Practice-, provider- and patient-level facilitators of and barriers to HPV vaccine promotion and uptake in Georgia: a qualitative study of healthcare providers’ perspectives

Abstract

Georgia experiences higher human papillomavirus (HPV)-associated cancer burden and lower HPV vaccine uptake compared with national estimates. Using the P3 model that concomitantly assesses practice-, provider- and patient-level factors influencing health behaviors, we examined facilitators of and barriers to HPV vaccine promotion and uptake in Georgia. In 2018, we conducted six focus groups with 55 providers. Questions focused on multilevel facilitators of and barriers to HPV vaccine promotion and uptake. Our analysis was guided by the P3 model and a deductive coding approach. We found that practice-level influences included organizational priorities of vaccinations, appointment scheduling, immunization registries/records, vaccine availability and coordination with community resources. Provider-level influences included time constraints, role, vaccine knowledge, self-efficacy to discuss HPV vaccine and vaccine confidence. Patient-level influences included trust, experiences with vaccine-preventable diseases, perceived high costs, perceived side effects and concerns with sexual activity. Findings suggest that interventions include incentives to boost vaccine rates and incorporate appointment scheduling technology. An emphasis should be placed on the use of immunization registries, improving across-practice information exchange, and providing education for providers on HPV vaccine. Patient–provider communication and trust emerge as intervention targets. Providers should be trained in addressing patient concerns related to costs, side effects and sexual activity.

Designing and psychometric assessment of the scale of factors influencing HPV vaccine uptake behaviors in young adults

“…Although these are basic vaccination requirements, they are likely to affect vaccination as well. Therefore, extensive research studies have been conducted in this field [ 20 , 62 ].…”

Association between patient characteristics and HPV vaccination recommendation for postpartum patients: A national survey of Obstetrician/Gynecologists

“…Sexual activity is a factor that providers are encouraged to avoid when recommending HPV vaccination with younger patients, and instead focus on how the HPV vaccination prevents cancer ( Fleming et al, 2018 , Vu et al, 2020 ). However, given the new recommendations for the mid-adult patient population (ages 27–45 years) and the differences in patient likelihood of engagement in these important risk factors, this is a topic that may be more appropriate to discuss when having a conversation with a mid-adult patient about the HPV vaccine.…”

Differences in stakeholder-reported barriers and implementation strategies between counties with high, middle, and low HPV vaccine initiation rates: a mixed methods study

“…HPV vaccine stakeholders (e.g., clinicians, parents, health department staff ) have identified a variety of barriers to HPV vaccination [12][13][14][15][16]. The main identified barrier to HPV vaccination is parental lack of HPV vaccine awareness and limited knowledge about the vaccine, especially concerns about vaccine safety and limited understanding of the links between HPV and sexual activity or cancer [12][13][14][15][16][17]. Another prominent barrier identified by stakeholders is clinician discomfort with or lack of routine recommendations of the HPV vaccine [13,16,17].…”