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Human papillomavirus (HPV) vaccination is below national goals in the United States. Health care providers are at the forefront of improving vaccination in the United States, given their close interactions with patients and parents.
The objective of this study was to assess the associations between demographic and practice characteristics of the health care providers with the knowledge of HPV vaccination and HPV vaccine guidelines. Furthermore, our aim was to contextualize the providers’ perceptions of barriers to HPV vaccination and strategies for improving vaccination in a state with low HPV vaccine receipt.
In this mixed-methods study, participating providers (N=254) were recruited from statewide pediatric, family medicine, and nursing organizations in Utah. Participants completed a Web-based survey of demographics, practice characteristics, HPV vaccine knowledge (≤10 correct vs 11-12 correct answers), and knowledge of HPV vaccine guidelines (correct vs incorrect). Demographic and practice characteristics were compared using chi-square and Fisher exact tests for HPV knowledge outcomes. Four open-ended questions pertaining to the barriers and strategies for improving HPV vaccination were content analyzed.
Family practice providers (52.2%, 71/136;
Providers require support to eliminate barriers to recommending HPV vaccination in clinical settings. Additionally, providers endorsed the need for parental educational materials and instructions on framing HPV vaccination as a priority cancer prevention mechanism for all adolescents.
In 2013, the US President’s Cancer Panel identified provider recommendations as one of three priorities for improving the rates of human papillomavirus (HPV) vaccination [
Knowledge about HPV vaccines influences the providers’ intention to recommend HPV vaccination to their patients [
Theoretically informed approaches to improving HPV vaccination are necessary to advance research and practice in this area. The social ecological framework (SEF) is a health promotion model that encompasses multiple levels of influence. In the SEF, individual, interpersonal, and organizational characteristics constitute three of the five levels of influence on a public health intervention. Multilevel targeted interventions promote healthy practices such as the administration of HPV vaccines to prevent HPV-related morbidity and mortality [
Moreover, the exposure of health care providers to the health care system, parents, and patients gives them unique perspectives on the clinical barriers and strategies for improving HPV vaccination. In this mixed-methods study, we describe providers’ knowledge of HPV vaccines and HPV vaccine guidelines and their perceptions of barriers to and strategies for improving HPV vaccination in Utah, which is a state with low HPV vaccination rates. We aimed to assess associations of demographic and practice characteristics with providers’ knowledge of HPV vaccination and HPV vaccination guidelines to identify provider groups with knowledge deficits. Providers’ perceptions of the barriers to and strategies for improving HPV vaccination were described to contextualize the results.
Mixed-method approaches that combine qualitative and quantitative data resources provide a more complete description of a phenomenon than a single methodological approach alone [
During three periods from 2014-2015, a self-administered closed survey was distributed via email listservs to 3 statewide provider organizations, with sample sizes of approximately 600, 740, and 330 for pediatrics, family medicine, and nursing, respectively. The survey comprised 58 items, with 1 to 4 questions per page. Participants received notification of a forthcoming opportunity to participate in a research study, with the option to opt out from further contact (n=1). Eligible participants who did not opt out received an additional email invitation to complete the Web-based survey within 2 weeks. Two biweekly reminder emails were then sent within 4 weeks after the initial email. Anonymous submission of the completed survey constituted consent. Participants had the option to receive a US $20 Amazon gift card or make a US $20 donation to a local children’s hospital. The approximate response rates were as follows: pediatrics 18.0% (108/600), family practice 21.8% (161/740), and nurse practitioners 39.1% (129/330). Of these, 65 participants were excluded because they were not a pediatrician, family medicine physician, or nurse practitioner (eg, office staff and medical assistant), and 79 participants were excluded because they did not see patients in a clinical setting. The final sample of 254 participants who were analyzed comprised 75 pediatricians, 136 family medicine physicians, and 43 nurse practitioners.
