Promoting Strategies to Increase HPV Vaccination in the Pediatric Primary Care Setting

Bernstein, Therese A; Broome, Marion E.; Millman, Jennifer E.; Epstein, Jessica; Derouin, Anne

doi:10.1016/j.pedhc.2021.10.009

Cited by 7 publications

(13 citation statements)

References 17 publications

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“…The use of individually tailored messages could be effective [ 37 ] to address the unique educational needs of vaccine-hesitant parents after the initial presumptive recommendation fails [ 38 ]. Similar to past studies [ 39 - 43 ], our preliminary data suggest that parents want HPV vaccine information from a provider before a clinic visit to have time to process the information and, in some cases, engage in communication and shared decision-making with their child (Cunningham-Erves, J, unpublished data, June 2022).…”

Section: Introductionsupporting

confidence: 76%

Development of a Tailored Mobile Phone–Based Intervention to Facilitate Parent-Child Communication and Build Human Papillomavirus Vaccine Confidence: Formative Qualitative Study

Cunningham-Erves¹,

Wilkins²,

Jones³

et al. 2023

JMIR Form Res

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Background Human papillomavirus (HPV) vaccine hesitancy is on the rise, and provider communication is a first-line strategy to address parental concerns. The use of the presumptive approach and motivational interviewing by providers may not be enough to influence parental decision-making owing to the providers’ limited time, self-efficacy, and skills to implement these strategies. Interventions to enhance provider communication and build parental HPV vaccine confidence have been undertested. Delivering tailored patient education to parents via mobile phones before they visit the health care provider may address time constraints during clinic visits and positively affect vaccine uptake. Objective This study aimed to describe the development and evaluate the acceptability of a mobile phone–based, family-focused intervention guided by theory to address concerns of HPV vaccine–hesitant parents before the clinic visit, as well as explore intervention use to facilitate parent-child communication. Methods The health belief model and theory of reasoned action guided intervention content development. A multilevel stakeholder engagement process was used to iteratively develop the HPVVaxFacts intervention, including a community advisory board review, a review by an advisory panel comprising HPV vaccine–hesitant parents, a health communications expert review, semistructured qualitative interviews with HPV vaccine–hesitant parents (n=31) and providers (n=15), and a content expert review. Inductive thematic analysis was used to identify themes in the interview data. Results The qualitative interviews yielded 4 themes: overall views toward mobile device use for health information, acceptability of HPVVaxFacts, facilitators of HPVVaxFacts use, and barriers to HPVVaxFacts use. In parent interviews after reviewing HPVVaxFacts prototypes, almost all parents (29/31, 94%) stated they intended to have their child vaccinated. Most of the parents stated that they liked the added adolescents’ corner to engage in optional parent-child communication (ie, choice to share and discuss information with their child; 27/31, 87%) and shared decision-making in some cases (8/31, 26%). After incorporating all input, the final intervention consisted of a 10-item survey to identify the top 3 concerns of parents, followed by tailored education that was mapped to each of the following concerns: evidential messages, images or graphics to enhance comprehension and address low literacy, links to credible websites, a provider video, suggested questions to ask their child’s physician, and an optional adolescents’ corner to educate the patient and support parent-child communication. Conclusions The multilevel stakeholder-engaged process used to iteratively develop this novel intervention for HPV vaccine–hesitant families can be used as a model to develop future mobile health interventions. This intervention is currently being pilot-tested in preparation for a randomized controlled trial aiming to increase HPV vaccination among adolescent children of vaccine-hesitant parents in a clinic setting. Future research can adapt HPVVaxFacts for other vaccines and use in other settings (eg, health departments and pharmacies).

