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Quantitative Research Article Critique of the Determinants of Human Papillomavirus Among U.S. Navy Personnel
Nadia Miller and Kevana Smith
Clayton State University School of Nursing
Quantitative Research Article Critique of the Determinants of Human Papillomavirus Among U.S. Navy Personnel
According to the Center for Disease Control, human papillomavirus is the most common sexually transmitted infection impacting over 79 million Americans (Control, n.d.). Most of those infected are in their late teens and early twenties. HPV is known to cause genital warts and reproductive cancers. Research studies support that HPV is more common amongst United States Navy personnel than in United States civilians. Buechel and Connelly aimed to analyze and identify the determinants that increase the odds of HPV vaccination among U.S. Navy personnel who are candidates for the vaccine.
The study included 233 participants between the ages of 18-26. Of the 233 participants, 174 were male and 59 were female. All participants were active military personnel enlisted in the United States Navy. The determining factors were analyzed through a modified version of a survey that was originally created by Waller, Ostini, Marlow, McCaffery and Zimet to assess the participant’s knowledge about the HPV vaccination. The original survey was modified to include a 29-item scale that addressed the participant’s knowledge of HPV. Within the 29 HPV knowledge questions; 16 items addressed general knowledge, 6 items addressed testing knowledge and 7 items addressed vaccination knowledge. The original survey was modified to make the survey applicable to the U.S. Navy personnel.
A binominal logistic regression analysis was used to identify the determining factor of HPV vaccination among navy personnel. Post analysis revealed that women were 4.52 times likely than men to be vaccinated for HPV. Hearing about the vaccination from a health care provider, media, and internet increased the odds of receiving the vaccination. Belief that the COC recommended the vaccination also increased the odds for vaccination.
Development of Study
The problem of this study addressed a lack of information regarding the factors that contributed to U.S. Navy personnel’s decision to receive or not receive the HPV vaccination as well as how those decisions affect the prevalence of HPV in U.S. navy personnel. This problem has a high clinical significance because of the morbidities that accompany HPV, which include reproductive cancers and fertility issues. The problem is feasible, as it can be addressed through a quantitative nonexperimental research study with cross sectional and descriptive design. The problem is justified as there is a gap in knowledge regarding the HPV vaccinations and prevalence in the U.S. Navy.
Throughout the article it was mentioned that “Factors associated with increased HPV vaccine intention rates nationally include greater HPV knowledge, race, and gender” (Bendik, Mayo, & Parker, 2011; Danial-Ulloa, Gilbert, & Parker, 2016). It was also noted that HPV vaccination rates were higher in females than in males of the general population. The results of this study are supported by the literature that was reviewed for this article. There was no mention of theoretical or conceptual framework for this study.
Purpose Statement1
The purpose of this study was to identify the determinants that increase the odds of HPV vaccinations amongst U.S. Navy personnel ages 18 through 26. The purpose fits with the identified problem because the aim is to reduce the rates of HPV infections amongst U.S. military personnel. The purpose statement included all of the necessary components of the PICO question. The population consisted of U.S. Navy personnel ages 18 through 26. The area of interest was to identify determinants that increase the odds of HPV among U.S. Navy personnel. There was no legitimate comparison identified in this study.
Variables.
There were nine independent variables addressed in study. The variables consisted of being deployed in the last three years, gender, heard about HPV testing, HPV knowledge self-rating, where one heard about HPV vaccines, HPV general knowledge, HPV testing knowledge and HPV vaccine knowledge. The dependent variable was the HPV vaccination. Confounding variables include the mood of the participants and whether they genuinely wanted to participate in the study, or if they were participating because they were instructed to do so by higher ranking personnel. Also, the participants could have been tired or not fully able to understand the questions that were being asked of them. Extraneous variables include the participant’s religion, mental status, cultural background, ethnic background and internal as well as external stressors. There is a causal relationship between the HPV vaccination and the prevalence of HPV among U.S. Navy personnel. However, this causal relationship does not determine the cause or specific reasons why the prevalence is higher in the military population versus the civilian population..
Research Question/ Hypothesis.
The authors did not state a research question or hypothesis in the study. However, the purpose of the study addressed the main research question which is: What are the determinants that increase the odds of HPV vaccination among U.S. Navy personnel? Based on the review of literature and study results the hypothesis would state: Determinants that increase the odds of HPV vaccination among U.S. Navy personnel include gender, HPV vaccine knowledge, where one heard about HPV vaccine, and belief that COC recommends the HPV vaccine.
Research Design.
