Barriers, facilitators, and potential strategies for increasing HPV vaccination: A statewide assessment to inform action

Kathleen B Cartmell,Jennifer Young-Pierce,Shannon Mcgue,Anthony J Alberg,John S Luque,Maria Zubizarreta,Heather M Brandt

doi:10.1016/j.pvr.2017.11.003

Abstract

ObjectiveThe objective was to investigate how state level strategies in South Carolina could maximize HPV vaccine uptake. DesignAn environmental scan identified barriers, facilitators, and strategies for improving HPV vaccination in South Carolina. Interviews were conducted with state leaders from relevant organizations such as public health agencies, medical associations, K-12 schools, universities, insurers, and cancer advocacy organizations. A thematic content analysis design was used. Digital interview files were transcribed, a data dictionary was created and data were coded using the data dictionary. ResultsThirty four interviews were conducted with state leaders. Barriers to HPV vaccination included lack of HPV awareness, lack of provider recommendation, HPV vaccine concerns, lack of access and practice-level barriers. Facilitators included momentum for improving HPV vaccination, school-entry Tdap requirement, pharmacy-based HPV vaccination, state immunization registry, HEDIS measures and HPV vaccine funding. Strategies for improving HPV vaccination fell into three categories: 1) addressing lack of awareness about the importance of HPV vaccination among the public and providers; 2) advocating for policy changes around HPV vaccine coverage, vaccine education, and pharmacy-based vaccination; and 3) coordination of efforts. DiscussionA statewide environmental scan generated a blueprint for action to be used to improve HPV vaccination in the state.

Highlights

HPV vaccination is a major cancer prevention breakthrough, but the full public health benefits of these vaccines have yet to be realized in the US
The key results for the environmental scan centered on barriers, facilitating factors, and strategies to increase HPV vaccination rates in South Carolina (SC); each is presented in detail below
A commonly reported barrier was that there has been a total absence of systematic messaging to promote accurate information about HPV vaccination

Summary

Introduction

HPV vaccination is a major cancer prevention breakthrough, but the full public health benefits of these vaccines have yet to be realized in the US. Barriers to HPV vaccination at the national level include factors related to vaccination in general and those specific to HPV vaccine These occur at the level of the patient, provider, and health system or policy environment. Barriers include: lack of recommendation by the provider [2,3,4], lack of knowledge about the vaccine and HPV-related diseases [5,6,7], concerns about vaccinating an adolescent against a sexually transmitted infection [2,8,9], lack of conviction that the vaccine is essential (especially for males) [10,11,12], and concerns about vaccine safety and costs [2,9,10,13,14]. Barriers at the health policy level include a lack of coverage of the vaccine among some populations [26,27,28,29,30,31] and a lack of legislation to make the vaccine mandatory for school entry in most US states [32]

Methods

Results

Conclusion