Rula Btoush, PhD, RN Associate Professor Presented ented at the - PowerPoint PPT Presentation

Rula Btoush, PhD, RN Associate Professor Presented ented at the New ew Jersey sey HPV Roundta oundtable ble on n Octo tober ber 11, , 2017 017

 Analysis of EHR data for 3,180 adolescents seen at a multi-site FQHC in Newark (2011)  Focus group discussions with 44 ethnically diverse Black women (2011)  Focus group discussions with 132 Latina mothers (2014)  Analysis of NJIIS data (2010-2014) 2

An Anal alysis ysis of f EHR HR dat ata a fo for r 3,1 ,180 80 ad adolesce lescents nts seen n at at a mu a multi ti-site site FQHC QHC in Ne Newark wark (2011 011) 3

 27.4% received at least 1 dose  HPV-V initiation was higher: Facto tor ALL Female emale Male le Blac ack Hispan panic ic Younger adolescents     Non-English speakers    Insured adolescents   Seen by pediatricians      Seen at the Irvington      or Orange sites Younger adolescents      seen by pediatricians 4

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 3-dose Series  7.8% of all adolescents  28.6% of adolescents who initiated  HPV-V Completion was higher: Factor ctor ALL Female emale Male le Black ack Hispan panic ic Younger adolescents Non-English speakers   Insured adolescents  Seen by pediatricians Seen at the Newark –  South or East Orange 6

Should be  Duration between doses 1 and 2 2 m months ◦ 5.52 52 months (SD=4.63) ALL Female emale Male le Black ack Hispan panic ic Insurance --- Insurance --- Insurance  Duration between doses 1 and 3 Should be 6 m months ◦ 10.02 .02 months (SD=6.07) ALL Female emale Male le Blac ack Hispan panic ic Insurance --- Insurance --- --- at Newark – at Newark – Non-English South or --- --- South or Speakers East Orange East Orange 7

An Anal alysis ysis of f NJ NJIIS IS dat ata a (2010 010-2014 2014) Preliminary Analysis 8

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Focus cus gr group up discussions cussions with th 44 ethnica hnically lly dive verse rse Blac ack k women men (2011 011) Funded by the UMDNJ Foundation 14 14

 Included Haitian, African, English-speaking Caribbean, and African American women  Lack of knowledge about: ◦ HPV infection and risk factors ◦ HPV vaccination guidelines  Haitian & African mothers were least knowledgeable 15 15

 Distrust in vaccines in general  Open and receptive to vaccination for girls  Unclear about need to vaccinate boys  Concerns about safety and side effects  Lack of HCPs’ recommen menda dation tion ◦ In some cases HCPs were dismissive of women’s questions (seeking information) 16 16

Focus cus gr group up discussions cussions with th 132 2 Latina La na mo mothers thers (2014 014) Funded by the American Nurses Foundation (ANF) 17 17

 Lower rates among: ◦ Spanis ish speakers ers (49%) than English speakers (90%) ◦ Those with income ome ≤$14,000 (49%) than those with higher income (83%) ◦ The uninsur insured ed (47%) than the insured (64%) 18 18

 Lower initiation rates among: ◦ Spanis nish h speakers ers (24%) than English speakers (45%) ◦ The uninsur insured ed (16.2%) than the insured (39%) ◦ Those who never ver heard rd of the vacc ccine ine (3%) than those who ever heard of the vaccine (47%) 19 19

 Lack of knowledge about HPV infection, vaccination, recommended age of vaccination, number of doses, side effects, cost, etc.  Receptive and believed that the vaccine should be given to both males and females  Mothers are the primary decision makers about the vaccine 20 20

Faci cili litato ators: rs: Barr rrie iers: rs:  HCP recommen menda dation tion  Lack of HCP was the strong ngest est recommen menda dation ion facil ilita itator or for HPV-V  Concern about side initiation and effects completion  Avoidance of  Perceived seriousness talking about sex of HPV (motivating with children factor) 21 21

 HCP CP rec ecomm mmen endation ation an and co commun mmunica cati tion on about the HPV-V ◦ Strong recommendation ◦ Addressing side effects and safety concerns  School-based approach in educating mothers about the vaccine  Use of texting smart phone technology to educate mothers and promote completion  Making appointments for 2 nd and 3 rd doses  Use of reminder calls for 2 nd and 3 rd doses 22 22

Curre rrent t Pro roject ject - Stat atewide ewide On Online ine Survey rvey of f 500 0 HC HCPs Ps Funded by Rutgers Cancer Institute of New Jersey 23 23

 St Statewide ide onli line e survey ey of 500 HCPs  Includes MDs & APNs in Peds, OB/GYN, and family medicine ◦ HCP recommendation of the HPV-V ◦ Knowledge and beliefs about the vaccine ◦ Barriers and facilitators for recommending and discussing the HPV-V with parents  Email announcements and word of mouth 24 24

Sampl ple e charact aracteris eristic ics Ge Gender er Male 28% Female 78% Speci cialty alty Pediatrics 63% Women’s Health or OB/ GYN 15% Family Medicine/Family Health 22% Healthcare He thcare Physician 78% Profes ession ion Nurse Practitioner 22% Pract ctic ice Private Practice 59% Public Clinic 16% Type FQHC 13% Other 12% Years s of Experience ience M ( (SD) D) 17 (11) Years s in current rrent pract ctice ice M ( (SD) D) 12 (11) 25 25

26 26 * Recommending the HPV vaccine >75% of the time

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 Healthcare providers in New Jersey  Physician (MD or DO) or advanced practice nurse (APN or NP)  Working in pediatrics, OB/GYN or women’s health, or family medicine  Online survey  < 20 minutes  http:/ ://j.m j.mp/ p/2muD 2muDce8 e8 34 34

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Ack cknowl nowledge edgeme ment nt of Collabo abora rators: tors:  Diane Brown, PhD; Rutgers School of Public Health  Dennis Carmody, PhD; Rutgers School of Nursing  Shawna Hudson, PhD; Rutgers - Robert Wood Johnson Medical School (RWJMS)  Lindsey Toller, MPH; Rutgers School of Public Health  Jennifer Tsui, PhD, Rutgers Cancer Institute of New Jersey (CINJ)  DOH - VPD and VFC programs 36 36