Successful Multi-Level HPV Vaccination Intervention at a Rural Healthcare Center in the Era of COVID-19

Deanna Kepka, Kaila Christini, Emily McGough, Anna Wagner, Guilherme Del Fiol, Bryan Gibson, Shauna Ayres, Heather M Brandt, Sara Mann, Amanda F Petrik, Gloria D Coronado, Deanna Kepka, Kaila Christini, Emily McGough, Anna Wagner, Guilherme Del Fiol, Bryan Gibson, Shauna Ayres, Heather M Brandt, Sara Mann, Amanda F Petrik, Gloria D Coronado

Abstract

Objectives: To develop and test a human papillomavirus (HPV) vaccination intervention that includes healthcare team training activities and patient reminders to reduce missed opportunities and improves the rate of appointment scheduling for HPV vaccination in a rural medical clinic in the United States. Methods: The multi-level and multi-component intervention included healthcare team training activities and the distribution of patient education materials along with technology-based patient HPV vaccination reminders for parents/caregivers and young adult patients. Missed vaccination opportunities were assessed pre- and post-intervention (n = 402 and n = 99, respectively) by retrospective chart review and compared using Pearson χ2. The patient parent/caregiver and young adult patient population (n = 80) was surveyed following the reminder messages and penalized logistic regression quantified unadjusted odds of scheduling a visit. Results: Missed opportunities for HPV vaccination declined significantly from the pre-intervention to the post-intervention period (21.6 vs. 8.1%, respectively, p = 0.002). Participants who recalled receipt of a vaccination reminder had 7.0 (95% CI 2.4-22.8) times higher unadjusted odds of scheduling a visit compared with those who did not recall receiving a reminder. The unadjusted odds of confirming that they had scheduled or were intending to schedule a follow-up appointment to receive the HPV vaccine was 4.9 (95% CI 1.51-20.59) times greater among those who had not received the vaccine for themselves or for their child. Conclusions: Results from this intervention are promising and suggest that vaccination interventions consisting of provider and support staff education and parent/caregiver and patient education materials, and reminders can reduce missed opportunities for vaccinations in rural settings.

Keywords: HPV vaccination; healthcare team training; intervention–behavioral; missed opportunities; patient education; rural; text reminders; visit reminder.

Conflict of interest statement

DK receives a small portion of her salary from a grant that is provided and supported by the American Cancer Society, who received funding from Merck, for the purpose of the “Mission: HPV Cancer Free Quality Improvement Initiative.” EM receives a small portion of her salary from a memorandum of understanding with the Huntsman Cancer Institute. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Kepka, Christini, McGough, Wagner, Del Fiol, Gibson, Ayres, Brandt, Mann, Petrik and Coronado.

Figures

Figure 1
Figure 1
Pre- and post-intervention survey of encountered HPV vaccination barriers among providers and support staffa with percent point changeb. Legend of survey questions and statements of barriers to vaccination.

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