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This paper is a precise review of a quantitative research study. It contains five major sections, viz. the background of the study, methods used, results from data analysis, discussion of the findings, and summary of the article. The background of the study presents the statement of the research problem and the justification of the study. The methods section discusses the research design used, while under “results” the findings are indicated. The discussion part explores the findings of the study and how they could be applied in practice. The final section is a summary of the overall presentation of the study.
The research problem is not stated clearly in the paper. However, it could be deduced from the introduction to be – what are the proportions and the trends of adolescent girls in the United States (US) receiving human papillomavirus (HPV) vaccine? HPV comes in different strains, which cause about 99.7 percent of cervical cancer cases and a myriad of other health complications, such as anal, vaginal, and vulvar cancers. Taking the HPV vaccine plays a major role in the prevention of these cancers among women. Therefore, this problem is significant to nursing because by knowing the number of teenagers taking this preventive measure and the associated trends, nurses could predict the level of risk of teenagers developing such cancers in the future. As such, nurses could plan on mitigation measures such as educating the public on the need to have the vaccine or lobbying for policymakers to make policies that promote prevention strategies.
This study is justified because, at the time of its publication, the proportion and trends of teenage girls in the US taking the HPV vaccine were unknown. Therefore, it was important for the study to be carried out because the findings would indicate the vaccination status around the country and allow nurses and other healthcare providers to plan effectively on ways of combating cervical and other related cancers caused by the virus. The study’s objective is clearly stated – “To examine the trend of provider-verified HPV vaccine initiation (≥1 dose) and completion (≥3 doses) among adolescent girls at the Advisory Committee on Immunization Practices (ACIP) recommended age (11-12 years)” (Rahman, McGrath, Hirth, & Berenson, 2014, p. 585).
The authors did not indicate any theoretical or conceptual framework for the study. However, it could be implied that by understanding the trends and the number of vaccinated teenage girls, healthcare providers and policymakers would plan better as a way of dealing with the cervical cancer epidemic. This understanding links the framework directly to the research purpose. This study was published in 2015, and the literature review section is missing. Some of the reference materials used in the paper are old, while others are current. The oldest one was published in 1999 and the recent one in 2014. As mentioned earlier, the literature review section is missing. However, the information given in the introduction adequately supports the need for the study.
The authors used a descriptive study design, which involved the analysis of routinely collected data on the number and the age of initiation when teenage girls in the US were vaccinated against HPV between 2008 and 2012. The design fitted the purpose of the study as it involved analyzing collected data from the National Immunization Survey–Teen (NIS–Teen) from 2008 to 2012. Besides, this study design is non-interventional, and thus it only interprets data as presented from other studies. The design is linked to the sampling method, which involved the number of teenagers in the US vaccinated against HPV, and the statistical analysis, viz. descriptive statistics.
The sample size was 40,438 teenage girls vaccinated against HPV in the US between 2008 and 2012. Out of the 40,438 participants, 24,466 had their vaccination data verified by their providers at the time of initiating the vaccination, and 15,972 completed the 3 or more doses. Therefore, the sample is adequately and clearly described in the article. Additionally, the sampling procedure was discussed in detail. The final sample that was used for statistical analysis was obtained from participants whose vaccination details had been verified by their providers. For instance, the available data from the NIS–Teen showed that 77,062 and 51,285 girls had started and completed the vaccination program respectively. However, only 24,466 and 15,972 girls started and completed the HPV vaccination respectively and their details were verified by their providers. Therefore, the latter (with provider-verified information) data was used for the final statistical analysis. Given the nature of the data used in this study, the study protocols were not needed because the information was obtained from the NIS-Teen database. However, the authors explained how such data was collected. Before 2011, data were collected using landline interviews. However, between 2011 and 2012, both cellphone and landline interviews were used for data collection.
