Understanding the Feasibility of Addressing Missed Opportunities in HPV Vaccination Uptake: A Qualitative Approach to Bring Practical Solutions Public

Abstract

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection among adolescents and adults in the United States; HPV causes anogenital tract (i.e. cervical, anal, vaginal, vulvar, penile cancers) and oropharyngeal cancers, and genital warts. Although there are vaccines to reduce HPV transmission, uptake of the vaccine remains low due to missed opportunities in vaccination and adolescents’ underutilization of preventive services.

 

Purpose: To understand the feasibility of vaccinating at every opportunity from the provider, parent, and adolescent perspective to minimize missed opportunities in HPV vaccination.

 

Methods: Consenting healthcare facilities in urban and rural healthcare settings lead to participant recruitment of providers, parents, and adolescents to conduct in-depth interviews; interviews were analyzed using the qualitative analysis software, MaxQDA to complete the coding process and create emerging themes. This process was used to identify relevant perceptions of missed opportunities and vaccinating at every opportunity.

 

Results: A total of 25 in-depth interviews (n=25) were conducted, nine with healthcare providers (n=9), nine with parents (n=9), and seven with adolescents (n=7). Most providers discussed applying the vaccinating at every opportunity approach. Parents were primarily hesitant of multiple vaccines during an acute visit due to potential contraindications. Adolescents were generally fearful of vaccines due to pain. There was no discussion of a standard protocol used to apply the vaccination at every opportunity method since some providers recommended vaccines during acute visits while others only provided vaccinations at wellness visits.

 

Discussion: Creating a practical and standard method to apply the vaccinating at every opportunity method that is recommended in the ACIP and CDC guidelines is necessary to reduce missed opportunities in HPV adolescent vaccination. A primary barrier to address is the adolescents’ underutilization of preventive care services and examining alternative methods to promote and administer HPV vaccination to increase HPV vaccination uptake.

 

Keywords: HPV, vaccination, adolescent health, missed opportunities.

Table of Contents

Table of Contents

Chapter I: Introduction ................................................................................................................ 1

Chapter II: Literature Review ..................................................................................................... 2

HPV & Vaccination Prevention .................................................................................................. 2

Current Adolescent Vaccination Standards ................................................................................. 3

Missed Opportunities for HPV Vaccination ............................................................................... 5

Current Methods to Increase HPV Vaccination Uptake ............................................................. 6

Implementation of Recommended HPV Vaccine Uptake Strategies .......................................... 7

Chapter III: Manuscript .............................................................................................................. 9

Introduction............................................................................................................................. 10

Methods.................................................................................................................................... 10

Results...................................................................................................................................... 13

Participant Demographics...................................................................................................... 13

Vaccination Opportunities..................................................................................................... 14

Vaccination Process............................................................................................................... 16

Visit Type.............................................................................................................................. 16

Vaccine Reluctance............................................................................................................... 19

Discussion................................................................................................................................. 20

Research Implications............................................................................................................ 21

Relevance of the study........................................................................................................... 21

Significance........................................................................................................................... 22

Strengths and Limitations...................................................................................................... 22

Chapter 4: Recommendations & Conclusion........................................................................... 24

Recommendations..................................................................................................................... 24

Conclusion................................................................................................................................. 25

References.................................................................................................................................... 26

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Mot-clé	vaccination adolescent health HPV missed opportunities
Committee Chair / Thesis Advisor	Bednarczyk, Robert A., Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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