Demographics included age, sex, race, marital status, and religion. Practice characteristics included practice location, Vaccines for Children (VFC) provider status, specialty type, practice type, practice size, number of patients per day, number of patients per week, most common form of patient payment, and provider-reported majority Hispanic population. Variable selection was guided by the SEF and included factors that represented multiple levels of influence, including individual, interpersonal, and community (eg, parents, patients, health care providers, organizations, and public policy). Variable selection was also based on extant literature and our previous research in Utah related to HPV vaccination.
On the basis of a review of the literature, two HPV knowledge measures were measured (see
The second outcome, knowledge of HPV vaccination guidelines, was measured for each respondent based on 3 questions about the timing and age of HPV vaccination. For analysis, we aggregated responses into a binary variable, with those who incorrectly answered any of the 3 questions as lower knowledge and those who answered all 3 questions correctly as high knowledge.
Summary statistics were reported for demographic and practice characteristics. Statistics were calculated for nonmissing data as indicated in
Qualitative data were extracted from 4 open-ended questions of the Web-based survey to describe providers’ perceptions of barriers to and strategies for improving HPV vaccination among males and females to “ground” the quantitative results. Grounding is a mixed-methods technique for combining qualitative and quantitative data to contextualize a phenomenon [
Outcome variable questions and responses.
Question | Correct response | Knowledge outcome |
Vaccine leads to long-lasting immunity. | True | HPVavaccination |
Vaccine does not cause adverse side effects. | True | HPV vaccination |
Vaccine protects against genital warts in addition to cervical cancer. | True | HPV vaccination |
Condom use in patients does not decrease after vaccination. | True | HPV vaccination |
Offering vaccination provides an opportunity to discuss sexuality issues with patients. | True | HPV vaccination |
The likelihood of patients having sex does not increase after vaccination. | True | HPV vaccination |
HPV vaccination is highly effective at preventing cervical cancer precursors. | True | HPV vaccination |
Almost all cervical cancers are caused by HPV infection. | True | HPV vaccination |
Women who have been diagnosed with HPV should not be given HPV vaccine. | False | HPV vaccination |
The incidence of HPV in women is highest among women in their 30s. | False | HPV vaccination |
Genital warts are caused by the same HPV types that cause cervical cancer. | False | HPV vaccination |
A pregnancy test should be performed prior to giving HPV vaccine. | False | HPV vaccination |
When is HPV vaccination recommended? | Before the beginning of sexual activity | HPV vaccine guideline |
The recommended age for HPV vaccination in adolescent girls is? | Subjects aged 11-12 years | HPV vaccine guideline |
The recommended age for HPV vaccination in adolescent boys is? | Subjects aged 11-12 years | HPV vaccine guideline |
aHPV: human papillomavirus.
Participants included 136 family practice physicians, 75 pediatricians, and 43 nurse practitioners. No demographic factors were associated with providers’ knowledge of HPV vaccination (see
In
Univariate analysis of demographic characteristics associated with human papillomavirus vaccination knowledge (N=254).
Demographics | Human papilloma virus vaccination knowledge | |||
Lower knowledge (N=148) | High knowledge (N=106) | |||
n (%) | n (%) | |||
.46a | ||||
18-29 | 14 (56.0) | 11 (44.0) | ||
30-39 | 47 (52.2) | 43 (47.5) | ||
40-49 | 43 (64.2) | 24 (35.8) | ||
≥50 | 44 (61.1) | 28 (38.9) | ||
.57a | ||||
Male | 76 (59.8) | 51 (40.2) | ||
Female | 71 (56.3) | 55 (43.7) | ||
.21a | ||||
White | 134 (57.0) | 101 (43.0) | ||
Otherc | 13 (72.2) | 5 (27.8) | ||
.87a | ||||
Single, divorced, widowed | 22 (59.5) | 15 (40.5) | ||
Married, living as married | 126 (58.1) | 91 (41.9) | ||
.84a | ||||
Latter-day Saint | 70 (56.9) | 53 (43.1) | ||
Other religion | 47 (61.0) | 30 (39.0) | ||
No religion | 31 (57.4) | 23 (42.6) | ||
.11a | ||||
Salt Lake, Utah, or Davis counties | 131 (60.1) | 87 (39.9) | ||
Other counties | 16 (45.7) | 19 (54.3) |
aChi-square test.
bMissing values: Sex=1; Race=1; Location=1.
cOther includes black or African American, American Indian or Alaska Native, Asian, Native Hawaiian or Pacific Islander, Other.
