The vaccine to prevent human papillomavirus (HPV) works most effectively with preteen patients to deliver a lifetime of protection against cervical and other cancers.
Data from the athenahealth network show HPV vaccination rates have risen to nearly 40 percent, but that rates are still much lower than other vaccines. Many parents remain wary, despite evidence that the HPV vaccine doesn't increase teenage sexual activity.
Part of the problem is that “providers often are not recommending the vaccine effectively," says Amanda Dempsey, M.D., a pediatrician and associate professor at the University of Colorado Denver. “They're using language that perhaps doesn't adequately deliver the message that the vaccine is really important and should be given at the recommended ages."
Dempsey and other researchers at UC Denver, the National Center for Immunization and Respiratory Diseases, and the Centers for Disease Control and Prevention designed a five-component intervention to help get parents past hesitancy to agreement.
The researchers used behavioral models that assessed parents' decision-making along a spectrum from awareness to potential action and identified places where they could intervene.
The intervention consisted of five educational tools: Fact-sheet templates that allow the physicians to customize information to individual patients and their parents; a parent-education website; disease images; a decision aid; and training for physicians in motivational interviewing. Physicians were coached on using a presumptive approach that made vaccinations seem normative, not optional.
“We tried to think of intervention components that would work within a clinical setting," says Dempsey. “We were cognizant of not trying to add any additional time to visits or disrupt clinical workflow by making something longer."
While HPV vaccination rates have been rising every year, the intervention accelerated those trends.
The study, as published in the Journal of the American Medical Association, shows that, compared to a control group, vaccination initiation rates rose by almost 10 percentage points in the test group of physicians and their patients in the course of a year. Completion of the full vaccine series was 4.4 percent higher.
Two components proved to be most effective: fact sheets for patients and communications training for physicians.
Based on qualitative assessments, the researchers believe that the ability for physicians to customize fact sheets helped raise awareness and buy-in among parents. Along the same lines, doctors frequently noted that once they started using a presumptive approach to discussing the vaccine, their appointments went more quickly and effectively without taking more time.
What's more, a follow-up survey of parents and providers revealed that the intervention did not negatively affect parents' satisfaction with appointments, and physicians were resoundingly positive.
Dempsey hopes to extend the study by focusing on channels for delivering information: in person, over the phone, or via the web. “We want to try to figure out how to disseminate use of the intervention more broadly and explore its applicability in a broader group of clinic settings," she says.
Katherine J. Igoe is a Boston-based freelancer specializing in health, wellness, and lifestyle.