Clinician communication strategies associated with increased uptake of the human papillomavirus (HPV) vaccine: A systematic review

Abstract

Human papillomavirus (HPV) is currently linked to almost 35,000 new cases of cancer in women and men each year in the United States. Gardasil‐9 (Merck & Company), the only HPV vaccine now available in the United States, is nearly 100% effective at preventing precancers caused by oncogenic HPV types. In the United States, however, only about one half of adolescents are up to date with HPV vaccination. It is well known that health care clinicians’ recommendations play a significant role in parents’ decisions regarding HPV vaccination. A growing body of literature examines specific communication strategies for promoting uptake of the HPV vaccine. A comprehensive review of the evidence for each of these strategies is needed. The authors searched the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Web of Science Complete databases for original articles with a defined clinician communication strategy and an outcome of HPV vaccine uptake or intention to vaccinate (PROSPERO registry no. CRD42020107602). In total, 46 studies were included. The authors identified two main strategies with strong evidence supporting their positive impact on vaccine uptake: strong recommendation and presumptive recommendation. Determinations about a causal relationship were limited by the small numbers of randomized controlled trials. There is also opportunity for more research to determine the effects of motivational interviewing and cancer‐prevention messaging.

Uptake of HPV vaccination among boys after the introduction of gender-neutral HPV vaccination in Germany before and during the COVID-19 pandemic

“…However, it should be noted that health care providers have a key role in making their clients aware about HPV vaccination. Research in the US has shown that a strong and presumptive provider recommendation increases HPV vaccine acceptance and uptake significantly [ 20 ] and more and better communication training for health care personnel in Germany could be proposed at least to a similar extent as public awareness campaigns. (2) Vaccine confidence, hesitancy, and safety concerns.…”

HPV vaccine recommendations by age: A survey of providers in federally qualified health centers

“…Strong provider recommendation has overwhelmingly been demonstrated as the most important factor associated with HPV vaccination acceptance in the literature. 28 , 36–38 Yet, a systematic review of studies published between 2012 and 2019 identified age, geographic, socioeconomic, and racial disparities in HPV vaccination recommendation, with fewer recommendations for patients who were younger, living in the South, nonwhite, low-income, or uninsured. 27 Prior national surveys indicated increasing rates of provider recommendation among 11–12-y-olds from 35% in 2009 to 40% in 2011 39 to 59% in 2021.…”

Optimizing timing of adolescent vaccines: Impact of initiating HPV vaccination before Tdap or meningococcal vaccination on timely completion of the HPV vaccine series

“…43 Other studies have noted associations between receipt of influenza and HPV vaccines, 44 which may indicate that parents who accept HPV vaccination may also have more positive attitudes toward other vaccines that are recommended but not mandatory. Alternatively, substantial research has documented the importance of healthcare provider recommendation in vaccine uptake, 45–47 and it is possible that parents who accept influenza, meningitis, and HPV vaccines are receiving higher quality recommendations. 48 …”