Effective Strategies for HPV Vaccine Delivery: The Views of Pediatricians

Abstract

Purpose-Pediatricians will play a critical role in human papillomavirus (HPV) vaccine delivery. The objectives of this research were to examine pediatricians' views about key issues related to HPV vaccine delivery and identify their strategies for effective vaccine delivery.Methods-A diverse sample of practicing pediatricians was recruited from a three-state region using a purposeful sampling strategy. Participants completed in-depth, semi-structured interviews. Qualitative data were analyzed using framework analysis.Results-The mean age of the 31 participants was 47 (range 30-78) years, 17 (55%) were female, 9 (29%) black, and 4 (13%) Latino. Participants noted that cultural issues, including a family's religious and ethnic background, were important considerations when recommending an HPV vaccine. Almost all participants believed that vaccination should be universal rather than targeted, but opinions regarding legislative mandates for vaccination varied. Those in favor of mandates cited their potential to maximize the public health impact of immunization, while those opposed noted that HPV is not transmitted casually and were concerned about limited data on the long-term safety and efficacy of HPV vaccines. Pediatricians noted that specific strategies for effective vaccine delivery would be needed for an STI vaccine targeted toward adolescents, especially considering the poor public understanding of HPV. These included provision of HPV vaccines in alternative settings, guidance for pediatricians as to how to address parental concerns, and specific educational initiatives.Conclusions-The views of pediatricians, who have extensive experience administering vaccines to children and adolescents, will be valuable as HPV vaccine delivery strategies are designed.

Provider communication about HPV vaccination: A systematic review

“…11,27,34,59,74 Finally, participants across several studies perceived clinical systems as unconducive to communication due to factors such as time constraints and deficiencies in reminder/recall systems. 11,43,59,85,94 In these ways, an audience with dynamic communication needs came together with unsupportive interpersonal, policy, and clinical contexts to create challenges for effective HPV vaccine communication.…”

“…12,29,33,35,[37][38][39] Conversely, providers who perceived professional organizations as influential more often recommended or intended to recommend the vaccine. [23][24][25]37,[40][41][42][43] Other frequently studied perceptions included those related to providers' confidence in HPV vaccine and their own abilities to discuss it. For example, providers who perceived high HPV vaccine efficacy consistently reported more positive recommendation intentions and behaviors.…”

“…87,103 Parents and providers across several studies voiced the need for educational materials that were tailored to parents' cultural background, language preference, and literacy level. 12,43,94,99,101,104 Given concerns about literacy, some providers suggested video as a promising educational channel, 43,94 but only a minority of parents viewed informational videos as helpful. 16 Notably, no studies examined educational materials designed specifically for adolescent patients themselves.…”

“…Providers identified patient reminder/recall as critical to their efforts to recommend HPV vaccination, but many reported that they did not use these systems, and instead relied on patients to initiate scheduling. 11,43,59,85,94 Finally, providers reported that time constraints in the clinical encounter were also a barrier to HPV vaccine communication. 9,11,12,35,41,45,59,63 Interventions to improve communication Only two studies evaluated the impact of interventions on providers' HPV vaccine communication.…”

Factors Influencing Mothers' Acceptance of Human Papillomavirus Vaccination to Prevent Cervical Cancer in their Daughters

“…외국의 선행연구결과 HPV 백신접종에 대한 어머니들의 수 용도는 전반적으로 긍정적이었는데 (Khan et al, 2008;Marlow, Waller, & Wardle, 2008;Olshen, Woods, Austin, Luskin, & Bauchner, 2005;Stretch et al, 2008;Walsh et al, 2008) (Peres, 2010), 이와 같은 경제적 부 담으로 인하여 외국에서도 대상자의 70.5%가 무료 백신접 종을 원하였고 (Walsh et al, 2008), 84%의 어머니들이 무료 백신이라면 자녀에게 접종할 것이라고 보고하였다 (Fazekas et al, 2008). 국내에서도 HPV 백신은 기관마다 차이는 있 지만 4가 백신의 경우 50~60만원 수준으로 국내 시판되는 백신중에서 가장 비싸기 때문에, 백신접종 권장에 대한 경 제성 논란도 제기되고 있는 실정이다 (Yoo, 2010) Yoo, 2010 (Lee & Park, 2011;Reiter, Brewer, Gottlieb, McRee, & Smith, 2009;Stretch et al, 2008;Tissot et al, 2007), 백신 이 성적 활동을 일찍 촉진할 수 있다는 걱정 (Bartolini et al, 2010)과 HPV에 대한 정보와 백신의 필요성 (Fazekas et al, 2008)이 제시되었다. 그 외로 어머니의 과거 생식기 사마귀 또는 HPV 감염력 (Dempsey et al, 2006), Pap 검사결과 (Mays, Strum, & Zimet, 2004), 어머니의 HPV 백신접종 (Brewer & Fazekas, 2007) (Table 1).…”