Factors Influencing Pediatricians' Intention to Recommend Human Papillomavirus Vaccines

Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA.
Ambulatory Pediatrics (Impact Factor: 2.49). 09/2007; 7(5):367-73. DOI: 10.1016/j.ambp.2007.05.010
Source: PubMed


The objectives of this qualitative study were to describe the range of pediatricians' attitudes about human papillomavirus (HPV) vaccines and to explore factors influencing their intention to recommend HPV vaccines, extending the findings of previous quantitative studies.
A diverse sample of pediatricians participated in semistructured individual interviews to assess attitudes and intentions regarding HPV immunization. Framework analysis was used for qualitative analysis.
The mean age of the 31 participants was 47 years, 17 (55%) were female, 9 (29%) were black, and 4 (13%) were Latino. The efficacy, safety, and potential health impact of vaccination were the primary factors driving participants' decisions about recommending HPV vaccines. Perceived benefits of HPV vaccination included prevention of HPV-related disease and the opportunity to educate adolescents. Perceived barriers included anticipated parental beliefs (eg, parental denial that their child would be at risk) and provider beliefs (eg, reluctance to discuss sexuality with preadolescents). Participants reported high intention to recommend HPV vaccines overall, but intention varied according to patient age, patient gender, and HPV vaccine type. The primary reasons underlying this variation included perceptions about the health impact of vaccination and relevance of HPV vaccines to the provider's patients. The main factors driving intention to recommend HPV vaccines included knowledge, personal and professional characteristics, office procedures, vaccine cost and reimbursement, parental factors, and specific attitudes about HPV vaccination.
These findings provide a framework for understanding pediatricians' decisions to recommend HPV vaccines and may be used to guide the design of interventions to maximize vaccine recommendations.

