Incidence of Cervical Cancer in Puerto Rico, 2001-2017

Ortiz, Ana P.; Ortiz‐Ortiz, Karen J.; Colón‐López, Vivian; Tortolero‐Luna, Guillermo; Torres‐Cintrón, Carlos R.; Wu, Chi-Fang; Deshmukh, Ashish A.

doi:10.1001/jamaoncol.2020.7488

Cited by 21 publications

(27 citation statements)

References 7 publications

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“…Previous negative experiences with a vaccine could lead a parent to be hesitant and mistrust the effectiveness and safety of the vaccination in general. 34,35 Unfortunately, when these stories get disseminated via social media, people rely more on this anecdotal, experience-based information than evidence-based information 14 . Besides, the spread of misinformation through these media could get more impact due to easy access.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the high incidence rate of HPV-related cancers in Puerto Rico 13 and the recent increase in cervical cancer observed, 14 the Secretary of Health established a school entry requirement of at least one dose of HPV vaccination in girls and boys aged 11 and 12 years, which took effect in August 2018. This requirement has been amended annually, now including adolescents [11][12][13][14][15][16] years old. 15 This study aimed to examine the perceptions of parents and guardians whose children were not in compliance with the new HPV vaccination school entry policy in Puerto Rico after it took effect in August 2018.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Understanding Parents’ Views Toward the Newly Enacted HPV Vaccine School Entry: A Qualitative Study

Colón‐López¹,

Medina-Laabes²,

Abreu³

et al. 2021

Preprint

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Background: Human papillomavirus vaccine (HPV) is an important tool for prevention of HPV- related cancers. In Puerto Rico, the Secretary of Health established a school entry requirement of at least 1 dose of HPV vaccination in girls and boys aged 11 and 12 years taking effect in August 2018. Our study aims to examine parents’ views and opinions of the process of implementing the new HPV vaccination school entry policy in Puerto Rico, and understand barriers and facilitators related to this HPV immunization policy. Methods: Three focus group (n=12) and eight in-depth semi-structured interviews were performed, along with a survey. The interviews were recorded and transcript by our staff members. Through a thematic analysis were identified emergent themes. Results: Lack of information in relation to the policy were the theme most mentioned in the interviews. Moreover, participants expressed that previous negative experiences, from friends or family member, adverse effect and the lack of communication from school and healthcare providers deter them from the decision of vaccinated their kids. Barriers in the process of soliciting an exemption was discussed. Conclusion: Most barriers mentioned by participants who express hesitation about vaccinating their kids with the HPV vaccine, are modifiable providing parents information about the mandate’s implementation, and educational materials that address their concerns related to the vaccine’s side effects. Implementation of this efforts, however, need to consider impacting the school (teachers, principal directors, and administrative staff), the government and parents. This multilevel approach will help to improve the dissemination of information about HPV vaccination in order to clarify doubts and misinformation among hesitant parents.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Understanding Parents’ Views Toward the Newly Enacted HPV Vaccine School Entry: A Qualitative Study

Colón‐López¹,

Medina-Laabes²,

Abreu³

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

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“…In addition, both the incidence of cervical cancer and anal cancer are increasing in this population. Speci cally for cervical cancer, incidence rates showed an increase of 2.4% per year from 2001 and 2017 in Puerto Rico [12] while for anal cancer, incidence increased 4.90% from 2001 and 2016 [13]. Due to its public health relevance, in 2018 the Secretary of Health of Puerto Rico implemented the HPV vaccine school-entry as a requirement to all students ages 11-12 years old for entering school [14].…”

Section: Introductionmentioning

confidence: 99%

Implementation of the human papillomavirus school-entry requirement in Puerto Rico: barriers and facilitators using the consolidated framework for implementation research

