Health Care Providers' Knowledge of HPV Vaccination, Barriers, and Strategies in a State With Low HPV Vaccine Receipt: Mixed-Methods Study

Echo L Warner, Qian Ding, Lisa Pappas, Julia Bodson, Brynn Fowler, Ryan Mooney, Anne C Kirchhoff, Deanna Kepka, Echo L Warner, Qian Ding, Lisa Pappas, Julia Bodson, Brynn Fowler, Ryan Mooney, Anne C Kirchhoff, Deanna Kepka

Abstract

Background: Human papillomavirus (HPV) vaccination is below national goals in the United States. Health care providers are at the forefront of improving vaccination in the United States, given their close interactions with patients and parents.

Objective: The objective of this study was to assess the associations between demographic and practice characteristics of the health care providers with the knowledge of HPV vaccination and HPV vaccine guidelines. Furthermore, our aim was to contextualize the providers' perceptions of barriers to HPV vaccination and strategies for improving vaccination in a state with low HPV vaccine receipt.

Methods: In this mixed-methods study, participating providers (N=254) were recruited from statewide pediatric, family medicine, and nursing organizations in Utah. Participants completed a Web-based survey of demographics, practice characteristics, HPV vaccine knowledge (≤10 correct vs 11-12 correct answers), and knowledge of HPV vaccine guidelines (correct vs incorrect). Demographic and practice characteristics were compared using chi-square and Fisher exact tests for HPV knowledge outcomes. Four open-ended questions pertaining to the barriers and strategies for improving HPV vaccination were content analyzed.

Results: Family practice providers (52.2%, 71/136; P=.001), institutional or university clinics (54.0%, 20/37; P=.001), and busier clinics seeing 20 to 29 patients per day (50.0%, 28/56; P=.04) had the highest proportion of respondents with high HPV vaccination knowledge. Older providers aged 40 to 49 years (85.1%, 57/67; P=.04) and those who were a Vaccines for Children provider (78.7%, 133/169; P=.03) had the highest proportion of respondents with high knowledge of HPV vaccine recommendations. Providers perceived the lack of parental education to be the main barrier to HPV vaccination. They endorsed stronger, consistent, and more direct provider recommendations for HPV vaccination delivered to parents through printed materials available in clinical settings and public health campaigns. Hesitancy to recommend the HPV vaccine to patients persisted among some providers.

Conclusions: Providers require support to eliminate barriers to recommending HPV vaccination in clinical settings. Additionally, providers endorsed the need for parental educational materials and instructions on framing HPV vaccination as a priority cancer prevention mechanism for all adolescents.

Keywords: health care provider; human papillomavirus; human papillomavirus vaccine; knowledge; mixed methods.

Conflict of interest statement

Conflicts of Interest: None declared.

©Echo L Warner, Qian Ding, Lisa Pappas, Julia Bodson, Brynn Fowler, Ryan Mooney, Anne C Kirchhoff, Deanna Kepka. Originally published in JMIR Cancer (http://cancer.jmir.org), 11.08.2017.

