Facilitators and barriers of healthcare workers’ recommendation of HPV vaccine for adolescents in Nigeria: views through the lens of theoretical domains framework

Abstract

Background The human Papillomavirus (HPV) vaccine has demonstrated efficacy in the prevention of cervical cancer when given in early adolescence. The recommendation of the vaccine by health care workers (HCW) is crucial to the uptake of the vaccine by adolescents and the process of this recommendation is important as it determines subsequent uptake of the vaccine. Understanding of the facilitators and barriers of recommendation of this vaccine can help in the development of strategies to improve its recommendation rates and uptake. This study therefore explored the facilitators and barriers for the recommendation of HPV vaccine for adolescents by HCW in Ibadan, Nigeria using the Theoretical Domain Framework (TDF). Methods Key informant interviews were conducted with 14 purposively selected HCW who were in charge of vaccination. Content analysis was used after deductive coding of the data using the domains of the TDF. Relevant concepts for facilitators and barriers of HPV vaccine recommendation and quotes were then identified. Results Mean age of the HCW was 47.7 ± 6.5 years and they consisted of eight nurses, four medical doctors, one medical social worker and one health visitor. Ten domains of the TDF were represented among the facilitators and barriers against the recommendation of HPV vaccination by the HCW, except the goals; memory, attention, decision process; emotion; and behavioral regulation domains. The domains with the highest frequency of concepts were: knowledge, skills, social/professional role and identity, beliefs about capabilities, beliefs about consequences, intention and environmental context and resources. Domains with conflicting statements in the concept were: environmental context and resources, and beliefs about consequences. While those with perceived strength of concept were: social influences, reinforcement and optimism. Conclusion All the 10 identified domains of the TDF are potential areas of focus for strategies for improving the recommendation of HPV vaccine for adolescents by health care workers in Nigeria and other countries with similar sociocultural settings.

Vaccination against human papillomavirus in Brazilian schoolchildren: National Survey of School Health, 2019

“…Regarding the source of information about HPV, a multicenter study with sexually active young adults recruited from 119 Primary Health Care (PHC) services revealed higher scores on knowledge about the virus among participants who were informed via health professionals and the media 23 . The research reinforced the importance of nurses working in these services of adopting communication strategies that favor the dissemination of information, favoring the adherence of this public to vaccination 21 ), ( 26 .…”

“…Health professionals, in addition to providing information on HPV vaccination, should recommend it to adolescents 14 ), ( 21 ), ( 22 ), ( 23 ), ( 24 ), ( 25 ), ( 26 . Studies show that parents who received the recommendation from a health professional have a higher chance of reporting their intention to vaccinate their children when compared to parents who did not 14 ), ( 26 . Another study, however, revealed that only 64.4% of the parents of girls and 41.6% of the parents of boys received recommendations from health professional regarding the vaccine 27 .…”

“…Another study, however, revealed that only 64.4% of the parents of girls and 41.6% of the parents of boys received recommendations from health professional regarding the vaccine 27 . Notably, a study conducted with nurses and other health professionals in Nigeria reported that knowledge about the HPV vaccine is favored by its recommendation to parents and adolescents 26 . Considering that in our study most adolescents did not know that they had to be vaccinated and that there is evidence that knowledge about the vaccine is favored by its recommendation from a health professional 26 , strategies that prioritize the training of nurses on HPV prevention are necessary 26 , especially those who work in the vaccine rooms.…”

Vacinação contra o papilomavírus humano em escolares brasileiros: Pesquisa Nacional de Saúde do Escolar, 2019

“…O ajuste foi realizado em virtude de a literatura documentar que meninas se vacinam mais contra o HPV do que meninos (5) , assim, foi possível considerar a influência desse fator sociodemográfico (18) . Para analisar Quanto aos motivos para não terem recebido a vacina, a maioria dos escolares adolescentes do país respondeu "não sabia que tinha que tomar" (46,8%; IC95% 45,4;48,3), seguido pelas respostas "outro motivo" (26,7%;IC95% 25,4;27,9) e "medo de reação à vacina" (7,7%;IC95% 6,9;8,6), respectivamente (Figura 3). (3,5;5,6) 1,2 (0,9;1,5) 6,8 (5,4;8,3) 0,9 (0,7;1,1) 3,3 (2,5;4,1) 0,9 (0,7;1,3) 2,4 (1,6;3,2) 0,7 (0,5;1,1) 3,1 (2,3;3,9) 0,4 (0,3;0,6)* 24,1 (21,9;26,2) 0,9 (0,8;1,0) Sudeste 47,2 (43,8;50,6) 0,9 (0,9;1,0) 3,1 (1,8;4,4) 0,7 (0,4;0,9)* 7,8 (5,8;9,9) 1,1 (0,9;1,4) 3,4 (2,0 ;4,8) 0,9 (0,6;1,4) 3,9 (2,4;5,4) 1,3 (0,9;2,0) 7,8 (5,4;10,3) 1,7 (1,3;2,3)* 25,2 (22,2;28,1) 1,0 (0,9;1,2) Sul 46,3 (42,2;50,4) 0,9 (0,8;1,0) 1,6 (0,5;2,7) 0,3 (0,2;0,6)* 9,7 (6,9;12,5) 1,2 (0,9;1,7) 5,8 (3,5;8,2) 1,3 (0,9;2,0) 3,5 (2,2;4,8) 1,0 (0,7;1,6) 5,5 (3,8;7,3) (10,8;13,7) 0,8 (0,7;0,9)* 36, 4 (34,3;38,4) 1,0 (1,0;1,3) Sudeste 29,6 (25,9;33,4) 0,9 (0,8;1,0) 2,7 (1,6;3,8) 0,9 (0,5;1,3) 13,1 (10,0;16,2) 1,6 (1,2;2,0) 3,1 (2;4,2) 1,2 (0,8;1,7) 3,1 (2,0;4,2) 0,9 (0,6;1,3) 14,1 (10,9;17,3) 1,0 (0,9;1,2) 33,8 (30,4;37,2) 0,9 (0,8;1,1) Sul 24,5 (21,2;27,8) 0,8 (0,7;0,9)* 0,9 (0,2;1,5) 0,3 (0,2;0,6)* 9,2 (7,0;11,5) 0,8 (0,6;1,0) 3,1 (1,8;4,4) 0,9 (0,6;1,4) 7,2 (4,9;9,5) 2,2 (1,6;3,1)* 17,8 (14,7;20,8) 1,3 (1,1;1,5)* 36, 9 (33,4;40,4) 1,1 (1,0;1,2)…”

“…Quanto à fonte de informações sobre o HPV, estudo multicêntrico com adultos jovens sexualmente ativos recrutados em 119 serviços de Atenção Primária à Saúde (APS) revelou maiores escores de conhecimento sobre o vírus entre os participantes que foram informados por profissionais de saúde e pela mídia (23) . A pesquisa reforçou a importância de os enfermeiros que atuam nesses serviços adotarem estratégias de comunicação que privilegiem a divulgação de informações, favorecendo a adesão desse público à vacinação (21,26) .…”