Univariate analysis of practice characteristics associated with human papillomavirus vaccination knowledge (N=254).
Practice characteristics | Human papillomavirus vaccination knowledge | |||
Lower knowledge (N=148) | High knowledge (N=106) | |||
n (%) | n (%) | |||
.06b | ||||
Yes | 94 (55.6) | 75 (44.4) | ||
No or Do not know | 44 (60.3) | 29 (39.7) | ||
Do not provide vaccinesc | 10 (90.9) | 1 (9.1) | ||
Pediatrician | 55 (73.3) | 20 (26.7) | ||
Family practice physician | 65 (47.8) | 71 (52.2) | ||
Nurse practitioner | 28 (65.1) | 15 (34.9) | ||
Private (solo or group) | 54 (64.3) | 30 (35.7) | ||
Primary care or Othere | 48 (49.5) | 49 (50.5) | ||
Institutional or University settings | 17 (46.0) | 20 (54.0) | ||
Hospital or Urgent care clinic | 27 (84.4) | 5 (15.6) | ||
.36d | ||||
1-5 | 47 (54.0) | 40 (46.0) | ||
6-10 | 37 (66.1) | 19 (33.9) | ||
>10 | 60 (57.7) | 44 (42.3) | ||
<15 | 52 (72.2) | 20 (27.8) | ||
15-19 | 36 (52.2) | 33 (47.8) | ||
20-29 | 28 (50.0) | 28 (50.0) | ||
≥30 | 30 (60.0) | 20 (40.0) | ||
.09d | ||||
<25 | 29 (74.4) | 10 (25.6) | ||
25-49 | 53 (55.8) | 42 (44.2) | ||
≥50 | 63 (55.3) | 51 (44.7) | ||
.31d | ||||
Private insurance | 86 (54.4) | 72 (45.6) | ||
Medicaid or Children's Health Insurance Program | 35 (64.8) | 19 (35.2) | ||
Uninsured, Self-pay, Other, or Do not know | 26 (63.4) | 15 (36.6) | ||
.59d | ||||
Yes | 15 (53.6) | 13 (46.4) | ||
No | 133 (58.9) | 93 (41.1) |
aVaccines for children provider not applicable or missing=1; Practice type not applicable or missing=4; Practice size not applicable or missing=7; Number of patients per day other, not applicable, or missing=7; Number of patients per week other, not applicable, missing=6; Most common patient payment not applicable or missing=1.
bFisher exact test.
cIndividuals who see patients but do not provide vaccinations (eg, oncology).
dChi-square test. Italics indicate
eIncludes ambulatory care, primary care clinic, health department, federally qualified health center, and other.
Univariate analysis for demographic characteristics associated with human papillomavirus vaccine recommendation knowledge (N=254).