References

    1. NIH. Bethesda, MD: National Cancer Institute; 2014. [2017-01-17]. Accelerating HPV vaccine uptake: urgency for action to prevent cancer: a report to the President of the United States from the President's cancer panel .
    1. Ylitalo KR, Lee H, Mehta NK. Health care provider recommendation, human papillomavirus vaccination, and race/ethnicity in the US National Immunization Survey. Am J Public Health. 2013 Jan;103(1):164–9. doi: 10.2105/AJPH.2011.300600.
    1. AAFP. [2016-07-18]. Give a strong recommendation for HPV vaccine to increase uptake! .
    1. Healthypeople. Atlanta, GA: Centers for Disease Control and Prevention; [2014-05-23]. Healthy people 2020 topics & objectives .
    1. Kahn JA, Zimet GD, Bernstein DI, Riedesel JM, Lan D, Huang B, Rosenthal SL. Pediatricians' intention to administer human papillomavirus vaccine: the role of practice characteristics, knowledge, and attitudes. J Adolesc Health. 2005 Dec;37(6):502–10. doi: 10.1016/j.jadohealth.2005.07.014.
    1. Leddy MA, Anderson BL, Gall S, Schulkin J. Obstetrician-gynecologists and the HPV vaccine: practice patterns, beliefs, and knowledge. J Pediatr Adolesc Gynecol. 2009 Aug;22(4):239–46. doi: 10.1016/j.jpag.2008.09.002.
    1. Perkins RB, Clark JA. Providers' attitudes toward human papillomavirus vaccination in young men: challenges for implementation of 2011 recommendations. Am J Mens Health. 2012 Jul;6(4):320–3. doi: 10.1177/1557988312438911.
    1. Lai D, Ding Q, Bodson J, Warner EL, Kepka D. Factors associated with increased HPV vaccine use in rural-frontier U.S. states. Public Health Nurs. 2016 Jul;33(4):283–94. doi: 10.1111/phn.12223.
    1. CDC. [2016-10-18]. Human papillomavirus (HPV) vaccination coverage among adolescents 13-17 years by State, HHS Region, and the United States, National Immunization Survey-Teen (NIS-TEEN), 2015 .
    1. Kepka D, Spigarelli M, Warner EL, Yoneoka Y, McConnell N, Balch A. Statewide analysis of missed opportunities for human papillomavirus vaccination using vaccine registry data. Papillomavirus Res. 2016 Dec;2:128–32. doi: 10.1016/j.pvr.2016.06.002.
    1. Stewart K. Sltrib. Salt Lake City, Utah: Salt Lake Tribune; 2013. [2017-01-17]. Utah health official bans Gardasil, stirring controversy .
    1. McRee A, Gilkey MB, Dempsey AF. HPV vaccine hesitancy: findings from a statewide survey of health care providers. J Pediatr Health Care. 2014;28(6):541–9. doi: 10.1016/j.pedhc.2014.05.003.
    1. Stokols D. Translating social ecological theory into guidelines for community health promotion. Am J Health Promot. 1996;10(4):282–98.
    1. Zhang W, Creswell J. The use of “mixing” procedure of mixed methods in health services research. Med Care. 2013 Aug;51(8):e51–7. doi: 10.1097/MLR.0b013e31824642fd.
    1. Morse J, Niehaus L. Mixed Method Design: Principles and Procedures (Developing Qualitative Inquiry) New York, NY: Left Coast Press; 2009. pp. 1–194.
    1. Riedesel JM, Rosenthal SL, Zimet GD, Bernstein DI, Huang B, Lan D, Kahn JA. Attitudes about human papillomavirus vaccine among family physicians. J Pediatr Adolesc Gynecol. 2005 Dec;18(6):391–8. doi: 10.1016/j.jpag.2005.09.004.
    1. Rosenblatt RA, Hart LG. Physicians and rural America. West J Med. 2000 Nov;173(5):348–51.
    1. Moss JL, Gilkey M, Rimer B, Brewer N. Disparities in collaborative patient-provider communication about human papillomavirus (HPV) vaccination. Hum Vaccin Immunother. 2016 Jun 02;12(6):1476–83. doi: 10.1080/21645515.2015.1128601.
    1. Dempsey AF, Zimet GD, Davis RL, Koutsky L. Factors that are associated with parental acceptance of human papillomavirus vaccines: a randomized intervention study of written information about HPV. Pediatrics. 2006 May;117(5):1486–93. doi: 10.1542/peds.2005-1381.
    1. Gilkey MB, Malo TL, Shah PD, Hall ME, Brewer NT. Quality of physician communication about human papillomavirus vaccine: findings from a national survey. Cancer Epidemiol Biomarkers Prev. 2015 Nov;24(11):1673–9. doi: 10.1158/1055-9965.EPI-15-0326.
    1. Gilkey MB, Calo WA, Moss JL, Shah PD, Marciniak MW, Brewer NT. Provider communication and HPV vaccination: the impact of recommendation quality. Vaccine. 2016 Feb 24;34(9):1187–92. doi: 10.1016/j.vaccine.2016.01.023.
    1. Vadaparampil ST, Kahn JA, Salmon D, Lee J, Quinn GP, Roetzheim R, Bruder K, Malo TL, Proveaux T, Zhao X, Halsey N, Giuliano AR. Missed clinical opportunities: provider recommendations for HPV vaccination for 11-12 year old girls are limited. Vaccine. 2011 Nov 03;29(47):8634–41. doi: 10.1016/j.vaccine.2011.09.006.
    1. Daley MF, Crane LA, Markowitz LE, Black SR, Beaty BL, Barrow J, Babbel C, Gottlieb SL, Liddon N, Stokley S, Dickinson LM, Kempe A. Human papillomavirus vaccination practices: a survey of US physicians 18 months after licensure. Pediatrics. 2010 Sep;126(3):425–33. doi: 10.1542/peds.2009-3500.

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