Challenges related to human papillomavirus (HPV) vaccine uptake in Minnesota: clinician and stakeholder perspectives

Abstract

Background Human papillomavirus (HPV) vaccination rates among adolescents are increasing in Minnesota (MN) but remain below the Healthy People 2020 goal of 80% completion of the series. The goal of this study was to identify messaging and interventions impacting HPV vaccine uptake in MN through interviews with clinicians and key stakeholders. Methods We conducted semi-structured key participant interviews with providers and stakeholders involved in HPV vaccination efforts in MN between 2018 and 2019. Provider interview questions focused on messaging around the HPV vaccine and clinic-based strategies to impact HPV vaccine uptake. Stakeholder interview questions focused on barriers and facilitators at the organizational or state level, as well as initiatives and collaborations to increase HPV vaccination. Responses to interviews were recorded and transcribed. Thematic content analysis was used to identify themes from interviews. Results 14 clinicians and 13 stakeholders were interviewed. Identified themes were grouped into 2 major categories that dealt with messaging around the HPV vaccine, direct patient–clinician interactions and external messaging, and a third thematic category involving healthcare system-related factors and interventions. The messaging strategy identified as most useful was promoting the HPV vaccine for cancer prevention. The need for stakeholders to prioritize HPV vaccination uptake was identified as a key factor to increasing HPV vaccination rates. Multiple providers and stakeholders identified misinformation spread through social media as a barrier to HPV vaccine uptake. Conclusion Emphasizing the HPV vaccine’s cancer prevention benefits and prioritizing it among healthcare stakeholders were the most consistently cited strategies for promoting HPV vaccine uptake. Methods to combat the negative influence of misinformation about HPV vaccines in social media are an urgent priority.

Differences in stakeholder-reported barriers and implementation strategies between counties with high, middle, and low HPV vaccine initiation rates: a mixed methods study

“…Consistent with previous research [12][13][14][15][16][17]34], stakeholders in all terciles of HPV vaccination counties identified parents' knowledge and clinicians' practices as the main barriers to HPV vaccination. Our identification of healthcare access as the main barrier to HPV vaccination within north-central Florida suggests that it may be a more salient barrier for rural populations, which aligns with previous research as it was mentioned only in one of the previous HPV vaccine stakeholder studies for the remote counties only [12].…”

“…Important differences in barriers and implementation strategies emerged between northern Florida counties with the highest, middle, and lowest HPV vaccine initiation rates, while stakeholders reported barriers focused on similar themes to each other and prior literature [12][13][14][15][16][17]34], stakeholders in counties with the highest, middle, and lowest vaccine initiation rates emphasized different constructs within themes. Differences also emerged between the highest, middle, and lowest vaccination rate counties' implementation strategies.…”

“…Our study includes three important strengths. First, expanding other stakeholder studies of HPV vaccination [12][13][14][15][16], we combined stakeholder interviews with HPV vaccination data to compare the barriers and implementation strategies between high, middle, and low vaccination rate counties. Second, we included a broad range of community stakeholders to create a more comprehensive view of the county's culture.…”

“…HPV vaccine stakeholders (e.g., clinicians, parents, health department staff ) have identified a variety of barriers to HPV vaccination [12][13][14][15][16]. The main identified barrier to HPV vaccination is parental lack of HPV vaccine awareness and limited knowledge about the vaccine, especially concerns about vaccine safety and limited understanding of the links between HPV and sexual activity or cancer [12][13][14][15][16][17]. Another prominent barrier identified by stakeholders is clinician discomfort with or lack of routine recommendations of the HPV vaccine [13,16,17].…”

Urban and rural healthcare providers’ perspectives on HPV vaccination in Minnesota

“…Most providers described similar immunization strategies to those identified in other studies of healthcare providers in Minnesota and throughout the United States. 17 , 18 The rural providers we interviewed were generally aware of evidence-based strategies to improve vaccinations and implemented them whenever possible and previous quantitative work largely corroborates this finding. For example, in a survey of urban and rural providers in Minnesota and Wisconsin, rural providers were more likely than urban providers to have standing orders to administer all recommended adolescent vaccines and provide HPV vaccine information to families before it is due.…”