Demographics | Human papillomavirus vaccine recommendation knowledge | |||
Lower knowledge (N=64) | High knowledge (N=190) | |||
n (%) | n (%) | |||
18-29 | 5 (20.0) | 20 (80.0) | ||
30-39 | 31 (34.4) | 59 (65.6) | ||
40-49 | 10 (14.9) | 57 (85.1) | ||
≥50 | 18 (25.0) | 54 (75.0) | ||
.26a | ||||
Male | 36 (28.3) | 91 (71.7) | ||
Female | 28 (22.2) | 98 (77.8) | ||
.05a | ||||
White | 56 (23.8) | 179 (76.2) | ||
Otherc | 8 (44.4) | 10 (55.6) | ||
.27a | ||||
Single, divorced, widowed | 12 (32.4) | 25 (67.6) | ||
Married, living as married | 52 (24.0) | 165 (76.0) | ||
.82a | ||||
Latter-day Saint | 29 (23.6) | 94 (76.4) | ||
Other religion | 20 (26.0) | 57 (74.0) | ||
No religion | 15 (27.8) | 39 (72.2) | ||
.72a | ||||
Salt Lake, Utah, or Davis counties | 56 (25.7) | 162 (74.3) | ||
Other counties | 8 (22.9) | 27 (77.1) |
aChi-square test. Italics indicate
bMissing values: Sex=1, Race=1, and Location=1.
cOther includes black or African American, American Indian or Alaska Native, Asian, Native Hawaiian or Pacific Islander, Other.
Univariate analysis for practice characteristics associated with human papillomavirus vaccine recommendation knowledge (N=254).
Characteristics | Human papillomavirus vaccine recommendation knowledge | |||
Lower knowledge (N=64) | High knowledge (N=190) | |||
n (%) | n (%) | |||
Yes | 36 (21.3) | 133 (78.7) | ||
No or Do not know | 22 (30.1) | 51 (69.9) | ||
Do not provide vaccinesc | 6 (54.6) | 5 (45.4) | ||
.20d | ||||
Pediatrician | 15 (20.0) | 60 (80.0) | ||
Family practice physician | 34 (25.0) | 102 (75.0) | ||
Nurse practitioner | 15 (34.9) | 28 (65.1) | ||
.72d | ||||
Private (solo or group) | 22 (26.2) | 62 (73.8) | ||
Primary care or Othere | 21 (21.7) | 76 (78.3) | ||
Institutional or University settings | 9 (24.3) | 28 (75.7) | ||
Hospital or Urgent care clinic | 10 (31.2) | 22 (68.8) | ||
.07d | ||||
1-5 | 26 (29.9) | 61 (70.1) | ||
6-10 | 17 (30.4) | 39 (69.6) | ||
>10 | 18 (17.3) | 86 (82.7) | ||
.20d | ||||
<15 | 19 (26.4) | 53 (73.6) | ||
15-19 | 21 (30.4) | 48 (69.6) | ||
20-29 | 16 (28.6) | 40 (71.4) | ||
≥30 | 7 (14.0) | 43 (86.0) | ||
.35d | ||||
<25 | 11 (28.2) | 28 (71.8) | ||
25-49 | 28 (29.5) | 67 (70.5) | ||
≥50 | 24 (21.0) | 90 (79.0) | ||
.07d | ||||
Private insurance | 32 (20.2) | 126 (79.8) | ||
Medicaid or Children's Health Insurance Program | 16 (29.6) | 38 (70.4) | ||
Uninsured, Self-pay, Other, or Do not know | 15 (36.6) | 26 (63.4) | ||
.98d | ||||
Yes | 7 (25.0) | 21 (75.0) | ||
No | 57 (25.2) | 169 (74.8) |
aVaccines for children provider not applicable or missing=1; Practice type not applicable or missing=4; Practice size not applicable or missing=7; Number of patients per day other, not applicable, or missing=7; Number of patients per week other, not applicable, or missing=6; Most common patient payment not applicable or missing=1.
bFisher exact test. Italics indicate
cIndividuals who see patients but do not provide vaccinations (eg, oncology).
dChi-square test.
eIncludes ambulatory care, primary care clinic, health department, federally qualified health center, and other.
The following results describe health care providers’ perceptions of barriers to HPV vaccination and strategies for improving HPV vaccination with accompanying illustrative quotes presented in the text and in
In the open-ended questions, providers described concerns about sexual activity and promiscuity (n=69), vaccine refusal or reluctance (n=62), inadequate or incorrect parental knowledge (n=96), and low perceived risk of HPV (n=67) as the most common barriers to vaccination for parents and patients (see
I do see a lot of moms “explain” the vaccine to their children saying, “It would be a good idea in case you were raped” rather than in case you had a sexual partner with HPV.
