BACKGROUND: Human papillomavirus (HPV) is a necessary cause of cervical dysplasia and cancer, and of genital warts. Few studies have examined attitudes to HPV vaccination since the introduction of HPV vaccines. We aimed to investigate the reasons for young women's acceptance or rejection of the quadrivalent HPV vaccine after its general availability in Denmark. METHOD: A literature review assessed attitudes towards HPV vaccination and the information was used to identify relevant questions for telephone and focus group interviews with women aged 16-26 who had decided to receive or reject HPV vaccination. 435 women across Denmark were interviewed by telephone. Qualitative interviews were undertaken in focus groups with 33 women living in Odense who had completed the telephone survey. Four focus groups were set up according to age (16-20 and 21-26 years of age) and acceptance/rejection of the vaccine. RESULTS: Of 839 women initially contacted by telephone, 794 were included, 411 (49%) said they accepted vaccination but only 201 (24%) had actually received the vaccine and these latter were interviewed. 242 women said they refused vaccination of which 234 were interviewed. Women who were undecided were excluded from the study. Prevention of cervical cancer was the main driver for acceptance of the vaccine, followed by parental encouragement and financial support, personal experience of someone with cancer and recommendation by health-care professionals. The greatest barrier to vaccination was its cost. A lack of information about the benefits of vaccination for sexually active women was also an important barrier and the older participants in particular considered that they were too old to be vaccinated. Knowledge about HPV and its role in the development of cervical cancer and genital warts was poor. CONCLUSIONS: The difference between intention to be vaccinated and starting vaccination was considerable, and a large proportion of women aged 16-26 did not wish to be vaccinated. If the most important barriers to vaccination were addressed (cost and a lack of information about vaccination benefits), it is likely that the uptake of vaccination in Denmark would increase substantially.
Few decision aids (DAs) have been developed to support an informed choice to citizens with lower educational attainment about colorectal cancer screening. The aim of this study was to identify information needs and preferences for formats and content in a DA for this group of citizens.
Four focus groups were conducted among Danish men and women aged 50-74 years with lower educational attainment. A semi-structured interview guide was developed to explore participants' perceptions about colorectal cancer screening and wishes for a DA. The interviews were transcribed and analysed using an ethnographic approach.
The participants appreciated information about the causes, symptoms, incidence and mortality of colorectal cancer compared with other common cancers. The majority preferred the information to be presented in a clear and simple way with numbers and figures kept to a minimum. Values clarification exercises were not found useful. Receiving a screening kit to collect a sample of faeces along with the invitation letter was seen by the participants as a clear request from the health authorities to get screened. However, the overall message in the DA was perceived as ambiguous by the participants as it both recommended screening and seemed to disclaim responsibility for it.
The results are relevant to a discussion of the delicate balance between participants' call for a clear recommendation, and the purpose of a DA to present options in a neutral and balanced way. This discussion is relevant beyond the group of citizens with lower educational attainment.
Male human papillomavirus (HPV) infections are frequent and lead to an increased risk of HPV-related disease in their female sexual partners. In males, HPV can cause head/neck, penile and anal cancer, as well as genital warts. In this study we assessed parental attitudes to HPV vaccination of their sons.
Telephone interviews were conducted in a random, nationally representative sample of 450 Danish parents with sons aged 12-15 years. We gave them information about the main direct benefits of male vaccination and then asked them about their views on HPV vaccination of their sons aged 12-15 years.
HPV vaccination of sons was accepted by 80% of respondents; 45% were willing to cover the cost themselves. Parents primarily wanted to protect their sons from cancer and genital warts. 20% rejected or had doubts about HPV vaccination of their sons. Their concerns were mainly due to lack of knowledge about the vaccine, fear of side effects and lack of recommendations from health care authorities.
These high acceptance rates are similar to those reported for vaccination of girls prior to its inclusion in the Danish immunisation programme. General practitioners and national health services play a crucial role in providing parents with the information required to make an informed decision about HPV vaccination of sons as well as daughters.
Herpes zoster (HZ or shingles) and its complication post-herpetic neuralgia (PHN) are common in persons above 50 years of age. A vaccine that decreases the incidence and morbidity associated with HZ was licensed for use in 2006 and will be marketed in Denmark as from 2013. This study aimed to explore the relations between illness perceptions of shingles and attitudes towards zoster vaccination.
Three qualitative focus group interviews were conducted with 22 patients, relatives and individuals with no personal experiences with HZ. Semi-structured interview guides were applied including questions identified in a literature study. The data were analysed using a medical anthropological approach.
The study showed that HZ and PHN, in particular, have severe impacts on patients' quality of life (QoL) and often affect their relatives' daily lives as well. Nevertheless, people who have no experience with HZ underrate both its prevalence and its QoL impacts. Such misperceptions often result in delayed treatment and may lead to a low uptake of zoster vaccination.
Individual attitudes towards zoster vaccination are closely related to subjective perceptions of HZ and views on vaccination in general. Vaccination recommendations to target groups are necessary, but individual choice is determined by knowledge about the disease, personal risk assessment and the recommendations of the general practitioner.
The study was funded by a research grant from Sanofi Pasteur MSD.
BACKGROUND: Genital warts, which are caused by infection with human papillomavirus (HPV), are one of the most common sexually transmitted diseases in Europe. Although genital warts are commonly perceived as a non-serious condition, treatment is often long, of varying effectiveness and the recurrence rate is high. Very few studies have been performed on the personal consequences of genital warts. The aim of this qualitative study, set in Denmark, was to examine the ways in which genital warts may affect patients' quality of life. METHODS: To obtain an in-depth understanding of patients' perceptions of genital warts, we used qualitative focus-group interviews with five men and five women aged between 18 and 30 years who had genital warts. The interview guide was based on a literature review that identified important issues and questions. The data were analysed using a medical anthropological approach. RESULTS: Patients' experiences were related to cultural conceptions of venereal diseases and the respective identities and sexuality of the sexes. The disease had negative psychological and social effects both for men and for women and it affected their sex and love lives, in particular. The psychological burden of the disease was increased by the uncertain timeline and the varying effectiveness of treatment. We identified a need for more patient information about the disease and its psycho-sexual aspects. CONCLUSIONS: The men and women participating in this study considered their quality of life to be significantly lowered because of genital warts. The experiences described by the participants give insights that may be valuable in treatment and counselling.The quadrivalent HPV vaccine that has now been added to the childhood vaccination programme for girls in Denmark for the prevention of cervical cancer can also prevent 90% of cases of genital warts. Our results suggest that HPV vaccination could considerably reduce the largely unacknowledged psychological and social burden associated with genital warts, in men as well as women.