Colón‐López

Soto-Abreu

Medina-Laabes

et al. 2021

Human Vaccines & Immunotherapeutics

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Background: In 2018, Puerto Rico (PR) enacted a Human papillomavirus (HPV) vaccine school-entry requirement for students ages 11 to 12. Using the Consolidated Framework for Implementation Research (CFIR), we aimed to identify potential barriers and facilitators of this implementation.Methods: We conducted a total of 36 qualitative interviews with key informants who were stakeholders from different organizations (Department of Health, Schools, Healthcare Providers, and Community organizations in favor of the requirement) from July 2018 to January 2020. Three researchers performed the interview guide, data coding, and analysis according to the CFIR framework. We evaluated construct rating variability between the organizations to determine barriers and facilitators.Results: The strongest facilitators determined under the CFIR construct include the stakeholder's awareness of the parent's and student's needs to meet the HPV school-entry requirement. Other facilitators include initiatives for school-entry policies and the relative advantage of this requirement over different strategies. The strongest barriers included the cost for private providers to administer the HPV vaccine, the negative in uence of social media about the vaccine, which affected parents' acceptance, and the lack of school nurses as available staff resources for the school entry requirement.Conclusions: Findings from this study can be used to improve implementation (adaptations/modi cations) and inform other US states and countries in earlier stages of consideration of the adoption of similar immunization policies. Most barriers can be modi able with the implementation of educational programs/training across schools, considering that they are the rst line of response to parents of this school entry requirement. Contributions To The LiteratureThis study is one of the few that explored the barriers and facilitators of the HPV school-entry vaccine requirement using the CFIR framework. This valuable tool leads us to evaluate the implementation process from multiple settings and stages.Results have shown the importance of capacity training to school staff and health stakeholders to boost parents' capacity and engage parents who are unaware or hesitant to vaccinate. These ndings provide new information about challenges that emerged in the implementation. These factors that support or impede the process will help guide other implementers that want to replicate HPVschool entry policies in other jurisdictions or countries.

show abstract

Section: Introductionmentioning

confidence: 99%

Implementation of the Human Papillomavirus School-entry Requirement in Puerto Rico: Barriers and Facilitators Using the Consolidated Framework for Implementation Research

Colón‐López¹,

Soto-Abreu²,

Medina-Laabes³

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

Background: In 2018, Puerto Rico (PR) enacted a Human papillomavirus (HPV) vaccine school-entry requirement for students ages 11 to 12. Using the Consolidated Framework for Implementation Research (CFIR), we aimed to identify potential barriers and facilitators of this implementation.Methods: We conducted a total of 36 qualitative interviews with key informants who were stakeholders from different organizations (Department of Health, Schools, Healthcare Providers, and Community organizations in favor of the requirement) from July 2018 to January 2020. Three researchers performed the interview guide, data coding, and analysis according to the CFIR framework. We evaluated construct rating variability between the organizations to determine barriers and facilitators. Results: The strongest facilitators determined under the CFIR construct include the stakeholder's awareness of the parent's and student's needs to meet the HPV school-entry requirement. Other facilitators include initiatives for school-entry policies and the relative advantage of this requirement over different strategies. The strongest barriers included the cost for private providers to administer the HPV vaccine, the negative influence of social media about the vaccine, which affected parents' acceptance, and the lack of school nurses as available staff resources for the school entry requirement. Conclusions: Findings from this study can be used to improve implementation (adaptations/modifications) and inform other US states and countries in earlier stages of consideration of the adoption of similar immunization policies. Most barriers can be modifiable with the implementation of educational programs/training across schools, considering that they are the first line of response to parents of this school entry requirement.

show abstract

Incidence of Cervical Cancer in Puerto Rico, 2001-2017

Cited by 21 publications

References 7 publications

Understanding Parents’ Views Toward the Newly Enacted HPV Vaccine School Entry: A Qualitative Study

Understanding Parents’ Views Toward the Newly Enacted HPV Vaccine School Entry: A Qualitative Study

Implementation of the human papillomavirus school-entry requirement in Puerto Rico: barriers and facilitators using the consolidated framework for implementation research

Implementation of the Human Papillomavirus School-entry Requirement in Puerto Rico: Barriers and Facilitators Using the Consolidated Framework for Implementation Research

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