Browsing by Author "Rosberger, Zeev"
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Item Are Health Care Professionals Prepared to Implement Human Papillomavirus Testing? A Review of Psychosocial Determinants of Human Papillomavirus Test Acceptability in Primary Cervical Cancer Screening(Liebert, 2020-03) Tatar, Ovidiu; Wade, Kristina; McBride, Emily; Thompson, Erika; Head, Katharine J.; Perez, Samara; Shapiro, Gilla K.; Waller, Jo; Zimet, Gregory; Rosberger, Zeev; Communication Studies, School of Liberal ArtsBackground: Guidelines for cervical cancer screening have been updated to include human papillomavirus (HPV) testing, which is more sensitive compared to cytology in detecting cervical intraepithelial neoplasia. Because of its increased sensitivity, a negative HPV test is more reassuring for a woman that she is at low risk for precancerous cervical lesions than a negative Pap test. Prompted by the inadequate translation of HPV test-based screening guidelines into practice, we aimed to synthesize the literature regarding health care providers (HCPs) knowledge, attitudes, and practices related to HPV testing and the influence of psychosocial factors on HCPs acceptability of HPV testing in primary cervical cancer screening. Materials and Methods: We searched MEDLINE, Embase, PsycINFO, CINAHL, Global Health, and Web of Science for journal articles from January 1, 1980 to July 25, 2018. A narrative synthesis of HCPs knowledge, attitudes, and practices related to HPV testing is provided. Informed by the Patient Pathway framework, we used deductive thematic analysis to synthesize the influence of psychosocial factors on HCPs acceptability of HPV testing. Results: The most important HCP knowledge gaps are related to the superior sensitivity of the HPV test and age-specific guideline recommendations for HPV testing. Thirty to fifty percent of HCPs are not compliant with guideline recommendations for HPV testing, for example, screening at shorter intervals than recommended. Barriers, facilitators, and contradictory evidence of HCPs' acceptability of the HPV test are grouped by category: (1) factors related to the HCP; (2) patient intrinsic factors; (3) factors corresponding to HCP's practice environment; and (4) health care system factors. Conclusions: HCP's adherence to guidelines for HPV testing in cervical cancer screening is suboptimal and could be improved by specialty organizations ensuring consistency across guidelines. Targeted educational interventions to address barriers of HPV test acceptability identified in this review may facilitate the translation of HPV testing recommendations into practice.Item Development and validation of the cervical cancer knowledge scale and HPV testing knowledge scale in a sample of Canadian women(Elsevier, 2022-12) Haward, Ben; Tatar, Ovidiu; Zhu, Patricia; Griffin-Mathieu, Gabrielle; Perez, Samara; Shapiro, Gilla K.; McBride, Emily; Zimet, Gregory D.; Rosberger, Zeev; Pediatrics, School of MedicineKnowledge of cervical cancer and HPV testing are important factors in proactive and continued engagement with screening and are critical considerations as countries move towards the implementation of HPV-based primary screening programs. However, existing scales measuring knowledge of both cervical cancer and HPV testing are not up to date with the current literature, lack advanced psychometric testing, or have suboptimal psychometric properties. Updated, validated scales are needed to ensure accurate measurement of these factors. Therefore, the aim of this study was to develop and validate two scales measuring cervical cancer knowledge and HPV testing knowledge. A pool of items was generated by retaining relevant existing items identified in a 2019 literature search and developing new items according to themes identified in recent systematic reviews. Items were assessed for relevance by the research team and then refined through seven cognitive interviews with Canadian women. A web-based survey including the remaining items (fourteen for each scale development) was administered to a sample of Canadian women in October and November of 2021. After data cleaning, N = 1027 responses were retained. Exploratory and Confirmatory Factor Analysis were conducted, and Item Response Theory was used to select items. The final cervical cancer knowledge scale (CCKS) and HPV testing knowledge scale (HTKS) were unidimensional, and each consisted of eight items. CFA demonstrated adequate model fit for both scales. The developed scales will be important tools to identify knowledge gaps and inform communications about cervical cancer screening, particularly in the context of HPV-based screening implementation.Item The Efficacy of a Brief, Altruism-Eliciting Video Intervention in Enhancing COVID-19 Vaccination Intentions Among a Population-Based Sample of Younger Adults: Randomized Controlled Trial(JMIR, 2022-05-30) Zhu, Patricia; Tatar, Ovidiu; Griffin-Mathieu, Gabrielle; Perez, Samara; Haward, Ben; Zimet, Gregory; Tunis, Matthew; Dubé, Ève; Rosberger, Zeev; Pediatrics, School of MedicineBackground: High COVID-19 vaccine uptake is crucial to containing the pandemic and reducing hospitalizations and deaths. Younger adults (aged 20-39 years) have demonstrated lower levels of vaccine uptake compared to older adults, while being more likely to transmit the virus due to a higher number of social contacts. Consequently, this age group has been identified by public health authorities as a key target