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    • "For 11-and 12-year-old patients, physicians indicated that they endorsed HPV vaccine less strongly than Tdap or meningococcal vaccines and often discussed it last. These findings add to a growing literature which suggests that, although physicians generally support HPV vaccination (Perkins et al., 2014; Feemster et al., 2008; Kahn et al., 2007), they discuss it in ways that likely discount its value (Perkins et al., 2014; Hughes et al., 2011; McRee et al., 2014; Hamlish et al., 2012). To the extent that physicians' strong endorsements of Tdap or Fig. 1. "
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    ABSTRACT: Low human papillomavirus (HPV) vaccination coverage stands in stark contrast to our success in delivering other adolescent vaccines. To identify opportunities for improving physicians' recommendations for HPV vaccination, we sought to understand how the communication context surrounding adolescent vaccination varies by vaccine type. A national sample of 776 U.S. physicians (53% pediatricians, 47% family medicine physicians) completed our online survey in 2014. We assessed physicians' perceptions and communication practices related to recommending adolescent vaccines for 11- and 12-year-old patients. About three-quarters of physicians (73%) reported recommending HPV vaccine as highly important for patients, ages 11-12. More physicians strongly recommended tetanus, diphtheria, and acellular pertussis (Tdap) (95%) and meningococcal vaccines (87%, both p<0.001) for this age group. Only 13% of physicians perceived HPV vaccine as being highly important to parents, which was far fewer than perceived parental support for Tdap (74%) and meningococcal vaccines (62%, both p<0.001). Physicians reported that discussing HPV vaccine took almost twice as long as discussing Tdap. Among physicians with a preferred order for discussing adolescent vaccines, most (70%) discussed HPV vaccine last. Our findings suggest that primary care physicians perceived HPV vaccine discussions to be burdensome, requiring more time and engendering less parental support than other adolescent vaccines. Perhaps for this reason, physicians in our national study recommended HPV vaccine less strongly than other adolescent vaccines, and often chose to discuss it last. Communication strategies are needed to support physicians in recommending HPV vaccine with greater confidence and efficiency. Copyright © 2015. Published by Elsevier Inc.
    Preventive Medicine 06/2015; 77. DOI:10.1016/j.ypmed.2015.05.024 · 3.09 Impact Factor
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    • "Another major barrier to the delivery of the HPV vaccine was the time constraints faced by GPs, which was also reported in previous HPV vaccination studies [16,27]. GPs noted that consultations of approximately 15 minutes were only adequate for addressing the patient’s immediate health issues, which deprives them of the opportunity to discuss HPV vaccination. "
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    ABSTRACT: Background Although the Human Papillomavirus (HPV) vaccine is registered in Australia for females aged 9 to 45 years, females aged 27 to 45 years have shown limited vaccine uptake. Our study explored general practitioners’ (GPs) views concerning HPV vaccination of females in this age group, with particular focus on the barriers and the facilitators to the delivery of the HPV vaccine. Methods Semi-structured telephone interviews were conducted with 24 randomly selected general practitioners from metropolitan Melbourne. Questions were based on a theoretical framework that explained the barriers and facilitators to professional behaviour change. Results According to the GPs, the major barriers to the uptake of the HPV vaccine included the cost of the vaccine, time constraints, and the three-dose schedule. Other barriers that were identified included GPs’ and patients’ beliefs that females in this age group were at low risk of contracting HPV, lack of awareness about the vaccine, and uncertainty about the benefits of this vaccine for females in this age group. In contrast, the facilitators that were identified included the availability of the vaccine on site, the availability of vaccine clinics or nurses for administering the vaccine, the availability of information related to the vaccine either on site or online, and positive opinions from experts in the field. Conclusions Our study has identified some of the barriers and facilitators to the delivery and uptake of the HPV vaccine in females aged 27 to 45 years, as perceived by GPs. Further studies should be conducted to determine which of these should be targeted or prioritised for intervention. The views of women in this age group should also be considered as these would also be influential in designing effective intervention strategies for improving the delivery and uptake of the HPV vaccine.
    BMC Women's Health 07/2014; 14(1):91. DOI:10.1186/1472-6874-14-91 · 1.50 Impact Factor
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    • "More commonly, resistance was anticipated due to connections with sexual activity [29,31,32,44,45]: “HPV has so many other implications for parents… it’s one they fight you on…because you’re suggesting that their child is or will be sexually active soon, and they don’t want to hear that” [Clinician, USA] [45]. In three studies, healthcare professionals reported that parents delayed vaccination of their daughter on this basis [31,32,44]. "
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    ABSTRACT: Background Vaccination against Human Papillomavirus (HPV) is recommended for adolescent young women prior to sexual debut to reduce cervical cancer related mortality and morbidity. Understanding factors affecting decision-making of HPV vaccination of young women is important so that effective interventions can be developed which address barriers to uptake in population groups less likely to receive the HPV vaccine. Methods We undertook a qualitative systematic review and evidence synthesis to examine decision-making relating to the HPV vaccination of young women in high-income countries. A comprehensive search of databases from inception to March 2012 was undertaken to identify eligible studies reporting the perspectives of key stakeholders including policy makers, professionals involved in programme, parents, and young women. Factors affecting uptake of the vaccine were examined at different levels of the socio-ecological model (policy, community, organisational, interpersonal and intrapersonal). Results Forty-one studies were included. Whether young women receive the HPV vaccine is strongly governed by the decisions of policy makers, healthcare professionals, and parents. These decisions are shaped by: financial considerations; social norms and values relating to sexual activity, and; trust in vaccination programmes and healthcare providers. Financial constraints may be overcome through universal healthcare systems offering the HPV vaccine free at the point of delivery. In the healthcare setting, judgements by healthcare professionals about whether to recommend the vaccine may restrict a young woman’s access to the vaccine irrespective of her own beliefs and preferences. Parents may decide not to allow their daughters to be vaccinated, based on cultural or religious perceptions about sexual activity. Conclusions Barriers to the uptake of the HPV vaccine have implications for young women’s future sexual, physical and reproductive health. Interventions to address barriers to uptake of the vaccine should target appropriate, and multiple, levels of the socio-ecological model. Issues of trust require clear, accessible, and sometimes culturally appropriate, information about the HPV vaccination programme. Although young women are central to the HPV vaccination programme, their views are underrepresented in the qualitative literature. Future research should consider young women’s perceptions of, and involvement in, consent and decision-making.
    BMC Public Health 07/2014; 14(1):700. DOI:10.1186/1471-2458-14-700 · 2.26 Impact Factor
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