Exploring HPV vaccination policy and payer strategies for opportunities to improve uptake in safety-net settings

Sloan, Kylie; Shin, Michelle B.; Palinkas, Lawrence A.; Hudson, Shawna V.; Crabtree, Benjamin F.; Cantor, Joel C.; Tsui, Jennifer

doi:10.3389/fpubh.2023.1099552

Cited by 3 publications

(2 citation statements)

References 33 publications

(37 reference statements)

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“…We have previously reported policy level strategies for improving HPV vaccination, such as raising awareness about minor consent policies in states where applicable. 47 However, we found that funding sources for HPV vaccination often did not benefit medically underserved adolescents, which could create tension when minors consent to getting the HPV vaccine for themselves in SBHCs in some states. For example, in July 2022 shortly after we finished interviews and focus groups, the Family PACT program, which covers reproductive health education and services in California, including programs within SBHCs, changed its policy to cover the HPV vaccine for adults between ages 19–45, but not for adolescents.…”

Section: Discussionmentioning

confidence: 83%

Multilevel perspectives on school-based opportunities to improve HPV vaccination among medically underserved adolescents: Beyond school entry mandates

Shin,

Sloan,

Baezconde-Garbanati

et al. 2023

Human Vaccines & Immunotherapeutics

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School-based HPV vaccination programs have improved vaccine uptake among adolescents globally. However, school-based HPV vaccination strategies in the United States (US) have mainly focused on school-entry mandates for vaccination, which have passed in only five states/jurisdictions. Many schools and school-based health centers (SBHCs) already provide health services to medically underserved adolescents and opportunities to improve disparities in HPV vaccine education and uptake are underexplored. This qualitative study of clinic and community members assessed potential opportunities within and outside schools to increase HPV vaccination. Data were generated from a larger mixed-methods study designed to understand experiences with HPV vaccination evidence-based strategies in medically underserved communities. The parent study included interviews and focus groups conducted with clinic (providers, clinic leaders, staff) and community (racial/ethnic minority parents, advocates, payers, policy representatives) members in Los Angeles and New Jersey between December 2020-January 2022. We created a reduced dataset of text related to schools/SBHCs (30 in-depth interviews, 7 focus groups) and conducted a directed content analysis. Participants indicated that schools and SBHCs are ideal venues for reaching medically underserved adolescents experiencing barriers to primary care access. Parents/providers expressed mutual interest in HPV vaccine administration/education in schools, but some advocates/policy participants experienced challenges due to increasing politicization of vaccines. Participants highlighted policies for expanding HPV vaccine education and administration in schools, including minor consent and increasing SBHC funding for HPV vaccines. More research is needed to explore existing infrastructure, partner motivation, and opportunities to improve HPV vaccination among medically underserved adolescents within schools beyond vaccine mandates.

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Section: Discussionmentioning

confidence: 83%

Multilevel perspectives on school-based opportunities to improve HPV vaccination among medically underserved adolescents: Beyond school entry mandates

Shin,

Sloan,

Baezconde-Garbanati

et al. 2023

Human Vaccines & Immunotherapeutics

Self Cite

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“…In some countries, this authority is clearly defined, while in others, it may be subject to interpretation or legal challenges [ 32 ]. It is important to navigate these legal considerations and ensure that the mandate is implemented within the boundaries of the law [ 47 ].…”

Section: Reviewmentioning

confidence: 99%

Implementing a School-Entry Mandate for the Human Papillomavirus Vaccine: Benefits and Challenges

