Health Care Provider Attitudes and Barriers Regarding HPV Vaccination: Factors Associated with Increasing HPV Vaccine Coverage Before and After an Intervention Program

Background: Marshfield Clinic implemented a provider focused intervention over a 12 month period in select departments to increase human papillomavirus (HPV) vaccine coverage. We assessed barriers, attitudes, and program participation, and factors associated with increase in HPV vaccination coverage following the intervention among adolescent primary care providers throughout the healthcare system.

Methods: Adolescent primary care providers at Marshfield Clinic were invited to complete a survey after the project period; surveys were linked to provider-specific vaccine coverage data. Adolescents (11-17 years) were attributed to a provider based on number and type of visits in the past 24 months; providers with <30 adolescent patients were excluded. The survey assessed attitudes, beliefs, and perceived barriers to HPV vaccination. The outcome was change in the percent of patients who received at least one HPV vaccine dose before and after the intervention. Linear regression was used to identify factors associated with change in HPV vaccination coverage.

Results: Among 106 eligible providers, 58% completed the survey. Median (interquartile range) HPV vaccine coverage was 52% (43, 60) before and 57% (48, 64) after the intervention. Reported barriers and competency self-assessment regarding HPV vaccination are shown in Figures 1 and 2, respectively.  Factors associated with a significant increase in HPV vaccine coverage included confidence in addressing concerns about HPV vaccine for boys, confidence in ability to persuade parents to accept vaccination, and perception of few parental concerns about HPV vaccine efficacy. Receipt of quarterly reports and attendance at other intervention activities (provider support sessions or Grand Rounds) were not associated with increase in HPV vaccine coverage.   

Conclusion: Efforts to increase HPV vaccine uptake should help providers improve their confidence in addressing parental concerns.