| 1. |
- Appelqvist, Emma, et al.
(författare)
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Exploring nurses' experiences of a tailored intervention to increase MMR vaccine acceptance in a Somali community in Stockholm, Sweden : a qualitative interview study
- 2023
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 13:2, s. 067169-067169
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To explore nurses' experiences of a tailored intervention that supported them with knowledge and tools to use during encounters and dialogue with parents with low vaccine acceptance. DESIGN: A qualitative study with in-depth interviews conducted in 2017. Data were analysed using thematic analysis. SETTING: This study was part of a multicomponent intervention targeting Somali parents and the nurses at child health centres in the Rinkeby and Tensta neighbourhoods of Stockholm. An area with documented low measles, mumps and rubella (MMR) vaccination coverage. Previous research has revealed that Somali parents in the community delayed MMR vaccination due to fear of autism despite lack of scientific evidence. The interventions were implemented in 2015-2017. PARTICIPANTS: Eleven nurses employed at the child health centres involved in the intervention participated in interviews. The tailored intervention targeting nurses included a series of seminars, a narrative film and an information card with key messages for distribution to parents. RESULTS: The qualitative analysis revealed an overarching theme: perception of improved communication with parents. Two underlying themes were identified: (1) feeling more confident to address parents' MMR vaccine concerns and (2) diverse tools as useful support to dispel myth and reduce language barriers. CONCLUSION: From the nurses' perspective, the tailored intervention was useful to improve communication with parents having vaccine concerns. Nurses have a crucial role in vaccine uptake and acceptance. Interventions aiming to strengthen their communication with parents are therefore essential, especially in areas with lower vaccine acceptance.
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| 2. |
- Appelqvist, Emma, et al.
(författare)
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Parental views and the key role of nurses for high vaccine acceptance in Sweden – a focus group study
- 2023
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Ingår i: BMC Public Health. - 1471-2458. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: In Sweden, vaccine uptake is exceptionally high due to an efficient child immunization program. More than 97% of Swedish children were vaccinated at child health care centers (CHCs) according to the schedule at 2 years of age in 2021. From the age of 6 years, vaccinations are given within the school health care. Maintaining high vaccination coverage over time is one of the central motives to explore and understand drivers for vaccine acceptance. The current study aimed to assess parental vaccine acceptance concerning the national immunization program and explore factors contributing to the high vaccine acceptance in Sweden. Methods: Parents of children aged 1–2 years and 8–12 years were recruited through purposive sampling and asked to participate in focus groups held in three cities in Sweden, in February and March 2019. In total, 47 parents participated in two focus groups per city, one session for parents of younger (1–2 years) and older (8–12 years) children respectively. The focus group discussions were analyzed using qualitative content analysis. Results: Parents of children aged 1–2 years expressed the themes; strong compliance to and protection of the value of vaccinations; parents feel safe with an attentive relationship with their nurse; the spectrum of communication needs is essential to meet. For parents to children aged 8–12 years, the themes expressed were; vaccinate to do good for the individual and society; a foundation of trust is built at CHCs for decisions later on; decisions for vaccination become more complex as children get older; communication changes as children get older and need to be explicit and tailored to the situation. Conclusion: Both individual and societal perspectives were shown to influence the vaccination decision for childhood immunizations, as manifested in parental reflections and experiences. As nurses have a key role, it is important to provide them with continued support and tools to facilitate their support for parents in making informed decisions. Continuous work for supporting driving factors for vaccination over time is needed to maintain high vaccine acceptance in Sweden.
