University of Warwick institutional repository: http://go.warwick.ac.uk/wrap A Thesis Submitted for the Degree of PhD at the University of Warwick http://go.warwick.ac.uk/wrap/71047 This thesis is made available online and is protected by original copyright. Please scroll down to view the document itself. Please refer to the repository record for this item for information to help you to cite it. Our policy information is available from the repository home page. FACTORS AFFECTING EXPOSURE TO HEALTH PROMOTION ABOUT HPV VACCINE IN ENGLAND AND VARIATIONS IN UPTAKE OF THE HPV VACCINE IN SECONDARY SCHOOLS IN THE WEST MIDLANDS by Corina Mihaela Chivu A thesis submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Health Sciences University of Warwick, Warwick Medical School June 2014 1 TABLE OF CONTENTS ABBREVIATIONS ....................................................................................................... 12 ACKNOWLEDGEMENTS .......................................................................................... 14 DECLARATION ........................................................................................................... 17 ABSTRACT ................................................................................................................... 19 1. 1. Background ............................................................................................................. 23 1. 2. Overview of the Thesis Structure ............................................................................ 24 1.3 Summary ................................................................................................................... 28 CHAPTER 2: LITERATURE REVIEW .................................................................... 29 2.1 Epidemiology of sexually transmitted infections ...................................................... 29 2.1.1. Epidemiology of human papillomavirus infection ........................................ 30 2.2 Vaccine ...................................................................................................................... 32 2.2.1. HPV vaccine .................................................................................................. 32 2.2.2. Effectiveness of vaccine ................................................................................ 33 2.2.3. Herd immunity ............................................................................................... 33 2.2.3.1. Pattern of mixing in heterogeneous population ...................................... 37 2.2.4. Effectiveness of HPV vaccine ....................................................................... 38 2.2.5. Cost-effectiveness of HPV vaccination ......................................................... 40 2.2.6. Doses of HPV vaccine ................................................................................... 42 2.2.7. Adverse effects of HPV vaccination .............................................................. 42 2.2.8. Successful strategies to improve vaccination rates ........................................ 43 2. 3. Description of HPV vaccination program in Europe .............................................. 45 2.3.1. Cervical cancer incidence and mortality rates ............................................... 45 2.3.2. Context of HPV vaccination .......................................................................... 47 2.3.3. Target populations for HPV vaccine ............................................................. 49 2.3.4. HPV vaccine delivery .................................................................................... 52 2.3.5. Literature review about HPV vaccination uptake in Europe ......................... 55 2.4. Summary .................................................................................................................. 61 CHAPTER 3: PART 1 PRINCIPLES AND FRAMEWORK OF “RIGHT TO HEALTH” ...................................................................................................................... 63 3(1). 1. Right to health .................................................................................................... 63 3(1).1.1. The National Health Service Constitution ................................................ 65 3(1).2. Access to health care ........................................................................................... 69 3(1). 2. 1. Need ........................................................................................................ 71 2 3(1). 2. 2. Need assessment...................................................................................... 71 3(1). 2. 3. Utilization of health services ................................................................... 72 3(1). 2. 4. Uptake of preventive health services in ethnic groups............................ 75 3(1). 3. Summary ............................................................................................................ 77 CHAPTER 3 PART 2: CONCEPTUAL FRAMEWORK OF EVALUATION OF QUALITY OF CARE ................................................................................................... 79 3(2). 1. Approach to evaluation - quality of care ............................................................ 79 3(2). 2. Equity – definition .............................................................................................. 82 3(2). 3. Health equity ...................................................................................................... 82 3(2). 4. Health inequity versus health inequality ............................................................ 83 3(2). 5. Explanations of health inequality ....................................................................... 84 3(2). 5. 1. Area socioeconomic status ...................................................................... 84 3(2). 5. 2. Individual socioeconomic position ......................................................... 88 3(2). 5. 3. Behavioral/cultural explanation .............................................................. 89 3(2). 5. 4. Health–related behaviors ......................................................................... 89 3(2). 5. 5. Psychosocial explanations ....................................................................... 90 3(2). 5. 6. Life course events ................................................................................... 90 3(2). 6. Ethnicity ............................................................................................................. 90 3(2). 7. Religion .............................................................................................................. 94 3(2). 7. 1. Definition ................................................................................................ 94 3(2). 7. 2. Religion and immunization ..................................................................... 97 3(2). 8. Ethnic inequalities in health ............................................................................... 98 3(2). 9. Equity in health service delivery ...................................................................... 100 3(2). 10. Equity in access to health care........................................................................ 102 3(2). 10. 1. Equity in access to vaccination ........................................................... 103 3(2). 11. Summary ........................................................................................................ 104 CHAPTER 4: NATIONAL STUDY – UPTAKE OF INFORMATIVE MATERIALS ON HPV VACCINE IN SECONDARY SCHOOLS IN THE UK 108 4. 1. Health promotion theories and models ................................................................. 108 4. 1. 1. Models of individual health behavior ........................................................ 111 4. 1. 1. 1. Health belief model ............................................................................ 111 4. 1. 1. 2. Theory of reasoned action .................................................................. 112 4. 1. 1. 3. Stages of change (transtheoretical) model ......................................... 113 4. 1. 2. Models of interpersonal health behavior ................................................... 113 4. 1. 2. 1. Social cognitive theory ....................................................................... 113 3 4. 1. 3. Community and group models of health behavior change ........................ 114 4. 1. 3. 1. Caplan and Holland’s model .............................................................. 114 4. 1. 3. 2. Health action model ........................................................................... 115 4. 1. 3. 3. French and Adams model................................................................... 115 4. 1. 3. 4. Diffusions of innovations theory ........................................................ 116 4. 1. 3. 5. Communication-behavior change model ........................................... 118 4. 1. 3. 6. Social marketing................................................................................. 119 4. 1. 4. Critique of behavior-based health promotion ............................................ 119 4. 2. Scoping literature review ...................................................................................... 120 4. 3. Quantitative research – National study ................................................................. 122 4. 3. 1. Methods ....................................................................................................