“I Don't Know What is HPV or ABC”: Perspectives on the Barriers to and facilitators of Human Papillomavirus Vaccine Uptake at Three Levels across Saskatchewan -- Patient-, Provider-, and System-Level.
Bibliographic record
Abstract
Background: Canada has successfully implemented a publicly funded school-based HPV vaccination (HPVV) program. Despite a widespread effort, the uptake of HPVV remained suboptimal in some Canadian jurisdictions. The status quo of the cervical cancer incidence rate since 2005, coupled with the suboptimal uptake of HPVV, is in-part because HPVV's impact on cancer prevention has not been realized adequately by vaccine providers and receivers. Migrant populations in Canada tend to have lower vaccination rates for some routine vaccines; hence, these subgroups have higher vaccine-preventable disease-related hospitalizations than their Canadian-born counterparts. Literature is sparse that examines migrant parents’ perspectives as well as providers' and system-level workers' perspectives to determine barriers to and facilitators in HPVV uptake. Methodology: This study employed a qualitative sequential mixed method inquiry using an Interpretive Description approach grounded in pragmatism. The study drew on 31 surveys (collected from migrant parents), all publicly available provincial documents that included information on HPVV from January 2015, the (pre-COVID-19 period) until July 2023 (the post-COVID-19 period), three Focus Group Discussions (FGDs) and interviews with 72 participants from across Saskatchewan, in which 56 members participated in one-on-one interviews and 16 in FGDs. All data gathered was subjected to a hybrid inductive-deductive coding approach to conducting a thematic analysis, whereas the study’s rigour was maintained through crystallization, member checking, and peer debriefing. Findings: Data analysis identified two key themes as significant factors in HPVV uptake. 1. information, awareness and education about HPV infection and HPV vaccine, and 2. vaccine-related logistics. A multi-component intervention to enhance HPV immunization rates remains instrumental, given the inconsistent uptake of HPVV by the population subgroups who voice unique barriers and facilitators. Interventions should target raising HPVV awareness, offering education, and tackling factors related to vaccine logistics in the cancer control continuum. An educational campaign that involves educating parents who consent for their child(ren) for HPVV, the children receiving the vaccine, and training staff providing HPVV through school-based immunization programs would be paramount. Future studies may want to look into the subgroups of immigrants and refugees and carry out sub-group analysis, which was not the scope of this study. iii Conclusion: The current awareness and education strategies are ineffective, and they do not convey the information in a way that can easily be understood by the parents, which is not enabling them to provide informed consent for the HPV vaccine. Vaccine-related logistics are equally important as HPV vaccine information, awareness, and education. The logistics of information delivery need to be revisited in the context of a hybrid digital and analog world. Culture is not as significant an issue as considered. Systems-level thinking approach that centers on the patient and family is needed to understand and improve HPV vaccine uptake. The persistence of disparity in the uptake of the HPV vaccine serves to add to the health gap contributing to health inequities in Saskatchewan and globally.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.015 | 0.008 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.002 | 0.006 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".