Collaborative patient-provider communication and uptake of adolescent vaccines

Abstract

Rationale Recommendations from healthcare providers are one of the most consistent correlates of adolescent vaccination, but few studies have investigated other elements of patient-provider communication and their relevance to uptake. Objective We examined competing hypotheses about the relationship of patient-versus provider-driven communication styles with vaccination. Methods We gathered information about vaccine uptake from healthcare provider-verified data in the 2010 National Immunization Survey-Teen for tetanus, diphtheria, and pertussis (Tdap) booster, meningococcal vaccine, and human papillomavirus (HPV) vaccine (initiation among females) for adolescents ages 13–17. We categorized communication style in parents’ conversations with healthcare providers about vaccines, based on parents’ reports (of whether a provider recommended a vaccine and, if so, if conversations were informed, shared, or efficient) (N = 9,021). Results Most parents reported either no provider recommendation (Tdap booster: 35%; meningococcal vaccine: 46%; and HPV vaccine: 31%) or reported a provider recommendation and shared patient-provider communication (43%, 38%, and 49%, respectively). Provider recommendations were associated with increased odds of vaccination (all ps < .001). In addition, more provider-driven communication styles were associated with higher rates of uptake for meningococcal vaccine (efficient style: 82% vs. shared style: 77% vs. informed style: 68%; p < .001 for shared vs. informed) and HPV vaccine (efficient style: 90% vs. shared style: 70% vs. informed style: 33%; p < .05 for all comparisons). Conclusion Efficient communication styles were used rarely (≤ 2% across vaccines) but were highly effective for encouraging meningococcal and HPV vaccination. Intervention studies are needed to confirm that efficient communication approaches increase HPV vaccination among adolescents.

Announcements Versus Conversations to Improve HPV Vaccination Coverage: A Randomized Trial

“…16,17 Similarly, Moss and colleagues found that among a probability sample of 4121 parents of adolescents from the National Immunization SurveyTeen, HPV vaccination coverage was higher among adolescent girls of parents who recalled "efficient" provider communication about HPV vaccination than those who recalled participatory discussions. 18 We speculate that announcements normalize HPV vaccination for both providers and parents, making providers more likely to raise the topic and parents more likely to consent to vaccination. In contrast, our conversation training did not increase HPV vaccine initiation.…”

“…Announcements are commonly used for early childhood vaccines and other routine clinical care. Furthermore, analyses of videotaped clinician encounters 16,17 and a nationally representative survey 18 suggest that announcements are associated with higher vaccine uptake. Alternatively, a "conversation" approach that engages parents in open-ended discussions may build rapport and thus increase parental openness to HPV vaccination for their children.…”

Disparities in collaborative patient-provider communication about human papillomavirus (HPV) vaccination

“…Some research studies have suggested that a presumptive approach, treating vaccination as routine and something that will happen as a matter of course during the healthcare visit, is best at encouraging vaccination. 17,18 Other correlational studies report evidence of the benefits of a shared approach for vaccination, 10,19 though a recent randomized trial found that a shared approach did not improve vaccination attitudes. 20 Similarly, in this study, we found that collaborative (or shared) communication style was associated with the highest rates of HPV vaccination, with particularly strong positive associations for rural and non-Hispanic white girls.…”

Provider communication about HPV vaccination: A systematic review

“…These studies found that collaborative communication was associated with HPV vaccine uptake. 92 However, traditionally underserved groups, such as parents of Hispanic and nonprivately insured adolescents, were less likely to report collaborative communication, which adversely affected HPV vaccination coverage for these groups. 93 Qualitative research generally supported the finding that providers were less likely to engage non-English speaking parents or parents from disadvantaged backgrounds in HPV vaccine-related communication.…”