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| 3. |
- Appelqvist, Emma
(författare)
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Understanding parental vaccine acceptance of childhood vaccinations in Sweden
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The vaccination coverage in Sweden's National Immunization Program (NIP) has been highand stable for decades. Although the coverage is high, few studies have assessed parental vaccineacceptance in Sweden. This doctoral thesis aimed to provide an in-depth understanding of currentparental vaccine acceptance, focusing particularly on Human papillomavirus (HPV) and measles, mumps and rubella (MMR) vaccinations to further identify factors influencing low vaccine acceptance and to evaluate a tailored intervention to improve vaccine uptake. The purpose of the studies was to develop evidence-based methods to systematically inform the management and implementation of the NIP in Sweden regarding parental vaccine acceptance. Mixed methods were used to assess parental vaccine acceptance, including a survey and focus group discussions. A retrospective registry-based study, which included nearly 500,000 girls born from 2002 to 2010, examined factors for non-timely HPV vaccination and their respective parents. MMR vaccination was in focus for designing and implementing a tailored intervention based on the Tailoring Immunization Programs (TIP) approach targeting nurses working in an area with low MMR uptake. To evaluate, in-depth interviews were conducted with the nurses. The findings of the studies identified driving factors and barriers to parental vaccine acceptance. The majority of parents (79%) vaccinated their child without any doubts while others (19%) vaccinated their child but had questions or concerns and a small group declined at least one vaccination for their child (2%).Parents had confidence in vaccinations as they perceived them as safe and effective and trusted thesystem and nurses implementing the NIP. Individual and societal factors were driving factors as children were vaccinated for solidarity reasons and not only to get individual protection. Challenges and barriers identified related to safety concerns of adverse events or perceptions of negative or inadequate information. Nurses had a key role in the high parental vaccine acceptance. They provided a backbone for the NIP. The TIP approach provided a valuable, stepwise process that facilitated the identification and design of a tailored intervention targeting nurses. According to the nurses, the dialogue with parents having low MMR vaccine acceptance, was facilitated and enhanced following the tailored intervention. The TIP approach can be useful in addressing vaccination barriers and tailoring NIP to support an equitable and resilient program. Not being HPV vaccinated, according to the NIP in grades 5 and 6, was associated with parents having low or medium income or high school education as their highest education. Girls to parents where one was born abroad and the other in Sweden were also associated with not being vaccinated, regardless of whether the girl was born in Sweden or abroad. To conclude, the driving factors and barriers identified in the studies of this thesis provide an in-depth understanding of the current parental of vaccine acceptance. The driving factors can be promoted, and barriers can beaddressed to strengthen the NIP. Systematic assessment of parental vaccine acceptance and inequity is valuable to inform the NIP implementation and to maintain high vaccination coverage in the future.
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| 4. |
- Appelqvist, Hanna, et al.
(författare)
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Lysosome-Mediated Apoptosis is Associated with Cathepsin D-Specific Processing of Bid at Phe24,Trp48, and Phe183
- 2012
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Ingår i: Annals of Clinical and Laboratory Science. - : Institute for Clinical Science. - 0091-7370 .- 1550-8080. ; 42:3, s. 231-242
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Tidskriftsartikel (refereegranskat)abstract
- Bax-mediated permeabilization of the outer mitochondrial membrane and release of apoptogenic factors into the cytosol are key events that occur during apoptosis. Likewise, apoptosis is associated with permeabilization of the lysosomal membrane and release of lysosomal cathepsins into the cytosol. This report identifies proteolytically active cathepsin D as an important component of apoptotic signaling following lysosomal membrane permeabilization in fibroblasts. Lysosome-mediated cell death is associated with degradation of Bax sequestering 14-3-3 proteins, cleavage of the Box activator Bid, and translocation of Box to mitochondria, all of which were cathepsin D-dependent. Processing of Bid could be reproduced by enforced lysosomal membrane permeabilization, using the lysosomotropic detergent O-methyl-serine dodecylamine hydrochloride (MSDH). We identified three cathepsin D-specific cleavage sites in Bid, Phe24, Trp48, and Phe183. Cathepsin D-cleaved Bid induced Bax-mediated release of cytochrome c from purified mitochondria, indicating that the fragments generated are functionally active. Moreover, apoptosis was associated with cytosolic acidification, thereby providing a more favorable environment for the cathepsin D-mediated cleavage of Bid. Our study suggests that cytosolic cathepsin D triggers Bax-mediated cytochrome c release by proteolytic activation of Bid.
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| 5. |
- Falkenstein-Hagander, Kathy, et al.
(författare)
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Waning infant pertussis during COVID-19 pandemic
- 2022
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Ingår i: Archives of Disease in Childhood. - : BMJ Publishing Group Ltd. - 0003-9888 .- 1468-2044. ; 107:3
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Tidskriftsartikel (refereegranskat)abstract
- Measures to reduce the spread of COVID-19 have been associated with reduction in other respiratory infections. Results of a national Swedish cohort study of infant pertussis during April 2020-September 2021 were compared with those during January 2014-March 2020. The number of pertussis cases decreased significantly during the COVID-19 pandemic, from an average of 21 infant cases per quarter of a year before the pandemic to an average of 1 case per quarter during the pandemic. Swedish strategies to mitigate the spread of COVID-19 seem to have had an impact on pertussis incidence in infants. Measures to prevent the spread of COVID-19 have also reduced other respiratory viral infections in children. This study from Sewden found that the number of infant pertussis infections also fell during the COVID-19 pandemic. The authors discuss the implications of this finding.
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| 6. |
- Jama, Asha, et al.
