Our study presents insights from a collection of ten country case studies aiming to assess the provision of sexual, reproductive, maternal, newborn, child and adolescent health and nutrition (abbreviated to women's and childern's health, i.e WCH in this paper) interventions in conflict-affected settings in Afghanistan,

Background HPV DNA testing has been shown to be an effective approach to cervical cancer screening, and self-collection sampling for HPV testing could be a potential alternative to Pap test, provided that women who tested positive by any method get timely follow-up and care. This feasibility study examined acceptability and usability of self-collected sampling for HPV testing among African American (AA) women in the Mississippi Delta in order to inform the development of interventions to promote cervical cancer screening in this population. Methods The study consisted of two phases. Phase I consisted of eight focus groups (N=87) with AA women to explore knowledge, attitudes, and beliefs about cervical cancer and HPV infection as well as acceptability of self-collected sampling for HPV testing. In Phase II, we examined the usability of this technology through one discussion group (N=9). The Health Belief Model guided data collection and analysis. Results Although participants perceived themselves as susceptible to cervical cancer and acknowledged its severity, there was a lack of knowledge of the link between HPV and cervical cancer, and they expressed a number of misconceptions. The most frequent barriers to screening included embarrassment, discomfort, and fear of the results. Women in both phases were receptive to self-collection sampling for HPV testing. All participants in the usability phase expressed that self-collection was easy and they did not experience any difficulties. Conclusion Self-collection for HPV testing is an acceptable and feasible method among AA women in the Mississippi Delta to complement current cytology cervical cancer screening programs.

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To examine factors associated with perceived susceptibility to cervical cancer among Latina immigrants in two counties in Alabama. Datasets from two anonymous cross-sectional surveys from two studies were combined for these analyses. The total sample size was 743 women. Participants' average age was 30 ± 6.8 years and they were mainly from Mexico (89.2%). Almost 36% of the participants did not perceive themselves as being susceptible to cervical cancer, 33.9% did not know if they were susceptible, and 30.4% perceived themselves as susceptible. Educational attainment, thinking they may have been exposed to an STI in the past, thinking they may be at risk of HPV currently, having had a Pap smear within the last year, and having a relative with cancer were significantly associated with perceived susceptibility to cervical cancer in the multinomial logistic regression. Greater knowledge about cervical cancer risk factors reduced the uncertainty about perceived susceptibility. Perceived susceptibility to cervical cancer seems to be influenced more importantly by the current or past perception of HPV/STI exposure, and by having a relative with cancer. This finding is critical in the development of interventions that are tailored to Latina immigrants as well as efforts to educate providers in a state where Latino immigration is a recent phenomenon.

In 2012, Colombia implemented a school-based HPV vaccination program of a 3-dose series for nine year old girls. Following a mass psychogenic response after vaccination in a Colombian town, vaccination rates dropped from 80% in 2012–2013 to 5% in 2016. The study aimed to identify barriers and facilitators of HPV vaccine uptake among girls eligible for vaccination in the initial years of vaccine implementation from 2012 to 2014, and their parents. We conducted 19 individual qualitative interviews and 18 focus groups with an average of 5 girls, in Manizales, Colombia between 2016 and 2017. In total, 49 girls from six schools and 58 of their parents participated in the study. Participants had some degree of awareness about cervical cancer, especially among those of middle and upper socioeconomic level. However, the vaccine was known as a prevention measure only after pap-smears and condoms. The main facilitator for vaccine uptake for parents was the desire to prevent diseases in general and for girls, it was facilitated by receiving positive information about the vaccine. The main barriers for vaccine uptake or for three doses completion were the event in Carmen de Bolivar, fear of adverse effects and fear of needles. Girls and parents stated that they received little or no information from schools or health care services about the HPV vaccine prior to vaccination. Our results suggest that improving HPV vaccination rates in Colombia will require a comprehensive education program including mass media information about HPV vaccine.

Background: In conflict-afflicted areas, pregnant women and newborns often have higher rates of adverse health outcomes. Objective: To describe maternal and child health indicators and interventions between 1998 and 2016 comparing high and low conflict areas in Colombia. Methods: Mixed study of convergent triangulation. In the quantitative component, 16 indicators were calculated using official, secondary data sources. The victimization rate resulting from armed conflict was calculated by municipality and grouped into quintiles. In the qualitative component, a comparative case study was carried out in two municipalities of Antioquia: one with high rates of armed conflict and another with low rates. A total of 41 interviews and 8 focus groups were held with local and national government officials, health professionals, community informants, UN agencies and NGOs. Results: All of the indicators show improvement, however, four show statistically significant differences between municipalities with high victimization rates versus low ones. The maternal mortality ratio was higher in the municipalities with greater victimization in the periods 1998-2004, 2005-2011 and 2012-2016. The percentage of cesarean births and women who received four or more antenatal visits was lower among women who experienced the highest levels of victimization for the period 1998-2000, while the fertility rate for women between 15 and 19 years was higher in these municipalities between 2012 and 2016. In the context of the armed conflict in Colombia, maternal and child health was affected by the limited availability of interventions given the lack of human resources in health, supplies, geographical access difficulties and insecurity. The national government was the one that mostly provided the programs, with difficulties in continuity and quality. UN Agencies and NGOs accessed more easily remote and intense armed conflict areas. Few specific health interventions were identified in the postconflict context. Conclusions: In Colombia, maternal and child health indicators have improved since the conflict, however a pattern of inequality is observed in the municipalities most affected by the armed conflict.

Objective It has been shown that cultural and linguistic barriers may have a great impact on the quality of health care received by immigrants. The recent growth of Latino immigrants in new areas of the country (particularly in the South) has presented great challenges to the health care system and health care professionals in these states. Through a NCI funded community-based educational program (Sowing the Seeds of Health), we created an informative DVD to aid health care providers in better understanding Latino immigrant health beliefs and health care seeking behaviors. The educational DVD presented information on how to provide culturally competent care as it relates to Latino immigrants, their expectations when seeking care, and common cultural beliefs and practices. Health care professionals and Latino immigrants participated in the development and content of the DVD. Methods The intervention was delivered though various mediums; on-site, on-line, two national webcasts and mailed copies of the DVD. Pre- post self-administered questionnaires assessing knowledge and attitudes regarding culture competency and relevant topics addressed in the DVD. Results Four-hundred and sixty-three (N=463) health care professionals participated from across the United States. Intervention produced significant overall knowledge increase (p-value <0.001) in cultural competency, Latino cultural beliefs and barriers to healthcare access for Latino immigrants. Conclusion The findings indicate that a short DVD offered via multiple mediums may be a promising avenue for educating health care professionals about the needs and expectations of Latino immigrants in the U.S.