Cancer epidemiol biomarkers

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RESEARCH CRITIQUES

Research Critiques

Student Sample

Grand Canyon University: Introduction to Nursing Research

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Running head: RESEARCH CRITIQUES

Research Critiques

Human papillomavirus (HPV) leads to 600 000 new cases annually of cervical and genitourinary cancer worldwide, 26 900 of which occur in the United States (CDC, 2019). Interventions such as educating help reduce HPV cases among young girls. HPV vaccines are currently available to protect against high-risk types of HPV, which account for approximately 70% of cervical cancers, as well as a proportion of vaginal, oral and anal cancers (Krawczyk, 2015). The practice problem is that many parents are not educated about HPV and HPV vaccines therefore, cause low acceptance rates. This is a major problem because parents are not educated about how the HPV vaccine is highly effective in preventing the targeted HPV types, as well as the most common health problems caused by them such as cervical cancer (CDC, 2019). The PICOT question, “Does providing education about HPV and HPV vaccinations increase HPV vaccination acceptability among mothers of young females compared to mothers that did not receive the education?” is well supported in this paper and provides significant evidence about how education interventions about HPV and HPV vaccinations increases HPV vaccination acceptability. The purpose of this paper will be to review two quantitative and two qualitative research articles and the significance to increasing HPV vaccination rates.

Background

The first qualitative article, “HPV vaccine acceptability among health workers, teachers, parents, female pupils, and religious leaders in northwest Tanzania,” by P. Remes, discussed knowledge and attitudes about cervical cancer and HPV, and acceptability of and potential barriers to HPV vaccination of Tanzanian primary schoolgirls. The problem is that teachers, parents, pupils and health workers interviewed in the qualitative sub-study had limited or no knowledge about cervical cancer, HPV, and the HPV vaccine. This article is significant to nursing because with limited or no knowledge about cervical cancer, HPV, and the HPV vaccine there will be a high occurrence of HPV and cervical cancer. Lack of knowledge about cervical cancer in targeted communities, including amongst health workers, could be a potential challenge to vaccine uptake. The purpose of this article was to assess what teachers, parents, pupils and health workers know about HPV, cervical cancer, and the HPV vaccine. The objective was to assess what teachers, parents, pupils and health workers know about HPV, cervical cancer, and the HPV vaccine. Research questions in the article asked about knowledge of cervical cancer and HPV, HPV vaccine acceptability, decision-making, other experiences with vaccines or school-based health services, and also asked about views on delivery strategies (Remes, 2012).

The second qualitative article, “Implementation of an HPV vaccination program in Eldoret, Kenya: results from a qualitative assessment by key stakeholders,” by H. Vermandere discussed knowledge and outlooks about vaccination programs, cervical cancer, and the HPV vaccine. The problem is that although an HPV vaccination program had been implemented, people still had poor knowledge regarding the HPV vaccine and cervical cancer. Not all teachers were informed by health care providers, only some schools invited the parents for informative sessions, and there were hardly any contact moments between health care providers and parents. This article is significant to nursing because it can help increase HPV vaccination rates with a closer collaboration with health care providers and schools. This would help to address questions of parents about the HPV vaccine as well as teachers’ own doubts. The purpose of this article was to evaluate the implementation of the HPV vaccination demonstration program in Eldoret. There are three objectives to this research article. The first, to verify whether fathers and teachers were aware about the program and had supported it. Second, to assess barriers in promotion, such as the level of understanding of cervical cancer and attitudes towards HPV vaccination. Third, to gather recommendations, among fathers, teachers, vaccinators and the program coordinator, to contribute to the improvement of future HPV vaccination programs in Kenya. Research questions in the article asked about acceptance, knowledge regarding cervical cancer, and prevention measures.

