A model of health care provider decision making about HPV vaccination in adolescent males

Abstract

Introduction: In the U.S. HPV vaccination of adolescent males remains low, despite the recommendation for routine vaccination. Although research has highlighted that health care provider (HCP) recommendation is very influential in HPV vaccine uptake, research on this topic in the male population is lacking. Accordingly, we used a qualitative approach to identify HCP knowledge, attitudes, and behaviors regarding adolescent male HPV vaccination, one year after routine vaccination of adolescent males was recommended. Method: Twenty U.S. pediatric HCPs participated in 20-30 minute interviews about knowledge, attitudes, and practices regarding male HPV vaccination. Interviews were audiorecorded, transcribed and analyzed using inductive content analysis. Results: The providers had been in practice for 1-35 years, 75% were female, and 75% were White. Opinions on HPV vaccination were shaped by knowledge/perception of the risks and benefits of vaccination. Although all providers frequently offered HPV vaccine to male patients, the strength and content of the offer varied greatly.Vaccination opinions determined what issues were emphasized in the vaccine offer (e.g., stressing herd immunity, discussing prevention of genital warts), while adolescent age influenced if and how they pitched their vaccine offer (e.g., HPV as an STI). Most providers agreed with the ACIP recommendations, however, several expressed that providers' pre-existing opinions might remain unchanged despite the recommendations. Consistent with the literature on determinants of HPV vaccination, providers believed that their own recommendation was a major factor in a family's decision to vaccinate. Barriers to vaccination included the "newness" and sexual nature of the vaccine, lack of insurance coverage and the vaccine not being mandated. Conclusions: Providers' opinions about, and approaches to offering, HPV vaccination to males were highly variable. Interventions designed to improve male HPV vaccination 3 should focus on helping providers to routinely recommend the vaccine to all of their eligible patients, both males and females.

Provider communication about HPV vaccination: A systematic review

“…9 few providers recommended or intended to recommend HPV vaccination for younger patients, ages 9 and 10. 22,23,27,35,40,51,59 These recommendation practices corresponded with the preferences of parents, who tended to favor communicating with providers about HPV vaccination in their adolescents' teenage vs. preteen years. 16,19,61 Among studies focusing on young adult patients, provider recommendations declined slightly in frequency for patients in their twenties.…”

“…[23][24][25][26] Qualitative studies further supported the hypothesis that knowledge informed provider communication, with incomplete knowledge of HPV-attributable cancers in males identified as a key barrier to HPV vaccine recommendations for boys. 27,28 However, other studies found no association between providers' knowledge and their HPV vaccine recommendations. [29][30][31] Studies assessed a wide range of provider perceptions and their relationship to HPV vaccine recommendations, with the most important perceptions being those related to discomfort talking about sex, parental hesitancy, and the role of professional organizations.…”

“…[29][30][31] Studies assessed a wide range of provider perceptions and their relationship to HPV vaccine recommendations, with the most important perceptions being those related to discomfort talking about sex, parental hesitancy, and the role of professional organizations. Discomfort talking about sex or sexually transmitted infections was associated with providing less frequent and lower-quality HPV vaccine recommendations, 27,[32][33][34] as was believing that talking about sex was a prerequisite to HPV vaccination. 29,35,36 Perceptions of parental hesitancy toward HPV vaccination were also negatively associated with communication; providers who perceived parents as unsupportive less often recommended or intended to recommend HPV vaccine.…”

“…29,32,37,44,45 In contrast, no studies found a correlation between providers' perceptions of HPV vaccine safety and their recommendation behaviors, perhaps because concerns about safety were relatively uncommon. 27,32,36,38,44,45 In terms of providers' perceptions of themselves, self-efficacy to communicate about HPV vaccine was associated with recommending and intending to recommend the vaccine. 12,26,46 Interestingly, providers who viewed themselves as "early adopters" were also more likely to recommend HPV vaccine.…”

“…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. 18,27,71,73,76,80 For some parents, the desire to maximize adolescents' role was even a reason for delaying HPV vaccination. 80 Studies suggested that parent-adolescent decisions were largely concordant and that most dyads ultimately reached agreement about the vaccination decision, but they sometimes looked to providers for guidance in the case of initial disagreement.…”