(författare)
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Design and implementation of tailored intervention to increase vaccine acceptance in a Somali community in Stockholm, Sweden - based on the Tailoring Immunization Programmes approach
- 2022
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Ingår i: Public Health in Practice. - : Elsevier BV. - 2666-5352. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Sweden has had a high and stable vaccination coverage for measles-mumps-rubella (MMR) vaccine (>96%) through the national immunization program (NIP), but coverage rates highlight local pockets of lower vaccination coverage. This project addressed low MMR vaccine acceptance among parents in a Somali community, in Stockholm. The objective of the intervention was to increase vaccine confidence and MMR-vaccine uptake and also to inform practices addressing vaccine acceptance. Study design: This paper describes the design and implementation of a multi-component intervention based on the Tailoring Immunization Programmes (TIP) approach, developed by the WHO European Regional Office. Methods: The theoretical underpinning of TIP is the Capability, Opportunity, and Motivation Model (COM-B model) and Behaviour Change Wheel framework (BCW), adapted for vaccination. The COM-model was used to identify barriers and drivers to vaccination and intervention types. The TIP-phases described in this paper are: pre-TIP (planning), three succeeding TIP phases (situational analysis, formative research, intervention design) and the post-TIP phase (implementation). Results: The situation analysis and formative research revealed that parents feared the MMR vaccine due to autism or that their child would stop talking following vaccination, despite lack of scientific evidence for an association between autism and MMR vaccines. Barriers were linked to their associated COM-B factors and mapped to appropriate intervention types for two target groups: Somali parents and nurses at the Child Health Centres (CHC). Selected intervention types targeting parents were education, persuasion and modelling whereas education and training were selected for CHC nurses. The intervention activities included community engagement for parents, while the activities for nurses focused on improving encounters and dialogue with parents having low vaccine acceptance. Following the intervention design the activities were developed, pilot tested and implemented. Conclusion: This study confirm that the TIP approach is valuable for guiding a stepwise working process for a thorough understanding of barriers and drivers for MMR vaccination among parents in this Somali community. It facilitated the design of a theory and evidence-informed intervention targeting parents and nurses.
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| 7. |
- Runngren, Eva, 1963-, et al.
(författare)
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Attitudes and knowledge about HPV vaccination of school children and their parents following a targeted information
- 2022
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Konferensbidrag (refereegranskat)abstract
- Background/Objective: This study aimed to investigate children’s’ and parents’attitudes and knowledge about HPV (human papilloma virus) following introductionof gender neutral HPV vaccination in the national immunization program (NIP) inSweden. An evaluation of a tailored information package for parents and childrenlaunched by the Public Health Agency (PHAS) alongside the introduction of genderneutral HPV vaccination was also performed.Method: In total, 276 parents and 206 children from 22 School Health Servicesresponded to a web-based survey, spring 2021 to January 2022.Result: Overall, parents (78%) perceived HPV vaccination to be of importance fortheir child’s health. About half of the participating children and two thirds of theparents had used the tailored information package for the HPV vaccination. The factsheet was mostly used by parents (55%) and children (20%) and also perceived as easyto understand (99% and 68% respectively). For both children and parents the schoolnurse (70% respectively) was the primary source for information. The teacher (59%)was also a common source of information of HPV vaccination for the children.Conclusion: The school health nurse is essential for informing about HPV vaccinationfor both children and parents. There is a need to strengthen the knowledge regardingHPV vaccination among teachers as they also are a key source of information for themajority of the children. Additional interventions are needed to support parents inmaking informed decisions for HPV vaccinations.POSTER 1Page 1
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| 8. |
- Runngren, Eva, 1963-, et al.
(författare)
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Attitudes and knowledge about HPV vaccination of school children and their parents following use of a targeted information
- 2023
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Konferensbidrag (refereegranskat)abstract
- Background/Objective: This study aimed to investigate children’s’ and parents’ attitudes and knowledge about HPV (human papillomavirus) following introduction of gender-neutral HPV vaccination in the national immunization program (NIP) in Sweden. An evaluation of a tailored information package for parents and children launched by the Public Health Agency (PHAS) alongside the introduction of gender-neutral HPV vaccination was also performed Method: In total, 276 parents and 206 children from 22 School Health Services responded to a web-based survey, spring 2021 to January 2022. Result: Overall, parents (78%) perceived HPV vaccination to be of importance for their child’s health. About half of the participating children and two thirds of the parents had used the tailored information package for the HPV vaccination. The fact sheet was mostly used by parents (55%) and children (20%) and also perceived as easy to understand (99% and 68% respectively). For both children and parents, the school nurse (70% respectively) was the primary source for information. The teacher (59%) was also a common source of information of HPV vaccination for the children. Conclusion: The school nurse is essential for informing about HPV vaccination for both children and parents. There is a need to strengthen the knowledge regarding HPV vaccination among teachers as they also are a key source of information for the majority of the children. Additional interventions are needed to support parents in making informed decisions for HPV vaccinations.
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