for vaccine uptake. Previous research has demonstrated that altruistic messaging and motivation is associated with vaccine acceptance. Objective: This study had 2 objectives: (1) to evaluate the within-group efficacy of an altruism-eliciting short, animated video intervention in increasing COVID-19 vaccination intentions amongst unvaccinated Canadian younger adults and (2) to examine the video's efficacy compared to a text-based intervention focused exclusively on non-vaccine-related COVID-19 preventive health measures. Methods: Using a web-based survey in a pre-post randomized control trial (RCT) design, we recruited Canadians aged 20-39 years who were not yet vaccinated against COVID-19 and randomized them in a 1:1 ratio to receive either the video intervention or an active text control. The video intervention was developed by our team in collaboration with a digital media company. The measurement of COVID-19 vaccination intentions before and after completing their assigned intervention was informed by the multistage Precaution Adoption Process Model (PAPM). The McNemar chi-square test was performed to evaluate within-group changes of vaccine intentions. Exact tests of symmetry using pairwise McNemar tests were applied to evaluate changes in multistaged intentions. Between-group vaccine intentions were assessed using the Pearson chi-square test postintervention. Results: Analyses were performed on 1373 participants (n=686, 50%, in the video arm, n=687, 50%, in the text arm). Within-group results for the video intervention arm showed that there was a significant change in the intention to receive the vaccine (χ21=20.55, P<.001). The between-group difference in postintervention intentions (χ23=1.70, P=.64) was not significant. When administered the video intervention, we found that participants who had not thought about or were undecided about receiving a COVID-19 vaccine were more amenable to change than participants who had already decided not to vaccinate. Conclusions: Although the video intervention was limited in its effect on those who had firmly decided not to vaccinate, our study demonstrates that prosocial and altruistic messages could increase COVID-19 vaccine uptake, especially when targeted to younger adults who are undecided or unengaged regarding vaccination. This might indicate that altruistic messaging provides a "push" for those who are tentative toward, or removed from, the decision to receive the vaccine. The results of our study could also be applied to more current COVID-19 vaccination recommendations (eg, booster shots) and for other vaccine-preventable diseases.Item Examining an Altruism-Eliciting Video Intervention to Increase COVID-19 Vaccine Intentions in Younger Adults: A Qualitative Assessment Using the Realistic Evaluation Framework(MDPI, 2023-03-11) Zhu, Patricia; Tatar, Ovidiu; Haward, Ben; Steck, Veronica; Griffin-Mathieu, Gabrielle; Perez, Samara; Dubé, Ève; Zimet, Gregory; Rosberger, Zeev; Pediatrics, School of MedicineCOVID-19 vaccine-induced immunity wanes over time, and with the emergence of new variants, additional "booster" doses have been recommended in Canada. However, booster vaccination uptake has remained low, particularly amongst younger adults aged 18-39. A previous study by our research team found that an altruism-eliciting video increased COVID-19 vaccination intentions. Using qualitative methods, the present study aims to: (1) identify the factors that influence vaccine decision-making in Canadian younger adults; (2) understand younger adults' perceptions of an altruism-eliciting video designed to increase COVID-19 vaccine intentions; and (3) explore how the video can be improved and adapted to the current pandemic context. We conducted three focus groups online with participants who: (1) received at least one booster vaccine, (2) received the primary series without any boosters, or (3) were unvaccinated. We used deductive and inductive approaches to analyze data. Deductively, informed by the realist evaluation framework, we synthesized data around three main themes: context, mechanism, and intervention-specific suggestions. Within each main theme, we deductively created subthemes based on the health belief model (HBM). For quotes that could not be captured by these subthemes, additional themes were created inductively. We found multiple factors that could be important considerations in future messaging to increase vaccine acceptance, such as feeling empowered, fostering confidence in government and institutions, providing diverse (such as both altruism and individualism) messaging, and including concrete data (such as the prevalence of vulnerable individuals). These findings suggest targeted messaging tailored to these themes would be helpful to increase COVID-19 booster vaccination amongst younger adults.Item Factors associated with human papillomavirus (HPV) test acceptability in primary screening for cervical cancer: A mixed methods research synthesis(Elsevier, 2018) Tatar, Ovidiu; Thompson, Erika; Naz, Anila; Perez, Samara; Shapiro, Gilla K.; Wade, Kristina; Zimet, Gregory D.; Gilca, Vladimir; Janda, Monika; Kahn, Jessica; Daley, Ellen; Rosberger, Zeev; Pediatrics, School of MedicinePrimary screening for cervical cancer is transitioning from the longstanding Pap smear towards implementation of an HPV-DNA test, which is more sensitive than Pap cytology in detecting high-risk lesions and offers greater protection against invasive cervical carcinomas. Based