HPV Vaccine Hesitancy: Findings From a Statewide Survey of Health Care Providers

Abstract

Introduction Healthcare provider recommendations are critical for human papillomavirus (HPV) vaccine uptake. We sought to describe providers' HPV vaccine recommendation practices and explore their perceptions of parental hesitancy. Method A statewide sample (n=575) of Minnesota healthcare providers (20% pediatricians, 47% family medicine physicians, 33% nurse practitioners) completed our online survey in April 2013. Results Only 76% of healthcare providers reported routinely recommending HPV vaccine for girls ages 11-12, and far fewer (46%) did so for boys (p<.001). A majority of providers reported asking questions about parents' concerns (74%), but many lacked time to probe reasons (47%) or felt that they could not change parents' minds (55%). Higher levels of self-efficacy and outcome expectations were associated with routine recommendations (p<.05). Discussion Findings suggest that providers' perceptions of hesitancy may discourage them from routinely recommending HPV vaccine. Improving providers' self-efficacy to address hesitancy may be important for improving vaccination rates.

Provider communication about HPV vaccination: A systematic review

“…29,35,36 Perceptions of parental hesitancy toward HPV vaccination were also negatively associated with communication; providers who perceived parents as unsupportive less often recommended or intended to recommend HPV vaccine. 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.…”

“…27,32,36,38,44,45 In terms of providers' perceptions of themselves, self-efficacy to communicate about HPV vaccine was associated with recommending and intending to recommend the vaccine. 12,26,46 Interestingly, providers who viewed themselves as "early adopters" were also more likely to recommend HPV vaccine. 30,45,47 Studies assessing the relationship between provider characteristics and HPV vaccine recommendations most often focused on clinical specialty and demographics.…”

“…30,45,47 Studies assessing the relationship between provider characteristics and HPV vaccine recommendations most often focused on clinical specialty and demographics. Most studies found that pediatricians reported more positive HPV vaccine recommendation practices than family physicians 9,11,12,30,33,[48][49][50][51] or other types of providers. 12,32 Other studies failed to find variation in recommendations by specialty, 23,[34][35][36]40,52,53 but several of these studies did not include pediatricians.…”

“…Most studies found that pediatricians reported more positive HPV vaccine recommendation practices than family physicians 9,11,12,30,33,[48][49][50][51] or other types of providers. 12,32 Other studies failed to find variation in recommendations by specialty, 23,[34][35][36]40,52,53 but several of these studies did not include pediatricians. 34,52,53 Most studies did not find variation in HPV vaccine recommendations by provider sex, 9,23,30,36,39,44,[47][48][49]54 but those that did most often favored female providers.…”

“…[8][9][10] Furthermore, a growing body of research suggests that those recommendation adolescents do receive are weaker than recommendations for other adolescent vaccines, such as tetanus, diphtheria, and acellular pertussis (Tdap) and meningococcal vaccines. 11,12 Understanding and improving provider communication, particularly with regard to recommendations, is imperative to increasing HPV vaccination coverage.…”