Abstract
BackgroundHuman Papillomavirus (HPV) vaccination among adolescents is an important strategy to prevent cervical and other cancers in adulthood. However, uptake remains far below the Healthy People 2020 targets for the US. Given the barriers to population-level vaccination policies and challenges to incorporating additional action items during clinical visits, we sought to explore alternative delivery mechanisms, specifically delivery of the vaccine in community settings.MethodsWe conducted six focus groups (three with adolescents aged 11–14 who had not received the HPV vaccine and three with caregivers of adolescents meeting those criteria) from Black, Latino, and Brazilian communities in Massachusetts. We utilized a framework analysis approach that involved a multi-stage coding process employing both prefigured and emergent codes. Initial interpretations were refined through consultation with an advisory board.ResultsAdolescents and caregivers expressed a range of concerns about the HPV vaccine and also described interest in learning more about the vaccine, emphasizing the importance of a relationship with a trusted provider as a facilitator of vaccine acceptance. Regarding community-based delivery of the vaccine, reactions were mainly negative. However, adolescents and caregivers noted that receiving information in community settings that could seed a conversation with a trusted provider would be welcome. Interestingly, the notion of a trusted provider seemed to extend broadly to practitioners linked to the trusted main provider.ConclusionsThe study highlights an opportunity for increasing HPV vaccination among some racial and ethnic minority populations by leveraging trusted community organizations to provide information and seed conversations with a potentially broad group of trusted providers. A task-shifting approach, or reliance on staff with fewer formal credentials, may offer opportunities to support vaccination in resource-constrained settings.
Highlights
Human Papillomavirus (HPV) vaccination among adolescents is an important strategy to prevent cervical and other cancers in adulthood
We considered the proposal to shift the delivery of the vaccine to more highly accessible settings with potentially less-burdened staff to be a test of a new implementation strategy, or method to support integration of an evidencebased innovation [37]
A total of 19 individuals participated in the caregiver focus group discussions; all were parents of at least one child aged 11–14 who had not received the HPV vaccine
Summary
Human Papillomavirus (HPV) vaccination among adolescents is an important strategy to prevent cervical and other cancers in adulthood. Across the US, HPV vaccine uptake among adolescents remains low, with only 54% of 13–17 years old completing the recommended course of the vaccine as of 2019 This uptake is far below the goal set by the federal government (Healthy People 2020) of 80% coverage among adolescents aged 13–15 years and rates of uptake of other routine child/adolescent vaccines [3, 4]. A range of provider-level interventions offers promise in increasing HPV vaccination rates, from prompting providers to recommend the vaccine to implementation of reminder-recall systems in the electronic health record [7,8,9,10,11] This focus is fitting, given that the majority of children in the US receive vaccinations from pediatricians and family physicians [12]. These challenges are compounded by barriers among adolescents and caregivers, e.g., concerns about vaccine safety and efficacy and low perception of risk of HPV infection, though provider recommendation has been shown repeatedly to be a major motivator for vaccination [13, 15]
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