Engaging Patients and Providers in Collaborative Communication on HPV Vaccination (EPPIC-HPV)

*This project was terminated due to issues relating to its study sites' recruitment and enrollment.

Vaccination against Human Papillomavirus (HPV) has been routinely recommended for adolescent females by the Advisory Committee on Immunization Practices, physicians, and many medical organizations, yet uptake of HPV vaccines remains very low. For example, although HPV vaccination is recommended for 11- and 12-year-old girls, as of 2013, approximately only 9 percent of 11- to 12-year-old girls in New Mexico had completed the three-dose series. Further, Centers for Disease Control data reveal that in 2013, only 44.3 percent of 13- to 17-year-old females in New Mexico (and 37.6 percent nationwide) had completed the three-dose HPV vaccine series. These data reveal the uptake of the HPV vaccines is unacceptably low, thereby diminishing its ability to provide population-level protection against the HPV types known to cause cervical, vaginal, and vulvar cancers in women, oropharyngeal and anal cancers in men and women, and penile cancers in men. The danger of the very low vaccination rates is that a significant proportion of adolescents of all ages will continue to be vulnerable to HPV and the associated cancer risks.

Despite recommendations for HPV vaccination and convincing data on the safety and effectiveness of the vaccines, parents continue to have concerns about HPV vaccination. Simultaneously, clinicians often lack a clear frame for discussions about HPV vaccination with parents, so much so that recent research indicates that pediatricians’ discussions with parents about vaccinations in general often take the form of bargaining (e.g., “Because this may be too early for the vaccination, can we delay the vaccination schedule?”). Effective messaging is needed to close a knowledge gap among parents around HPV and HPV vaccines, improve communication and shared decision making about HPV vaccination between adolescent girls’ parents and physicians, and ultimately prompt uptake of HPV vaccines.

This project will employ a developed and efficacious web-based intervention on HPV messaging, GoHealthyGirls.org, as a way to improve knowledge, communication, and shared decision making about HPV vaccination between 11- to 13-year-old girls, their parents, and clinicians. A clinic-based comparative effectiveness randomized trial will be used to examine the impact of the GoHealthyGirls website on vaccine-related outcomes and vaccine uptake. Pediatric clinics within New Mexico will be randomly assigned to either the usual care clinic-based communication about HPV vaccination or to usual care plus web-based dissemination. Assessments of vaccine-related outcomes—including shared decision making among girls, parents, and physicians—will be assessed at baseline, three months, and nine months, and vaccine uptake and dose adherence will be abstracted from clinic vaccine records at nine months. An effective web-based resource should increase parents’ knowledge, intentions, and motivations to vaccinate, enhance shared decision making for HPV vaccination, and increase HPV vaccination rates.