Abstract
BackgroundDespite recommendations that 11–12-year-olds receive the full three-shot Human papillomavirus (HPV) vaccine series, national HPV immunization coverage rates remain low. Disparities exist, with Blacks and Latinos being less likely than Whites to complete the series. We aimed to identify and compare barriers to HPV immunization perceived by healthcare providers, Black and Latino adolescents, and their caregivers to inform a clinic-based intervention to improve immunization rates.MethodsWe conducted semi-structured interviews between March and July 2014 with Black and Latino adolescents (n = 24), their caregivers (n = 24), and nurses (n = 18), and 2 focus groups with 18 physicians recruited from two pediatric primary care clinics. Qualitative protocol topics included: general perceptions and attitudes towards vaccines; HPV knowledge; and perceived individual and systems-level barriers affecting vaccine initiation and completion.ResultsThemes were identified and organized by individual and systems-level barriers to HPV immunization. Adolescents and their caregivers, particularly Blacks, expressed concerns about HPV being an untested, “newer” vaccine. All families felt they needed more information on HPV and found it difficult to return for multiple visits to complete the vaccine series. Providers focused on challenges related to administering multiple vaccines simultaneously, and perceptions of parental reluctance to discuss sexually transmitted infections.ConclusionsOptimizing HPV immunization rates may benefit from a multi-pronged approach to holistically address provider, structural, and individual barriers to care. Further research should examine strategies for providing multiple modalities of support for providers, including a routinized system of vaccine promotion and delivery, and for addressing families’ concerns about vaccine safety and efficacy.
Highlights
Despite recommendations that 11–12-year-olds receive the full three-shot Human papillomavirus (HPV) vaccine series, national HPV immunization coverage rates remain low
Human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) in the United States (U.S.), and each year, an estimated 26,000 new cancers attributable to oncogenic HPV are diagnosed in women and men [1]
In mid2014, only 57.3 % of girls aged 13–17 in the U.S had initiated the three-dose series and only 37.6 % had completed it, and only 20.8–34.6 % of boys had received ≥1 HPV dose [13]. These figures are striking when compared with immunization rates for other adolescent vaccines, which range from 74.0 % for MenACWY up to 86.0 % for Tdap [13]
Summary
Despite recommendations that 11–12-year-olds receive the full three-shot Human papillomavirus (HPV) vaccine series, national HPV immunization coverage rates remain low. In mid2014, only 57.3 % of girls aged 13–17 in the U.S had initiated the three-dose series and only 37.6 % had completed it, and only 20.8–34.6 % of boys had received ≥1 HPV dose [13] These figures are striking when compared with immunization rates for other adolescent vaccines (e.g., tetanus, diphtheria, and acellular pertussis vaccine [Tdap] and meningococcal conjugate vaccine [MenACWY]), which range from 74.0 % for MenACWY up to 86.0 % for Tdap [13]. Black female adolescents who initiate the vaccine have significantly lower rates of HPV 3-dose series completion than do White and Latina female adolescents, and overall rates of immunization remain lower among boys than girls [13]
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