Implementation and evaluation of a multilevel intervention to increase uptake of the human papillomavirus vaccine among rural adolescents

Abstract

Purpose Geographic disparities exist in uptake of the human papillomavirus vaccine (HPV). In 2020, the National Immunization Survey‐Teen reported that adolescents living in nonmetropolitan statistical areas (MSAs) had lower HPV vaccination coverage (≥ 1 dose) compared to adolescents living in MSA principal cities. This paper describes the implementation and evaluation of a multilevel pilot intervention study to increase uptake of the HPV vaccine among adolescent patients ages 11‐17 of a rural health clinic. Methods This parent, primary care team, and clinic multilevel pilot intervention was guided by evidence‐based approaches to increase HPV vaccinations, formative research, and input from the community. HPV vaccination initiation and completion rates were analyzed at baseline and 23 months follow‐up. Findings The proportion of adolescent patients ages 11‐17 who had initiated the HPV vaccine series was significantly greater at follow‐up compared to baseline, (82.7% compared to 52.4%), χ2 (1, n = 498) = 49.2, P < .0001. The proportion of adolescent patients ages 11‐17 who had completed the HPV vaccine series was also significantly greater at follow‐up compared to baseline, (58.0% compared to 27.0%), χ2 (1, n = 498) = 50.8, P < .0001. Conclusions The multilevel intervention significantly increased HPV initiation and completion rates among adolescent patients ages 11‐17 at this rural health clinic. This study demonstrates the feasibility of utilizing a multilevel intervention to address low HPV vaccination rates among rural adolescents and the potential of employing this strategy for a large‐scale randomizing‐controlled trial.

Understanding Clinic and Community Member Experiences with Implementation of Evidence-Based Strategies for HPV Vaccination in Safety-Net Primary Care Settings

“…On the other hand, the pandemic served as an opportunity for innovations in community level vaccine delivery (Omer et al, 2021 ; Petrova et al, 2021 ). Other multilevel interventions to improve HPV vaccine uptake during the pandemic also demonstrated effectiveness in other regions and diverse populations (e.g., rural) through community partnerships (Dang et al, 2023 ; Kepka et al, 2021 ). Policy-level representatives in LA mentioned greater awareness of immunization strategies within communities and few had worked with clinics directly before the pandemic.…”

“You Don’t Know If It’s the Truth or a Lie”: Exploring Human Papillomavirus (HPV) Vaccine Hesitancy among Communities with Low HPV Vaccine Uptake in Northern California

“…We recruited parents, health professionals, and community members from rural inland northern California counties with lower UTD HPV rates than the U.S. (16-25% compared to 62.6%) [12][13][14][15][16][17][18][19] and from Latino and Slavic communities located in the University of California, Davis Comprehensive Cancer Center's catchment area to participate in semistructured focus groups and key informant interviews. We did not include the counties with the lowest HPV vaccination rates in the catchment area in this study as another study has been published that focused on those rural counties and Native American adolescents [20]. Participants were recruited from Nevada, Placer, Yolo, El Dorado, Sacramento, San Joaquin, and Merced Counties.…”