Results of a Multilevel Intervention Trial to Increase Human Papillomavirus (HPV) Vaccine Uptake among Adolescent Girls

Abstract

Background Uptake of the human papillomavirus (HPV) vaccine is low in Appalachian Ohio, and area with high cervical cancer rates. Methods We conducted a group-randomized trial among 12 counties in Appalachian Ohio randomized to receive either an HPV vaccine (intervention counties) or influenza vaccine (comparison counties) multi-level intervention (MLI). Parents (n=337) who had a daughter aged 9 to 17 years who had not received the HPV vaccine were recruited from commercial lists. Clinics (N=24) and 119 providers from these clinics were also recruited. The primary outcome was medical record confirmed receipt of the first shot of the HPV vaccine three months after receiving the intervention among daughters of parents enrolled in the study. Secondary outcomes included receipt of the first HPV vaccine shot by 6 months and changes in provider knowledge. Results According to medical records, 10 (7.7%) daughters of intervention participants received the first shot of the HPV vaccine within three months of being sent the intervention materials compared to 4 (3.2%) daughters of comparison group participants (p=0.061). By six months, 17 (13.1%) daughters of intervention participants received the first HPV vaccine shot compared to eight (6.5%) daughters of comparison group participants (p=0.002). Provider knowledge about HPV increased (p<0.001, from baseline to post-education). Conclusions The MLI increased uptake of the HPV vaccine among girls aged 9 to 17 years, however, uptake was low. Impact To improve HPV vaccine uptake, attention to additional levels of influence (e.g., policy, community) and more elements within levels (e.g., reminders, automated prompts) may be needed.

Belief About Mandatory School Vaccinations and Vaccination Refusal Among Ohio Appalachian Parents: Do Demographic and Religious Factors, General Health, and Political Affiliation Play a Role?

“…Interviews were conducted between February 2013 and March 2014. Out of the 4,798 recruitment letters sent to households, 2,168 households were unable to be contacted, 9 parents were deceased, 1,599 were ineligible, 685 refused, and 337 were eligible, consented, and completed the baseline survey . The overall cooperate rate was 33.0% (337 of 1,022 eligible parents).…”

“…One area, Ohio Appalachia, a 32‐county area, is characterized by lower income, higher prevalence of unemployment, lower level of educational attainment, and numerous health disparities than the United States as a whole . Research on vaccination beliefs, refusal, and uptake among the Ohio Appalachian population has primarily focused on HPV vaccination due to the higher cervical cancer incidence within that area compared to non‐Appalachian regions of the United States . HPV vaccine uptake is low in the United States, compared to other adolescent vaccinations, and this is no exception within Ohio Appalachia …”

“…[23][24][25] Research on vaccination beliefs, refusal, and uptake among the Ohio Appalachian population has primarily focused on HPV vaccination due to the higher cervical cancer incidence within that area compared to non-Appalachian regions of the United States. [25][26][27] HPV vaccine uptake is low in the United States, compared to other adolescent vaccinations, and this is no exception within Ohio Appalachia. 26 Previous research has found lower rates of adolescent vaccinations in rural areas compared to other populations.…”

“…[25][26][27] HPV vaccine uptake is low in the United States, compared to other adolescent vaccinations, and this is no exception within Ohio Appalachia. 26 Previous research has found lower rates of adolescent vaccinations in rural areas compared to other populations. Vielot et al 28 found that rural adolescents were less likely to receive each of the recommended adolescent vaccinations than their urban counterparts in all geographical regions including Appalachia.…”

Multilevel Interventions To Address Health Disparities Show Promise In Improving Population Health

“…However, the absolute number of girls who received the vaccine, as verified by a review of medical records, remained very low (ten in the intervention group versus four in the comparison group). 16 Meanwhile, providers’ knowledge about HPV and the HPV vaccine increased significantly. 13 …”