Assessment of needs-based usefulness of interventions to address system barriers to HPV vaccination

Abstract Background Adolescents of underserved communities face multiple health system barriers to access HPV vaccination. The Horizon 2020 project RIVER-EU will implement interventions to address these barriers in the migrant community in Greece, the Turkish and Moroccan communities in the Netherlands, the Ukrainian community in Poland and the Roma community in Slovakia. The objective of this study was to identify promising evidence-based interventions that potentially meet the specific contextual needs of the target groups, as a basis for assessing their transferability. Methods Based on the PIET-T models of transferability, we developed a methodology to assess the needs-based usefulness of an intervention for a target context. Criteria of intervention usefulness addressed specific aspects of the health issue, population, intervention content, outcomes, up-to-datedness, applicability, quality and usefulness of the evidence-base. Guided by methodological workshops, country members with their local advisory boards performed a rating of 32 interventions identified from a systematic literature search. Results Through independent assessment in each country, 5 of 32 interventions were selected as useful, with overlap: 2 interventions were selected by all countries, and 1 by 2 countries. In all countries, trained community members to support HPV vaccination were seen as promising. In Greece and the Netherlands, an educational programme in schools was included. Further, the Netherlands chose an intervention addressing providers’ HPV vaccine communication, and Slovakia a multilevel intervention. Discussion The feedback of the country members on the assessment emphasised the structured way to face complexity of understanding the potential usefulness of an intervention from the perspective of the target country. Critical discussions on the interventions enabled to specify needs for further clarification, for adaptations, and alternatives to consider for transferability analyses. Key messages Identifying potentially useful health system approaches to vaccination in specific contexts is a complex step that goes beyond analysing quality of primary evidence. Our methodology for intervention selection emphasises the consideration of the unique needs of target communities to address health system barriers to vaccination.


Background:
Cervical cancer incidence and mortality rates remain high in Estonia and participation in organized cervical cancer screening program is low.The aim of this pilot study was to estimate the impact of offering an HPV self-sampling option on screening uptake.

Methods:
A randomized intervention study was conducted within Estonian organized cervical cancer screening program in 2021.Among target group women who had not participated in screening by August 2021, 26,000 women were randomly selected and allocated to two equally sized intervention arms offering a choice between attending a clinic or taking a selfsample.The opt-out group received a Qvintip sampler by regular mail to home address, the opt-in group received by email a link to order the sampler from a web-site.A control group of 32,000 women received the usual reminder to attend screening at a clinic.Participation rates were calculated and data on user experience were collected with a questionnaire.

Results:
Significant difference in participation rates was observed between opt-out (41%) (among them 20% chose self-sampling, 21% chose clinic attendance), opt-in (34%) (8% self-sampling, 26% clinic) and control group (28%).Intervention arms showed higher screening uptake in all agegroups and regions, but the largest effect was seen at ages 60 and 65 years and in regions showing the lowest screening participation rates.Among self-sampling users, 99% agreed that self-sampling was easy and only 3% prefer testing at a clinic.

Conclusions:
Offering women a choice between HPV self-sampling or attending a clinic significantly increased cervical cancer screening uptake.Sending an HPV self-sampling kit to home address was the most effective approach.Majority of women who chose HPV self-sampling want to use this option in the future.HPV self-sampling should be integrated in the cervical cancer screening program in Estonia.

Key messages:
HPV self-sampling increased cervical cancer screening participation in Estonia and was highly accepted.
It is important to make HPV self-sampling available in cervical cancer screening program.

Background:
Adolescents of underserved communities face multiple health system barriers to access HPV vaccination.The Horizon 2020 project RIVER-EU will implement interventions to address these barriers in the migrant community in Greece, the Turkish and Moroccan communities in the Netherlands, the Ukrainian community in Poland and the Roma community in Slovakia.The objective of this study was to identify promising evidence-based interventions that potentially meet the specific contextual needs of the target groups, as a basis for assessing their transferability.

Methods:
Based on the PIET-T models of transferability, we developed a methodology to assess the needs-based usefulness of an intervention for a target context.Criteria of intervention usefulness addressed specific aspects of the health issue, population, intervention content, outcomes, up-to-datedness, applicability, quality and usefulness of the evidence-base.
Guided by methodological workshops, country members with their local advisory boards performed a rating of 32 interventions identified from a systematic literature search.

Results:
Through independent assessment in each country, 5 of 32 interventions were selected as useful, with overlap: 2 interventions were selected by all countries, and 1 by 2 countries.In all countries, trained community members to support HPV vaccination were seen as promising.In Greece and the Netherlands, an educational programme in schools was included.Further, the Netherlands chose an intervention addressing providers' HPV vaccine communication, and Slovakia a multilevel intervention.

Discussion:
The feedback of the country members on the assessment emphasised the structured way to face complexity of understanding the potential usefulness of an intervention from the perspective of the target country.Critical discussions on the interventions enabled to specify needs for further clarification,

Background:
Overweight and obesity rates are increasing worldwide, particularly among people with a low socioeconomic status (SES).Care-physical activity (care-PA) initiatives may lower overweight and obesity rates.A two-year care-PA initiative specifically developed for citizens with a low SES, X-Fittt 2.0, included 12 weeks of intensive guidance and sports sessions, and 21 months of aftercare.We answered the research question: what are the short-and long-term outcomes of participation in X-Fittt 2.0 in terms of health, quality of life and societal participation?Methods: Questionnaires and body measurements were taken from 208 participants at the start of X-Fittt 2.0 (t0) and after 12 weeks (t1), 1 year (t2) and 2 years (t3).We also held 17 group discussions (t1, n = 71) and 68 semi-structured interviews (t2 and t3).Continuous variables were analysed using linear mixed-model analysis, while we used descriptive statistics for the categorical variables.Qualitative data were analysed using thematic analysis.

Results:
Body weight was significantly lower at all three post-initiative time points compared with t0, with a maximum of 3.8 kg difference at t2 (p < 0.05).BMI, waist circumference, blood pressure and self-perceived health only significantly improved during the first 12 weeks (p < 0.05

Background:
Studies have shown increased rates of intimate partner violence (IPV) during the Covid-19 lockdowns.Healthcare services (HCS) have an important role in detection and screening of women victims of IPV.These women tend to visit the HCS more frequently, which creates an opportunity to