Alice S. Forster

Ethnic differences in human papillomavirus awareness and vaccine acceptability

Background: Studies of human papillomavirus (HPV) awareness and HPV vaccine acceptability have included few non-white participants, making it difficult to explore ethnic differences. This study assessed HPV awareness and HPV vaccine acceptability in a sample of women representing the major UK ethnic minority groups. Methods: A cross-sectional study design was used to assess awareness of HPV and acceptability of HPV vaccination. Participants were recruited using quota sampling to ensure adequate representation of ethnic minority women: Indian, Pakistani, Bangladeshi, Caribbean, African and Chinese women (n = 750). A comparison sample of white British women (n = 200) was also recruited. Results: Awareness of HPV was lower among ethnic minority women than among white women (6–18% vs 39% in white women), and this was not explained by generational status or language spoken at home. In a subsample who were mothers (n = 601), ethnicity and religion were strongly associated with acceptability of HPV vaccination. Acceptability was highest among white mothers (63%) and lowest among South Asians (11–25%). Those from non-Christian religions were also less accepting of the vaccine (17–34%). The most common barriers to giving HPV vaccination were a need for more information, sex-related concerns and concern about side-effects. South Asian women were the most likely to cite sex-related concerns, and were also least likely to believe the vaccine would offer their daughters protection. Conclusion: These findings suggest some cultural barriers that could be addressed in tailored information aimed at ethnic minority groups. They also highlight the importance of recording ethnicity as part of HPV vaccine uptake data.

Factors affecting uptake and adherence to breast cancer chemoprevention: a systematic review and meta-analysis

In this systematic review of studies investigating decision-making in the context of breast cancer preventive therapy, we observed low uptake of all agents and poor long-term persistence. Our meta-analysis including over 21 000 women demonstrated that only 1 in 6 eligible women decided to take preventive therapy. Persistence for 5 years was low, limiting the preventive effect in these women.

Attitudes towards human papillomavirus vaccination: a qualitative study of vaccinated and unvaccinated girls aged 17-18 years

Background and methodology This study explored knowledge about human papillomavirus (HPV) and attitudes towards HPV vaccination among girls who were part of the ‘catch-up’ vaccination programme. Interviews were carried out between March and May 2009 with girls (aged 17–18 years) who had received HPV vaccine (n=5) and girls who had opted not to receive HPV vaccine (n=5). Interviews lasted approximately 25 minutes, were recorded and transcribed verbatim. The data were analysed qualitatively using framework analysis. Results Most girls were aware that HPV is sexually transmitted, but beyond this had limited understanding of HPV and HPV vaccination, and expressed a desire for further information. Girls were uncertain about the need for the vaccine both in terms of perceived risk (e.g. because they were not sexually active) and because of its novelty. Some had concerns about the efficacy and safety of the vaccine, while others were mistrusting of the information provided. Being embarrassed about discussing the vaccine with parents and practical barriers to vaccination were also discussed. Discussion and conclusions Understanding of HPV was poor, despite participants having been offered the vaccine. School-based interventions might be a useful supplement to leaflets, and should focus on improving knowledge of HPV and awareness of the purpose of HPV vaccination.

Predicting human papillomavirus vaccination behaviour among adolescent girls in England: results from a prospective survey

Background To maximise the benefits of human papillomavirus (HPV) vaccination, uptake needs to be high. We examined psychosocial predictors of HPV vaccine uptake and the association between vaccine intention and uptake 1 year later in adolescent girls (aged 16–17 years) in England. Method Adolescent girls in the catch-up cohort were recruited from colleges in the South East of England in 2009 and 2010. Participants completed a questionnaire 6 months before (n=606) and 6 months after (n=214) being offered the vaccine, which assessed vaccine intention, vaccine uptake, demographics and attitudes based on the Health Belief Model and Theory of Planned Behaviour. Results A number of demographic and psychological factors, including intention, showed associations with vaccine uptake in uni-variable analyses. In multi-variable analyses, only ethnicity was independently associated with vaccine uptake. Participants from Black or ‘Other’ ethnic backgrounds were less likely to have received the HPV vaccine than White participants. Conclusions More research is needed to help understand variation in vaccine coverage between ethnic groups.

Influences on individuals' decisions to take up the offer of a health check: a qualitative study.

Health checks are promoted to evaluate individuals’ risk of developing disease and to initiate health promotion and disease prevention interventions. The NHS Health Check is a cardiovascular risk assessment programme introduced in the UK aimed at preventing cardiovascular disease (CVD). Uptake of health checks is lower than anticipated. This study aimed to explore influences on peoples decisions to take up the offer of a health check.

