Article Figures & Data
Tables
Clinician Characteristics No. (%) Sex, female 49 (50.0) Practice specialty Family physician 62 (63.3) Pediatrician 21 (21.4) Nurse practitioner 7 (7.1) Physician assistant 8 (8.2) Practice setting Community health center 29 (29.6) Indian Health Service 27 (27.6) Academic medical center 27 (27.6) Private practice 10 (10.2) School-based health center 1 (1.0) Other 4 (4.1) Domain Prelicensure (2004–2005) Postlicensure (2009–2012) HPV counseling in the clinical encounter High clinician receptivity
Low patient/parent HPV knowledge
Complexity of topic challenging
HPV infection counseling typically not part of guidance about STI preventionHigh clinician receptivity
High patient/parent receptivity
Low patient/parent HPV knowledge
Topic ever more complex with 2 competing vaccines and approval for boys
Framing of HPV vaccine as cancer prevention rather than STI preventionRecommended age Preference for vaccinating older adolescents
Topics discussed with younger girls different from older girls
Parents accompany younger adolescents to most primary care visits (though clinicians prefer them not to be present)Mixed results about age range that clinicians are comfortable vaccinating
Framing of HPV vaccine as cancer prevention rather than STI prevention (to get around discomfort of discussing sex with younger girls)
Challenges in talking about sex (avoidance of discussion), including parents being presentSystem and compliance issues Challenges speculated: Wide range of topics to cover
Time constraints
Getting adolescents to return for 2 subsequent doses within 6 month
Challenges borne out: Adolescents less likely to return for well-person visit
Wide range of topics to cover
Time constraints
Getting adolescents in for second and third shots difficult
Lack of knowledge about 6-month time frameExternal factors Anticipated impact of mass media advertising campaigns
Concern that diverse social or religious beliefs about sexual activity would influence acceptability; fear that adolescents would feel overprotectedMedia campaign influential, but brought awareness, not necessarily knowledge
Mandatory vaccination proposals generated controversy
Less concern about adolescent overprotection; responses to mandatory vaccination proposals negative
Bundling of HPV vaccine into adolescent platformHPV=human papillomavirus; STI=sexually transmitted infection.
Item Mean Range SD Attitudes about HIP vaccine 12. Compared with other vaccines, I prioritize the HPV vaccine 65.9 0–100 24.4 13. HPV vaccine offers the most benefit before intercourse 89.2 0–100 19.5 14. Is it worthwhile to give HPV vaccine after intercourse 75.0 0–100 26.2 Perceived influence on patient and/or parent decision making 15. Side effects 38.0 0–100 27.7 16. Duration of protection 35.9 0–100 29.6 17. Adolescents feel overprotected and more likely to engage in risky sexual behavior 23.3 0–91 26.5 19. Don’t have enough time to discuss HPV vaccine 37.2 0–94 27.0 20. I have sufficient information about HPV vaccine to explain to my patients 73.0 0–100 25.0 21. I strongly endorse the HPV vaccine 88.0 5–100 17.3 22. Parents make the decision without input from their daughters 64.4 0–100 24.0 23. Patients get second and third doses whenever they come in 50.6 0–100 31.0 24. In presenting the HPV vaccine, I emphasize cancer prevention benefits 87.2 14–100 16.6 25. Presenting HPV vaccine is opportunity to discuss adolescent sexual behavior 74.0 0–100 23.1 26. Patients will feel overprotected and not come back for cervical cancer screening 17.7 0–86 19.5 29. I am prepared to provide counseling about differences between HPV vaccines 42.0 0–100 32.5 30. Parents of my male patients will be receptive to the HPV vaccine 61.0 0–100 27.2 HPV=human papillomavirus.
Note: Responses are on a scale from 0 to 100, in which 0 = strongly disagree and 100 = strongly agree.
Item % 7. Age you feel the most comfortable first offering the HPV vaccine, 9–10 y 21.4 11–12 y 65.3 13–14 y 10.2 15–16 y 3.1 8. Does your clinic report to Statewide Immunization System Yes 80.6 No 3.1 Don’t know 16.3 9. Way to track patient HPV vaccination status Electronic health record 68.4 Paper charts 20.4 Don’t know 5.1 Other 6.1 10. Does your clinic send reminders to patients for second and third doses Yes 21.4 No 57.1 Don’t know 20.4 11. For patients who received all 3 doses, timing of series completion By 6 mo 9.2 By 9 mo 30.6 By 12 mo 29.6 >12 mo 13.3 Don’t know 16.3 31. Should the HPV vaccine be mandated for school entry for all 11- to 12-year-old girls Yes 27.6 No 49.0 Don’t know 21.4 HPV=human papillomavirus.
Additional Files
Supplemental Appendix
Appendix 1: HPV Vaccine Survey
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file
The Article in Brief
Catching Up With the HPV Vaccine: Challenges and Opportunities in Primary Care
Andrew L. Sussman , and colleagues
Background Rates of vaccination for human papillomavirus (HPV) are lower than rates for other teen vaccines. This study investigates a broad range of factors in health care delivery, health policy, and attitudes that influence HPV vaccination.
What This Study Found Interview and survey data from primary care clinicians, health policy makers and immunization experts reveal health service delivery challenges as the greatest barrier to HPV vaccination, specifically the inability to track and distribute reminders to eligible patients. Clinicians also report variations in counseling approaches due to patient age and emphasis on cancer prevention benefits of the vaccine. Sociocultural influences on vaccine decision-making and fear that adolescents would feel overprotected do not appear to be factors.
Implications
- The authors call for interventions targeting innovative communication techniques, as well as health system changes that build on efforts toward coordinated care and utilization of other venues to promote vaccination.
