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Promoting and Providing HPV Vaccination in Hawaii: Barriers Faced by Health Providers

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Abstract

Despite the availability of HPV prophylactic vaccines, uptake has been suboptimal in the US. In the state of Hawaii, HPV vaccine coverage has decreased among females and remains low among males aged 13–17. The reasons for low uptake are unknown and may indicate the existence of critical barriers to HPV vaccination. The purpose of this investigation was to identify policy, system and environmental barriers and promoters of pediatric HPV vaccination in Hawaii. An online 86-item survey addressing knowledge, attitudes, beliefs, practices, and barriers to HPV vaccination was distributed to practicing physicians in Hawaii specializing in Pediatrics, Family Medicine, and Obstetrics-Gynecology. Survey responses were received from a total of 120 physicians. Private practice physicians reported more concerns with vaccine ordering and stocking costs (p < 0.0001), reimbursement levels (p < 0.0001), and insurance coverage (p < 0.0001) compared to physicians in large group practices. Eighty-three percent of providers cited lack of parent knowledge and understanding of HPV infection as a barrier. Over half of physicians (58 %) reported that completion of the 3-dose schedule was a barrier. Most physicians did not use tracking or reminder systems to ensure dose completion. A majority (58 %) of providers cited the lack of school-based vaccination requirements as a barrier. Uptake of HPV vaccination in Hawaii may be impeded by physician perception of parent knowledge and attitudes. Cost-related system barriers are particular barriers among those in private practice. Completion of the 3-dose schedule also remains a challenge.

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Acknowledgments

The authors gratefully acknowledge Noel T. Brewer, Ph.D. of the University of North Carolina Chapel Hill and Susan Vadaparampil, Ph.D, MPH of the Moffitt Cancer Center for their scientific discussions and Steve Hankins, MD, MPH and Youngju Jeong, MS of the John A. Burns School of Medicine, John Baleix MD, MPH, and Teresa Michaud for their technical contributions to the project.

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Authors and Affiliations

  1. Cancer Epidemiology Program, University of Hawaii Cancer Center, 701 Ilalo St., Honolulu, HI, 96813, USA

    Ashlyn Tom & Brenda Y. Hernandez

  2. Prevention and Control Program, University of Hawaii Cancer Center, Honolulu, HI, 96813, USA

    Hali Robinett

  3. Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, 96813, USA

    Lee Buenconsejo-Lum

  4. Department of Obstetrics, Gynecology and Women’s Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, 96813, USA

    Reni Soon

  5. The American Academy of Pediatrics (Hawaii Chapter), Honolulu, HI, 96813, USA

    Michael Hamilton

  6. Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, 96813, USA

    Pia Francisco-Natanauan

  7. Imi Hale Native Hawaiian Cancer Network, Honolulu, HI, 96813, USA

    May Rose Dela Cruz

  8. Immunization Branch, Hawaii State Department of Health, Honolulu, HI, 96813, USA

    Ronald Balajadia

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  1. Ashlyn Tom
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Correspondence to Brenda Y. Hernandez.

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The authors have no financial disclosures or conflicts of interest to report.

Funding Sources

This project is supported by the National Cancer Institute, Grant number 3 P30 CA071789-15S4.

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Tom, A., Robinett, H., Buenconsejo-Lum, L. et al. Promoting and Providing HPV Vaccination in Hawaii: Barriers Faced by Health Providers. J Community Health 41, 1069–1077 (2016). https://doi.org/10.1007/s10900-016-0191-9

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  • DOI: https://doi.org/10.1007/s10900-016-0191-9

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