Introduction
The article by Joseph et al. (2014) investigates racial and ethnic disparities in human papillomavirus knowledge, attitudes, and vaccination rates among low-income African-American, Haitian, Latina, and Caucasian young adult women. The research problem of this study is “to examine how the knowledge, attitudes, and beliefs related to HPV disease and HPV vaccination affect vaccine uptake among young adult African-American, Haitian, Latina, and White women ages 18–22” (Joseph et al., 2014, p. 83).
The research questions are to investigate facilitators and obstacles for HPV vaccine compliance among African-American, Haitian, Latina, and Caucasian young adult women and figure out the rates of vaccination completion over five years among the respondents. The authors believe that HPV vaccination is a preventive method against human papillomavirus of two oncogenic types which results in the development of 70% of cervical cancers (Joseph et al., 2014).
There is a necessity to encourage HPV vaccination and achieve an increase in vaccination rates because cervical cancer still demonstrates high incidence and mortality rates in low socioeconomic districts.
The research objective is to study the racial disparities concerning the intent of HPV vaccination and also current vaccination rates. Although the authors do not state a clear hypothesis, the investigation is aimed to observe the impact of knowledge, beliefs, and attitudes concerning HPV and vaccination on the perception of vaccination by young adult African-American, Haitian, Latina, and White women aged 18–22.
The authors supposed there were disparities between the acceptance of HPV vaccination and the completion of vaccination series. The research findings proved that although 90% of young women were ready to accept HPV vaccination, only 45% completed the vaccine series of three doses. The researchers concluded that physicians have to recommend HPV vaccination to young women because it can improve acceptance rates.
Evaluation of the Research Methods
The authors do not provide a detailed literature review. However, the introduction part includes statistics concerning cervical cancer incidence and mortality rates. According to the statistical data provided in the article, HPV is the reason for 99% of cervical cancers which are a burden of American society. The authors cite the information from the Advisory Committee on Immunization practice that recommended the introduction of immunization with a Quadrivalent HPV vaccine for adolescent girls starting from 2006 (Joseph et al., 2014). This intervention is expected to “catch-up immunization through age 26” (Joseph et al., 2014, p. 84). Moreover, the authors support the necessity of vaccination before this age because the advantages and cost-efficiency of HPV vaccination reduce with age due to the increasing sexual activity of young women.
The issue of HPV vaccination and the attitudes it presented in the research is current and relevant to the burning of contemporary health concerns. HPV vaccination acceptance and educational interventions aimed at its increase were investigated by Fu, Bonhomme, Cooper, Joseph, and Zimet (2014). The research proves that the variety of existing educational approaches have different efficiency and thus this problem needs further investigation.
Goncalves, Cobucci, Rodrigues, Melo, and Giraldo (2014) discover the aspects of safety, tolerability, and side effects of human papillomavirus vaccines stressing the importance of vaccination and its safety. The issue of vaccinating is regularly reviewed by the Advisory Committee on Immunization Practices to update recommendations concerning HPV vaccination schedule and appropriate vaccines (Meites, Kempe, & Markovitz, 2016).
National Cancer Institute (2016) provides comprehensive information concerning HPV and the peculiarities of vaccination. It regards HPV as a cause of cancer, informs on the available vaccines, informs on their efficiency and safety, and answers other questions on HPV immunization. Finally, the growth of vaccination coverage of HPV for both young males and females is included as one of the objectives of Healthy People 2020 (“Immunization and infectious diseases,” 2017). Consequently, the significance of HPV vaccination is evident and demands the development of interventions to increase vaccination acceptance.
The research utilizes both quantitative and qualitative methods to evaluate the existing knowledge about the HPV vaccine and attitudes to vaccination among Haitian immigrant, African-American, Latina, and White young adult women ages 18–22 (Joseph et al., 2014). The research follows the experimental design. Research data were collected with the help of the interview that was conducted during the visits of respondents to their clinics.
The participants could select a preferred language of the semi-structured interview which contributed to a better comprehension of the questions. The interviews revealed data for both the quantitative and qualitative parts of the study. The quantitative assessment included “demographic information, knowledge about HPV-related disease and HPV vaccination, personal experience with HPV, level of trust in the physician, and intent to vaccinate” (Joseph et al., 2014, p. 85).
Qualitative questions were supposed to reveal the possible obstacles to HPV vaccine acceptance. Statistical analysis of the quantitative data applied to chi-square and fisher’s tests. At the same time, analysis of variance (ANOVA) proved to efficient in the determination of the dependence of vaccination knowledge on race. Qualitative data were assessed with the help of content analysis. The selected methods proved to be efficient in answering the research questions.
