In 2019, the U.S. Advisory Committee on Immunization Practices recommended shared clinical decision-making (SCDM) for HPV vaccination among unvaccinated adults aged 27–45 years (i.e., mid-adult). However, the implementation of this recommendation is challenging. This study assessed a decision tool, HPV Decide, designed to facilitate SCDM for mid-adult HPV vaccination. We used exploratory sequential mixed methods to gather stakeholder and provider perspectives on a beta version of HPV Decide. Qualitative feedback from providers and stakeholders (N = 24) was collected through semi-structured interviews. Quantitative data from health care providers (N = 600) on usability in clinical practice was collected via online surveys. Interviewees provided feedback on the preferred delivery method and timing, the need for support and training, and key barriers and facilitators to SCDM. Quantitative data showed that 68.3

Background: This study investigates the implementation of the 2019 U.S. guideline recommending shared clinical decision-making (SCDM) for HPV vaccination among mid-adults (ages 27-45) by health care providers. Methods: A quota sample of 600 health care providers serving mid-adults in the U.S. was surveyed on their practices regarding HPV vaccination and the implementation of the SCDM guideline. The survey collected descriptive statistics and conducted bivariate analyses. Results: Approximately 47 % of providers often or always engaged in shared clinical decision-making for HPV vaccinations, and 50 % offered the HPV vaccine, which significantly varied by provider type (p < 0.01). OB/ GYNs had the highest frequency of always offering the vaccine (26 %), compared to family medicine (10 %) and internal medicine (12.5 %) providers. The major barriers identified were limited time (67 %) and perceived inadequate patient insurance coverage (65 %). Conclusions: Despite approval of the shared clinical decision-making guideline for mid-adult HPV vaccination, implementation is inconsistent across different provider types, influenced by specific patient demographics. The identified barriers, including time constraints and insurance issues, impede uniform adoption of the guideline. Future initiatives should focus on tailored interventions for different provider disciplines to promote consistent and equitable health care delivery.

Non-traditional providers and healthcare settings (e.g., dental offices, pharmacies) provide an opportunity to increase human papillomavirus (HPV) vaccine accessibility; however, they remain underutilized. The purpose of this study was to examine United States (U.S.) parents' perceptions of healthcare provider recommendations for the HPV vaccine and perceived convenience and likelihood of vaccination across healthcare settings. Parents' perceptions were assessed and compared according to the Transtheoretical Model stages of change (action: adolescent already vaccinated; preparation: intend-to-vaccinate; contemplation: unsure of intention). Parents of adolescents ages 11-12 from across the U.S. were recruited to participate in an online survey via Qualtrics that measured their perceptions of HPV vaccination by healthcare provider type and setting. The convenience and likelihood of vaccinating in different settings and the importance of provider recommendation were evaluated for those in the preparation and contemplations groups using one-way repeated measures ANOVAs. Participants across all stages of change were similar in their perceptions of vaccination across healthcare settings, rating family practice and pediatric offices as the most convenient and most likely settings for vaccination. Dental offices were perceived as the least convenient and least likely settings, and dental provider recommendations were rated as the least important. Among those in the contemplation stage, pharmacies were also rated lower in convenience and likelihood. There is a missed opportunity for HPV vaccination in non-traditional settings, including dental offices and pharmacies. Increasing education on HPV and availability of the vaccine in alternative settings can encourage vaccine uptake and move parents towards preparation and action.

