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Innovative and Impactful Strategies to Increase HPV Vaccine Delivery and Uptake

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A special issue of Vaccines (ISSN 2076-393X). This special issue belongs to the section "Human Papillomavirus Vaccines".

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 19032

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Special Issue Editors

Dr. Jane Richards Montealegre

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Guest Editor

Baylor College of Medicine, Houston, TX, USA
Interests: behavioral epidemiology; health disparities; cancer prevention; implementation science; health system interventions

Dr. Lindy U. McGee

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Guest Editor

Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
Interests: health system interventions; provider communication; vaccine hesitancy; child and adolescent vaccines

Special Issue Information

Dear Colleagues,

The HPV vaccine has the potential to prevent over 90% of cervical and other HPV-associated cancers. However, its promise is challenged by suboptimal coverage, which has been further exacerbated by the COVID-19 pandemic. Innovative and impactful strategies to improve HPV vaccine delivery and uptake are imperative in order to meet the World Health Organization goal of 90% vaccination of girls by age 15.

We are seeking high-quality contributions that explore strategies to increase HPV vaccination in healthcare and/or community settings and address the challenge of achieving equitable access and uptake for vaccine-eligible individuals. We are pleased to invite you to contribute to this Special Issue, which aims to explore the effectiveness and implementation of interventions and strategies to improve HPV vaccine coverage, as well as the adaptation of evidenced-based interventions and strategies to meet the needs of specific populations and contexts. We welcome multidisciplinary work, including submissions from behavioral and implementation scientists, epidemiologists, data analytics experts, public health practitioners, communication specialists, and others.

Dr. Jane Richards Montealegre
Dr. Lindy U. McGee
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Vaccines is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

HPV
HPV vaccination
evidence-based interventions
implementation science
behavioral science
health disparities
cancer prevention
adolescent health

Published Papers (9 papers)

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22 pages, 818 KiB

Open AccessArticle

Adaptation and Formative Evaluation of Online Decision Support to Implement Evidence-Based Strategies to Increase HPV Vaccination Rates in Pediatric Clinics

by Ross Shegog, Lara S. Savas, Erica L. Frost, Laura C. Thormaehlen, Travis Teague, Jack Steffy, Catherine Mary Healy, Laura Aubree Shay, Sharice Preston and Sally W. Vernon

Vaccines 2023, 11(7), 1270; https://doi.org/10.3390/vaccines11071270 - 21 Jul 2023

Viewed by 1068

Abstract

Human papilloma virus (HPV) vaccination rates remain below national goals in the United States despite the availability of evidence-based strategies to increase rates. The Adolescent Vaccination Program (AVP) is a multi-component intervention demonstrated to increase HPV vaccination rates in pediatric clinics through the implementation of six evidence-based strategies. The purpose of this study, conducted in Houston, Texas, from 2019–2021, was to adapt the AVP into an online decision support implementation tool for standalone use and to evaluate its feasibility for use in community clinics. Phase 1 (Adaptation) comprised clinic interviews (n = 23), literature review, Adolescent Vaccination Program Implementation Tool (AVP-IT) design documentation, and AVP-IT development. Phase 2 (Evaluation) comprised usability testing with healthcare providers (HCPs) (n = 5) and feasibility testing in community-based clinics (n = 2). AVP-IT decision support provides an Action Plan with tailored guidance on implementing six evidence-based strategies (immunization champions, assessment and feedback, continuing education, provider prompts, parent reminders, and parent education). HCPs rated the AVP-IT as acceptable, credible, easy, helpful, impactful, and appealing (≥80% agreement). They rated AVP-IT supported implementation as easier and more effective compared to usual practice (p ≤ 0.05). The clinic-based AVP-IT uses facilitated strategy implementation by 3-month follow-up. The AVP-IT promises accessible, utilitarian, and scalable decision support on strategies to increase HPV vaccination rates in pediatric clinic settings. Further feasibility and efficacy testing is indicated. Full article

(This article belongs to the Special Issue Innovative and Impactful Strategies to Increase HPV Vaccine Delivery and Uptake)

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19 pages, 1477 KiB

Open AccessArticle

Creating and Activating an Implementation Community to Drive HPV Vaccine Uptake in Texas: The Role of an NCI-Designated Cancer Center

by Rosalind S. Bello, Michael T. Walsh, Jr., Blake Harper, Charles E. Amos, Jr., Katherine Oestman, Stephanie Nutt, Marcita Galindez, Kaitlyn Block, Ruth Rechis, Erica M. Bednar, Jennifer Tektiridis, Lewis Foxhall, Mark Moreno, Sanjay Shete and Ernest Hawk

Vaccines 2023, 11(6), 1128; https://doi.org/10.3390/vaccines11061128 - 20 Jun 2023