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Section: Introductionsupporting

confidence: 76%

Development of a Tailored Mobile Phone–Based Intervention to Facilitate Parent-Child Communication and Build Human Papillomavirus Vaccine Confidence: Formative Qualitative Study

Cunningham-Erves¹,

Wilkins²,

Jones³

et al. 2023

JMIR Form Res

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“…Many parents believe the HPV vaccine is not necessary for an adolescent who is not yet sexually active. 22,23 Some parents oppose HPV vaccines because of concerns that HPV vaccination may encourage sexual activity, despite no evidence to support this concern. 16 Clinicians may overestimate parental HPV vaccine concerns and hesitancy, and may wish to avoid uncomfortable discussions with parents.…”

Section: Barriers To Vaccine Acceptancementioning

confidence: 99%

“…23 This initiative included a 1-hour education session that emphasized the role of HPV vaccination as cancer prevention and allowed clinicians time to practice their use of an announcement approach when discussing the HPV vaccine. 23 The training included a 15-minute simulated case-based scenario created by the AAP. 23,33 A two-arm controlled study by Malo and colleagues randomized clinics to receive one of two interventions: announcement training or conversation training.…”

Section: Improving Clinician Training On Vaccine Communicationmentioning

confidence: 99%

“…23 The training included a 15-minute simulated case-based scenario created by the AAP. 23,33 A two-arm controlled study by Malo and colleagues randomized clinics to receive one of two interventions: announcement training or conversation training. 28 After the 1-hour training sessions, clinicians in both intervention groups offered stronger, more urgent, and more consistent messages about the importance of HPV vaccination.…”

Section: Improving Clinician Training On Vaccine Communicationmentioning

confidence: 99%

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Improving clinician communication to increase adolescent HPV vaccination rates

Meachum

2024

Jaapa

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Despite the proven effectiveness of human papillomavirus (HPV) vaccination, this vaccine is underused in the United States and is associated with many disparities and barriers to acceptance. Adolescent HPV vaccination rates failed to meet the Healthy People 2020 goal of 80% vaccine coverage when nearly all other routine adolescent vaccines met or were near this goal. When introducing the HPV vaccine series, many clinicians use a conversational approach, although years of research show that an announcement approach is more effective at increasing HPV vaccination rates. This article reviews current HPV vaccine communication practices used by clinicians and recommends evidence-based best practices to improve adolescent HPV vaccination rates in the United States.

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“…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 …”

Section: Findings and Relevancementioning

confidence: 99%

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

Constable

Ferguson

Nicholson

et al. 2022

CA A Cancer J Clinicians

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Human papillomavirus (HPV) is currently linked to almost 35,000 new cases of cancer in women and men each year in the United States. Gardasil‐9 (Merck & Company), the only HPV vaccine now available in the United States, is nearly 100% effective at preventing precancers caused by oncogenic HPV types. In the United States, however, only about one half of adolescents are up to date with HPV vaccination. It is well known that health care clinicians’ recommendations play a significant role in parents’ decisions regarding HPV vaccination. A growing body of literature examines specific communication strategies for promoting uptake of the HPV vaccine. A comprehensive review of the evidence for each of these strategies is needed. The authors searched the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Web of Science Complete databases for original articles with a defined clinician communication strategy and an outcome of HPV vaccine uptake or intention to vaccinate (PROSPERO registry no. CRD42020107602). In total, 46 studies were included. The authors identified two main strategies with strong evidence supporting their positive impact on vaccine uptake: strong recommendation and presumptive recommendation. Determinations about a causal relationship were limited by the small numbers of randomized controlled trials. There is also opportunity for more research to determine the effects of motivational interviewing and cancer‐prevention messaging.

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Promoting Strategies to Increase HPV Vaccination in the Pediatric Primary Care Setting

Cited by 7 publications

References 17 publications

Development of a Tailored Mobile Phone–Based Intervention to Facilitate Parent-Child Communication and Build Human Papillomavirus Vaccine Confidence: Formative Qualitative Study

Development of a Tailored Mobile Phone–Based Intervention to Facilitate Parent-Child Communication and Build Human Papillomavirus Vaccine Confidence: Formative Qualitative Study

Improving clinician communication to increase adolescent HPV vaccination rates

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

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