Objectives: Despite high overall vaccination coverage in Galicia, Spain, human papillomavirus (HPV) vaccine uptake remains below the 90% target set by the World Health Organization for 2030. This study aimed to assess baseline knowledge of HPV and attitudes towards HPV vaccination among Galician adolescents and to evaluate the impact of a brief educational intervention delivered as a “pill of knowledge”. Methods: A quasi-experimental pre-/post-intervention study was conducted among 967 students aged 12–16 years from 16 secondary schools in Galicia during the 2023–2024 academic year. A concise, structured 15-min educational session termed a “pill of knowledge” was delivered, and HPV-related knowledge and vaccination intention were measured immediately before and after the intervention using a standardized questionnaire. Results: Following the “pill of knowledge”, the mean proportion of correct responses increased by 30.1 ± 16.6% across all knowledge items. Among unvaccinated participants, intention to accept HPV vaccination rose from 77.7% to 94.4% in girls and from 64.7% to 85.8% in boys. Pre-intervention predictors of vaccination intention included perceived vaccine efficacy and baseline HPV knowledge. Post-intervention independent predictors comprised being female, younger age (12–13 years), and prior sexual education delivered by teachers or parents. The overall predictive accuracy of the logistic regression model for vaccination intention improved from 75.6% before the intervention to 92.7% afterwards. Conclusions: A brief, school-based “pill of knowledge” produced substantial and immediate improvements in HPV knowledge and vaccination acceptance among Galician adolescents. These findings strongly support the systematic incorporation of short, evidence-based educational interventions of this kind into the school setting as an effective public health measure to increase HPV vaccine coverage and advance progress toward WHO elimination targets.

Background/Objectives: Unintended pregnancy is linked to an increased risk of subsequent unintended pregnancies, but its impact on contraceptive use and intention remains vastly understudied. This study assessed whether unintended pregnancy independently influences women's stages of behavior change for contraceptive use and the effectiveness of their chosen contraceptive methods. Methods: Using pooled data from three cross-sectional surveys of the Performance Monitoring and Accountability 2020 project in Nigeria, we analyzed responses from 8014 non-pregnant women aged 15-49 years nested within 892 communities. Multilevel multinomial logistic regression accounted for compositional and contextual factors. Results: Women with a mistimed pregnancy had higher odds of being in the contemplation stage of behavior change compared to those with an intended pregnancy (adjusted odds ratio [aOR] = 1.59, 95% confidence interval [CI] = 1.13-2.22), with a similar but non-significant trend for unwanted pregnancies (aOR = 1.46, 95% CI = 0.91-2.34). Mistimed and unwanted pregnancies were also linked to higher odds of being in the action stage (aOR = 2.17 and 1.85, respectively). Regarding contraceptive effectiveness, women with a mistimed pregnancy were more likely to use moderately effective methods (aOR = 1.47, 95% CI = 1.02-2.12) and highly effective methods (aOR = 2.45, 95% CI = 1.41-4.26). Unwanted pregnancies showed even stronger associations with highly effective methods (aOR = 4.03, 95% CI = 1.18-13.74). Community-level variability significantly influenced outcomes. Conclusions: Together, these findings underscore the importance of person-centered approaches and public health interventions tailored to stages of contraceptive behavior change, targeting both women and communities at high risk of unintended pregnancy.

Covert contraceptive use is a strategy to avoid unintended pregnancy. However, evidence regarding the multilevel factors linking past experiences of unintended pregnancy with covert contraceptive use is limited. The objective of this study was to identify the compositional and contextual factors associated with covert contraceptive use among women with a prior unintended pregnancy. Framed by the socio-ecological model, a cross-sectional study was conducted using data from Round 5 of the Performance Monitoring and Accountability 2020 project in Nigeria. Non-pregnant women aged 15-49 years who reported a previous mistimed or unwanted pregnancy were included (N = 1631). Multilevel logistic regression models with random intercepts were specified to investigate the relationship between covert contraceptive use and compositional and contextual factors. Approximately 4.54% (95% CI = 3.28-6.25) of women reported covert contraceptive use. At the individual level, having less than secondary education (aOR = 5.88, 95% CI = 1.20-28.72) and being single (aOR = 11.29, 95% CI = 2.93-43.56) were associated with higher odds of covert contraceptive use. There was no significant association between covert contraceptive use and the type of unintended pregnancy (mistimed: aOR = 3.13, 95% CI = 0.88-11.13). At the community level, living in a community with average poverty levels (aOR = 6.18, 95% CI = 1.18-32.55) and high exposure to family planning mass media (aOR = 6.84, 95% CI = 1.62-29.11) were associated with higher odds of covert contraceptive use. Measures of variation showed significant variation in covert contraceptive use across communities. Further research is warranted to better understand the underlying mechanisms in these observed associations and variations in covert contraceptive use among women following the experience of an unintended pregnancy. Additionally, there is a need to design family planning strategies that integrate community-level structures.

