Primary care visits fail to impact parental knowledge and attitudes on HPV vaccination: RAVE study findings

A health care visit with a child’s primary care provider is not associated with parents’ knowledge and attitudes toward human papilloma virus (HPV), according to a recent study published in the Journal of Primary Care & Community Health.

HPV is the most common sexually transmitted infection in the United States, reported in nearly 14 million individuals and causing approximately 46,000 new cases of HPV-related cancers annually. Safe and effective vaccines to prevent HPV have been available since 2006 and are most effective when administered in patients aged 9 to 12 years.

While 92% of HPV-preventable cancers per year can be prevented by HPV vaccination, vaccine uptake remains low, with full vaccination against HPV reported in only 61.4% of US women and 56% of US men in the 2020 National Immunization Survey.

Parents’ attitudes commonly impact vaccine uptake, with parents citing safety concerns or a belief the vaccine is unnecessary as reasons not to get their child vaccinated. This indicates a need for strategies to change parental knowledge and attitudes toward HPV vaccination.

To evaluate how a partnership between clinic and community groups can impact parental knowledge and attitudes toward HPV vaccination, investigators conducted the Rural Adolescent Vaccine Enterprise (RAVE) study. The RAVE study included primary care clinicians, community partners, and academicians studying the delivery of health care.

The intervention partnered primary care clinics with a practice care facilitator to improve HPV vaccination over an 18-month period using quality improvement methodology. Strategies included finding vaccine-eligible patients, conducting reminders for follow-up vaccination visits, and improving provider communication about vaccination.

Clinics conducted a social media campaign during the final 12 months of the intervention. This involved collaborating with community-based groups such as libraries, coffee shops, schools, and local public health departments.

The association between interventions and parents’ information seeking behavior and knowledge was measured using a 21-item survey completed within 48 hours of a health care visit. Questions determined the reason for a health care visit, whether there was discussion of the HPV vaccine, parental information seeking behavior, and parental knowledge and attitudes.

Participation was reported in 27 RAVE clinics from September 2020 to January 2021. There were 72 participants who completed the survey, 43 of whom were from intervention clinics and 29 controls. Patients were aged an average 13.4 years and 56.9% were female. Over 90% of health care visits were injury, sports physical, illness, or well-child visits.

Discussions about HPV and the HPV vaccine during the health care visit were reported by 54.3% of patients, with 31.3% of patients recently learning about HPV, HPV risks, and the HPV vaccine before the visit. Being knowledgeable about HPV-related cancers was reported by 83.1% of patients and considering or having initiated or completed the HPV vaccine in their children by 79.2%.

Associations between demographic characteristics and health care visits with the mean Vaccination Confidence Scale score did not differ between the intervention and control groups. Scores from 6.7 to 11 for vaccine confidence were observed among Hispanic patients in the intervention group.

In the control group, vaccine confidence scores ranged from 5.6 among fathers to 10 among mothers, non-Hispanic White individuals, and individuals with a college degree. Vaccination Confidence Scores for individual questions ranged from 9.2 to 9.9.

The only difference in Vaccination Confidence scores observed between groups was for the item, “If I do not vaccinate my older child or teenager, he/she may get a disease such as meningitis or human papilloma virus and cause other teenagers or adults to also get the disease.” The score was 8 in the intervention group and 9.9 in the control group.

While knowledge about HPV-related cancers was higher than expected, an association was not found between the intervention and participant knowledge. Investigators recommended further research be conducted on how vaccines are discussed during wellness and illness health care visits.

Reference

Dickinson C, Bumatay S, Valenzuela S, Hatch BA, Carney PA. An exploratory study of rural parents’ knowledge and attitudes about HPV vaccination following a healthcare visit with their child’s primary care provider. Journal of Primary Care & Community Health. 2023;14. doi:10.1177/21501319231201227