June 06, 2018
2 min read

Provider persistence improves HPV vaccination rates in teens

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The type of communication used with parents who are hesitant about having their teenager vaccinated against HPV can improve or hinder the chances of same-day vaccination, with persistence toward immunization resulting in more vaccinations.

“Despite the causal role of human papillomavirus in multiple cancers, HPV vaccination in the United States remains inadequate,” Laura A. Shay, PhD, from the department of health promotion and behavioral sciences at the UTHealth School of Public Health, and colleagues wrote. “In 2016, only 43.4% of adolescents aged 13 to 17 years were up-to-date. As a result, significant numbers of adolescents are not protected from HPV-related cancers, and we are not meeting the Healthy People 2020 goal of 80% series completion.”

“Although authors of several studies have documented missed clinical opportunities in which providers did not offer or recommend the HPV vaccine, others have shown that parents are hesitant and delay making a decision,” the researchers added.

To prevent HPV-related cancers and promote vaccination through communication between parents and providers regarding vaccine hesitancy, the researchers assessed audio recordings from 43 pediatric visits at six clinics in Dallas. All adolescents included in the study were not vaccinated against HPV, and parents had not decided whether their child should be vaccinated.

A qualitative analysis was conducted to examine how hesitancy was expressed verbally by parents, with assertive responses, questions and expressions of concern recorded. Furthermore, the researchers assessed whether health care providers agreed to defer vaccination against HPV or continued to discuss the benefits of vaccination. The assigned codes for each of these provider, and parental communications were then described in relation to same-day vaccination.

Of the 43 visits recorded, at least one instance of hesitancy was expressed by parents in 37 visits. Shay and colleagues most frequently observed assertive responses (n = 27 visits), questions (n = 16 visits) and concerns (n = 12 visits). Same-day vaccination was reported in 71% of teenagers whose parents asked questions and 75% of teenagers whose parents raised concerns about vaccination. This percentage dropped to 33% when parents gave assertive responses.

Persistence from health care providers regarding vaccination was recorded in 18 visits. A combination of acquiescence and persistence was recorded in 13 visits, and providers allowed deferral completely in six visits. When persistence was used without considering deferment, 17 of the 18 teenagers were vaccinated. No adolescents were vaccinated against HPV when providers allowed deferral.

“With our exploratory examination of the relationship between parent-provider communication about HPV vaccine hesitancy and vaccination behavior, we suggest that persistently engaging parents who express hesitancy can lead to same-day vaccination and that these conversations are short — approximately 2 to 3 minutes,” Shay and colleagues wrote. “Although a mix of persistence and acquiescence may be warranted in cases of parents who express high restraint, our findings reveal a potentially important missed opportunity when providers simply acquiesce to parental expressions of hesitation.” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.