Strengthening HPV Vaccination Communication Between Caregivers and Providers in Georgia Öffentlichkeit
Whitson, Cassidy (Spring 2020)
Abstract
Background: Despite the availability and recommendation of Human Papillomavirus (HPV) vaccination for adolescents in the United States since 2006, vaccination rates remain low. While many national studies have been conducted on the strength of recommendation quality and the communication strategies used to recommend HPV vaccination, there is little evidence on both provider and caregiver perceptions of communication. There is a need for local context in diverse socioeconomic communities, such as in the state of Georgia.
Methods: We conducted six focus group discussions (FGDs) with healthcare providers and eight FGDs with caregivers of adolescents in Georgia. We sought to identify parent and provider perceptions on communication around HPV vaccine recommendations and suggest improved strategies to tailor recommendations to local contexts. FGDs were recorded and verbatim transcribed. We conducted a thematic analysis to discover communication strategies used and identify major themes.
Results: We found three major themes: perceptions of communication identified by providers; perceptions of communication identified by caregivers; and communication strategies utilized by both caregivers and providers. Providers identified best practices for recommending HPV vaccination, including emphasizing cancer prevention and framing the vaccine as routine. Caregivers discussed how HPV was recommended but not required for school made them feel it was less important. They also identified the influence their peers, both in-person and online, had on their perceptions of HPV vaccination. Providers discussed how they liked using the announcement approach to recommend vaccination, but caregivers felt tricked and unable to say no. Providers used VIS and written information as tools to help recommend, but caregivers disliked the lack of explanation of the content of written materials. Caregivers felt more satisfied with the recommendation when providers took time to discuss written materials and answer questions.
Conclusions: There is a need for providers to be well-versed in strategies to promote HPV vaccination and be well-prepared for adapting their recommendation style to the needs of the caregiver/adolescent. Information sources, such as written material and peer influence, are important for caregiver perceptions. Although strategies such as the announcement approach are useful in increasing uptake, they may be damaging to provider/caregiver relationships and trust.
Table of Contents
Introduction……………………………………………………………………………………………………………………..……....1
Problem statement………………………………………………………………………………………………………..1
Purpose statement…………………………………………………………………………………………….…………..2
Research Objective (Aims) ………………………………………………………………………………………….…2
Significance Statement………………………………………………………………………………………………….3
Literature Review………………………………………………………………………………………………………………………5
HPV Epidemiology………………………………………………………………………………………………………….5
Prevention…………………………………………………………………………………………………………………….6
Vaccine Development…………………………………………………………………………………………………….8
Vaccine Recommendations…………………………………………………….……………………………………10
Parental Reactions and Barriers to Vaccination…………………………………………………………….11
HPV Vaccination in Georgia………………………………………………………………………………………….14
Communication Between Parents and Providers………………………………………………………….16
Methodology……………………………………………………………………………………………………………………………20
Introduction………………………………………………………..……………………………………………………….20
Population and Sample………………………………………………………………………………………………..20
Procedures and Instruments………………………………………………………………………………………..21
Ethical Considerations………………………………………………………………………………………………….22
Analysis……………………………..…………………………………………………………………………………………23
Results……………………………………………………………………………………………………………………………………..26
Demographic Characteristics……………………………………………………………………..…………………26
Focus Group Discussions with Healthcare Providers…………………………………………………….27
Perceptions that Parents Don’t Want to Discuss HPV Vaccination……………….……27
Importance of Strong Engagement with Caregivers……………………………………….…29
Best Practices for Adolescent HPV Vaccination………………………………………….……..31
Focus Group Discussions with Caregivers………………………………………………………….………….37
Perceived Importance of HPV Vaccination……………………………..…………………………37
Importance of Peer Influence……………………………………………………………………………39
Communication Approaches………………………………………………………………………………………..41
Written Information………………………………………………………………………………………….41
Perceptions of Announcement Approach……………………………………………………..….44
Tailored Messaging…………………………………………………………………………………………..45
Discussion……………………………………………………………………………………………………………………………..…47
Hesitation in Discussion of HPV Vaccination………………………………………………………..……….48
HPV as Recommended: Perceptions of this Distinction and Importance of Strong Recommendations………………………………………………………………………………………………………50
Sources of Information: Peers, Sheets and Conversations…………………………………………..52
Message Delivery: Presumptive and Tailored Approaches…………………………………………..55
Conclusions, Strengths and Limitations……………………………………………………………………….57
Implications and Recommendations for Future Research and Practice………………………………..….59
References…………………………………………………………………………………………………………………….………..60
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