Clinic-based interventions for human papillomavirus (HPV) vaccination

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 warts (Medeiros 2009*, Rambout 2007). 

Expected Beneficial Outcomes (Rated)

  • Increased vaccination

Other Potential Beneficial Outcomes

  • Reduced incidence of HPV

Evidence of Effectiveness

There is some evidence that multi-component clinic-based interventions increase HPV vaccination rates among eligible adolescent girls and young women (Cassidy 2014*, Fiks 2013*). 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 series (Fiks 2013*). In-clinic education through brochures and physician-provided education combined with telephone reminders also appear to increase vaccine uptake and completion (Cassidy 2014*). Overall, provider-focused interventions appear to be more effective at promoting series initiation, and family-focused interventions at promoting series completion (Fiks 2013*).

Decision support alerts for providers within an EHR appear to increase completion of the HPV vaccine series, even without patient or parent reminders (Bundy 2013*). Provider recommendation of the vaccine increases acceptability (Brewer 2007*) and uptake (Kester 2013, Kessels 2012*). Text message reminders sent to parents may increase children’s on time receipt of doses two and three of the vaccine (Matheson 2013*, Kharbanda 2011*), though reminders sent to young adult patients may not (Patel 2014*).

There is no evidence that receipt of the HPV vaccine increases sexual risk behavior among adolescent girls and young women (Mayhew 2014*, Rysavy 2014*). 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 Prevention (AAP 2012*).

Impact on Disparities

No impact on disparities likely
Citations - Evidence

* Journal subscription may be required for access.

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.

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.

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.

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

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. National Institutes of Health Public Access (NIH). 2014;17(5):879-885.

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.

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.

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

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.

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.

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.

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

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