Clinician knowledge, clinician barriers, and perceived parental barriers regarding human papillomavirus vaccination: Association with initiation and completion rates

Abstract

Purpose We tested the hypothesis that clinician knowledge, clinician barriers, and perceived parental barriers relevant to the human papillomavirus (HPV) vaccination account for the variation in vaccine delivery at the practice-site level. Methods We conducted a survey from October 2015 through January 2016 among primary care clinicians (n=280) in a 27-county geographic region to assess clinician knowledge, clinician barriers, and perceived parental barriers regarding HPV vaccination. Primary care clinicians included family medicine physicians, general pediatricians, and family and pediatric nurse-practitioners. We also used the Rochester Epidemiology Project to measure the HPV vaccination delivery. Specifically we used administrative data to measure receipt of at least one valid HPV vaccine dose (initiation) and receipt of three valid HPV vaccine doses (completion) among 9 to 18 year old patients residing in the same 27-county geographic region. We assessed associations of clinician survey data with variation in vaccine delivery at the clinical site using administrative data on patients aged 9 to 18 years (n=68,272). Results Consistent with our hypothesis, we found that greater knowledge of HPV and the HPV vaccination was associated with higher rates of HPV vaccination initiation (Incidence rate ratio [IRR]=1.05) and completion of three doses (IRR=1.28). We also found support for the hypothesis that greater perceived parental barriers to the HPV vaccination was associated with lower rates of initiation (IRR=0.94) and completion (IRR=0.90). These IRRs were statistically significant even after adjustment for site-level characteristics including percent white, percent female, percent ages 9–13, and percent with government insurance or self-pay at each site. Conclusions Clinician knowledge and their report of the frequency of experiencing parental barriers is associated with HPV vaccine delivery rates—initiation and completion. Higher measures of knowledge correlated with higher rates. Fewer perceived occurrences of parental barriers correlated with lower rates. These data can guide efforts to improve HPV vaccine delivery in clinical settings.

Testing the Impact of Mixed‐Mode Designs (Mail and Web) and Multiple Contact Attempts within Mode (Mail or Web) on Clinician Survey Response

“…The methods and results associated with the larger investigation are reported elsewhere (Rutten et al. ). We compared two mixed‐mode designs (sequential: mail/web and sequential: web/mail) to two single‐mode designs (mail‐only and web‐only), with respect to response rate and nonresponse bias.…”

“…This study was embedded in a larger survey study conducted from October 2015 to January 2016 and designed to assess clinician knowledge, clinician barriers, and perceived parental barriers regarding HPV vaccination using a validated instrument. The methods and results associated with the larger investigation are reported elsewhere (Rutten et al 2017). We compared two mixed-mode designs (sequential: mail/web and sequential: web/mail) to two single-mode designs (mail-only and web-only), with respect to response rate and nonresponse bias.…”

Association of both consistency and strength of self-reported clinician recommendation for HPV vaccination and HPV vaccine uptake among 11- to 12-year-old children

“…We conducted a survey of primary care clinicians in a 27-county geographic region captured by the Rochester Epidemiology Project (REP) using a validated instrument to assess clinician knowledge, attitudes, and behaviors related to HPV vaccination[20–23]. The REP is a research infrastructure that links medical records from the majority of clinical practices across the 27 counties to individuals residing in the community and maintains an electronic index of medical record information, including clinical diagnoses, procedure codes, drug prescriptions, office visits, emergency room visits, and hospitalizations.…”

“…[20, 21, 23] The survey included questions to assess clinicians’ knowledge, attitudes, and behaviors related to HPV and HPV vaccination. Clinicians were asked to rate the frequency with which they recommended the HPV vaccine separately for their female and male patients: In the past 12 months, how often did you recommend the HPV vaccine to your female [male] patients?…”

Ineffectiveness of information and access to health services: vulnerability to human papillomavirus

“…In consonance with these results, a study conducted in 2007 concluded that despite the difficulties faced, health centres operating within schools are important disseminators of preventive care for vulnerable adolescents and youths (Rutten et al. ). Therefore, one way to revise these representations, as shown in the studies above, is to ensure a more effective presence of health services in schools.…”