Abstract
Background: The human papillomavirus (HPV) vaccine is an important tool for cancer prevention. Vaccination rates in Alabama, a state with high rates of HPV-related cancers, remain below the national average. Our objective was to develop a comprehensive assessment of HPV vaccination in our state, with the goal to make recommendations for tailored multilevel interventions.
Methods: With the PRECEDE-PROCEED model as a theoretical framework, a multimodal approach with quantitative and qualitative data was used to determine barriers and facilitators to HPV vaccination in Alabama. This included a survey of pediatricians and family medicine providers as well as structured qualitative interviews with pediatricians, parents, nurses, and community stakeholders. Two separate investigators evaluated the interview transcripts for major themes that occurred in 65% or more interviews.
Results: Major barriers that overlapped between all groups in both qualitative and quantitative data included lack of parental knowledge, concerns about vaccine safety, and the link between the HPV vaccine and sexuality. Opportunities for increasing HPV vaccination identified include parental education, establishment of a reminder system, increasing access to HPV vaccine providers, and education for providers. Qualitative interviews further expanded on these themes and revealed barriers such as misinformation received from the Internet and parental vaccine hesitancy. Additional opportunities and facilitators revealed through interviews included the trust patients have in physicians, using the Internet or social media to propagate positive messaging about the HPV vaccine, provider education for both physicians and clinical staff, utilizing existing technology more effectively, highlighting nurses' roles as partners in HPV prevention, and the potential of schools as a venue for patient education and promotion of the vaccine.
Conclusion: Our data are consistent with prior research showing major barriers to HPV vaccination. There is an especially high resistance to vaccination due to the link between the vaccine and sexual activity, often attributed to religious beliefs. Several recommendations for optimizing HPV vaccination uptake in Alabama on the patient, provider, and system level are given.
Citation Format: Sarah E. Dilley, Sylvia Peral, J. Michael Straughn, Jr., Isabel Scarinci. A diagnostic review of barriers to and opportunities for improving HPV vaccination in Alabama [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C92.
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