[This corrects the article DOI: 10.1371/journal.pgph.0002570.].

INTRODUCTION:Birthing people around the world experience mistreatment during labor and birth, contributing to adverse maternal health outcomes. The adoption of respectful maternity care (RMC) has been recommended to address this mistreatment and improve care quality. Most RMC and mistreatment research has been conducted internationally. The purpose of this scoping review was to (1) explore the extent of RMC research and (2) describe labor and birth experiences in the United States. METHODS:Embase, Scopus, and CINAHL databases were searched for concepts relating to RMC and mistreatment. A total of 66 studies met review inclusion criteria. Two reviewers screened titles, abstracts, and full-text articles. Data were extracted and categorized using the Bohren et al typology of mistreatment. Summary statistics and narrative summaries were used to describe study characteristics and birthing people's experiences. RESULTS:Most studies represented national or urban samples and Western or Northeastern US regions. Few were from the South, and only one represented rural participants specifically. Few studies represented the unique experiences of justice-involved birthing people, and none represented sexual and gender minorities or Indigenous people. Qualitative methods were predominant. The most common forms of mistreatment included (1) poor rapport between women and health care providers (88% of studies), (2) stigma and discrimination (79%), and (3) a failure to meet professional standards of care (73%). DISCUSSION:The extent of mistreatment in the United States highlights the need for robust programs and policies targeting provision of RMC. Additional research is needed to better understand the experiences of additional minority communities and those living rural areas and in the Southern United States.

Objectives Clinical trial data sharing is crucial for promoting transparency and collaborative efforts in medical research. Differential privacy (DP) is a formal statistical technique for anonymizing shared data that balances privacy of individual records and accuracy of replicated results through a "privacy budget" parameter, epsilon. DP is considered the state of the art in privacy-protected data publication and is underutilized in clinical trial data sharing. This study is focused on identifying epsilon values for the sharing of clinical trial data. Materials and Methods We analyzed 2 clinical trial datasets with privacy budget epsilon ranging from 0.01 to 10. Smaller values of epsilon entail adding greater amounts of random noise, with better privacy as a result. Comparison of rates, odds ratios, means, and mean differences between the original clinical trial datasets and the empirical distribution of the DP estimator was performed. Results The DP rate closely approximated the original rate of 6.5% when epsilon > 1. The DP odds ratio closely aligned with the original odds ratio of 0.689 when epsilon >= 3. The DP mean closely approximated the original mean of 164.64 when epsilon >= 1. As epsilon increased to 5, both the minimum and maximum DP means converged toward the original mean. Discussion There is no consensus on how to choose the privacy budget epsilon. The definition of DP does not specify the required level of privacy, and there is no established formula for determining epsilon. Conclusion Our findings suggest that the application of DP holds promise in the context of sharing clinical trial data.

Although the human papillomavirus (HPV) vaccine is effective at preventing infection and certain types of cancer, uptake is suboptimal. HPV vaccine requirements for school entry are an underutilized strategy to increase HPV vaccine uptake among adolescents. The purpose of this study was to understand the factors that are predictive of parents' attitudes toward schools requiring the HPV vaccine for entry into middle school. Parents of adolescents ages 11-12 y were recruited to participate in an online survey via Qualtrics. Descriptive frequencies were obtained, and sequential regression analyses were conducted controlling for demographic characteristics. A total of 1,046 participants were included in the analysis. The mean age was 40.3 y (SD = 6.3) and the majority of participants were White (74.4%) and had some college education or higher (80.9%). Participant's gender, political affiliation, urban/rural setting, and education level were significantly associated with attitudes toward school entry requirements. Adding psychosocial items related to perceptions of benefits, risks, and social norms significantly increased the amount of variance explained in the model [(Delta R2 = .312, F(5, 1036) = 132.621)]. Perceived social norms was the strongest predictor of attitudes [beta = 0.321]. The results of this study can be used to inform policy changes around school-entry requirements in the United States. Further studies are needed to assess the influence of perceived social norms in vaccine hesitant groups.

