Māori suffer higher morbidity and mortality from cervical cancer than non-Māori, and also have lower vaccination rates of publicly funded vaccines than non-Māori. The HPV vaccine provides an exciting opportunity to prevent cervical cancers, but if Māori receive this vaccination less than non-Māori, cervical cancer inequalities for Māori will be further widened.
Aim. To consider the HPV vaccine from an inequalities and KMR-consistent perspective, and determine how the vaccine could be implemented in New Zealand to avoid increasing Māori:non-Māori inequalities in immunisation and cervical cancer.
Methods. (1) Critical literature review to identify strategies for improving vaccination coverage rates for Māori, and other indigenous/ethnic minority groups. (2) Quantitative analysis of school-based vaccination coverage data for 11 year olds in CMDHB—the HPV vaccine is recommended for adolescent girls, but there are no published data regarding vaccination coverage rates in this age group in New Zealand. (3) Health Equity Assessment Tool (HEAT) analyses of possible policy options for the HPV vaccine in New Zealand. (4) Key informant interviews with experts in fields such as Māori health, immunisation and policy-making to enhance analyses.
Results. There is insufficient evidence relating to Māori immunisation strategies in New Zealand, although attitudes do not appear to explain immunisation inequalities. Universal vaccination programmes have been more successful than targeted programmes for indigenous people elsewhere. Coverage of the 11 year old vaccinations through CMDHB's school based programme was 48% for Māori and 56% for non-Māori, with non-return of consent forms a major driver of lower coverage for Māori. There are a number of interventions which could make a publicly funded vaccination programme work better for Māori, including national and local awareness-raising targeted at Māori, a culturally appropriate and piloted consent form, providing sufficient time and information to enable parents to make a decision, and intensive culturally appropriate follow-up/outreach. Catch-up clinics should be built in to the programme from the start.
Conclusion. The HPV vaccine should be universally publicly funded for 11 year old girls, in conjunction with additional efforts targeted at Māori, to avoid immunisation and cervical cancer inequalities widening. The HPV vaccine should be delivered through a school-based programme, supported by database tracking of all children on school rolls, and with intensive, culturally-appropriate follow-up of children who do not have consent forms returned.
|Advisor:||Curtis, Elana Taipapaki|
|School:||The University of Auckland (New Zealand)|
|School Location:||New Zealand|
|Source:||MAI 48/05M, Masters Abstracts International|
|Subjects:||Public health, Public policy, Ethnic studies|
Copyright in each Dissertation and Thesis is retained by the author. All Rights Reserved
The supplemental file or files you are about to download were provided to ProQuest by the author as part of a
dissertation or thesis. The supplemental files are provided "AS IS" without warranty. ProQuest is not responsible for the
content, format or impact on the supplemental file(s) on our system. in some cases, the file type may be unknown or
may be a .exe file. We recommend caution as you open such files.
Copyright of the original materials contained in the supplemental file is retained by the author and your access to the
supplemental files is subject to the ProQuest Terms and Conditions of use.
Depending on the size of the file(s) you are downloading, the system may take some time to download them. Please be