Two Shots to Cancer Prevention: Improving Uptake of the Human Papillomavirus (HPV) Vaccine among Preadolescent Patients of a Primary Care Network

The current HPV vaccine uptake rate is not on track to achieve the Healthy People 2020 goal of 80%, nor attain the desired reduction in HPV-related cancer burden that could be achieved through optimal uptake. Increasing the HPV vaccination rates to 80% could prevent an additional 53,000 future cervical cancer cases in the U.S among girls who are 12 years or younger over the course of their lifetime as well as many additional cases of other cancers, precancers, and genital warts in both sexes. Understanding the current HPV vaccination trends, determining predictors of vaccination, and identifying the characteristics of primary care visits that are missed opportunities for HPV vaccination allows for the development of more effective strategies that can accelerate HPV vaccine uptake.My dissertation, comprised of three papers, examines the multiple levels of influence associated with uptake of the HPV vaccine among preadolescents ages 11-12 at the provider, patient/parent, and visit levels. The findings will help elucidate salient factors that influence the provider’s decision to recommend the HPV vaccine to their patients, the parent’s decision to accept and follow through with that recommendation, the processes of care that are required to ensure that recommendation is carried out, and the relationships among these various factors. The first and second paper utilizes electronic medical records and administrative data to identify: 1) patient and provider factors associated with HPV vaccine uptake and 2) patient, provider and visit factors associated with missed clinical opportunities to recommend and administer the HPV vaccine. The third paper explores the clinic, primary care team and parent level factors that affect uptake of the HPV vaccine through semi-structured key-informant interviews.The primary conclusions from this research highlight the importance of developing and implementing multi-level interventions that engage parents, all clinic staff (e.g. providers and support staff) and health care systems. Education, training and communication for HPV vaccines should focus on emphasizing the importance of timely vaccinations, bundling the HPV vaccines with other vaccines due at the same time, and ensuring that all clinic staff provide a strong and consistent HPV vaccination recommendation