Providers responded that parents believed that the HPV vaccine increases sexual promiscuity, is unnecessary because their child is not sexually active, and that their child is not at risk for HPV infection. Providers connected parents’ concerns about sexuality with perceived risk of HPV infection. For example, one provider stated:
...if they’ve remained virginal, they assume the partner they marry is virginal and thus they aren’t at risk [for HPV]. Not thinking their partner might not be truthful OR that this marriage might not last and they could be exposed when they remarry, which by then [they] could be past immunization age.
Providers listed inadequate or incorrect parental knowledge as a barrier to vaccination about the purpose of HPV vaccination (
Only a few respondents identified providers’ barriers to HPV vaccination. However, there were some concerns such as vaccination not being a priority (n=19). One provider stated:
We occasionally forget the vaccine at sick visits.
Some providers were openly unsupportive of HPV vaccination (n=16). One provider stated:
Without a history of homosexuality, I do not see a great advantage to the immunization of boys.
Whereas some providers felt HPV vaccines were not cost-effective, others expressed skepticism, stating they wanted “more science showing benefit in men” (n=13). A provider downplayed the need for HPV vaccination by stating:
Issues of sexually transmitted disease do not seem to be an issue in my clinical setting.
Organizational barriers to HPV vaccination included cost (n=32), completing follow-up doses (n=22), and infrequency of vaccinating at regular well-child or primary care visits (n=16).
Parental education was the most common strategy for improving HPV vaccination (n=81). Providers felt that education should focus on reducing negative sexual connotations about the HPV vaccine. One provider relayed:
Basically, debunking the myth that it leads to more sex.
Providers felt that parents could be educated directly during clinic visits and through broader community health promotion campaigns. Informing parents about the prevalence of HPV within their community was suggested. One provider stated:
Better understanding that it is a ubiquitous virus and infects nearly everyone in the world, regardless of sexual partner number.
In some instances, providers’ perceptions varied by gender, with different ideas for vaccinating girls and boys (n=23,
The most common suggestion for improving HPV vaccination by the providers was to tailor recommendations (n=23) and to focus on preventing cancer rather than sexually transmitted infections (n=18). Providers also felt that routine HPV vaccination would reduce parental and patient hesitancy (n=17,
...discussing the fact that [patients] can be exposed from a future husband who did not know he was infected.
Another provider echoed this perception:
Emphasizing that nonsexual intercourse exposure results in HPV acquisition and that there are respiratory and oral cancers associated too.
Thematic findings and examples by levels of the social ecological framework (SEF).
