Strength of Provider Recommendations and Perceived Barriers to Administering the Human Papillomavirus Vaccine, Washington State, 2014

BACKGROUND:  Human papillomavirus (HPV) causes significant cancer morbidity and mortality in the United States. Although effective vaccines for prevention of HPV infection are available for use in adolescents, vaccination rates remain low. A clear, brief, and strong recommendation from a healthcare provider has been shown to be a key factor in increased uptake of HPV vaccine, but many providers still do not strongly recommend the vaccine. We surveyed adolescent healthcare providers in Washington State to better characterize their recommendation patterns and perceived barriers to vaccinating eligible adolescents against HPV.

METHODS:  The survey was distributed to members of four professional organizations in Washington between June 2014 and October 2014. Survey questions elicited responses regarding HPV vaccine recommendation practices in different age group and gender combinations, perceived barriers to administering the HPV vaccine, needed educational materials, general perception/knowledge about the HPV vaccine, and topics used to discuss the HPV vaccine with patients and parents.

RESULTS: We received 492 survey responses, with a response rate of 13.6%. Respondents were most likely to report always recommending the vaccine to 13-18 year-old females (81.9%) and least likely to report always recommending the vaccine to 11-12 year-old males (65.7%). The most frequently reported barriers to vaccinating adolescents related to perceived parent or patient concerns about the HPV vaccine. Although 80% of providers report strongly emphasizing cancer prevention when discussing the HPV vaccine, more than 60% discuss the vaccine in the context of sexual initiation, and 50% strongly emphasize the benefit to sexual partners. The most commonly requested educational material was safety and efficacy information formatted to be easily understood by parents. 

CONCLUSIONS:  Despite national recommendations for a 3-dose HPV vaccination series in 11-to-12 year-old males and females, a third of responding Washington adolescent healthcare providers reported they do not always recommend the vaccine to eligible patients. Additionally, HPV vaccine discussions still include strong emphasis on HPV as a sexually transmitted disease. Providers largely perceive parental attitudes and beliefs as the major barriers to vaccination. In addition to encouraging healthcare providers to give a strong recommendation for HPV vaccine, public health agencies can use survey results to design and enhance programs to increase the number and strength of provider recommendations. Making improved educational materials available to providers, patients, and their parents should help decrease the overall number of barriers to HPV vaccination faced by providers.