What Affects Human Papillomavirus Vaccination Rates? A Qualitative Analysis of Providers' Perceptions
ABSTRACT To define factors that providers perceive as affecting their administration of human papillomavirus (HPV) vaccination in their clinical practices.
We conducted in-depth, qualitative interviews with 34 pediatric and family medicine providers in four community health centers to explore providers' perceptions of factors that either enabled or impeded their ability to vaccinate their patients against HPV.
Providers' self-reported vaccination rates ranged from 25 to 95% (median, 75%) of the 11- to 26-year-old females in their practices. Factors that enabled vaccination included providers' beliefs that HPV vaccines were safe and would provide important health benefits, structured visits that promoted vaccination, and coadministration of HPV with other recommended vaccines. Factors that impeded vaccination included safety concerns, a low perceived severity of HPV disease, lack of school mandates, and policies against coadministration of HPV and meningococcal vaccines. Providers who described more enabling factors than impeding factors reported vaccinating more of their patients.
Provider perceptions around the ease or difficulty of providing HPV vaccination may influence their behavior when offering HPV vaccines to their patients.
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ABSTRACT: Objective: Routine immunisation of adolescent girls aged 12-17 years against human papillomavirus (HPV) was recommended in Germany in March 2007. We aimed to assess HPV-vaccine uptake and knowledge about post-vaccination cervical cancer screening and condom use in women aged 18-20 years, three years after adoption of HPV-vaccination into the routine vaccination schedule. Results: Overall 2,001 females participated in our study. Of these, 49% reported receipt of a complete three-dose course of HPV-vaccines; 11% received 1 or 2 doses. Living in East-Germany, high educational status, and interest in health-related issues were independently associated with HPV-vaccination. Misconceptions among survey-participants were rare: Only 8% believed that HPV-vaccination would obviate the need for cervical screening and 1% that condom use would be dispensible after vaccination. Methods: In 2010, a nationwide cross-sectional telephone-survey was carried out among randomly-selected women aged 18-20 years living in Germany. Telephone interviews were conducted by a large professional market research institute as part of a daily omnibus survey. Conclusion: HPV-vaccination coverage is low in Germany. The results indicate that there is an urgent need for the implementation of a coordinated adolescent vaccination programme to facilitate access to vaccination, including balanced information tailored to this age group. Otherwise, the HPV-vaccination effort will fall short of reaching its maximum public health benefit.Human Vaccines & Immunotherapeutics 05/2013; 9(8). DOI:10.4161/hv.24904 · 3.64 Impact Factor
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ABSTRACT: Current cervical cancer prevention recommendations include human papillomavirus (HPV) vaccination, Pap and HPV co-testing, and Pap testing at 3- to 5-year intervals. To examine attitudes, practice patterns, and barriers related to HPV vaccination and cervical cancer screening guidelines among U.S. obstetrician-gynecologists. In 2011-2012, a national sample of members of the American Congress of Obstetricians and Gynecologists responded to a 15-item (some with multiple parts) questionnaire assessing sociodemographic characteristics, clinical practices, and perceived barriers to HPV vaccination and cervical cancer screening. Multivariate logistic regression was used to identify factors associated with guideline adherence. Analyses were conducted in 2012. A total of 366 obstetrician-gynecologists participated. Ninety-two percent of respondents offered HPV vaccination to patients, but only 27% estimated that most eligible patients received vaccination. Parent and patient refusals were commonly cited barriers to HPV vaccination. Approximately half of respondents followed guidelines to begin cervical cancer screening at age 21 years, discontinue screening at age 70 years or after hysterectomy, and appropriately utilize Pap and HPV co-testing. Most physicians continued to recommend annual Paps (74% aged 21-29 years, 53% aged ≥30 years). Physicians felt that patients were uncomfortable with extended screening intervals and were concerned that patients would not come for annual exams without concurrent Paps. Solo practitioners were less likely to follow both vaccination and screening guidelines than those in group practices. This survey of obstetrician-gynecologists indicates persistent barriers to the adoption of HPV vaccination and cervical cancer screening guidelines. Interventions to promote guideline adherence may help improve the quality of cervical cancer prevention.American journal of preventive medicine 08/2013; 45(2):175-81. DOI:10.1016/j.amepre.2013.03.019 · 4.28 Impact Factor
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ABSTRACT: Importance Since licensure of the human papillomavirus (HPV) vaccine in 2006, HPV vaccine coverage among US adolescents has increased but remains low compared with other recommended vaccines.Objective To systematically review the literature on barriers to HPV vaccination among US adolescents to inform future efforts to increase HPV vaccine coverage.Evidence Review We searched PubMed and previous review articles to identify original research articles describing barriers to HPV vaccine initiation and completion among US adolescents. Only articles reporting data collected in 2009 or later were included. Findings from 55 relevant articles were summarized by target populations: health care professionals, parents, underserved and disadvantaged populations, and males.Findings Health care professionals cited financial concerns and parental attitudes and concerns as barriers to providing the HPV vaccine to patients. Parents often reported needing more information before vaccinating their children. Concerns about the vaccine’s effect on sexual behavior, low perceived risk of HPV infection, social influences, irregular preventive care, and vaccine cost were also identified as potential barriers among parents. Some parents of sons reported not vaccinating their sons because of the perceived lack of direct benefit. Parents consistently cited health care professional recommendations as one of the most important factors in their decision to vaccinate their children.Conclusions and Relevance Continued efforts are needed to ensure that health care professionals and parents understand the importance of vaccinating adolescents before they become sexually active. Health care professionals may benefit from guidance on communicating HPV recommendations to patients and parents. Further efforts are also needed to reduce missed opportunities for HPV vaccination when adolescents interface with the health care system. Efforts to increase uptake should take into account the specific needs of subgroups within the population. Efforts that address system-level barriers to vaccination may help to increase overall HPV vaccine uptake.11/2013; 168(1). DOI:10.1001/jamapediatrics.2013.2752