Human Papillomavirus Immunization in Rural Primary Care

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

“…19 Another mixed-methods study reported a nurse practitioner describing a strategy in which "going into the discussion with confidence as a provider is the most important aspect to how the results play out" while also placing an emphasis on cancer prevention. 27 Included transcripts of clinical encounters also highlight the use of the first-person voice as an important feature of a strong recommendation ("I do, however, recommend it completely between now and being 18") versus the third-person voice for weak recommendations ("they do recommend it for boys"). 34 authors did not report on whether specific guidelines were being referenced when third-person pronouns were used.…”

“…42 The presumptive strategies most commonly used by clinicians in the included studies entailed not only presenting the recommendation as a statement not requiring a response but also bundling the HPV vaccine together with other recommended adolescent vaccines, thereby presuming no special hesitancy for the HPV vaccine. 25,27,34,41,44,50,57 For example, in one study, a physician introduced the HPV vaccine by saying: "Got a couple of shots today. The ones you're getting are Adacil, Menactra, and the HPV."…”

“…With the exception of a study that was divided into two reports of male and female patients—both included in the main table—one primary report for each study is included in the main body of Table S2, and additional reports from the same study were collated beneath (see Table S3). We included all studies that met our inclusion criteria for analysis in Table 2, and reports of the included studies are indicated in the same table 16,17,19–62 …”

Nurses’ perceptions, experiences, and practices regarding human papillomavirus vaccination in a large, rural U.S. state

“…[4][5][6] Despite its proven safety and effectiveness, the HPV vaccine uptake has remained consistently low over the years at the national level in the U.S. [8,9] Rural communities in the U.S. face a disproportionate burden of health disparities resulting from a complex interplay between a host of factors like barriers to accessing primary care services, higher rates of un-or under-insurance, lower health literacy and vaccination rates, and a shortage of pediatricians. [11][12][13] [ [27][28][29][30]45] Indeed, pediatricians contribute to higher rates of HPV vaccine coverage. For example, pediatricians more often administered a complete HPV series to their patients and reported higher con dence in their ability to address HPV vaccine concerns than family medicine providers compared to family care practitioners.…”

“…[58,59] Rural areas have also been associated with negative parental attitudes about the HPV vaccine, and higher incidence and mortality from HPV-caused cancers. [27][28][29][30]45] In Montana, a large and primarily rural state, the HPV vaccine series completion rate in 2020 was 54.4% for adolescents ages 13-17 years, as reported by the Centers for Disease Control and Prevention's National Immunization Survey-Teen, far below the Healthy People 2030 goal of 80%. [9,10] Furthermore, for the years 2015-2019, the proportion of rural adolescents in Montana who received at least one dose of the HPV vaccine (56.0%) was 11.9 percentage points lower when compared to Montana adolescents living in more urban areas (67.9%), indicating a pronounced urban-rural disparity in vaccine uptake.…”