The sample was selected among the patients of pediatric and adolescent departments of health centers. These healthcare facilities mainly take care of low-income families that represent national minorities. The recruitment criteria comprised young women aged 18-22 who identified themselves as African-American, White, Latina, or Haitian, both immigrants and born in the United States. The sample included 132 young women, 45 (34%) were African-American, 47 (36%) Haitian, 20 (15%), Latina, and 20 (15%) White (Joseph et al., 2014). The average age of respondents was 19 years. The selected sample is appropriate to the purpose of the study because it includes all target categories. The exclusion of pregnant women and individuals who had received HPV vaccination contributes to the reliability of the research results.
The research provides theoretical conclusions and, at the same time, suggests some practical implications. First of all, it outlines factors that are powerful tools to encourage HPV vaccination. They include “strong provider recommendation, and risk-based education aimed at increasing knowledge of HPV infection and vaccination, utilizing every clinical opportunity, and allowing sexually active adolescents to consent for vaccination without parental consent” (Joseph et al., 2014, p. 90).
Moreover, the researchers give practical recommendations that can be applied by the physicians. One of the approaches able to stimulate HPV vaccination is culturally-oriented messaging that considers the HPV needs of ethnic minorities and thus increases vaccination acceptance. Also, physicians should accept HPV vaccination as normative and support patients in their decision to get vaccinated. These practical implications can be executed in conditions of different healthcare facilities and those serving national minorities in particular.
I believe the study could have been improved if the sample had been bigger. 132 respondents are not a reliable sample for the United States. Moreover, the representation of national minorities in the sample is not equal and does not allow comparison of HPV vaccination acceptance between the members of different minorities.
The article is written in a clear language and comprehensive style. It provides a detailed description of the investigation. The research results are presented adequately and practical implications are outlined. The style of writing and the interpretation of the research results make this article valuable for scholars, clinical practitioners, and nursing students interested in the issue of HPV vaccination.
The research under analysis reveals racial and ethnic disparities in human papillomavirus knowledge, attitudes, and vaccination rates among low-income African-American, Haitian, Latina, and Caucasian young adult women. However, it does not predict the health outcomes depending on acceptance or not acceptance of the HPV vaccine by young women from low-income communities. Further research on this subject can be dedicated to the issue of HPV incidence and its influence on the development of cervical cancer among the same population. Such research will provide a better picture of the impact that HPV vaccination has on the prevalence of HPV and cervical cancer.
Conclusion
On the whole, the article under analysis presents a detailed report of the research conducted by Joseph et al. (2014). The significance of this study is the discovery of racial and national disparities in HPV acceptance, knowledge, and immunization rates. I consider the issue of vaccination acceptance to be crucial for further patient outcomes.
The knowledge of possible patient reactions among the vulnerable populations can contribute to the development of efficient strategies that can be applied by both physicians and registered nurses to stimulate HPV vaccine acceptance. Such interventions are likely to reduce the incidence of HPV and, as a result, the mortality of cervical cancer. However, further research can be necessary to trace the dependence of HPV and cervical cancer incidence from the vaccination rates and vaccine acceptance among young women who live in low-income communities.
References
Fu, L.Y., Bonhomme, L.A., Cooper, S.C., Joseph, J.G., & Zimet, G.D. (2014). Educational interventions to increase HPV vaccination acceptance: A systematic review. Vaccine, 32, 1901-1920.
Goncalves, A.K., Cobucci, R.N., Rodrigues, H.M., Melo, A.G., & Giraldo, P.C. (2014). Safety, tolerability and side effects of human papillomavirus vaccines: A systematic quantitative review. The Brazilian Journal of Infectious Diseases, 18(6), 651-659.
Immunization and infectious diseases. (2017).
Joseph, N., Clark, J., Mercilus, G., Wilbur, M., Figaro, J., & Perkins, R. (2014). Racial and ethnic differences in HPV knowledge, attitudes, and vaccination rates among low-income African-American, Haitian, Latina, and Caucasian young adult women. Journal of Pediatric and Adolescent Gynecology, 27(2), 83-92.
Meites, E., Kempe, A., & Markovitz, L.E. (2016). Use of a 2-dose schedule for human papillomavirus vaccination — Updated recommendations of the Advisory Committee on Immunization Practices. Morbidity and Mortality Weekly Report, 65(49), 1405-1408.
National Cancer Institute. (2016). Human papillomavirus (HPV) vaccines.