The first quantitative article, “Disparities of perceptions and practices related to cervical cancer prevention and the acceptability of HPV vaccination according to educational level in a French cross-sectional survey of 18–65 years old women,” by J. Haesebaert discussed the relationships between educational level, women’s knowledge about cervical cancer (CC), and acceptance of HPV vaccination for their daughters. The problem is that women of low socioeconomic status are less knowledgeable about the HPV vaccine and less likely to have a pap smear, and are more prone to CC. This article is significant to nursing because without acceptance of the HPV vaccine, HPV and cervical cancer will continue to occur. The purpose of this article was to study the relationships between educational level, women’s knowledge about cervical cancer, and acceptance of HPV vaccination for their daughters. The objective was to assess knowledge about CC, pap smear and the HPV vaccine among 18–65 year-old women in relation to socio-economic status measured by educational level; and to investigate determinants of HPV vaccine acceptance among mothers of low educational level (Haesebaert, 2014). Research question in the article is, will educating and about HPV and cervical cancer enable parents to vaccinate their adolescent with the HPV vaccine?

The second quantitative article, “HPV and HPV vaccine education intervention: Effects on parents, healthcare staff, and school staff,” by P. Reiter, discussed if increased HPV and HPV vaccine knowledge among groups is influential to the HPV vaccination behaviors of adolescent females, provides research and assesses the effectiveness of education interventions among healthcare providers or school employees. The problem is that there are low levels of knowledge about HPV and the HPV vaccine among the parents, healthcare staff, and school staff. This research article is significant to nursing because it helps educate the parents, healthcare staff, and school staff about HPV and the HPV vaccine which helps them become accepting of the HPV vaccine. Increased education about HPV vaccinations helps vaccine rates and helps decrease health problems such as, cervical cancer. The purpose of the study was to incorporate HPV vaccination programs for parents in middle schools so they can make an informed decision regarding the HPV vaccine. The objectives of the research are to assess participants’ knowledge about HPV and HPV vaccine acceptability before and after educational intervention, assess beliefs surrounding HPV vaccine, education programs, and school-based vaccination clinics. The research question of this research is, does education intervention increase knowledge and acceptability of the HPV vaccine among parents, healthcare staff, and school staff members?

Method

The first qualitative research article, “HPV vaccine acceptability among health workers, teachers, parents, female pupils, and religious leaders in northwest Tanzania,” consisted of 31in-depth interviews and 12 group discussions with a total of 160 participants, using a purposive sampling strategy with the purpose of recruiting specific groups or types of people such as, parents, caregivers, female students, teachers, religious leaders (seven Christian and two Muslim), and health workers who would be involved in the different sites of school-based vaccination. Two group discussions were conducted with parents after a cultural dance and drama troupe performed a show on cervical cancer and HPV. When the participants showed no knowledge of HPV, the HPV vaccine, and cervical cancer, the interviewer provided education about the planned HPV vaccination project, and answered the participant’s questions.

The second qualitative research article, “Implementation of an HPV vaccination program in Eldoret, Kenya: results from a qualitative assessment by key stakeholders,” consisted of focus group discussions with four teachers, and three fathers. The discussions were recorded, transcribed, translated, and analyzed using thematic analysis. A meeting with the program coordinator was held to reflect upon the program and the results of the focus group discussions, and to formulate recommendations for future programs was also held. Researchers assessed HPV vaccine acceptance among a randomly selected sample of women with eligible daughter’s in the ten initially included schools using a structured questionnaire about knowledge regarding cervical cancer and prevention measures were assessed, followed by a short, standardized informative session to provide correct information about HPV.

The first quantitative article, “Disparities of perceptions and practices related to cervical cancer prevention and the acceptability of HPV vaccination according to educational level in a French cross-sectional survey of 18–65 years old women,” consisted analysis from a quantitative self-administrated questionnaire. The study was conducted in France and included 1,229 French 18–65-year-old women recruited by 39 general practitioners. Women were categorized into three educational level groups: low (LEL: 43.9%), medium (MEL: 33.4%) and high (HEL: 22.6%) (Haesebaert, 2014). The study used quantitative, by self-administered, anonymous questionnaire. Women who agreed to participate were asked to complete the questionnaire after their general practitioner’s consultation and before they left the practice premises. It consisted of multiple choice and open-ended questions covering five areas: 1) socio-demographic data; 2) practices relating to disease prevention; 3) gynaecological history; 4) knowledge about CC and its prevention; and 5) attitude towards HPV vaccination for their daughters (Haesebaert, 2014). Acceptability of the HPV vaccine was assessed by response to six questions.

