R I Henderson1, M Shea-Budgell2, C Healy3, A Letendre4, L Bill3, B Healy3, R A Bednarczyk5, K Mrklas6, C Barnabe7, J Guichon6, N Bedingfield6, S MacDonald8, A Colquhoun9, S Glaze2, T Nash10, C Bell9, J Kellner11, R Richardson12, T Dixon13, J Starlight14, G Runner14, G Nelson2. 1. Department of Family Medicine, Cumming School of Medicine, Calgary, AB, Canada. Electronic address: rihender@ucalgary.ca. 2. Department of Oncology, Cumming School of Medicine, Calgary, AB, Canada. 3. Alberta First Nations Information Governance Centre, Calgary, AB, Canada. 4. Alberta Cancer Prevention Legacy Fund, Edmonton, AB, Canada. 5. Rollins School of Public Health, Emory University, Atlanta, GA, United States. 6. Department of Community Health Sciences, Cumming School of Medicine, Calgary, AB, Canada. 7. Department of Medicine, Cumming School of Medicine, Calgary, AB, Canada. 8. Faculty of Nursing, University of Alberta, Edmonton, AB, Canada. 9. Alberta Ministry of Health, Edmonton, AB, Canada. 10. Indigenous Mental Health Program, Calgary, AB, Canada. 11. Department of Pediatrics, Cumming School of Medicine, Calgary, AB, Canada. 12. First Nations and Inuit Health Branch, Alberta Region, Edmonton, AB, Canada. 13. Elder, Eden Valley Nation, AB, Canada. 14. Elder, Tsuut'ina Nation, AB, Canada.
Abstract
OBJECTIVE: In Canada, Indigenous people have higher human papillomavirus (HPV) infection rates, lower screening rates for cervical cancer, and higher rates of invasive cancer, leading to worse cervical cancer-related outcomes than observed in non-Indigenous Canadian women. Lingering harms from European colonization drive these health inequities and create public health challenges. Policy guidance is needed to optimize HPV vaccination rates and, thereby, decrease the burden of HPV-related illness, including high-morbidity surgical procedures and chemo-radiotherapy. The Enhancing HPV Vaccination In First Nations Populations in Alberta (EHVINA) project focuses on First Nations, a diverse subset of recognized Indigenous people in Canada, and seeks to increase HPV vaccination among girls and boys living in First Nation communities. METHODS: Developing an effective strategy requires partnership with affected communities to better understand knowledge and perceptions about cancer, healthcare, and the HPV vaccine. A 2017 community gathering was convened to engage First Nations community members, health directors, and health services researchers in dialogue around unique barriers and supports to HPV vaccination in Alberta. Voices of community Elders, parents, health directors, and cancer survivors (n=24) are presented as qualitative evidence to help inform intervention design. RESULTS: Key findings from discussions indicate barriers to HPV vaccination include resource constraints and service infrastructure gaps, historical mistrust in healthcare systems, impacts of changing modes of communication, and community sensitivities regarding sexual health promotion. Supports were identified as strengthened inter-generational relationships in communities. CONCLUSIONS AND FUTURE DIRECTION: Ongoing dialogue and co-development of community-based strategies to increase HPV vaccine uptake are required. The identification of possible barriers to HPV vaccination in a Canadian Indigenous population contributes to limited global literature on this subject and may inform researchers and policy makers who work with Indigenous populations in other regions.
OBJECTIVE: In Canada, Indigenous people have higher human papillomavirus (HPV) infection rates, lower screening rates for cervical cancer, and higher rates of invasive cancer, leading to worse cervical cancer-related outcomes than observed in non-Indigenous Canadian women. Lingering harms from European colonization drive these health inequities and create public health challenges. Policy guidance is needed to optimize HPV vaccination rates and, thereby, decrease the burden of HPV-related illness, including high-morbidity surgical procedures and chemo-radiotherapy. The Enhancing HPV Vaccination In First Nations Populations in Alberta (EHVINA) project focuses on First Nations, a diverse subset of recognized Indigenous people in Canada, and seeks to increase HPV vaccination among girls and boys living in First Nation communities. METHODS: Developing an effective strategy requires partnership with affected communities to better understand knowledge and perceptions about cancer, healthcare, and the HPV vaccine. A 2017 community gathering was convened to engage First Nations community members, health directors, and health services researchers in dialogue around unique barriers and supports to HPV vaccination in Alberta. Voices of community Elders, parents, health directors, and cancer survivors (n=24) are presented as qualitative evidence to help inform intervention design. RESULTS: Key findings from discussions indicate barriers to HPV vaccination include resource constraints and service infrastructure gaps, historical mistrust in healthcare systems, impacts of changing modes of communication, and community sensitivities regarding sexual health promotion. Supports were identified as strengthened inter-generational relationships in communities. CONCLUSIONS AND FUTURE DIRECTION: Ongoing dialogue and co-development of community-based strategies to increase HPV vaccine uptake are required. The identification of possible barriers to HPV vaccination in a Canadian Indigenous population contributes to limited global literature on this subject and may inform researchers and policy makers who work with Indigenous populations in other regions.
Authors: L León-Maldonado; A Cabral; B Brown; G W Ryan; A Maldonado; J Salmerón; B Allen-Leigh; E Lazcano-Ponce Journal: Hum Vaccin Immunother Date: 2019-07-10 Impact factor: 3.452