Abstract
Provider recommendation for the HPV vaccine is considered a critical determinant of vaccine uptake compared to other interventions such as parent education. However, providers cite continued barriers to discuss the vaccines with parents including sexual concerns and other misconceptions. The purpose of this mixed methods study was to evaluate physician knowledge and comfort discussing the vaccine with parents and perceived barriers to vaccine uptake among pediatric residents and attending physicians at a university-affiliated county health clinic. Physicians completed surveys guided by HPV Roundtable information to assess HPV vaccine knowledge, comfortability, and parental barriers to administration. A total of 28 pediatric physicians (20 residents and 8 attendings) completed the survey. HPV vaccine knowledge was high among providers in this study, with 75% of providers reporting high confidence. The majority of physicians in this study reported being comfortable or very comfortable talking to parents about the HPV vaccine (82.1%), recommending the HPV vaccine (89.3%), and recommending the HPV vaccine specifically to hesitant parents (82.1%). Attendings were more comfortable than residents talking to (p = .009) and recommending the vaccine to parents (p = .002). However, physicians reported parents’ sexual concerns, vaccine safety, and misconceptions as the predominant barriers. These findings suggest that persistent stigma about the HPV vaccine as prevention for sexually transmitted infection, rather than the HPV vaccine as cancer prevention persist. Findings from this study suggest the need for HPV vaccine education for parents and provider training on targeted communication strategies.
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Data Availability
The data used to support findings of this study are available from the corresponding author, [SF], and are upon reasonable request.
References
Chido-Amajuoyi OG, Jackson I, Yu R, Shete S (2020) Declining awareness of HPV and HPV vaccine within the general US population. Hum Vaccin Immunother 17(2):420–427. https://doi.org/10.1080/21645515.2020.1783952
Sriram S, Ranganathan R (2019) Why human papilloma virus vaccination coverage is low among adolescents in the US? A study of barriers for vaccination uptake. J Fam Med Primary Care 8(3):866. https://doi.org/10.4103/jfmpc.jfmpc_107_19
Gravitt PE (2011) The known unknowns of HPV natural history. J Clin Invest 121(12):4593–4599. https://doi.org/10.1172/JCI57149
Munoz N, Castellsague X, Berrington de Gonzales A, Lutz G (2006) Chapter 1 HPV in the etiology of human cancer. Vaccine 24(3):S1–S10. https://doi.org/10.1016/j.vaccine.2006.05.115
Centers for Disease Control and Prevention. Cancers Associated with Human Papillomavirus, United States—2014–2018. USCS Data Brief, no. 26. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2021.
National Cancer Institute Surveillance, Epidemiology, and End Results Program (SEER) Cancer Stat Facts. Accessed September 1, 2022 at SEERCancerStatFacts
NCI Staff. Study confirms HPV vaccine prevents cervical cancer - national cancer institute. www.cancer.gov. Published October 14, 2020. https://www.cancer.gov/news-events/cancer-currents-blog/2020/hpv-vaccine-prevents-cervical-cancer-sweden-study
HPV | Understanding HPV coverage | CDC. www.cdc.gov. Published October 18, 2018. https://www.cdc.gov/hpv/partners/outreach-hcp/hpv-coverage.html
Torjesen I (2019) HPV vaccine: high coverage could eradicate cervical cancer within decades, say researchers. BMJ 365:l44-150. https://doi.org/10.1136/bmj.l4450.pmid:31248937
Basu P, Hutubessy, R, Broutet N (2019) Cervical cancer: WHO called for elimination, not eradication. BMJ 366. https://doi.org/10.1136/bmj.l5668
National HPV Roundtable – The official website of the National HPV Vaccination Roundtable. https://hpvroundtable.org/. Accessed 15 Aug 2022
Healthy People - HP2020 - Progress review - Immunization and infectious disease and global health. Published 2019. Accessed December 4, 2019. https://www.cdc.gov/nchs/healthy_people/hp2020/hp2020_iid_gh_progress_review.htm
Oh NL, Biddell CB, Rhodes BE, Brewer NT (2021) Provider communication and HPV vaccine uptake: a meta-analysis and systematic review. Prev Med 148:106554. https://doi.org/10.1016/j.ypmed.2021.106554
Nguyen KH, Santibanez TA, Stokley S (2021) Parental vaccine hesitancy and its association with adolescent HPV vaccination. Vaccine. Published online March 2021. https://doi.org/10.1016/j.vaccine.2021.03.048
Rositch AF (2022) Levels of parental human papillomavirus vaccine hesitancy and their reasons for not intending to vaccinate: insights from the 2019 national immunization survey-teen. J Adoles Health. https://doi.org/10.1016/j.jadohealth.2022.01.223
Fisher RA (1954) Statistical methods for research workers Oliver and Boyd
Williams M, Moser T (2019) The art of coding and thematic exploration in qualitative research. Int Manage Rev 15(1):45–55. http://www.imrjournal.org/uploads/1/4/2/8/14286482/imr-v15n1art4.pdf. Accessed 15 Aug 2022
O’Leary ST, Allison MA, Stokely S, Crane L, Hurley, Beatty B, Kempe A (2013) Physicians’ confidence in vaccine safety studies. Prev Med 56(3–4):231–233. https://doi.org/10.1016/j.ypmed.2013.01.001
Bednarczyk RA, Davis R, Ault K, Orenstein W (2012) Sexual activity–related outcomes after human papillomavirus vaccination of 11- to 12-year-olds. Pediatrics 130(5):798–805. https://doi.org/10.1542/peds.2012-1516
Brouwer AF, Delinger RL, Eisenberg MC (2019) HPV vaccination has not increased sexual activity or accelerated sexual debut in a college-aged cohort of men and women. BMC Public Health 19:821. https://doi.org/10.1186/s12889-019-7134-1
Bylund CL, Thompson LA, Hansen M et al (2022) A pilot test of a workshop for pediatric clinicians about communicating with parents about the HPV vaccine using the C-LEAR approach. J Canc Educ. https://doi.org/10.1007/s13187-022-02188-2
Reno JE, Thomas J, Pyrzanowski J, Lockhart S, O’Leary ST, Campagna EJ, Dempsey AF (2019) Examining strategies for improving healthcare providers’ communication about adolescent HPV vaccination: evaluation of secondary outcomes in a randomized controlled trial. Hum Vaccin Immunother 15(7–8):1592–1598. https://doi.org/10.1080/21645515.2018.1547607
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Dickson, T., Hirko, K.A. & Ford, S. Provider Confidence and Perceived Barriers when Recommending the Human Papillomavirus Vaccine to Parents. J Canc Educ 38, 1193–1199 (2023). https://doi.org/10.1007/s13187-022-02248-7
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DOI: https://doi.org/10.1007/s13187-022-02248-7