Health care providers' perspectives on low HPV vaccine uptake and adherence in Appalachian Kentucky

Katharine J Head, Robin C Vanderpool, Laurel A Mills, Katharine J Head, Robin C Vanderpool, Laurel A Mills

Abstract

Objective: Previous intervention research conducted in Appalachian Kentucky resulted in extremely low uptake and adherence to the human papillomavirus (HPV) vaccine among women ages 18-26, despite provision of free vaccine. Because of these findings, the purpose of this qualitative, follow-up study was to elicit health care providers' perspectives on barriers and facilitators to HPV vaccination and suggested strategies for improving vaccination rates.

Design and sample: Researchers conducted semi-structured qualitative interviews with a purposive sample of eight health care providers (seven nursing professionals, one physician) at the health clinic where the original HPV vaccination intervention took place. Interviews were audio-recorded and transcribed and authors used a constant-comparative method to analyze the data.

Results: Significant themes emerged from the interviews, centering around two primary issues: vaccine uptake and vaccine adherence. Related to uptake, health care providers identified perceived patient barriers and inadequate HPV vaccine education. They also identified the vaccine schedule and clinic-centered communication deficiencies as adherence-related barriers.

Conclusion: These Appalachian Kentucky health care providers provided important insights into barriers and facilitators to HPV vaccine uptake and adherence that need to be readily addressed in this community. As informed by these providers, several suggestions for improving HPV vaccination, such as more targeted education efforts and patient-centered reminder systems, may be applicable to other nursing professionals working in rural and medically underserved communities.

Keywords: cancer; health behaviors; immunization; perceptions; qualitative research; rural health; women's health.

© 2013 Wiley Periodicals, Inc.

Figures

Figure 1. Line Graph Originated by Crosby…
Figure 1. Line Graph Originated by Crosby et al. (2011)
Note: This line graph was presented to the clinicians as a topic of discussion during the in-depth interviews. Data represents initial uptake of dose 1 of the vaccine among those women recruited from the rural, FQHC, as well as subsequent receipt of doses 2 and 3. HPV vaccine receipt was tracked using redeemed free vouchers. While doses 2 and 3 should be given at 2 and 6 months, respectively, from dose 1, the intervention allowed for three extra months at each time point. Despite this time allowance and provision of free vaccine, the rates are strikingly low.

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