The instruments mentioned in the paper are the interviews used to collect the data entered in the NIS–Teen, which was used for the current study. The instrument does not measure the concept it is intended to measure, and the authors did not indicate information on its reliability and validity. To reduce threats to internal and validity that are inherent in the study design, the authors estimated standard errors using Taylor series linearization. Besides, the unequal probabilities of sample selection were adjusted using STATA 12 svy commands. There is no evidence provided regarding the human subject’s review and approval. Similarly, the authors did not indicate any ethical concerns. However, based on the nature of the study and the source of data, such requirements may not be applicable. Finally, the study is described with enough detail for replication.
The characteristic of the sample is described by the number of participants who started and those that completed the vaccination dosage. The participants are described by their age and the year when they started and finished the HPV vaccination. For instance, the number of girls, aged less than 13 years, who started the vaccination in 2008, was 14.1 percent. 24.1 percent, 35.9 percent, 47.7 percent, and 55.9 percent started the vaccination in 2009, 2010, 2011, and 2012 respectively. A similar trend was also observed in the number of those that completed the vaccination protocol between 2008 and 2012. Therefore, the types of data collection involved the age of the girls selected girls and the year when they started and completed the vaccination.
The research questions were not answered separately. The authors used multiple linear and logistic regression analyses to determine the trends of vaccination initiation and completion together with the number of girls receiving the HPV vaccination. The data were presented using bar graphs to indicate the percentage of girls aged less than 13 years that initiated the vaccine plotted against the year of vaccination. The bar graphs also captured data on three different races – Hispanics, non-Hispanic White, and non-Hispanic Black. In summary, the text supplements and repeats the data in the bar graph. The findings indicated that the percentage of girls aged less than 13 years that received the HPV vaccine rose from 14.1 percent in 2008 to 55.9 percent in 2012. The same trend was observed in the number of girls who completed the vaccination program by taking three or more doses. The trend did not differ based on the participants’’ race or ethnicity.
Discussion/Implications for Practice
The author relates the findings to the study purpose. The main objective was to establish the proportion of girls in the US who received HPV vaccination before the recommended age of 13 years. Besides, the authors sought to establish the trend of these vaccinations from 2008 to 2012. The findings of this study are consistent with other research works indicating that most girls did not start the vaccination at the recommended age of fewer than 13 years. The authors also discussed the findings that conflict with previous works. For instance, one study had indicated that most girls started the HPV vaccination between the ages of 11 and 12 years. However, this study relied on data collected from 7 states in the US, and thus the results were not representative of all other states in the country. As such, the data could not be generalized or extrapolated in other set-ups across the country.
The study had one major limitation – the potential bias that remained especially after NIS–Teen started collecting data using both cellphones and landlines in 2012. From this study, new research emerged on ways through which parents and providers could be encouraged to start administering the HPV vaccine before the age of 13, which is recommended by the Advisory Committee on Immunization Practices (ACIP). The findings of this research are highly useful in nursing practice. It was established that over 50 percent of teenage girls start taking the HPV vaccine between the ages of 13 and 17 years. This trend is worrying because initiating the vaccination after the age of 13 years increases the probability of developing cervical cancer. Therefore, nurses should come up with strategies to educate parents and providers on the need to start the vaccination at the right time for positive health outcomes. Consequently, the mortality and morbidity rates caused by cervical cancer and other related health conditions would be reduced significantly.
Overall Presentation and Final Summary
The title accurately describes the type of study, major variables, and the target population. For example, from the title, a reader could tell that the study investigated the age at which teenage girls in the US started and completed HPV vaccination between 2008 and 2012. The abstract also represents the study accurately. For example, the abstract states the objective, methods, results, and conclusions drawn from the study. By looking at the abstract alone, a reader gets a complete picture of what the study investigated and how the paper is structured. Similarly, the report is logically consistent as the author’s transition from one section to another with clearly labeled sub-topics such as introduction, methods, results, and discussion. Finally, the writing is clear and concise. The information is presented in a simple and intelligible style. The results are shown clearly with the aid of bar graphs. Overall, the paper meets the basic requirements of a scientific study.
Rahman, M., McGrath, C. J., Hirth, J. M., & Berenson, A. B. (2015). Age at HPV vaccine initiation and completion among US adolescent girls: Trend from 2008 to 2012. Vaccine, 33(5), 585-587.