Integrating Human Papilloma Virus (HPV) Vaccination Promotion and Cervical Cancer Screening in a Diverse Inner City Primary Care Settings

Abstract

Offering cervical cancer screening and HPV vaccination as an integrated model at health appointments has not previously been considered. This study examines the feasibility of an innovative integrated model to improve HPV vaccination and cervical cancer (CC) screening rates in a diverse inner city Primary Care setting during the same primary care appointment. Using qualitative research methods we explored and evaluated both provider and parent perceptions, barriers, potential concerns and acceptance of the integrated primary and secondary prevention model which provides the HPV vaccine to adolescent females and CC screening of their adult female guardian (AFG) during the same primary care appointment. Semi-structured, in-depth interviews were conducted with 10 providers and 20 AFGs. In line with modified grounded theory methodology, the research team analyzed AFG and provider transcripts to determine key themes. We interviewed 2 Pediatricians, 3 Adolescent Medicine (AM) and 5 Family Medicine (FM) providers, 5 AFGs of adolescent girl from FM and, 5 AFGs from pediatrics and 10 AFGs from AM. Mean age of AFGs is 39.6 years (SD 6.4) and of daughters 15 years (SD 2). 64.0% of AFGs are Black/ African American, and 12% Hispanic/Latino. 96% of AFGs reported having had a pap smear and 20% reported history of abnormal Pap Smear, and none with personal experienced with CC. The majority of AFGs and providers were open to conversations about the HPV vaccine and CC during both AFGs and adolescents female primary care appointments. Unlike FM providers, some of the Pediatric/AM providers and AFGs expressed reluctance performing or receiving a CC screening at their adolescent female’s visits. Most providers’ concerns with the integrated model stem from: (1) lack of time with patients (2) limited space and (3) lack of manpower to carry out the model. Pediatrics/AM providers recommend having another provider in the clinic to refer AFGs to have the pap screening during the daughter’s primary care appointment. Many AFGs recommend scheduling CC screening with their provider on the same day as daughter’s primary care appointment. AFGs requested educational reading materials within the clinic and/or health information by provider, newsletters via email or link from a text. A majority of AFGs and providers expressed comfort with adolescent females receiving the HPV vaccine in general or at the AFG appointment, comparing the process and acceptance to the flu shot model. Providers and AFGs agreed that a family medicine setting is an ideal setting to implement this model but open to pilot this model in an AM clinic with extra manpower, time and support. Our findings demonstrate the acceptability by providers and AFGs of the integrated model to conversations about the HPV vaccine and CC screening during both AFGs and adolescents female primary care appointments but offer different strategies for screening for CC. Our conclusions provide innovative methods of primary and secondary CC prevention integration in a primary care setting, in need of further exploration and pilot testing.