Provider communication and HPV vaccination: The impact of recommendation quality

Abstract

Background Receiving a healthcare provider’s recommendation is a strong predictor of HPV vaccination, but little is known empirically about which types of recommendation are most influential. Thus, we sought to investigate the relationship between recommendation quality and HPV vaccination among U.S. adolescents. Methods In 2014, we conducted a national, online survey of 1,495 parents of 11- to 17-year-old adolescents. Parents reported whether providers endorsed HPV vaccination strongly, encouraged same-day vaccination, and discussed cancer prevention. Using an index of these quality indicators, we categorized parents as having received no, low-quality, or high-quality recommendations for HPV vaccination. Separate multivariable logistic regression models assessed associations between recommendation quality and HPV vaccine initiation (≥1 dose), follow through (3 doses, among initiators), refusal, and delay. Results Almost half (48%) of parents reported no provider recommendation for HPV vaccination, while 16% received low-quality recommendations and 36% received high-quality recommendations. Compared to no recommendation, high-quality recommendations were associated with over nine times the odds of HPV vaccine initiation (23% vs. 74%, OR=9.31, 95% CI, 7.10–12.22) and over three times the odds of follow through (17% vs. 44%, OR=3.82, 95% CI, 2.39–6.11). Low-quality recommendations were more modestly associated with initiation (OR=4.13, 95% CI, 2.99–5.70), but not follow through. Parents who received high-versus low-quality recommendations less often reported HPV vaccine refusal or delay. Conclusions High-quality recommendations were strongly associated with HPV vaccination behavior, but only about one-third of parents received them. Interventions are needed to improve not only whether, but how providers recommend HPV vaccination for adolescents.

Provider communication about HPV vaccination: A systematic review

“…52,63 Provider communication was consistently associated with patients' sex such that providers' recommendation intentions and behavior were more supportive of HPV vaccination for girls versus boys. 10,12,24,25,29,33,37,44,55,57,58,60,64,65 For example, the 2014 NIS-Teen found that 64% of age-eligible girls had received a provider recommendation compared to just 42% of boys. 10 All but one study examining patients' race/ethnicity suggested disparities in provider communication with parents of African American and Hispanic adolescents less often discussing HPV vaccine with a provider or receiving HPV recommendations than parents of non-Hispanic White adolescents.…”

“…Some studies emphasized their lack of participation, particularly in the case of younger adolescents. 4,19,74,78,79 Indeed, some parents indicated a preference for vaccinating in the preteen years specifically because they viewed adolescents as having little say during this 11 Cross-sectional, online survey rout rout F, M 776 National sample of pediatricians and family physicians Gilkey, 2016 60 Cross-sectional, online survey rout rout F, M 1495 National sample of parents of adolescents (ages 11-17) Gilkey, under review 16 Cross-sectional, online survey rout rout F, M 1484 National sample of parents of adolescents (ages [11][12][13][14][15][16][17] (Continued on next page) time. 18,80 In contrast, other studies found that adolescents did play a role in communication and decision-making in clinical settings, one which increased with age, maturity, and social privilege.…”

“…22 Although two studies sought to assess the association between the prevention content and HPV vaccine acceptance, results were inconclusive. 60,84 Content about safety and side effects featured somewhat less prominently in studies of provider communication about HPV vaccination. Qualitative studies suggested that some parents and adolescents prioritized safety and side effects as important topics for discussion, 19,21,38,61,82 but studies of actual content suggested that such communication was fairly limited.…”

“…22,76 Style Studies of communication style focused on four areas: 1) recommendation strength; 2) recommendation quality; 3) the framing of HPV vaccine in relation to other adolescent vaccines; and 4) collaborative communication. First, with regard to recommendation strength, quantitative studies consistently found an association between the extent to which providers endorsed the importance of HPV vaccine and parents' positive perceptions of HPV vaccine, 60,86 their intention to get their children vaccinated, 60,87 and adolescents' receipt of HPV vaccine. 60,[87][88][89] Qualitative studies also found strong provider endorsement to be uniquely influential on parents' HPV vaccination decisions.…”

“…First, with regard to recommendation strength, quantitative studies consistently found an association between the extent to which providers endorsed the importance of HPV vaccine and parents' positive perceptions of HPV vaccine, 60,86 their intention to get their children vaccinated, 60,87 and adolescents' receipt of HPV vaccine. 60,[87][88][89] Qualitative studies also found strong provider endorsement to be uniquely influential on parents' HPV vaccination decisions. 27,38,74,77 Unfortunately, these same studies suggested that providers often failed to strongly endorse HPV vaccine.…”