Providing training on communication with patients and vaccine-hesitant parents on vaccination against HPV, alongside educational material such as tailored fact sheets and a parent education website, significantly increases the number of adolescents who both begin and complete the series.
“As of 2016, only 60.4% of children aged 13 to 17 years had started the HPV vaccination series, and only approximately two-thirds of those starting the series completed it,” Amanda F. Dempsey, MD, PhD, from the Adult and Child Consortium for Outcomes Research and Dissemination Service at the University of Colorado, Denver, and colleagues wrote. “Attempts to use policy changes to increase uptake, such as mandating HPV vaccination for school entry, have been largely unsuccessful and ineffective.”
“Interventions to improve adolescent HPV vaccination by other means are a national priority,” the researchers continued. “A key factor influencing adolescent HPV vaccination is whether and how a health care professional recommends it.”
To examine the efficacy of a communication intervention targeted at teenagers that incorporates five components to be used by a health care professional, the researchers conducted a cluster randomized clinical trial. Dempsey and colleagues led this study in 16 primary care settings, all located within the Denver, Colorado, metropolitan area. The research was completed using covariate-constrained randomization, which assigned study participants and an intent-to-treat procedure.
The five-component intervention provided health care providers with a fact sheet library focused on HPV. All sheets were customized to the relevant patient population. The intervention also supplied health care providers with a parent education website, images relating to HPV and a decision tool.
Furthermore, all participating providers participated in a 2.5-hour training session related to communicating with patients. Presumptive vaccine recommendations were supported, and further assistance was given on motivational interviewing for vaccine-hesitant parents. Development meetings were held before implementation, and all providers attended two meetings between Aug. 1, 2014, to Jan. 31, 2015.
Of the 43,132 patients seen at 16 locations, 50.3% were female (median age, 12.6 years; interquartile range, 10.8-14.7 years). Teens who received the five-component intervention were much more likely to begin the vaccine series (adjusted OR, 1.46; 95% CI, 1.31-1.62) and to complete the series (aOR, 1.56; 95% CI, 1.27-1.92) when compared with adolescents who did not receive the intervention. Specifically, researchers observed a 9.5-absolute percentage point rise in initiation and a 4.4-absolute percentage point increase in series completion in those participating in the intervention.
Dempsey and colleagues observed that the intervention was more likely to be effective in pediatric practices when compared with family medicine practices. Additionally, private practices were more likely to see success with this intervention than public practices. According to reports from providers who participated in the intervention, training and fact sheets were the most helpful and useful components.
“Improvements in HPV vaccination among intervention practices occurred primarily at well-child care visits. While there was some decrease in missed opportunities for vaccination at sick visits in intervention practices, this decrease was small, and most vaccines were still provided during routine wellness examinations,” Dempsey and colleagues wrote. “… Given that adolescents see medical professionals for sick visits more commonly than for preventive visits, finding mechanisms to improve vaccination at sick visits is a clear research priority.” – by Katherine Bortz
Disclosures: Dempsey reports serving on advisory boards for Merck, Pfizer and Sanofi Pasteur, and reports being a consultant to Pfizer. She reports that she does not receive funding from these agencies and that they had no role in the research.