Parental Acceptance of HPV Vaccine in Peru A Decision Framework 英文参考文献.docVIP

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Parental Acceptance of HPV Vaccine in Peru A Decision Framework 英文参考文献.doc

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Parental Acceptance of HPV Vaccine in Peru A Decision Framework 英文参考文献

ParentalAcceptanceofHPVVaccineinPeru:ADecision Framework RosarioM.Bartolini1,JenniferL.Winkler2,MaryE.Penny1,D.ScottLaMontagne2,3* 1Instituto de Investigacio′n Nutricional, La Molina, Lima, Peru, 2PATH, Seattle, Washington, United States of America, 3Department of Global Health, University of Washington,HarborviewMedicalCenter,Seattle,Washington,UnitedStatesofAmerica Abstract ObjectiveandMethod:Cervicalcanceristhethirdmostcommoncanceraffectingwomenworldwideanditisanimportant causeofdeath, especiallyin developingcountries.Cervicalcancer iscaused byhumanpapillomavirus(HPV) andcanbe preventedbyHPVvaccine.Thechallengeistoexpandvaccineavailabilitytocountrieswhereitismostneeded.In2008 Peru’s Ministry of Health implemented a demonstration project involving 5th grade girls in primary schools in the Piura region. We designed and conducted a qualitative study of the decision-making process among parents of girls, and developedaconceptualmodeldescribingtheprocessofHPVvaccineacceptance. Results: We found anonlinear HPV decision-making process that evolvedover time. Initially, the vaccine’s newness, the requirementofwrittenconsent,andprovisionofinformationwereimportant.Ifinformationwassufficientandprovidedby credible sources, many parents accepted the vaccine. Later, after obtaining additional information from teachers, health personnel,andothertrustedsources,moreparentsacceptedvaccination.Anunderstandingoftheissuessurroundingthe vaccine developed, parents overcomefears andrumors, andengagedin family negotiations–including hearing thegirl’s voicein thedecision-making process. The conceptof prevention(cancer asdanger, futurehealth, andtrustin vaccines) combinedwithpragmaticfactors(nocost,availableatschool)andthecredibilityoftheoffer(informationinthemedia, recommendationofrespectedauthorityfigure)werecentraltomotivationsthatledparentstodecidetovaccinatetheir daughters.Alackofconfidenceinthehealthsystemwastheprimaryinhibitorofvaccineacceptance. Conclusions:Healthpersonneland