Cited by 1 | Viewed by 1354

Abstract

The University of Texas MD Anderson Cancer Center, a comprehensive cancer center designated by the National Cancer Institute (NCI), defines its service population area as the State of Texas (29.1 M), the second most populous state in the country and the state with the greatest number of uninsured residents in the United States. Consistent with a novel and formal commitment to prevention as part of its core mission, alongside clear opportunities in Texas to drive vaccine uptake, MD Anderson assembled a transdisciplinary team to develop an institutional Framework to increase adolescent HPV vaccination and reduce HPV-related cancer burden. The Framework was developed and activated through a four-phase approach aligned with the NCI Cancer Center Support Grant Community Outreach and Engagement component. MD Anderson identified collaborators through data-driven outreach and constructed a portfolio of collaborative multi-sector initiatives through review processes designed to assess readiness, impact and sustainability. The result is an implementation community of 78 institutions collaboratively implementing 12 initiatives within a shared measurement framework impacting 18 counties. This paper describes a structured and rigorous process to set up the implementation of a multi-year investment in evidence-based strategies to increase HPV vaccination that solves challenges preventing implementation of recommended strategies and to encourage similar initiative replication. Full article

(This article belongs to the Special Issue Innovative and Impactful Strategies to Increase HPV Vaccine Delivery and Uptake)

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19 pages, 512 KiB

Open AccessArticle

Factors Associated with College Students’ Human Papillomavirus (HPV) Vaccination and Preferred Strategies for Catch-Up Vaccine Promotion: A Mixed-Methods Study

by Seok Won Jin, Yeonggeul Lee, Sohye Lee, Haeun Jin and Heather M. Brandt

Vaccines 2023, 11(6), 1124; https://doi.org/10.3390/vaccines11061124 - 20 Jun 2023

Cited by 1 | Viewed by 2240

Abstract

Human papillomavirus (HPV) vaccination protects against six types of cancer—cervical, anal, oropharyngeal, penile, vulvar, and vaginal. In the United States (U.S.), HPV vaccination coverage in college students remains low, especially in the Mid-South region, despite the highest risk of HPV infections and disease burden. However, few studies have assessed HPV vaccination among college students here. This study examined factors associated with HPV vaccination among college students in the Mid-South and explored preferred strategies for promoting vaccination. A mixed-methods design comprising a cross-sectional, self-report online survey and dyadic virtual interviews was conducted. Simple random sampling was performed to recruit a total of 417 undergraduate students aged 18–26 from March to May 2021; convenience sampling was performed to recruit three sex-matched dyads of a total of six (four female and two male) undergraduates from survey respondents who had not completed the HPV vaccine series in May 2021. Binary logistic regression analyses showed HPV vaccine knowledge and perceived barriers to vaccination were factors contributing to coverage for both female and male students, while perceived risks of HPV and vaccine hesitancy were factors only among female students. Findings from the qualitative content analysis identified college students’ perceived barriers to the vaccination at multiple levels and preferred strategies for vaccination promotion, corroborating the findings from the survey study. The findings provide implications that benefit the development of tailored interventions aimed at facilitating catch-up vaccination among college students in the Mid-South region. There is an urgent need for further research and the implementation of effective strategies that address the identified barriers and improve HPV vaccine uptake in this population. Full article

(This article belongs to the Special Issue Innovative and Impactful Strategies to Increase HPV Vaccine Delivery and Uptake)

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12 pages, 451 KiB

Open AccessArticle

Lessons Learned from All for Them: Best Practices for a Cross-Collaboration Approach to HPV Vaccination in Public Schools

by Paula M. Cuccaro, Jihye Choi, Efrat K. Gabay, J. Michael Wilkerson, Diane Santa Maria, Sanghamitra M. Misra, Mayra Aguilar McBride and Sally W. Vernon

Vaccines 2023, 11(5), 946; https://doi.org/10.3390/vaccines11050946 - 05 May 2023

Cited by 1 | Viewed by 1819

Abstract

The Community Preventive Services Task Force endorses vaccination programs in schools to increase access to vaccinations. However, implementing a school-based approach requires substantial coordination, planning, and resources. All for Them (AFT) is a multilevel, multicomponent approach to increase HPV vaccination among adolescents attending public schools in medically underserved areas in Texas. AFT comprised a social marketing campaign, school-based vaccination clinics, and school nurse continuing education. Process evaluation metrics and key informant interviews to understand experiences with AFT program implementation informed lessons learned. Lessons emerged in six domains: strong champion, school-level support, tailored and cost-effective marketing approaches, mobile provider collaboration, community presence, and crisis management. Strong support at district and school levels is vital for gaining principal and school nurse buy-in. Social marketing strategies are integral to program implementation and should be adjusted to maximize their effectiveness in motivating parents to vaccinate children against HPV, which also can be achieved through increased community presence of the project team. Preparing contingency plans and flexibility within the program can facilitate appropriate responses to provider restrictions in mobile clinics or in the event of unforeseen crises. These important lessons can offer useful guidelines for the development of prospective school-based vaccination programs. Full article