BACKGROUND:In the United States, human papillomavirus (HPV) vaccination among 27- to 45-y-olds (mid-adults) is recommended based on shared clinical decision making with a health care provider. We developed a patient decision aid tool to support the implementation of this mid-adult HPV vaccination guideline. The purpose of this study was to evaluate the effect of a patient decision aid tool for HPV vaccination, HPV DECIDE, compared with an information fact sheet among mid-adults who have not received the HPV vaccine. METHOD:Participants were recruited between December 2023 and January 2024. We used a randomized Solomon, 4-group, pretest/posttest design with mid-adults aged 27 to 45 y who were unvaccinated for HPV and balanced based on sex (n = 612). The primary outcome was decisional conflict. Intermediate outcomes included knowledge, behavioral expectancies, self-efficacy, and perceived risk. Variables were measured using validated scales. Pretest sensitization was not present; intervention and control groups were compared. Fixed-effects inverse-variance weighting was used to pool effect estimates and determine meta-analytic statistical significance across tests with and without pretest controls. RESULTS:Participants in the intervention group had significantly lower total decisional conflict scores (B = -3.58, P = 0.007) compared with the control group. Compared with the control group, participants in the intervention group showed higher knowledge (B = 0.48, P = 0.020), greater intention to receive (B = 0.196, P = 0.049) and discuss the HPV vaccine (B = 0.324, P ≤ 0.001), and greater self-efficacy about HPV vaccine decision making (B = 3.28, P = 0.043). There were no statistically significant results for perceived risks of HPV infection. CONCLUSIONS:The HPV DECIDE tool for mid-adult HPV vaccination shows promise for immediate reductions in decisional conflict and improvement in knowledge, intentions, and self-efficacy about the HPV vaccine. Future studies are warranted to evaluate the effectiveness of this patient decision aid tool in real-world settings. HIGHLIGHTS:Shared clinical decision making is recommended for HPV vaccination with mid-adults.A patient decision aid for HPV vaccination reduced decisional conflict for mid-adults.The HPV vaccine patient decision aid was acceptable to mid-adults.

Clinical trial selection bias is a common issue, as patients are typically not selected randomly from a target population. Various statistical approaches have been proposed to adjust for this bias, including IPW (inverse probability weights), SPS (subclassification with propensity scores), and EVB (external validity bias). However, there has been very little statistical research to compare the performance of these methods in clinical trials. To bridge this gap, we conducted a simulation study using a patient population with seven covariates and a true treatment effect size of 0.5 (Cohen's d). Next, we assessed the efficacy of the three statistical methods on nonrandom clinical trial samples with varying sizes and covariates. Based on our simulation results, EVB is the most effective method for adjusting clinical trial selection bias when there are seven covariates. SPS is the most effective method for adjusting clinical trial selection bias when there are three and five covariates. However, we observed that IPW's performance was inadequate, indicating that it may not be a suitable option for selection bias adjustment in clinical trials. In summary, our study sheds light on the effectiveness of various statistical methods in mitigating selection bias in clinical trials.

In the United States, HPV vaccination is available for unvaccinated 27 to 45 year olds based on a shared clinical decision with a health care provider. Since the implementation of the guideline, little has been known about provider perceptions of this recommendation. The purpose of this study was to elucidate health care provider perspectives on HPV vaccination for 27 to 45 year olds in the United States. Semi-structured interviews were conducted virtually with 18 health care providers regarding current HPV vaccination practices for 27 to 45 year olds, perceptions of the guideline, and shared clinical decision-making needs. Thematic analysis was conducted using interview transcripts, and interrater reliability was achieved for >10% of the transcripts. Overall, most participants reported that they have recommended HPV vaccination to patients aged 27 to 45 year olds; however, they applied various criteria to guide these discussions. Some participants considered the patients' relationship statuses, sexual partnerships, past HPV infection history, and age. Potential needs to facilitate shared clinical decision-making processes included medical record prompts and brief educational materials. While most health care providers in this sample discussed HPV vaccination with their patients ages 27 to 45 years old, there were inconsistencies in the interpretation of the guideline. The lack of specificity in the recommendation will likely result in significant and potentially inequitable implementation difficulties.

