Strategies to improve human papillomavirus vaccination rates among adolescents in family practice settings in the United States: A systematic review

Abstract

Aims and Objectives To explore the interventions aimed at increasing human papillomavirus (HPV) vaccination rates among adolescents in family practice settings. Background HPV is the most common sexually transmitted disease in the United States, and the cause of thousands of anogenital and oropharyngeal cancers annually. Although HPV infection can be prevented with recommended vaccination during adolescence, national HPV vaccine rates remain low. Design Systematic review. Methods Four databases (MEDLINE, CINAHL, EMBASE and the Cochrane Library) were searched. The search was guided by PRISMA and by the question, ‘What are targeted interventions that improve HPV vaccination rates among adolescents in family practice settings?’ Articles were reviewed for study characteristics and appraised for quality using the revised Cochrane risk of bias tools. Results Eleven studies met inclusion and exclusion criteria. Individual study size samples ranged from 749–147,294, with a combined total from all included studies of 276,205; the largest sample reviewed to date from family practice settings. Interventions used to increase HPV vaccination rates included reminder systems; provider and staff education; sensory incentives such as hitting a gong or petting a puppy; and iPad tailored messaging programmes. Studies that employed interventions pre‐, during and postvisit were most effective in increasing HPV vaccination rates. Conclusions This review provides the largest data supporting multimodal strategies to increase HPV vaccination rates among adolescent populations. It provides strong evidence to suggest that vaccination rates can be improved using measures at varying times of the patient visit. Relevance to Clinical Practice Adolescents seek health care in various settings. Many studies have examined interventions to increase HPV vaccination in paediatric settings, but few have examined interventions in family practice settings. This review suggests that family practices should implement multimodal measures before, during and after visits to increase HPV vaccination among adolescent patients.

Which interventions improve HPV vaccination uptake and intention in children, adolescents and young adults? An umbrella review

“…21,23,[25][26][27][28] Most of the included primary studies in the systematic reviews were conducted in the USA. [20][21][22][23][24][25][26][27][28][29] Other countries that were represented were Australia (n=5), 21,[23][24][25]28 the UK, (n=3) 20,23,24 Sweden (n=3), 20,23,24 India (n=2), 24,27 Canada (n=1), 28 China (n=1), 27 Hong Kong (n=2), 23,24 Hungary (n=1), 23 Ireland (n=1), 24 Singapore (n=1), 23 Tanzania (n=1), 20 and Taiwan (n=1). 23 Two reviews only included studies from the USA.…”

“…23 Two reviews only included studies from the USA. 22,29 The total number of participants across all ten systematic reviews was 451,132 and the number of participants in each systematic review ranged from 2625 21 to 276,205 22 with all reviews, except one 22 including studies with small sample sizes of less than 200 participants. Five systematic reviews did not report the ethnicity of participants 20,21,23,27,28 and in one further systematic review, 28 of the 30 included studies did not report on ethnicity.…”

“…Five systematic reviews did not report the ethnicity of participants 20,21,23,27,28 and in one further systematic review, 28 of the 30 included studies did not report on ethnicity. 29 For the remaining systematic reviews, populations were either predominately white (n=2) 22,24 or included a broad range of ethnicities. 25,26 The outcomes included within the systematic reviews were HPV vaccination uptake rates (n=9) [20][21][22][23][24][25][26][27][28][29] and/or HPV vaccination intention (n=6).…”

HPV immunization among young adults (HIYA!) in family practice: A quality improvement project

“…HIYA! was designed based on current evidence that multimodal approaches involving measures pre-, during, and post-visit are the most effective method to increase HPV vaccination rates in family practice (Eisenhauer et al, 2020). HIYA!…”

“…A pooled analysis of five randomized controlled trials suggested that reminder systems significantly increased HPV vaccination rates (Dempsey et al, 2019;Eisenhauer et al, 2020;Henrikson et al, 2018;Rand et al, 2017;Szilagyi et al, 2015Szilagyi et al, , 2020. Reminder systems included phone calls, text messages, emails and postcards.…”