Clinic-based interventions for human papillomavirus (HPV) vaccination

Evidence Rating  
Some Evidence
Evidence rating: Some Evidence

Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.

Health Factors  
Decision Makers

Multi-component clinic-based interventions supporting HPV vaccination combine information about HPV and the benefits of vaccinating against it with efforts to support vaccine series completion. Interventions can include education for patients and their parents (e.g., brochures, phone calls, or physician conversations), patient or parent reminders, and physician education and decision support alerts throughout the vaccine series. Two HPV vaccines, each given in a three shot series, protect against HPV and cervical cancer; one also protects against genital warts1, 2.

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Increased vaccination

Potential Benefits

Our evidence rating is not based on these outcomes, but these benefits may also be possible:

  • Reduced incidence of HPV

What does the research say about effectiveness? This strategy is rated some evidence.

There is some evidence that multi-component clinic-based interventions increase HPV vaccination rates among eligible adolescent girls and young women3, 4. However, additional evidence is needed to confirm effects and determine which elements of these interventions are most effective.

Patient and parent decision supports including informational telephone calls combined with physician education and electronic health record (EHR) alerts increase initiation and completion of the HPV vaccine series4. In-clinic education through brochures and physician-provided education combined with telephone reminders also appear to increase vaccine uptake and completion3. Overall, provider-focused interventions appear to be more effective at promoting series initiation, and family-focused interventions at promoting series completion4.

Decision support alerts for providers within an EHR appear to increase completion of the HPV vaccine series, even without patient or parent reminders5. Provider recommendation of the vaccine increases acceptability6 and uptake7, 8. Text message reminders sent to parents may increase children’s on time receipt of doses two and three of the vaccine9, 10, though reminders sent to young adult patients may not11.

There is no evidence that receipt of the HPV vaccine increases sexual risk behavior among adolescent girls and young women12, 13. HPV vaccination for all children, including males, is recommended by the American Academy of Pediatrics and the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention14.

How could this strategy impact health disparities? This strategy is rated no impact on disparities likely.

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1 Medeiros 2009 - Medeiros LR, Rosa DD, da Rosa MI, Bozzetti MC, Zanini RR. Efficacy of human papillomavirus vaccines: A systematic quantitative review. International Journal of Gynecological Cancer. 2009;19(7):1166-76.

2 Rambout 2007 - Rambout L, Hopkins L, Hutton B, Fergusson D. Prophylactic vaccination against human papillomavirus infection and disease in women: A systematic review of randomized controlled trials. Canadian Medical Association Journal. 2007;177(5):469-79.

3 Cassidy 2014 - Cassidy B, Braxter B, Charron-Prochownik D, Schlenk EA. A quality improvement initiative to increase HPV vaccine rates using an educational and reminder strategy with parents of preteen girls. Journal of Pediatric Health Care. 2014;28(2):155–64.

4 Fiks 2013 - Fiks AG, Grundmeier RW, Mayne S, et al. Effectiveness of decision support for families, clinicians, or both on HPV vaccine receipt. Pediatrics. 2013;131(6):1114–24.

5 Bundy 2013 - Bundy DG, Persing NM, Solomon BS, et al. Improving immunization delivery using an electronic health record: The ImmProve project. Academic Pediatrics. 2013;13(5):458–65.

6 Brewer 2007 - Brewer NT, Fazekas KI. Predictors of HPV vaccine acceptability: A theory-informed, systematic review. Preventive Medicine. 2007;45(2-3):107-14.

7 Kester 2013 - Kester LM, Zimet GD, Fortenberry JD, Kahn JA, Shew ML. A national study of HPV vaccination of adolescent girls: Rates, predictors, and reasons for non-vaccination. Maternal and Child Health Journal. 2014;17(5):879-885.

8 Kessels 2012 - Kessels SJ, Marshall HS, Watson M, et al. Factors associated with HPV vaccine uptake in teenage girls: A systematic review. Vaccine. 2012;30(24):3546-56.

9 Matheson 2013 - Matheson EC, Derouin A, Gagliano M, Thompson JA, Blood-Siegfried J. Increasing HPV vaccination series completion rates via text message reminders. Journal of Pediatric Health Care. 2013;(13):e1–5.

10 Kharbanda 2011 - Kharbanda EO, Stockwell MS, Fox HW, et al. Text message reminders to promote human papillomavirus vaccination. Vaccine. 2011;29(14):2537–41.

11 Patel 2014 - Patel A, Stern L, Unger Z, et al. Staying on track: A cluster randomized controlled trial of automated reminders aimed at increasing human papillomavirus vaccine completion. Vaccine. 2014;32(21):2428–33.

12 Mayhew 2014 - Mayhew A, Mullins TLK, Ding L, et al. Risk perceptions and subsequent sexual behaviors after HPV vaccination in adolescents. Pediatrics. 2014;133(3):404-11.

13 Rysavy 2014 - Rysavy MB, Kresowik JD, Liu D, et al. Human papillomavirus vaccination and sexual behavior in young women. Journal of Pediatric and Adolescent Gynecology. 2014;27(2):67-71.

14 AAP 2012 - Committee on Infectious Diseases. HPV vaccine recommendations. Pediatrics. 2012;129(3):602-5.

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