HPV vaccine decision making in pediatric primary care: a semi-structured interview study

Area of Science:

• Public Health
• Adolescent Medicine
• Vaccinology

Background:

• National recommendations for human papillomavirus (HPV) vaccination have not translated into high uptake rates, with less than 30% of adolescent girls fully vaccinated by 2009.
• Previous research on HPV vaccination barriers has examined parents, adolescents, and clinicians in isolation, neglecting the crucial point-of-care decision-making process involving all three parties.

Purpose of the Study:

• To explore the decision-making process for HPV vaccination at the point of care by examining the perspectives of parents, adolescents, and clinicians.
• To generate hypotheses for interventions aimed at increasing HPV vaccine receipt by understanding the interplay between these three key stakeholders.

Main Methods:

• Qualitative interviews were conducted with 20 adolescent-mother-clinician triads (60 individuals) immediately following a preventive care visit where the HPV vaccine was due.
• Data collection occurred between March and June 2010 across 9 diverse practices, continuing until thematic saturation was reached.
• A modified grounded theory approach was employed, analyzing interview data using NVivo8 software both within and across triads to identify emergent themes.

Main Results:

• Parents frequently delayed HPV vaccination rather than outright refusing it; clinicians often hesitated to discuss parental reluctance.
• Clinicians employed two primary communication strategies: presenting HPV vaccine as routine or as an optional choice with detailed risk/benefit information.
• Adolescents perceived themselves as passive participants in the vaccination decision, even when parents and clinicians reported their involvement.

Conclusions:

• Interventions to enhance HPV vaccine delivery in primary care settings should prioritize fostering effective communication between parents and clinicians.
• Further research is necessary to develop and evaluate strategies that empower clinicians to engage hesitant parents and passive adolescents, and to assess the impact of different clinician communication approaches on vaccination rates.