Alzahrani

2024

Cureus

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Human papillomavirus (HPV), a common sexually transmitted infection, has prompted the development of vaccines to mitigate associated cancer risks, particularly cervical cancer. Regions that have achieved a high rate of vaccination coverage are witnessing a transformative impact on public health, with a notable reduction of up to 30% in the incidence of cervical cancer cases. Emphasizing the broader impact of vaccination on public health, this review investigates the role of a school-entry mandate for the HPV vaccine, aiming to inform decisions about its potential benefits and challenges. With a focus on understanding the significance of vaccination, the review delves into its potential to reduce the physical, emotional, and financial burdens associated with HPV-associated cancers. Implementing school-entry mandates for the HPV vaccine offers benefits such as increased vaccination rates, protection against HPV-related diseases, and long-term health advantages. However, challenges include ethical concerns, parental opposition, and logistical issues. Successful implementation requires clear communication, collaboration, and education, with legal and ethical considerations addressing constitutional rights, liability concerns, autonomy, and equitable access. In summary, the implementation of school-entry mandates for the HPV vaccine offers the potential for increased vaccination rates and the reduction of health disparities. However, this approach is challenged by factors such as opposition, associated costs, and legal and ethical considerations. The decision to mandate the HPV vaccine requires a delicate balance between public health priorities and individual rights, necessitating clear communication, education, and collaborative efforts to address the complexities involved.

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Use of concept mapping to inform a participatory engagement approach for implementation of evidence-based HPV vaccination strategies in safety-net clinics

Tsui,

Shin,

Sloan

et al. 2024

Implement Sci Commun

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Background Multiple evidence-based strategies (EBS) for promoting HPV vaccination exist. However, adolescent HPV vaccination rates remain below target levels in communities at high risk for HPV-associated cancers and served by safety-net clinics. Participatory engaged approaches are needed to leverage the expertise of community and clinical partners in selecting EBS relevant to their local context. We engaged concept mapping as a method to inform the adoption and adaptation of EBS that seeks to empower implementation partners to prioritize, select, and ultimately implement context-relevant EBS for HPV vaccination. Methods Using 38 EBS statements generated from qualitative interviews and national HPV vaccine advocacy sources, we conducted a modified concept mapping activity with partners internal to safety-net clinics and external community members in two study sites of a larger implementation study (Greater Los Angeles and New Jersey), to sort EBS into clusters and rate each EBS by importance and feasibility for increasing HPV vaccination within safety-net clinics. Concept mapping findings (EBS statement ratings, ladder graphs and go-zones) were shared with leaders from a large federally qualified health center (FQHC) system (focusing on three clinic sites), to select and implement EBS over 12 months. Results Concept mapping participants (n=23) sorted and rated statements, resulting in an eight-cluster solution: 1) Community education and outreach; 2) Advocacy and policy; 3) Data access/quality improvement monitoring; 4) Provider tracking/audit and feedback; 5) Provider recommendation/communication; 6) Expanding vaccine access; 7) Reducing missed opportunities; and 8) Nurse/staff workflow and training. The FQHC partner then selected to intervene on eight of 17 EBS statements in the “go-zone” for action, with three from “reducing missed opportunities,” two from “nurse/staff workflow and training,” and one each from “provider tracking/audit and feedback,” “provider recommendation/communication,” and “expanding vaccine access,” which the research team addressed through the implementation of three multi-level intervention strategies (e.g., physician communication training, staff training and workflow assessment, audit and feedback of clinic processes). Conclusions Concept mapping provided a powerful participatory approach to identify multilevel EBS for HPV vaccination relevant to the local safety-net clinic context, particularly when several strategies exist, and prioritization is necessary. This study demonstrates how a clinic system benefited directly from the ratings and prioritization of EBS by multilevel clinic and community partners within the broader safety-net clinic context to identify and adapt prioritized solutions needed to advance HPV vaccine equity.

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Exploring HPV vaccination policy and payer strategies for opportunities to improve uptake in safety-net settings

Cited by 3 publications

References 33 publications

Multilevel perspectives on school-based opportunities to improve HPV vaccination among medically underserved adolescents: Beyond school entry mandates

Multilevel perspectives on school-based opportunities to improve HPV vaccination among medically underserved adolescents: Beyond school entry mandates

Implementing a School-Entry Mandate for the Human Papillomavirus Vaccine: Benefits and Challenges

Use of concept mapping to inform a participatory engagement approach for implementation of evidence-based HPV vaccination strategies in safety-net clinics

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