Main theme and SEFalevel | Subtheme | Sample quotes | |
Parents and Patients | Sexual activity and promiscuity (n=69) | “Their parents’ opinions regarding the teen’s sexuality [obviate the] legitimacy of the vaccine.” | |
Vaccine refusal or reluctance (n=62) | “For some reason it is okay for women to have PAP exams but it is scandalous to get the vaccine that can prevent the cancer Pap exams detect.” | ||
Inadequate or incorrect parental knowledge (n=96) | “...very misinformed by relatives, or friends.” | ||
Low perceived risk of human papillomavirus (HPV) infection (n=67) | “They underestimate the risks of not being vaccinated. And overestimate the risks of vaccination.” | ||
Providers | Vaccine not a priority (n=19) | “We occasionally forget the vaccine at sick visits.” | |
Not supportive of HPV vaccine (n=16) | “...[HPV vaccination] is a commercial success for HPV vaccines manufacturers; however, cervical cancer is not a pandemic disease and could be better controlled under personal choices than other diseases that [patients] must be vaccinated against.” |
||
More scientific evidence desired (n=13) | “...more science showing benefit in men.” | ||
Organizational | Cost (n=32) | “I recommend HPV in those that participate in VFC, but once they are 19 and older, it is too expensive.” |
|
Completing follow-up doses (n=22) | “If it were not a series, they forget to finish it.” |
||
Infrequency of visits (n=16) | “[There are] not enough well child visits to get in the entire series.” | ||
Parents and Patients | Education (n=81) | “Discussion about rates of infection in Utah especially in suburban areas and discussion about cervical cancer and its causes as a television campaign.” | |
Gender differences (n=23) | “Better information about genital warts, anal cancer and other diseases caused by HPV that affect boys, and can be minimized by use of the vaccine.” | ||
Providers | Cancer prevention focus (n=18) | “Focusing on cancer prevention ‘later in life’ is more effective—especially when the discussion can be combined with the discussion about meningococcal meningitis and tetanus/pertussis. [HPV vaccination] is just a routine part of the preteen triad of immunizations.” | |
Make HPV vaccination routine practice (n=17) | “To make it more routine like it is expected to get it in medical culture rather than this optional/additional vaccine.” | ||
Tailored recommendation (n=23) | “Discussing the fact that [patients] can be exposed from a future husband who did not know he was infected.” | ||
Educational information (n=22) | “I need some information sheets, reassurance sheets, on side effects and safety, which are easy to hand out.” | ||
Organizational | Public policy and standing orders (n=22) | “Adding it to the list of required vaccines for junior high and high school.” |
aSEF: social ecological framework.
Providers endorsed the need for better educational information to be displayed in health clinics and comprehensible educational information on HPV vaccination to share with parents (n=22,
Providers expressed support for public policy requiring HPV vaccination for school enrollment (n=22,
This study is the first to describe providers’ knowledge of HPV vaccination and HPV vaccination guidelines, with added context of providers’ perceptions related to the barriers to and facilitators of HPV vaccination. Despite Utah’s very low HPV vaccination prevalence, another study with providers in Utah using similar survey items to assess providers’ knowledge of HPV indicated a substantially lower proportion of providers with correct knowledge compared with our sample (mean proportion of correct responses=57.7% vs 79.4%; [
Examination of multiple levels of the SEF is integral to designing effective HPV vaccination interventions. On an individual and interpersonal level, health care practice characteristics that were associated with lower knowledge of HPV vaccination and guidelines among providers in Utah include provider specialty (eg, pediatricians and nurse practitioners), practice type (eg, private practice and hospitals or urgent care clinics), and number of patients seen per day (eg, <15 and ≥30 patients per day). Additionally, younger providers (aged 30-39 years) and older providers (aged ≥50 years) had lower knowledge compared with those who were middle aged (40-49 years). The lower level of HPV vaccination knowledge among providers aged 30 to 39 years warrants attention. Given that HPV vaccination may not have been approved at the time of their clinical training, it is possible that these individuals may not have received training on HPV vaccination as a part of their clinical curriculum. Moreover, as new clinicians, these providers may have yet to establish robust continuing education opportunities to learn about HPV vaccines and guidelines. Thus, targeted opportunities for continuing education for those who have completed their medical or nursing training within the last 10 to 15 years may be merited. Continuing education for more established providers may help improve knowledge about HPV vaccination.