(This article belongs to the Special Issue Innovative and Impactful Strategies to Increase HPV Vaccine Delivery and Uptake)

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12 pages, 597 KiB

Open AccessArticle

Using Electronic Reminders to Improve Human Papillomavirus (HPV) Vaccinations among Primary Care Patients

by Kathleen Hanley, Tong Han Chung, Linh K. Nguyen, Tochi Amadi, Sandra Stansberry, Robert J. Yetman, Lewis E. Foxhall, Rosalind Bello, Talhatou Diallo and Yen-Chi L. Le

Vaccines 2023, 11(4), 872; https://doi.org/10.3390/vaccines11040872 - 20 Apr 2023

Cited by 2 | Viewed by 2171

Abstract

The COVID-19 pandemic led to delays in routine preventative primary care and declines in HPV immunization rates. Providers and healthcare organizations needed to explore new ways to engage individuals to resume preventive care behaviors. Thus, we evaluated the effectiveness of using customized electronic reminders with provider recommendations for HPV vaccination to increase HPV vaccinations among adolescents and young adults, ages 9–25. Using stratified randomization, participants were divided into two groups: usual care (control) (N = 3703) and intervention (N = 3705). The control group received usual care including in-person provider recommendations, visual reminders in exam waiting rooms, bundling of vaccinations, and phone call reminders. The intervention group received usual care and an electronic reminder (SMS, email or patient portal message) at least once, and up to three times (spaced at an interval of 1 reminder per month). The intervention group had a 17% statistically significantly higher odds of uptake of additional HPV vaccinations than the usual care group (Adjusted Odds Ratio: 1.17, 95% CI: 1.01–1.36). This work supports previous findings that electronic reminders are effective at increasing immunizations and potentially decreasing healthcare costs for the treatment of HPV-related cancers. Full article

(This article belongs to the Special Issue Innovative and Impactful Strategies to Increase HPV Vaccine Delivery and Uptake)

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11 pages, 576 KiB

Open AccessArticle

Perceived Barriers and Use of Evidence-Based Practices for Adolescent HPV Vaccination among East Texas Providers

by Sarah Kim, Kelvin Zhou, Susan Parker, Kimberly N. Kline, Jane R. Montealegre and Lindy U. McGee

Vaccines 2023, 11(4), 728; https://doi.org/10.3390/vaccines11040728 - 25 Mar 2023

Viewed by 2031

Abstract

Adolescents living in rural areas are less likely to be up to date on the human papillomavirus (HPV) vaccine, which can prevent cervical cancer. We administered a telephone survey to 27 clinics in rural East Texas to assess perceived barriers to HPV vaccination and current use of evidence-based interventions to promote HPV vaccination. Perceived barriers were assessed using a 5-point Likert scale and clinical implementation of evidence-based practices was determined. Findings are reported using descriptive statistics. The most commonly reported barriers were missed vaccination opportunities due to the pandemic (66.7%), followed by vaccine hesitancy due to the pandemic (44.4%) and due to the HPV vaccine specifically (33.3%). Fewer than a third of clinics reported using the evidence-based strategies of use of a “refusal to vaccinate” form (29.6%), having an identified HPV vaccine champion (29.6%), and recommending the HPV vaccine at age 9 (22.2%). While many clinics surveyed currently implement evidence-based practices to promote HPV vaccination, there is a need and desire for additional HPV vaccination interventions in East Texas clinics. Full article

(This article belongs to the Special Issue Innovative and Impactful Strategies to Increase HPV Vaccine Delivery and Uptake)

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16 pages, 739 KiB

Open AccessArticle

Human Papillomavirus Vaccination Uptake in the Rio Grande Valley: Results from a Pilot Community-Based Educational and School-Based Vaccination Program and Its Expansion

by Ana M. Rodriguez, Thuy Quynh N. Do, Mostafa F. Eyada, Lu Chen, Kathleen M. Schmeler and Jane R. Montealegre

Vaccines 2023, 11(2), 329; https://doi.org/10.3390/vaccines11020329 - 01 Feb 2023

