Rula Btoush, PhD, RN Associate Professor Presented ented at the - - PowerPoint PPT Presentation

Rula Btoush, PhD, RN Associate Professor

Presented ented at the New ew Jersey sey HPV Roundta

• undtable

ble on n Octo tober ber 11, , 2017 017

 Analysis of EHR data for 3,180

adolescents seen at a multi-site FQHC in Newark (2011)

 Focus group discussions with 44

ethnically diverse Black women (2011)

 Focus group discussions with 132

Latina mothers (2014)

 Analysis of NJIIS data (2010-2014)

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An Anal alysis ysis of f EHR HR dat ata a fo for r 3,1 ,180 80 ad adolesce lescents nts seen n at at a mu a multi ti-site site FQHC QHC in Ne Newark wark (2011 011)

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 27.4% received at least 1 dose  HPV-V initiation was higher:

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Facto tor ALL Female emale Male le Blac ack Hispan panic ic Younger adolescents     Non-English speakers    Insured adolescents   Seen by pediatricians      Seen at the Irvington

• r Orange sites

     Younger adolescents seen by pediatricians     

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 3-dose Series  7.8% of all adolescents  28.6% of adolescents who initiated  HPV-V Completion was higher:

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Factor ctor ALL Female emale Male le Black ack Hispan panic ic Younger adolescents Non-English speakers   Insured adolescents  Seen by pediatricians Seen at the Newark – South or East Orange 

 Duration between doses 1 and 2

• 5.52

52 months (SD=4.63)

 Duration between doses 1 and 3

• 10.02

.02 months (SD=6.07)

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ALL Female emale Male le Black ack Hispan panic ic Insurance

• Insurance
• Insurance

ALL Female emale Male le Blac ack Hispan panic ic Insurance

• Insurance
• at Newark –

South or East Orange Non-English Speakers

• at Newark –

South or East Orange

Should be 2 m months Should be 6 m months

An Anal alysis ysis of f NJ NJIIS IS dat ata a (2010 010-2014 2014) Preliminary Analysis

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Focus cus gr group up discussions cussions with th 44 ethnica hnically lly dive verse rse Blac ack k women men (2011 011)

Funded by the UMDNJ Foundation

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 Included Haitian, African, English-speaking

Caribbean, and African American women

 Lack of knowledge about:

• HPV infection and risk factors
• HPV vaccination guidelines

 Haitian & African mothers were least

knowledgeable

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 Distrust in vaccines in general  Open and receptive to vaccination for girls  Unclear about need to vaccinate boys  Concerns about safety and side effects  Lack of HCPs’ recommen

menda dation tion

• In some cases HCPs were dismissive of women’s

questions (seeking information)

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Focus cus gr group up discussions cussions with th 132 2 La Latina na mo mothers thers (2014 014) Funded by the American Nurses Foundation (ANF)

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 Lower rates among:

• Spanis

ish speakers ers (49%) than English speakers (90%)

• Those with income
• me

≤$14,000 (49%) than those with higher income (83%)

• The uninsur

insured ed (47%) than the insured (64%)

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 Lower initiation

rates among:

• Spanis

nish h speakers ers (24%) than English speakers (45%)

• The uninsur

insured ed (16.2%) than the insured (39%)

• Those who never

ver heard rd of the vacc ccine ine (3%) than those who ever heard of the vaccine (47%)

 Lack of knowledge about HPV infection,

vaccination, recommended age of vaccination, number of doses, side effects, cost, etc.

 Receptive and believed that the vaccine

should be given to both males and females

 Mothers are the primary decision makers

about the vaccine

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Barr rrie iers: rs:

 Lack of HCP

recommen menda dation ion

 Concern about side

effects

 Avoidance of

talking about sex with children Faci cili litato ators: rs:

 HCP recommen

menda dation tion was the strong ngest est facil ilita itator

• r for HPV-V

initiation and completion

 Perceived seriousness

• f HPV (motivating

factor)

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 HCP

CP rec ecomm mmen endation ation an and co commun mmunica cati tion

• n about

the HPV-V

• Strong recommendation
• Addressing side effects and safety concerns

 School-based approach in educating mothers

about the vaccine

 Use of texting smart phone technology to educate

mothers and promote completion

 Making appointments for 2nd and 3rd doses  Use of reminder calls for 2nd and 3rd doses

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Curre rrent t Pro roject ject - Stat atewide ewide On Online ine Survey rvey of f 500 0 HC HCPs Ps Funded by Rutgers Cancer Institute of New Jersey

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 St

Statewide ide onli line e survey ey of 500 HCPs

 Includes MDs & APNs in Peds, OB/GYN, and

family medicine

• HCP recommendation of the HPV-V
• Knowledge and beliefs about the vaccine
• Barriers and facilitators for recommending and

discussing the HPV-V with parents

 Email announcements and word of mouth

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Sampl ple e charact aracteris eristic ics Ge Gender er Male Female 28% 78% Speci cialty alty Pediatrics Women’s Health or OB/GYN Family Medicine/Family Health 63% 15% 22% He Healthcare thcare Profes ession ion Physician Nurse Practitioner 78% 22% Pract ctic ice Type Private Practice Public Clinic FQHC Other 59% 16% 13% 12% Years s of Experience ience M ( (SD) D) 17 (11) Years s in current rrent pract ctice ice M ( (SD) D) 12 (11)

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* Recommending the HPV vaccine >75% of the time

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 Healthcare providers in New Jersey  Physician (MD or DO) or advanced

practice nurse (APN or NP)

 Working in pediatrics, OB/GYN or

women’s health, or family medicine

 Online survey  < 20 minutes  http:/

://j.m j.mp/ p/2muD 2muDce8 e8

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Ack cknowl nowledge edgeme ment nt of Collabo abora rators: tors:

 Diane Brown, PhD; Rutgers School of Public Health  Dennis Carmody, PhD; Rutgers School of Nursing  Shawna Hudson, PhD; Rutgers - Robert Wood Johnson Medical

School (RWJMS)

 Lindsey Toller, MPH; Rutgers School of Public Health  Jennifer Tsui, PhD, Rutgers Cancer Institute of New Jersey (CINJ)  DOH - VPD and VFC programs

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