Despite the fact that human papillomavirus (HPV) vaccine is the only licensed vaccine that can prevent any type of cancer, rates of vaccine uptake continue to be low, with only half of youth being vaccinated. Additionally, youth from minority groups have lower rates of HPV vaccination.
Dr. Joanne Cox and colleagues from Harvard University, University of Missouri-Kansas City, Albert Einstein School of Medicine, and the RAND Corporation used quality improvement strategies to increase these rates, and they report their results in a Quality Report entitled, “Improving HPV Vaccination Rates in a Racially and Ethnically Diverse Pediatric Population,” (10.1542/peds.2021-054186) which is being early released by Pediatrics this week.
The authors conducted this quality improvement project at a hospital-based primary care pediatric clinic and a community health center in Massachusetts; both practices served a population that was majority Black and Hispanic.
The team first talked to providers, parents, and adolescents to identify barriers to vaccination, and they learned the barriers for providers and parents/adolescents were different.
Barriers for providers included:
- Discomfort with talking about HPV, because HPV is associated with sexual activity
- Lack of time
Barriers for parents included:
- Mistrust of vaccines
- Lack of information
- Belief that the child is at low risk for HPV
- Inability or unwillingness to return for subsequent vaccines
The team then developed their quality improvement initiatives. Some of these were:
- Developing standing orders, so that nurses could recommend and give the vaccine without a provider order
- Giving the first HPV vaccine at 9 years
- Developing prompts in the electronic health record to give subsequent vaccine doses
- Using a declarative approach (“Your child is due for the HPV vaccine today.”) rather than a questioning approach (“Would you like your child to get the HPV vaccine today?”)
How did they do? You will be happy to know that the team increased rates of vaccine completion by age 13 from 37% to 77%. The vaccine completion rates were particularly high in Hispanic children, who were more than 2 times more likely than White and Black children to complete their HPV series by age 13.
If you’re looking to improve your HPV vaccination rates, take a look at this article. You will get some great ideas for how to start!