OBJECTIVE:To design, develop, and field test the HPV Decide decision tool to facilitate shared clinical decision-making recommendation for mid-adult HPV vaccination. METHODS:The 'HPV Decide' online tool was developed through a 6-step process, involving community and provider advisory boards, usability testing with 10 end users (unvaccinated adults aged 27-45), field testing interviews with another 10, and interviews with 18 healthcare providers. The process incorporated both inductive and deductive qualitative data analyses. RESULTS:The logic model, based on the Ottawa Decision Support Framework, highlighted the importance of objective knowledge and managing decisional conflict. Iterative modifications were informed by the advisory boards, alpha testing, and usability testing. Field testing showed utility to end users, highlighting the straightforward design, and lack of medical jargon. Many expressed a desire to access the tool before doctor appointments, emphasizing its value in a healthcare context and in partnership with providers. Lastly, healthcare provider feedback highlighted information quality, structure, acceptability, and future implementation. DISCUSSION:While users recognized the tool's information quality and user-centric design, full evaluation focused on changes in informed decision making and clinic-based implementation are needed. PRACTICAL VALUE:The HPV Decide decision tool demonstrates promise in supporting informed decisions about HPV vaccination among mid-adults.

Objective: To explore health literacy needs and preferences for a technology-based intervention (app) to improve sexual and reproductive health (SRH) among college students.Participants: In Spring 2019, in-depth interviews were conducted with 20 participants (10 male, 10 female) from a large, public university.Methods: Interview guide was developed based on Integrated Model of Health Literacy domains and Diffusion of Innovation constructs. Data were analyzed in MaxQDA using applied thematic analysis.Results: Dominant themes included accessing health information and services, evaluating options to make decisions, intervention utility and characteristics, and the emergent theme of credibility. Specific topics included accessing STI testing, contraceptive decision making, information on human papillomavirus (HPV) and the HPV vaccine, patient-provider communication, app design and function elements, and modifying the app to meet the SRH needs of diverse college students.Conclusions: Findings identified areas where an app could address college students' SRH literacy, ultimately improving SRH outcomes among this population.Supplemental data for this article can be accessed online at https://doi.org/10.1080/07448481.2022.2040517 .

Purpose: Human papillomavirus (HPV) is a prevalent sexually transmitted infection responsible for many anogenital and oropharyngeal cancers. Dental care providers have the potential to influence vaccine uptake, yet little is known about how patients perceive their role in HPV education and prevention. Methods: Parents of adolescents aged 9 to 17 years (n = 375) were recruited from Valdeorras District Hospital (Galicia, Spain) to investigate parents' attitudes concerning the involvement of dental care providers in discussions related to HPV. A survey was distributed to the participants, and 343 (91.5%) were included in the analysis. Results: In general, nearly half of the parents reported feeling comfortable regarding discussing HPV with their dentist. Participants described more comfort with dentists than with dental hygienists. Parents' comfort levels were influenced by various social determinants of health, including education level, marital status, geographic origin, and child vaccination status (p > 0.05). Conclusion: Parents reported varying comfort levels when discussing HPV and its vaccine with dental professionals, displaying a preference for dentists. Dental settings have the potential to promote vaccination, but the existence of ongoing barriers needs to be addressed.

