Parents’ Recall and Reflections on Experiences Related to HPV Vaccination for Their Children

Abstract

Human papillomavirus (HPV) vaccination coverage remains suboptimal in the United States. We conducted in-depth interviews with parents of adolescents from an urban primary care center serving a low-income minority population to describe their experiences. We identified the following themes: (a) parents of unvaccinated children generally had not discussed the vaccine with providers and had low awareness; (b) among unaware parents, provision of brief information generally resulted in positive comments about the vaccine; (c) vaccine was typically not requested by parents but rather offered by providers; (d) strength of the recommendations from providers varied, and vaccine was sometimes presented as optional or low-priority; (e) parents had low awareness of the 3-dose regimen and poor recall about completion; and (f) limited understanding of why boys should be vaccinated. More than seven years after introduction of HPV vaccine, there is substantial room for improving the way it is recommended and discussed by providers.

Provider communication about HPV vaccination: A systematic review

“…38,74 In the other approach, providers distinguished HPV vaccine from other adolescent vaccines by presenting it as an "optional" vaccine which was not required for school; this approach often involved a more lengthy discussion of risks and benefits as well as obtaining parental consent separately from, not along with, other vaccines. 38,74,77,79,91 Providers using the second approach reported higher levels of parental hesitancy and vaccine refusal or delay, but nevertheless felt obligated to mention the absence of school entry requirements for HPV vaccine and offer the option to delay vaccination in order to more closely coincide with sexual debut. 38,74 Providers who presented HPV vaccine as optional expressed the hope that this open-ended communication style would foster trust with vaccine hesitant parents, thereby encouraging the acceptance of other adolescent vaccines in the short term as well as HPV vaccine in the long term.…”

“…Quantitative and qualitative studies found that providers spent longer talking about HPV vaccine than other vaccines, 11,27,35,74,76,84 endorsed HPV vaccine less strongly than Tdap and meningococcal vaccines, 11,12,22,74,87 and often presented HPV vaccine as an "optional" vaccine vs. one that was "routine" or "required." 12,22,38,74,79,91 Finally, one study found that, among providers with a preferred order for discussing adolescent vaccines, over two-third preferred to discuss HPV vaccine last. 11 A fourth area of communication style considered the extent to which providers engaged parents and patients in discussion about HPV vaccination.…”

“…79 All studies that assessed who initiated HPV vaccine conversations found in favor of providers; parents and patients brought up the topic only rarely and preferred that providers initiate the discussion. 76,77,79,87,91,[94][95][96][97] Decisional timeframe Both qualitative and quantitative studies found that parents often preferred not to make an immediate decision about HPV vaccination during discussions with a provider, but rather wished to decide later after thinking more about the issue and getting more information. 12,16,18,73,74,79,80 Studies suggested that providers may contribute to extending the timeframe for HPV vaccination decision making, given that many gave parents a choice about when to vaccinate or, even at times, actively suggested delay.…”

“…12,16,18,73,74,79,80 Studies suggested that providers may contribute to extending the timeframe for HPV vaccination decision making, given that many gave parents a choice about when to vaccinate or, even at times, actively suggested delay. 33,38,60,74,77,91 For example, a national survey of physicians found that only about half usually recommended same-day vaccination for 11-and 12-year-old patients. 33 …”

“…38 Unfortunately, some parents who delayed HPV vaccination with the intention of getting it later reported that they never followed-up to do so. 38,91 The extent to which providers adhere to these overall approaches of aligning HPV vaccine with or distinguishing it from other vaccines is unknown. However, the existing literature consistently supported the assertion that providers often communicated about HPV vaccine differently from other vaccines in discrete ways.…”