on these results, many countries are recommending and implementing HPV testing-based screening programs. Understanding what factors (e.g., knowledge, attitudes) will impact on HPV test acceptability by women is crucial for ensuring adequate public health practices to optimize cervical screening uptake. We used mixed methods research synthesis to provide a categorization of the relevant factors related to HPV primary screening for cervical cancer and describe their influence on women's acceptability of HPV testing. We searched Medline, Embase, PsycINFO, CINAHL, Global Health and Web of Science for journal articles between January 1, 1980 and October 31, 2017 and retained 22 empirical articles. Our results show that while most factors associated with HPV test acceptability are included in the Health Belief Model and/or Theory of Planned Behavior (e.g., attitudes, knowledge), other important factors are not encompassed by these theoretical frameworks (e.g., health behaviors, negative emotional reactions related to HPV testing). The direction of influence of psychosocial factors on HPV test acceptability was synthesized based on 14 quantitative studies as: facilitators (e.g., high perceived HPV test benefits), barriers (e.g., negative attitudes towards increased screening intervals), contradictory evidence (e.g., sexual history) and no impact (e.g., high perceived severity of HPV infection). Further population-based studies are needed to confirm the impact of these factors on HPV-based screening acceptability.Item The feminization of HPV: How science, politics, economics and gender norms shaped U.S. HPV vaccine implementation(Elsevier, 2017-06) Daley, Ellen M.; Vamos, Cheryl A.; Thompson, Erika L.; Zimet, Gregory D.; Rosberger, Zeev; Merrell, Laura; Kline, Nolan S.; Pediatrics, School of MedicineHuman papillomavirus (HPV) can cause a number of anogenital cancers (i.e., cervical, penile, anal, vaginal, vulvar) and genital warts. A decade ago, the HPV vaccine was approved, and has been shown to be a public health achievement that can reduce the morbidity and mortality for HPV-associated diseases. Yet, the mistaken over-identification of HPV as a female-specific disease has resulted in the feminization of HPV and HPV vaccines. In this critical review, we trace the evolution of the intersection of science, politics, economics and gender norms during the original HPV vaccine approval, marketing era, and implementation. Given the focus on cervical cancer screening, women were identified as bearing the burden of HPV infection and its related illnesses, and the group responsible for prevention. We also describe the consequences of the feminization of HPV, which has resulted primarily in reduced protection from HPV-related illnesses for males. We propose a multilevel approach to normalizing HPV vaccines as an important aspect of overall health for both genders. This process must engage multiple stakeholders, including providers, parents, patients, professional organizations, public health agencies, policymakers, researchers, and community-based organizations.Item Human Papillomavirus Vaccines: Successes and Future Challenges(Springer, 2018-09) Perez, Samara; Zimet, Gregory D.; Tatar, Ovidiu; Stupiansky, Nathan W.; Fisher, William A.; Rosberger, Zeev; Pediatrics, School of MedicineOver a decade has passed since the first human papillomavirus (HPV) vaccine was introduced. These vaccines have received unequivocal backing from the scientific and medical communities, yet continue to be debated in the media and within the general public. The current review is an updated examination that the authors made five years ago on some of the key sociocultural and behavioral issues associated with HPV vaccine uptake and acceptability, given the changing HPV vaccine policies and beliefs worldwide. We explore current worldwide HPV vaccination rates, outline HPV vaccine policies, and revisit critical issues associated with HPV vaccine uptake including: risk compensation, perceptions of vaccine safety and efficacy, age of vaccination, and healthcare provider (HCP) recommendation and communication. While public scrutiny of the vaccine has not subsided, empirical evidence supporting its safety and efficacy beyond preventing cervical cancer has amassed. There are conclusive findings showing no link that vaccinated individuals engage in riskier sexual behaviors as a result of being immunized (risk compensation) both at the individual and at the policy level. Finally, HCP recommendation continues to be a central factor in HPV vaccine uptake. Studies have illuminated how HCP practices and communication enhance uptake and alleviate misperceptions about HPV vaccination. Strategies such as bundling vaccinations, allowing nurses to vaccinate via “standing orders,” and diversifying vaccination settings (e.g., pharmacies) may be effective steps to increase rates. The successes of HPV vaccination outweigh the controversy, but as the incidence of HPV-related cancers rises, it is imperative that future research on HPV vaccine acceptability continues to identify effective and targeted strategies to inform HPV vaccination programs and improve HPV coverage rates worldwide.Item Investigating Canadian parents' HPV vaccine knowledge, attitudes and behaviour: a study protocol for a longitudinal national online survey(BMJ Journals, 2017-09-11) Shapiro, Gilla K; Perez, Samara; Naz, Anila; Tatar, Ovidiu; Guichon, Juliet R; Amsel, Rhonda; Zimet, Gregory