Providers who saw adolescent patients but did not routinely provide vaccinations, as well as those who were not VFC providers had lower knowledge about HPV vaccination and guidelines than did VFC providers. One explanation for this finding may be that VFC providers are potentially more accustomed to routinely providing HPV vaccines and thus may be more knowledgeable about this vaccine. In addition, the differential distribution of clinicians by specialty, with more family medicine providers than physicians practicing in rural areas [
Despite finding several associations between provider demographics and knowledge, the most compelling finding from this study was from our qualitative analyses demonstrating providers’ overwhelming perception of an immediate need for improved parental education regarding HPV vaccines. Misinformation among parents was portrayed by providers as the strongest and most consistent barrier to vaccination. Providers described how parental beliefs regarding sexuality and HPV vaccination impede HPV vaccination and make it difficult to deliver a strong recommendation in support of HPV vaccination. Providers expressed frustration at not having access to educational materials that they need to accurately and efficiently communicate with parents and patients about HPV vaccination. However, improvements in parental knowledge alone may not eliminate hesitancy toward HPV vaccination [
Although health care providers’ hesitancy was not explicitly noted as a barrier to HPV vaccination, our qualitative analysis revealed that some providers have persistent negative perceptions of HPV vaccination. This reticence to endorse HPV vaccination has not only been observed in Utah but has also been described in national surveys [
Limitations of this study include sampling of providers across a single state, which could be a potential threat to external validity. However, our results may be generalizable to other states with a low HPV vaccination rate and to states in the Intermountain West region. This depiction of HPV vaccination in Utah may be incomplete because we neither investigated perceptions of parents, patients, and communities nor the policies that influence HPV vaccination in Utah. Only 48.4% of providers responded to all 4 open-ended questions, thus nonresponse bias may exist in the qualitative findings, which means that those who did not respond to the open-ended questions may hold different perspectives on HPV vaccine barriers and strategies with regard to HPV vaccination for girls and boys. Our response rate was low, which may indicate that the knowledge of HPV vaccination and guidelines among providers who chose not to participate may differ. The variation in, and overall low response rate, among the different provider groups may have introduced differential bias to the results. Additionally, given the changing nature of listserv membership, it is possible that some providers may not have had equal opportunities to participate in the survey if they were added or removed from the listserv during the data collection period. However, we have no reason to believe that knowledge and perceptions of HPV vaccination would have been different for those who were migrating into and out of the sample for this reason.
HPV vaccination knowledge is commonly operationalized using a variety of measurement tools and survey items. Whereas standardized tools have been developed for measuring parental knowledge, tools that measure health care providers’ knowledge have yet to be tested. Utilization of standardized measurement tools to assess HPV vaccination knowledge among health care providers may facilitate comparisons across future studies. Lastly, we did not ask providers to report the exact location of their health care practice, which limited the data analyses.
Utah’s vaccination rates are among the lowest in the United States. Theoretically informed interventions to improve vaccination through provider recommendations need to fully appreciate the public health benefit of HPV vaccination. This study provides evidence that provider-based HPV vaccine interventions must extend beyond improving providers’ knowledge about vaccination. Our analysis revealed that providers have knowledge of HPV vaccination and guidelines, but contextual factors accentuate the need for supporting providers in administering strong, consistent, and high-quality recommendations for the HPV vaccine in Utah. Recognizing the importance of provider’s experiences, we summarized their suggestions for improving HPV vaccination and recommend that providers’ perspectives be considered in the development of future interventions. Specifically, providers consider parental misconceptions to be the strongest barrier to HPV vaccination in Utah. Yet, they believe that misinformation can be corrected through direct parental education and broad public health campaigns. Providers’ recognize the value parents place on the dissemination of accurate information through clinical settings and appreciate the importance of a strong provider recommendation. In summary, providers in Utah have high knowledge about HPV vaccination, but they need support in correcting misinformation that persists at multiple levels of the SEF, including among patients, parents, colleagues, and communities.
Centers for Disease Control and Prevention
human papillomavirus
social ecological framework
Vaccines for Children
The authors thank the administrators from the health care provider organizations who assisted in recruitment for this study. This study was supported by the University of Utah Study Design and Biostatistics Center, with funding, in part, from the Huntsman Cancer Institute, the National Cancer Institute through Cancer Center Support P30 CA042014, the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 8UL1TR000105 (formerly UL1RR025764), the Beaumont Foundation, the Primary Children’s Hospital Foundation, and the Jonas Center for Nursing and Veteran’s Healthcare. The authors also thank Laura Martel for her assistance with editing the manuscript.
None declared.