The second quantitative article, “HPV and HPV vaccine education intervention: Effects on parents, healthcare staff, and school staff,” included quantitative method using pre- and post intervention surveys after approval was obtained from members of the Guilford County School System, education sessions in middle schools were implemented. In participating schools, separate sessions for parents and school staff were held, which occurred in locations such as the school library or media room. Additional sessions were conducted on-site at various community events and sites (Reiter, 2011). Parent sessions were open to anyone interested in attending. Data was collected from 118 healthcare staff members (from 5 education sessions), 456 school staff members (from 11 education sessions), and 376 parents (from 16 education sessions), excluding data for 5 healthcare staff members and 25 school staff members who did not complete both pre- and post intervention surveys (Reiter, 2011). Pre intervention surveys were distributed, completed, and collected prior to presentations, and post intervention surveys were distributed and completed following presentations. Surveys were conducted to assess participant’s knowledge about HPV and HPV vaccine. The participants were asked to rate their knowledge of HPV from 1 to 10, with 10 being the highest level. Both pre- and post interventions surveys contained the 1 to 10 item for school and healthcare staff members. On parent’s post intervention surveys, they rated their current knowledge and estimated their knowledge before the educational presentation. School and healthcare staff surveys (pre- and post intervention) contained multiple choice items regarding the number of new HPV cases diagnosed each year in the United States. Each item was scored as correct or incorrect (Reiter, 2011). The surveys also assessed beliefs about the HPV vaccine, education programs, and school-based vaccination clinics.

Results

The qualitative research article, “HPV vaccine acceptability among health workers, teachers, parents, female pupils, and religious leaders in northwest Tanzania” consisted of nine female health workers who were interviewed. The interviews and discussions conducted studied the following themes: knowledge of cervical cancer and HPV, HPV vaccine acceptability, decision-making, and other experiences with vaccines or school-based health services, views on delivery strategies (Remes, 2012). All nurses had heard of cervical cancer but they had limited knowledge and was inaccurate. Only two nurses identified HPV as the cause of cervical cancer. Most parents who participated in the study didn’t know very much about cervical cancer, but they did know that cervical cancer was a serious and possibly deadly illness. After assessing knowledge of the parents who participated in the study it was learned that none of them had heard about HPV or the HPV vaccine, two of the parents who participated in a group discussion had heard about HPV on the radio, but did not remember any details. Two of the two of the mothers, and four parents who participated in the in depth interviews had never heard of cervical cancer. One fifty-three-year-old father participating in an in depth interview heard information on the radio but the knowledge was inaccurate. Teachers had heard of cancer occurring from HPV, but only 1 of 37 knew about cervical cancer, and none of the teachers had heard of HPV or the HPV vaccine (Remes, 2012). Most of the participants welcomed the HPV vaccine because it helps prevent cervical cancer. Almost all the adult participants who were interviewed said they would allow their daughters to be vaccinated since it provided HPV prevention. All of the participants including, teachers, parents, pupils and health workers had limited or no knowledge about cervical cancer, HPV, and the HPV vaccine when the interview was conducted. Most of these participants welcomed the vaccine to prevent cervical cancer, parents said they would agree to give their daughter the HPV vaccination and some adopted a “wait and see” approach. Even though the women participants did not have very much knowledge about the HPV vaccine and cervical cancer, in all of the sub-Saharan studies, majority of the women were willing to vaccinate their child. 35% of the 14 male teachers participating in this study dissented and said they would not allow their own daughters to be vaccinated.