INTRODUCTION:MCH training programs in schools of public health provide specialized training to develop culturally competent and skilled MCH leaders who will play key roles in public health infrastructure. Previous literature has reported on the effectiveness of MCH training programs (e.g., number of trainees, improvement in knowledge/skills); less attention has been devoted to understanding factors influencing program implementation during times of rapid change, while considering internal and external contexts (e.g., global pandemic, social unrest, uncertainty of funding, mental health issues, and other crises).PURPOSE:This article describes a graduate-level MCH leadership training program and illustrates how an implementation science framework can inform the identification of determinants and lessons learned during one year of implementation of a multi-year program.ASSESSMENT:Findings reveal how CFIR can be applicable to a MCH training program and highlight how constructs across domains can interact and represent determinants that serve as both a barrier and facilitator. Key lessons learned included the value of accountability, flexibility, learner-centeredness, and partnerships.CONCLUSION:Findings may apply to other programs and settings and could advance innovative training efforts that necessitate attention to the multi-level stakeholder needs (e.g., student, program, institution, community, and local/regional/national levels). Applying CFIR could be useful when interpreting process and outcome evaluation data and transferring findings and lessons learned to other organizations and settings. Integrating implementation science specifically into MCH training programs could contribute to the rigor, adaptability, and dissemination efforts that are critical when learning and sharing best practices to expand leadership capacity efforts that aim to eliminate MCH disparities across systems.

Objective: To identify theory-based innovation characteristics associated with the adoption of consumer-based self-sampling methods for sexually transmitted infection screening. Participants: Guided by the Diffusion of Innovation, survey data from people assigned female at birth (AFAB) (n = 92) were analyzed. Methods: Forward regression models and a path analysis were used to predict adoption by characteristics, using maximum likelihood estimation. Measures included acceptability, comfort, addresses healthcare needs, willingness to adopt self-sampling methods, and innovation characteristics. Results: Predictors of willingness to adopt were no clinic visit (relative advantage), convenient pick-up (relative advantage), and low cost. Variables with direct effects on adoption included: addresses healthcare needs, comfort, acceptability, and no clinic visit. Conclusions: Relative advantage was a salient factor and prioritizing this construct in intervention development may facilitate adoption. Results can guide the development of an innovative, theory-based intervention that promotes adoption of self-sampling methods, ultimately improving STI screening rates.

The disrupted introduction of the HPV-based cervical screening program in several jurisdictions has demonstrated that the attitudes and beliefs of screening-eligible persons are critically implicated in the success of program implementation (including the use of self-sampling). As no up-to-date and validated measures exist measuring attitudes and beliefs towards HPV testing and self-sampling, this study aimed to develop and validate two scales measuring these factors. In October-November 2021, cervical screening-eligible Canadians participated in a web-based survey. In total, 44 items related to HPV testing and 13 items related to HPV self-sampling attitudes and beliefs were included in the survey. For both scales, the optimal number of factors was identified using Exploratory Factor Analysis (EFA) and parallel analysis. Item Response Theory (IRT) was applied within each factor to select items. Confirmatory Factor Analysis (CFA) was used to assess model fit. After data cleaning, 1027 responses were analyzed. The HPV Testing Attitudes and Beliefs Scale (HTABS) had four factors, and twenty-two items were retained after item reduction. The HPV Self-sampling Attitudes and Beliefs Scale (HSABS) had two factors and seven items were retained. CFA showed a good model fit for both final scales. The developed scales will be a valuable resource to examine attitudes and beliefs in anticipation of, and to evaluate, HPV test-based cervical screening.

PurposeEffectiveness of message tactics in social marketing projects often varies across groups of individuals, which suggests the importance of tailoring communication approaches to maximize the success of promotional strategies. This study aims to contribute in this direction by using an innovative approach to promote targeted human papillomavirus vaccination, applying conjoint analysis to understand parental preferences for social media content features. Design/methodology/approachAn online purpose-built quantitative survey was administered to a group of parents meeting eligibility criteria. The survey questions were designed based on inputs from formative qualitative research conducted in a previous phase of the study. FindingsIn the overall sample of 285 parents, responses show that image was the most important feature of social media posts overall, followed by source and text. Cluster analysis identified eight segments in the sample based on parental preferences for content features. Significant differences across segments were identified in terms of need for cognition, vaccine hesitancy, parental gender, concerns around side effects, trust in medical providers, information sharing behaviors on social media and information seeking online. Originality/valueThe application of conjoint analysis to promotional content allows to assess which features of the content are most important in persuading different individuals and provide insights on how people process the information, ultimately to inform targeted promotion based on preferences. Conjoint analysis has been widely used in consumer research to explore audience preferences for products or services, but only a few applications of conjoint analysis to the design and testing of promotional content are found in the literature.