A Mixed-Methods Analysis of Barriers to and Facilitators of Human Papillomavirus Vaccination Among Adolescents in Montana

Abstract

Objectives Human papillomavirus (HPV) vaccination rates among adolescents are lower in rural areas than in urban areas of the United States. The objective of this study was to identify barriers to and facilitators of adolescent HPV vaccination in Montana, a large, primarily rural state. Methods Using a mixed-methods design, we integrated quantitative analyses of Montana’s National Immunization Survey–Teen (NIS-Teen) data from 2013-2017 with qualitative data collected at a statewide meeting in October 2018 and from stakeholder interviews conducted from October 2018 through June 2019. Using NIS-Teen data, we identified trends and estimated adjusted prevalence ratios (aPRs) to identify factors associated with vaccine uptake. Using directed content analysis of qualitative data, we identified themes related to vaccine uptake. Results In Montana, initiation of the HPV vaccine series among adolescents aged 13-17 increased from 34.4% in 2013 to 65.5% in 2017. We identified 6 themes related to HPV vaccination from qualitative analyses, including medical providers’ recommendation style as a facilitator of vaccination and parental vaccine hesitancy as a barrier to vaccination. In NIS-Teen 2017 data (n = 326 adolescents), receiving a medical provider recommendation was significantly associated with series initiation (aPR = 2.3; 95% CI, 1.5-3.6). Among parents who did not intend to initiate the vaccine series for their adolescent within 12 months (n = 71), vaccine safety was the top concern (aPR = 24.5%; 95% CI, 12.1%-36.9%). Conclusions HPV vaccination rates have increased in Montana but remain lower than rates for other adolescent vaccines. Future work should focus on reducing missed opportunities, increasing parents’ knowledge of and confidence in vaccination, and training medical providers on addressing common vaccine concerns.

HPV Vaccine Hesitancy Among Medical Students in China: A Multicenter Survey

“…A study in Florida has noted that doctors' advice on the HPV vaccine predicts vaccination status ( 32 ). Therefore, training healthcare providers to address common vaccine problems ( 33 ) may be a feasible way to reduce vaccine hesitancy. On the one hand, public health providers can provide those considering vaccinations with any information they may need ( 34 ).…”

Beyond words: Parental perceptions on human papilloma virus vaccination recommendations and its impact on uptake

“…Compared to urban U.S. populations, rural populations have a lower rate of HPV vaccianation as noted above and a higher incidence of HPV-related cancer ( Peterson et al, 2020 ). Provider recommendation has been shown to be the most important variable associated with HPV vaccination uptake, and a number of efforts have been implemented to booster providers’ recommendation ( Gilkey et al, 2016 , Suryadevara et al, 2021 , Newcomer et al, 2020 ). For instance, announcements, or brief statements assuming parents are ready to vaccinate, have been used for most early childhood vaccines with success ( Brewer et al, 2017 ).…”

HPV vaccine hesitancy among medical students in China: A multicenter survey

“…A study in Florida has noted that doctors' advice on the HPV vaccine predicts vaccination status [33]. Therefore, training healthcare providers to address common vaccine problems [34] may be a feasible way to reduce vaccine hesitancy. On the one hand, public health providers can provide those considering vaccinations with any information they may need [35].…”