The second qualitative research article, “Implementation of an HPV vaccination program in Eldoret, Kenya: results from a qualitative assessment by key stakeholders,” concluded that cervical cancer was poorly understood by fathers and teachers. The focused group discussions conducted studied the following themes: knowledge about the HPV vaccination program, participation in the program, barriers of promotion: knowledge of cervical cancer and attitudes towards HPV vaccination, and cervical cancer knowledge. There were very few of the fathers who participated in the study and that heard about HPV vaccination program and when they did, it was through their wives or children (Vermander, 2015). Not all teachers had received information about the HPV vaccination program or if the promotion had reached them. Once participants were provided education about the HPV vaccination, and cervical cancer they were all accepting the vaccine. There were several hidden barriers that concealed a certain level of distrust, towards vaccines in general or towards the HPV vaccine (Vermander, 2015). Bad experiences or rumors about other vaccines such as polio and asthma especially were brought up as to indicate the possible danger of vaccines, and that the HPV vaccine was a new suggested and hidden experiment. All focused group participants wanted to know when a next vaccination program would be organized, or where they could go to vaccinate their daughters given that now they were better informed, they did not want to wait any longer (Vermander, 2015).

The quantitative research article, “Disparities of perceptions and practices related to cervical cancer prevention and the acceptability of HPV vaccination according to educational level in a French cross-sectional survey of 18–65 years old women” there were total of 188 women were mothers of a 14–18-year-old daughter. Among the 174 mothers who gave an opinion, 60.3% were favorable towards the vaccine and 47.6% of them had already had their daughters vaccinated (Haesebaert, 2014). Interestingly, high education level mothers had the lowest acceptance rate (46.9%) vs. 68.6% for medium education level and 60.4% for lower education level (Haesebaert, 2014). Knowledge about cervical cancer and its prevention was lower among lower education level women. Although lower education level women had poorer knowledge about cervical cancer and its prevention, they were more likely to accept HPV vaccination than high level education level mothers. Whatever their level of education, the main reason given by unfavorably disposed mothers was the newness of the vaccine or the fear of side effects (70.6% of unfavorable high education level mothers, 56.2% of medium education level and 41.7% of low education level) (Haesebaert, 2014).

The second quantitative research article, “HPV and HPV vaccine education intervention: Effects on parents, healthcare staff, and school staff” results concluded that healthcare staff members indicated much higher levels of self-rated HPV knowledge on their post intervention surveys (pre = 86%, post = 91%) (Reiter, 2011). The education intervention increased staff members’ objectively assessed knowledge about HPV and HPV vaccine. Healthcare staff members tended to hold positive beliefs about HPV vaccine. Most would choose to vaccinate their daughters against HPV if they were in the vaccine’s approved age range. School staff members rated their HPV knowledge higher following the intervention. The education intervention also increased the proportion of staff members who answered HPV knowledge items correctly compared with pre-intervention surveys, more staff members responded correctly following the intervention that there are about 6 million new HPV cases in the United States each year (Reiter, 2011). Although school staff members tended to support HPV education and vaccination programs prior to the intervention, a higher proportion believed post intervention that HPV and HPV vaccine education is worthwhile for school personnel, that middle schools are an appropriate venue for such education, and would be supportive of school-based vaccination clinics (Reiter, 2011). After the intervention, parents recalled having moderate self-rated knowledge about HPV prior to the intervention. They offered higher self-ratings of their HPV knowledge following the intervention. 97% of parents indicated they would be supportive of a school-based vaccination clinic (Reiter, 2011). Although all groups experienced an increase in self-rated knowledge, the largest increase was seen among parents, with healthcare and school staff experiencing smaller increases (Reiter, 2011).

PICOT and article Relationship

The relationship between the PICOT question and the nursing practice problem significantly cororlates with the research articles. It provides research and evidence about how providing education and information about HPV and HPV vaccines is crucial to help increase HPV vaccination rates. Educational intervention increases vaccination acceptability among educated parents. This is significant to nursing because it can help increase HPV vaccination rates and decrease HPV and cervical cancer rates. According to The National Cancer Institute, infections with HPV 16 and 18 decreased by 83% among girls aged 15–19 years and by 66% among women aged 20–24 years at up to 8 years after vaccination began (The National Cancer Institute, 2019). The prevalence of precancerous lesions that can lead to cervical cancer decreased by 51% among girls aged 15–19 years and by 31% among women aged 20–24 years at up to 9 years after vaccination began (The National Cancer Institute, 2019). HPV vaccines prevent infection with HPV types 16 and 18, two high-risk HPVs that cause about 70% of cervical cancers and an even higher percentage of some of the other HPV-caused cancers (The National Cancer Institute, 2019).