“A prospective, descriptive and cross-sectional design was used in this study” (Buechel & Connelly, 2018). The researchers used a prospective study design to determine what causes military personnel to get the HPV vaccination and then analyze how vaccination rates effect the prevalence of HPV infections in the U.S. Navy personnel. The researcher used a descriptive research design to describe how the occurrence of HPV infections relates to variables such as knowledge of the HPV vaccination, general knowledge of HPV, and whether or not the participant had heard of the HPV vaccination. The researcher’s intentions were to only collect and describe the data obtained from the study. No conclusions were made with the data that was collected. Lastly, the research design was cross-sectional, with data collected only in June through October 2015. Data collection was completed in Japan and the United States from both active duty and activated reservists.
The design used in the study was not the strongest design that the researchers could have used. The strongest design is a randomized control trial. The researchers did not use a RCT design because there aim was to observe and gather information to fill the gap in knowledge about HPV and military personnel. While, a randomized control would have required experimental manipulation to test the theory that the independent variables had an effect on the outcomes of the study. The authors did not indicate that the design used was the strongest design that could have been used for the study. The study was also weakened by the small size of the sample. The sample size consisted of 233 participants from the Navy branch of the U.S. military active duty and activated reservists between the ages of 18 through 26. The sample size reduced the generalizability of the study.
Strategies were implemented to reduce biases and threats to internal validity. The researchers observed a diverse population of Navy personnel, provided anonymity, and used survey styles that provided privacy to participants, so they could answer honestly without fear of repercussions. Researchers also modified the questions in the survey to make them more applicable to the U.S. Navy personnel.
The target population for this research study was U.S. Navy personnel with active duty and active reservist status. The participants were between the ages of 18 and 26 and serving in active status for at least the past 6 months. The study took place in the United States and Japan; specifically, with personnel who were stationed to the Commander, Naval Surface Force, U.S. Pacific Fleet (COMNAVSURFPAC).
Participants for the study were recruited via numerous measures including email invitations, flyers, posters, intranet, command newspapers, information cards, command announcements and in person recruitment at subordinate commands and military facilities. The personnel who expressed interest in participating in the study were contacted with an Internal Review Board approved email or flyer with the information needed to complete the anonymous electronic survey. Of the personnel who expressed interest, 233 participants were recruited to participate in the study. The inclusion criteria mandated that the participants be between the ages of 18 to 26 and be in active military status for at least 6 months. The article did not provide information on exclusion criteria or how many participants dropped out of the study and why.
During the study data was collected through an internet survey, Max Survey, a web design that is approved by the Department of Defense. Participants were provided with instructions via email or flyer on how to access the anonymous web survey. The instrument used for this study was a modified version of a survey that was created by Waller, Ostini, Marlow, McCaffery and Zimet in 2013. The survey aimed to assess the participant’s knowledge of HPV. The survey was modified to ensure the questions were applicable to the U.S. Navy population. Some omitted questions include “What type of health insurance do you have? How many of your children have gotten at least one dose of the HPV vaccine?” (Buechel & Connelly, 2018). Questions such as these are not applicable to the population that was being surveyed. However, adding questions such as “Does the COC recommend the HPV vaccine?” (Buechel & Connelly, 2018) would prove to be a major determining factor of the survey outcomes. Advantages to the chosen method of data collection via electronic survey include anonymity, lowered costs, greater privacy, and a reduction in interviewer bias.
The survey results measured 7 variables including (1) knowledge regarding the health consequences of HPV, (2) HPV and cancer screening, (3) symptoms of HPV, (4) causes, risks and transmission mechanisms, (5) prevention and treatment, (6) prevalence, and (7) testing and vaccination. Adequate reliability on classical test theory indices was found in the 29 and 16 item scales assessing general HPV knowledge. Alternately, “subscales of HPV testing and vaccination items showed reasonable test-retest reliability but low internal consistency” (Buechel & Connelly, 2018). The study used a nominal level of measurement, as gender was a measured variable.
Descriptive, bivariate and inferential statistical analysis was used in this study. The researchers implemented nonparametric test where deemed appropriate. Bivariate analysis revealed that there is a correlational relationship between HPV vaccination and vaccine knowledge, gender, where the participants heard about the vaccination and whether they believed that the COC recommended that they receive the vaccination. In total, all predictor models presented with p-values of <.001, with a level of significance set to p=<.05 and variable significance set to p=<.01. P=<.001 reveals that the result is statistically significant, and we reject the null hypothesis. The statistics used in the study were appropriate for the level of measurement and for the nominal variables used in the study. The statistics consisted of empirical data collected from characteristics that that were divided into unordered categories.
References
Buechel, J. J., & Connelly, C. D. (2018). Determinants of Human Papillomavirus Vaccination Among U.S. Navy Personnel. Nursing Research, 67(4), 341-346.
Control, U. C. (n.d.). STD facts – Human papillomavirus (HPV). Retrieved 10 24, 2018, from Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/STD/HPV/STDFact-HPV.htm
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