Cited by 1 | Viewed by 1736

Abstract

Human papillomavirus (HPV) vaccine is a safe and effective strategy for reducing HPV morbidity and mortality. Schools have become an increasingly attractive setting for delivering vaccinations and supporting vaccination health literacy and decisional support. This study assesses the effectiveness of a community-based, physician-led HPV education campaign (starting in 2016) and onsite middle school-based HPV vaccination program across six school districts (2017, 2019, 2020) in a rural, medically underserved Texas area (Rio Grande Valley). Pre- and post-intervention HPV vaccination rates were tracked against the 2016 National Immunization Survey—Teen target rates (initiation: 49.3%; completion: 32.9%). Summary statistics were stratified by gender, school district, and grade level. The study reached 19,951 students who received HPV vaccines directly or indirectly through our program (10,289 females; 9662 males) (August 2016–August 2022). Of those, 2145 students (1074 females; 1071 males) were vaccinated directly through our program. The overall HPV up-to-date (UTD) rates were 58.8%. The overall median age at HPV vaccine initiation and HPV-UTD (range) was 11 years (9–21) and 12 years (9–20). The overall median interval between HPV vaccine doses (range) was 291 days (146–2968). Recommending HPV vaccine initiation at younger ages increases HPV vaccine completion and providing access to HPV vaccines encourages on-time vaccination and completion. Full article

(This article belongs to the Special Issue Innovative and Impactful Strategies to Increase HPV Vaccine Delivery and Uptake)

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13 pages, 287 KiB

Open AccessArticle

Motivators and Barriers to HPV Vaccination: A Qualitative Study of Underserved Women Attending Planned Parenthood

by Emilia J. Fields, Suellen Hopfer, Jennifer R. Warren, Rhonda BeLue, Joel Lebed and Michael L. Hecht

Vaccines 2022, 10(7), 1126; https://doi.org/10.3390/vaccines10071126 - 15 Jul 2022

Cited by 2 | Viewed by 2014

Abstract

Human papilloma virus (HPV) is the most common sexually transmitted infection in the United States. Disease-associated strains of HPV can cause genital warts and six cancer types. HPV-associated cervical cancer disproportionately impacts medically underserved women including Black and Latina women with respect to incidence, prevalence, and mortality rates. Although safe and effective vaccines are available, HPV vaccination rates remain low among low-income individuals and women of color. The current study examined individual and structural motivators and barriers to HPV vaccination among medically underserved women utilizing a Planned Parenthood health center in Southeast Pennsylvania. Guided by narrative engagement theory (NET), qualitative interviews (N = 24) were used to elicit HPV vaccine decision stories from both vaccinated and unvaccinated women. Using a phronetic iterative data analysis approach, we identified three motivators to vaccinate against HPV: (1) receiving an explicit vaccine recommendation from a healthcare provider (a structural determinant), (2) feeling empowered to take control of one’s health (an individual determinant), and (3) knowing someone infected with HPV (an individual determinant). Among unvaccinated participants, barriers to HPV vaccination included: (1) not receiving an explicit vaccine recommendation from a healthcare provider (a structural determinant), (2) low perceived risk for acquiring HPV or that HPV is not severe (an individual determinant), and (3) lack of maternal support to vaccinate (a structural determinant). Healthcare providers are optimally positioned to fill the gap in prior missed vaccine opportunities and empower women by recommending HPV vaccination. Full article

(This article belongs to the Special Issue Innovative and Impactful Strategies to Increase HPV Vaccine Delivery and Uptake)

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15 pages, 1090 KiB

Open AccessSystematic Review

Digital Health Interventions to Improve Adolescent HPV Vaccination: A Systematic Review

by Jihye Choi, Irene Tamí-Maury, Paula Cuccaro, Sooyoun Kim and Christine Markham

Vaccines 2023, 11(2), 249; https://doi.org/10.3390/vaccines11020249 - 22 Jan 2023

Cited by 5 | Viewed by 3442

Abstract

Digital technologies are being increasingly utilized in healthcare to provide pertinent and timely information for primary prevention, such as vaccination. This study aimed to conduct a systematic review to describe and assess current digital health interventions to promote HPV vaccination among adolescents and parents of adolescents, and to recommend directions for future interventions of this kind. Using appropriate medical subject headings and keywords, we searched multiple databases to identify relevant studies published in English between 1 January 2017 and 31 July 2022. We screened and selected eligible studies for inclusion in the final analysis. We reviewed a total of 24 studies, which included interventions using text messages (4), mobile apps (4), social media and websites (8), digital games (4), and videos (4). The interventions generally improved determinants of HPV vaccination, such as HPV-related knowledge, vaccine-related conversations, and vaccination intentions. In particular, text message and social media interventions targeted improved vaccine uptake behaviors, but little meaningful change was observed. In conclusion, digital health interventions can cost-effectively provide education about HPV vaccination, offer interactive environments to alleviate parental vaccine hesitancy, and ultimately help adolescents engage in HPV vaccine uptake. Full article

(This article belongs to the Special Issue Innovative and Impactful Strategies to Increase HPV Vaccine Delivery and Uptake)

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