D; Rosberger, Zeev; Pediatrics, School of MedicineIntroduction Human papillomavirus (HPV), a sexually transmitted infection, can cause anogenital warts and a number of cancers. To prevent morbidity and mortality, three vaccines have been licensed and are recommended by Canada’s National Advisory Committee on Immunisation (for girls since 2007 and boys since 2012). Nevertheless, HPV vaccine coverage in Canada remains suboptimal in many regions. This study will be the first to concurrently examine the correlates of HPV vaccine decision-making in parents of school-aged girls and boys and evaluate changes in parental knowledge, attitudes and behaviours over time. Methods and analysis Using a national, online survey utilising theoretically driven constructs and validated measures, this study will identify HPV vaccine coverage rates and correlates of vaccine decision-making in Canada at two time points (August–September 2016 and June–July 2017). 4606 participants will be recruited to participate in an online survey through a market research and polling firm using email invitations. Data cleaning methods will identify inattentive or unmotivated participants. Ethics and dissemination The study received research ethics board approval from the Research Review Office, Integrated Health and Social Services University Network for West-Central Montreal (CODIM-FLP-16–219). The study will adopt a multimodal approach to disseminate the study’s findings to researchers, clinicians, cancer and immunisation organisations and the public in Canada and internationally.Item Recent changes in cervical cancer screening guidelines: U.S. women's willingness for HPV testing instead of Pap testing(Elsevier, 2020-01) Thompson, Erika L.; Galvin, Annalynn M.; Daley, Ellen M.; Tatar, Ovidiu; Zimet, Gregory D.; Rosberger, Zeev; Pediatrics, School of MedicineCervical cancer screening guidelines in the United States were revised in 2018 to include the option of primary human papillomavirus (HPV) testing. The transition to this screening method may face difficulties as Pap testing has been the primary screening modality in the United States. The objective of this study is to assess information, motivation, and behavioral skills associated with willingness to receive an HPV test instead of a Pap test among women. The sample included U.S. 812 women, ages 30 to 65 years. Participants completed an online survey in 2018. The Information, Motivation, and Behavioral Skills (IMB) model was used to measure predictors of willingness for HPV testing. The outcome variables were willingness to receive the HPV test instead of the Pap test, with and without time interval details. Logistic regression modeling was used with SAS 9.4. Over half of the sample (55%) were willing to receive the HPV test. For the information domain, HPV knowledge was significantly associated with willingness for HPV testing (OR = 1.08, 95%CI 1.04–1.13). Significant motivating factors included: positive attitudes, social norms, perceived benefits, worry about cervical cancer, and worry about abnormal HPV tests. For behavioral skills, women were significantly more willing to get the HPV test if a provider recommended it (OR = 2.43, 95%CI 1.53–3.87) and currently up-to-date on cervical cancer screening guidelines (OR = 1.52, 95%CI 1.52–2.26). Addressing barriers and facilitators to willingness to transition to primary HPV testing over Pap testing is needed as the United States has updated guidelines for cervical cancer screening.Item Tempest in a teapot: A systematic review of HPV vaccination and risk compensation research(Taylor & Francis, 2016-06-02) Kasting, Monica L.; Shapiro, Gilla K.; Rosberger, Zeev; Kahn, Jessica A.; Zimet, Gregory D.; Department of Epidemiology, Richard M. Fairbanks School of Public HealthThere has been some concern among parents and in the media that vaccinating children against human papillomavirus could be seen as giving children permission to engage in risky sexual behaviors (also known as sexual disinhibition). Several studies have found this concern to be unfounded but there have been no attempts to synthesize the relevant studies in order to assess if there is evidence of sexual disinhibition. The aim of this study was to synthesize recent literature examining sexual behaviors and biological outcomes (e.g., sexually transmitted infections) post-HPV vaccination. We reviewed literature from January 1, 2008-June 30, 2015 using PubMed, CINAHL, and Embase with the following search terms: [(sex behavior OR sex behavior OR sexual) AND (human papillomavirus OR HPV) AND (vaccines OR vaccine OR vaccination)] followed by a cited reference search. We included studies that examined biological outcomes and reported behaviors post-vaccination in both males and females. Studies were reviewed by title and abstract and relevant studies were examined as full-text articles. We identified 2,503 articles and 20 were eventually included in the review. None of the studies of sexual behaviors and/or biological outcomes found evidence of riskier behaviors or higher rates of STIs after HPV vaccination. Instead, the studies found that vaccinated compared to unvaccinated individuals were less likely to report vaginal intercourse without a condom (OR = 0.5; 95%CI = 0.4-0.6) and non-use of contraception (OR = 0.27; 95%CI = 0.15-0.48) and unvaccinated participants had higher rates of Chlamydia (OR = 2.3; 95%CI = 1.06-5.00). These results should be reassuring to parents and health care providers.