Proposed Evidence Based Practice Change

A potential practice change that I could implement in my clinical area is educate parents about HPV, HPV vaccine and possible complications that can occur without the vaccination. Educating parents about how cervical cancer is a cause from HPV and how it can be fatal is a change that can potentially help parents agree to the HPV vaccine. Providing educational pamphlets to parents of high school students about HPV and how HPV educational interventions in schools help prevent HPV is a great change that can occur in school systems.

Ethical Considerations

Ethical considerations associated with the nursing research of the two qualitative research articles were that the researcher was able to respect anonymity and confidentiality of all of the participants who participated in depth interviews. The people who participated in group discussions were voluntarily participating in the group study and were attending at their own free will. When the interviewers conducted interviews they only assessed relevant components that pertained to the study topic. In the quantitative research the participants used a self-administrated questionnaire to answer questions. The self-administered questionnaire made it confidential and protected the participant’s privacy.

Conclusion

The practice problem is that many parents are not educated about HPV and HPV vaccines, therefore cause low acceptance rates. Evidence supports the practice change that I will be implementing because education about HPV and HPV vaccines causes acceptability. Education will help HPV vaccination rates. It is vital to implement intervention strategies to improve vaccine uptake. Results provide valuable information for future HPV programs intended to increase not only knowledge about HPV and HPV vaccine but also vaccination rates. An important first step in increasing HPV vaccination rates among adolescent females in the United States is to improve knowledge levels among key groups influential to the adolescents’ vaccination behaviors. Education and information on the HPV vaccine is required to avoid misconceptions among lower education level mothers and to improve its acceptance. Education intervention greatly improves HPV and HPV vaccine knowledge levels among parents, healthcare staff, and school staff members. Education interventions offer a relatively low effort and potentially effective strategy for increasing HPV vaccination (Reiter, 2011).

References

CDC. (2019). Retrieved from https://www.cdc.gov/std/hpv/stdfact-hpv-vaccine-young-

women.htm

Haesebaert J., Lutringer-Magnin D, Kalecinski J, Barone G, Jacquard A-C, Leocmach Y, et al.

(2014). Disparities of perceptions and practices related to cervical cancer prevention and the acceptability of HPV vaccination according to educational Level in a French cross-sectional survey of 18–65 Years Old Women. PLoS ONE 9(10): e109320. https://doi.org/10.1371/journal.pone.0109320

Krawczyk A., Knäuper, B., Gilca, V., Eve Dubé, Samara Perez, Keven Joyal-Desmarais & Zeev Rosberger (2015) Parents’ decision-making about the human papillomavirus vaccine for their daughters: I. Quantitative results, Human Vaccines & Immunotherapeutics, 11:2,322-329, DOI: 10.1080/21645515.2014.1004030

National cancer institute. (2019). Retrieved from https://www.cancer.gov/about cancer/causes-

prevention/risk/infectious-agents/hpv-vaccine-fact-sheet

Reiter, P., Stubbs, B., Panozzo, C., Whitesell. D., & Brewer, N. HPV and HPV vaccine

education intervention: Effects on parents, healthcare staff, and school staff. Cancer

epidemiol biomarkers prev November 1 (2011). (20) (11) 23542361; DOI: 10.1158/1055-

9965.EPI-11-0562

Remes P., Veronica Selestine, John Changalucha, David A. Ross, Daniel Wight, Silvia de Sanjosé, Saidi Kapiga, Richard J. Hayes, Deborah Watson-Jones. A qualitative study of HPV vaccine acceptability among health workers, teachers, parents, female pupils, and religious leaders in northwest Tanzania. Volume 30, Issue 36, 3 August 2012, Pages 5363-5367. Science direct. https://doi.org/10.1016/j.vaccine.2012.06.025

Vermandere, H., Naanyu, V., Degomme, O. et al. Implementation of an HPV

vaccination program in Eldoret, Kenya: results from a qualitative assessment by

key stakeholders. BMC Public Health 15, 875 (2015) doi:10.1186/s12889-015-

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