Estimating the yield of NHS Health Checks in England: a population-based cohort study

BACKGROUND This study aimed to evaluate the yield of the NHS Health Checks programme. METHODS A cohort study, conducted in the Clinical Practice Research Datalink in England. Electronic health records were analysed for patients aged 40-74 receiving an NHS Health Check between 2010 and 2013. RESULTS There were 65 324 men and 75 032 women receiving a health check. For every 1000 men assessed, there were 205 smokers (95% confidence interval 195-215), 355 (340-369) with hypertension (≥140/90 mmHg) and 633 (607-658) with elevated cholesterol (≥5 mmol/l). Among 1000 women, there were 161 (151-171) smokers, 247 (238-257) with hypertension and 668 (646-689) with elevated cholesterol. In the 12 months following the check, statins were prescribed to 18% of men and 21% of women with ≥20% cardiovascular risk and antihypertensive drugs to 11% of men and 16% of women with ≥20% cardiovascular risk. Slight reductions in risk factor values were observed in the minority of participants with follow-up values recorded in the 15 months following the check. CONCLUSIONS A universal primary prevention programme identifies substantial risk factor burden in a population without known cardiovascular disease. Research is needed to monitor interventions, and intermediate- and long-term outcomes, in those identified at high risk.

Non-attendance at diabetic eye screening and risk of sight-threatening diabetic retinopathy: a population-based cohort study.

Aims/hypothesisThis study evaluated whether repeated non-attendance for diabetic eye screening is associated with the risk of sight-threatening diabetic retinopathy (STDR).MethodsThis was a cohort study of 6,556 residents with diabetes who were invited for screening between 2008 and 2011 in a population-based eye screening programme in inner London and who attended for their first-ever screen in 2008. The proportion of participants with STDR was evaluated in relation to the number of years in which screening was missed.ResultsThe proportion of participants who did not attend screening decreased between 2009 and 2011 (annual reduction 1.6% [95% CI 0.9%, 2.3%]). The adjusted relative odds of STDR for 210 participants who did not attend two consecutive years of screening were 3.76 (95% CI 2.14, 6.61; p < 0.001), compared with participants who were screened annually. In 605 participants with mild non-proliferative retinopathy at the first screen, the adjusted relative odds of developing proliferative or moderate to severe non-proliferative retinopathy were 5.72 (95% CI 7.43, 22.83; p = 0.013) for 53 participants who missed two screens.Conclusions/interpretationPatients who do not attend diabetic eye screening are at increased risk of developing STDR. Tracing of non-attenders with evidence of established retinopathy should be an important fail-safe procedure.

Changes in Detection of Retinopathy in Type 2 Diabetes in the First 4 Years of a Population-Based Diabetic Eye Screening Program: Retrospective cohort study

OBJECTIVE Annual diabetic eye screening has been implemented in England since 2008. This study aimed to estimate changes in the detection of retinopathy in the first 4 years of the program. RESEARCH DESIGN AND METHODS Participants included 32,340 patients with type 2 diabetes resident in three London boroughs with one or more screening records between 2008 and 2011. Data for 87,570 digital images from 2008 to 2011 were analyzed. Frequency of sight-threatening diabetic retinopathy (STDR) was estimated by year of screen for first screens and for subsequent screens according to retinopathy status at first screen. RESULTS Among 16,621 first-ever screens, the frequency of STDR was 7.1% in 2008, declining to 6.4% in 2011 (P = 0.087). The proportion with a duration of diabetes of <1 year at first screen increased from 18.7% in 2008 to 48.6% in 2011. Second or later screens were received by 26,308 participants. In participants with mild nonproliferative retinopathy at first screen, the proportion with STDR at second or later screen declined from 21.6% in 2008 to 8.4% in 2011 (annual change −2.2% [95% CI −3.3 to −1.0], P < 0.001). In participants with no retinopathy at first screen, STDR declined from 9.2% in 2008 to 3.2% in 2011 (annual change −1.8% [−2.0 to −1.7], P < 0.001). Declining trends were similar in sociodemographic subgroups. CONCLUSIONS After the inception of population-based diabetic eye screening, patients at lower risk of STDR contribute an increasing proportion to the eligible population, and the proportion detected with STDR at second or subsequent screening rounds declines rapidly.

Do health checks improve risk factor detection in primary care? Matched cohort study using electronic health records

Background To evaluate the effect of NHS Health Checks on cardiovascular risk factor detection and inequalities. Methods Matched cohort study in the Clinical Practice Research Datalink, including participants who received a health check in England between 1 April 2010 and 31 March 2013, together with matched control participants, with linked deprivation scores. Results There were 91 618 eligible participants who received a health check, of whom 75 123 (82%) were matched with 182 245 controls. After the health check, 90% of men and 92% of women had complete data for blood pressure, total cholesterol, smoking and body mass index; a net 51% increase (P < 0.001) over controls. After the check, gender and deprivation inequalities in recording of all risk factors were lower than for controls. Net increase in risk factor detection was greater for hypercholesterolaemia (men +33%; women +32%) than for obesity (men +8%; women +4%) and hypertension in men only (+5%) (all P < 0.001). Detection of smoking was 5% lower in health check participants than controls (P < 0.001). Over 4 years, statins were prescribed to 11% of health -check participants and 7.6% controls (hazard ratio 1.58, 95% confidence interval 1.53–1.63, P < 0.001). Conclusion NHS Health Checks are associated with increased detection of hypercholesterolaemia, and to a lesser extent obesity and hypertension, but smokers may be under-represented.

Experiences of cervical screening and barriers to participation in the context of an organised programme: a systematic review and thematic synthesis.

As uptake of cervical screening continues to decline, this systematic review synthesises the qualitative literature on womens perceptions and experiences of cervical screening in the context of an organised call–recall programme, in order to understand the barriers to informed uptake.