Supporting immunization clinic nurses in framing the conversation: recommending HPV vaccination for 11-12-year-old adolescents to increase HPV immunization rates

Abstract

Despite the widespread availability of a safe and effective vaccine to prevent cancers caused by high-risk strains of human papillomavirus (HPV), vaccination rates in the United States remain low. Rates in Flathead County, Montana, have historically been even lower, below Healthy People 2020's goal of 80% series completion, and below state HPV immunization rates. Existing literature supports a strong recommendation for HPV vaccination (HPVV) from a health care professional (HCP) as the single most influential factor in vaccination behavior (Chuang et al., 2017; Gilkey et al., 2016; Sturm et al., 2017). The aim of this project was to educate and empower the nurses within the Flathead City-County Health Department's (FCCHD) Immunization Clinic in how to make strong, clear, and consistent recommendations for HPVV with the overall goal of increasing HPVV series initiation and completion rates for 11-12-year-olds. Staff were surveyed to assess baseline HPV knowledge and perceived barriers to HPVV. A series of communication interventions based on specific language from the Centers for Disease Control and Prevention's (CDC) 'You are the Key to HPV Cancer Prevention' campaign was used to train HCPs in more frequently and confidently recommending HPVV to parents and patients. Interventions were instituted during the Immunization Clinic's scheduled nurses' meeting by a change agent (DNP student), over the course of six months. A post-survey was administered upon project completion. A resource binder for the HCPs was developed which included handouts for HPVV hesitant parents, infographics for the clinic and patient rooms, succinct information on how to recommend HPVV, upcoming continuing education credits involving recommending HPVV, appointment reminder cards for parents/adolescents, and the clinic's HPVV policies. Lippitt's Phases of Change Theory served as the framework for this project. Efficacy was assessed by comparison of pre- and post-survey results, the actual number of HPV vaccines administered during the intervention period, and rates of HPVV series initiation and completion in 11-12-year-olds pre- and post-intervention. The communication intervention increased the comfort and confidence of HCPs as well as HPVV initiation and completion rates. An intervention such as this can help increase the uptake of HPVV and in turn, protect adolescents from HPV-associated cancers.