The goal of this study was to identify the rationale by parents/guardians and providers for delaying or administering human papillomavirus (HPV) vaccination to girls.
Qualitative interviews were conducted with parents/guardians accompanying their vaccine-eligible 11- to 17-year-old daughters to medical visits. Interviews were conducted in 1 public clinic and 3 private practice settings to ascertain why girls did or did not receive HPV vaccination. Questions probed vaccine decision-making from the point of view of parents/guardians and providers.
A total of 124 parents/guardians and 37 providers participated. The most common reasons parents reported for not vaccinating their daughters was the lack of a physician recommendation (44%). Both parents and providers believed that HPV vaccination provided important health benefits, but the timing of vaccination with relation to sexual activity was an important theme related to vaccine delay. Providers with lower self-reported vaccination rates delayed vaccine recommendations in girls perceived to be at low risk for sexual activity, and several parents reported that their providers suggested or supported delaying vaccination until their daughters were older. However, parents/guardians and providers agreed that predicting the timing of sexual debut was extremely difficult. In contrast, providers with high vaccination rates presented HPV vaccination as a routine vaccine with proven safety to prevent cancer, and parents responded positively to these messages.
Although most parents and providers believe that HPV vaccination is important, missed opportunities result from assumptions about the timing of vaccination relative to sexual activity. Routinely recommending HPV vaccination as cancer prevention to be coadministered with other vaccines at age 11 years can improve vaccination rates.
Comments
Timing of HPV vaccine
Timing of HPV vaccination is of critical importance to the success of this vaccine. HPV discussion at younger ages often collides with the clinician's angst in discussing sex in early adolescence.[1] Messaging about routine use, safety, and cancer prevention, however, resonates with parents.
In addition, I have found a simple analogy of great utility in my practice. Most parents are familiar with, and endorse the use of bicycle helmets. When discussing HPV vaccine with 11 and 12 year-olds and their parents, I will ask the simple question:
When do you want your children to put on their bike helmets?
A. Before they get on their bike
B. When they are riding their bike in the street
C. When they see the car heading directly at them
D. After the car hits them
I usually end up with a smile and a successfully launched series.
The work of Perkins, et al. [2] validates the difficulties incurred with provider hesitancy. Reassurance on the long-term effectiveness of HPV vaccine, as shown by Ferris and colleagues [3], removes another of the buttresses of this hesitancy. Appropriate messaging is essential to parental and child acceptance of this greatly beneficial preventive tool. Physicians need not be one of the obstacles to widespread use.
1. Offit PA. Let's Not Talk About Sex. New York Times Opinion, Aug 19.2014. 2. Perkins RB, Clark JA, Apte G, et al. Missed opportunities for HPV vaccination in adolescent girls: a qualitative study. Pediatrics 2014;134:e666-674. 3. Ferris D, Samakoses R, Block SL, et al. Long-term study of quadrivalent human papillomavirus vaccine. Pediatrics 2014;134:e557-665.
Conflict of Interest:
None declared