Please use this identifier to cite or link to this item: https://www.um.edu.mt/library/oar/handle/123456789/34576
Title: Missed clinical opportunities for HPV vaccination
Authors: Cuschieri, Liliana
Keywords: Vaccines -- Malta
Papillomavirus vaccines -- Malta
Cervix uteri -- Cancer
Issue Date: 2015
Citation: Cuschieri, L. (2015). Missed clinical opportunities for HPV vaccination (Master of Science).
Abstract: Background: The introduction of vaccines against human papillomavirus (HPV) has essentially rendered cervical cancer a vaccine-preventable disease. Yet the uptake of the HPV vaccines has been much lower than anticipated all over the world, mainly due to missed clinical opportunities. These may be a consequence of gaps in the knowledge, attitudes and practices of healthcare professionals towards the HPV vaccines as doctors are known to play an important and influential role when it comes to patients deciding whether to accept vaccines or not. Identifying the barriers which prevent doctors from recommending these vaccines may help improve their recommendation practices and the uptake of the HPV vaccines. Method: The study consisted of both quantitative and qualitative methodologies. The quantitative aspect was a cross-sectional study performed by means of a postal questionnaire sent to doctors specialised in family medicine, paediatrics and obstetrics and gynaecology in the Maltese Islands. The questionnaire assessed the knowledge, attitudes and practices of these doctors with regards to the HPV vaccines and identified any perceived barriers they reported. The data gathered was analysed statistically to identify significant differences in the above-mentioned factors depending on physicians' age, gender and specialty as well as the patients' age and gender, amongst other things. The qualitative methodology consisted of three focus groups carried out with members of the three specialties referred to during which a set of recommendations was drawn up according to the main themes which emerged and which can help local doctors in their recommendation of the HPV vaccines to patients. Results: Quantitative: Of the 412 doctors to whom the questionnaire was posted 175 eligible participants returned a completed questionnaire (46.7%). The final respondent population was analysed and found to be representative of the original sample of doctors. The level of knowledge was found to be good although a significant difference was observed in level of knowledge according to physician's age (p=<0.001) and specialty (p=<0.001). Younger doctors and obstetricians and gynaecologists were found to have the highest level of knowledge about HPV and its vaccines. While doctors' attitudes towards the vaccines appeared positive these were more positive when it came to recommending the vaccines to females than males. Recommendation of the vaccine, however, was very low. Doctors were found to recommend the vaccine least to young adolescent females (11-12 years old); obstetricians and gynaecologists were most likely to recommend the vaccines to the two younger female age groups and had 9.3- (95% el, 2.8-30•7), 7.2- (95% el, 2.7-18.8) and 5.5- (95% el, 2.2-14) fold greater odds of "always" recommending the vaccines when compared to family doctors. The majority of physicians claimed that they "never" recommend the vaccines to male patients. The main barriers encountered by physicians in recommending the vaccines were related to cost and lack of parent education and understanding about HPV infection. Qualitative: The main barriers faced by physicians to recommending the HPV vaccines were vaccine cost and lack of parent education - effectively reiterating the same findings made in the survey. Recommendations for actions to improve recommendation of the vaccines included improving health literacy and patient education, methods to reduce the burden of the cost of the vaccines, lowering the recommended age group for vaccination and providing more education for the health care providers. Conclusion: While the level of knowledge of participants about HPV and its vaccines is good, and the attitudes towards the vaccines are positive, recommendation practices leave much to be desired. The cost of the vaccines seems to be a major barrier, something which is perhaps reflected in the fact that while uptake of the vaccine in Malta where it is available for free is very good, its uptake in other sectors where it needs to be bought out of pocket is very low. This, and a lack of patient knowledge, seem to impact uptake of the HPV vaccines the most in the Maltese Islands, and are amongst the main issues which need to be addressed in order for the full benefits of the HPV vaccines to be enjoyed by all those eligible to receive them.
URI: https://www.um.edu.mt/library/oar//handle/123456789/34576
Appears in Collections:Dissertations - FacM&S - 2015
Dissertations - FacM&SPH - 2015
Dissertations - FacM&SPH - 2017

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