Impact of Pharmacist Delivered Education on Early Parent Awareness and Perceptions Regarding Human Papillomavirus (HPV) Vaccination in the Community Pharmacy Setting in West Virginia

"[I]t can reasonably be concluded that educational interventions during early childhood may be effective for changing parental vaccine intentions regarding the HPV vaccine."

West Virginia, in the United States (US), is primarily a rural state, plagued by a lack of education regarding human papillomavirus (HPV). Vaccine uptake is also low; in that state, just over 60% of female adolescents and 45% of males aged 13-17 have started the HPV series, according to the 2015 National Immunization Survey-Teen (NIS-Teen). Motivated by the belief that pharmacists can play a key role in providing patient interaction and education regarding the HPV vaccine, this study sought to demonstrate the impact of a pharmacist-led group educational intervention on HPV vaccine awareness and intent of parents/legal guardians of children under the age of 9, the youngest age for which the HPV vaccine is approved.

This was a prospective pretest, posttest study with a convenience sample conducted at parenting groups throughout northern West Virginia in 2018. Parenting groups contacted were formed for a variety of reasons, such as common interests, socialising young children (play groups), or involvement in a community organisation. Study participants, a total of 34 parents/guardians, attended a 30-minute educational session on HPV vaccination featuring a short PowerPoint® presentation, with additional time allotted for questions. The sessions were led by a community-based pharmacy resident with a Master's in Public Health focusing on health behaviours.

A survey was administered to participants prior to the educational session and immediately following the session. Selected findings:

• Vaccination status - Nine percent (n=3) had another child in the Advisory Committee on Immunization Practices (ACIP) recommended age range or older and had begun vaccination. Notably, of the 34 participants, only 29% (n=10) had received at least 1 dose of the HPV vaccine themselves, with just 14% (n=5) of the study population having completed the full 3-dose series.
• Vaccination intentions and perceptions - Following the intervention, intention to vaccinate according to the ACIP recommendations increased from 35% (n=12) to 44% (n=15). Only 12% (n=4) of the population decidedly would not vaccinate their child (vs. 23% (n=8) before the intervention), while 18% (n=6) were unsure or chose not to respond (vs. 21% (n=7) before the intervention). (Open response item explanations for such choices were safety and efficacy concerns and lack of information. This was further confirmed during the Q&A portion of the educational session.) Overall, participants now intending to vaccinate (either at the ACIP recommended age or at a later age) increased by 14% following the intervention.
• Vaccine decision-making - The majority of parents made vaccination decisions prior to birth or very early in the child's life. In a "select all that apply" format survey item, 91% (n=31) of parents indicated they used information from their doctor regarding vaccines; only 6% (n=2) of parents relied on their pharmacist for vaccine information. Twenty-one percent and 24% of participants used information from their family/friends and the internet to inform their vaccine decisions, respectively, and 15% (n=5) of participants used information from social media.
• Awareness - Participants demonstrated increased awareness of HPV vaccine availability at community pharmacies, with awareness increasing from 32% (n=11) to 100% (n=34). (This dramatic shift could be explained in part by the fact that pharmacist-provided HPV vaccination was newly available at the time of intervention due to state law expansion.)

Reflecting on the implications of the findings, the researchers note:

• "Early intervention by healthcare practitioners, such as pharmacists, is vital for contacting parents when decisions are made, rather than trying to reverse a vaccine hesitant decision."
• "Healthcare providers must be aware of parents turning elsewhere for vaccine information, and be prepared to answer questions and concerns. Pharmacists can take a proactive approach by asking all patients about vaccine status and concerns at each patient encounter."
• "Establishment of community relationships with faith-based and parental community groups will be vital for reaching vaccine-hesitant groups. Specifically, partnerships between public health officials and pharmacists and community group influencers such as parish nurses, parent group organizers, and childcare facilities must be established."
• "Although policies such as the West Virginia legislation allowing vaccination of children 11-18 year-olds with a prescription is a positive move towards vaccination goals, it is not enough. Practitioners must continue to advocate for the expansion of vaccine offerings with fewer restrictions, particularly the HPV vaccine, in all 50 states."

In conclusion, this study has shown that pharmacist-delivered education may be useful in increasing both parent/legal guardian awareness of immunisation services and intention to vaccinate their child.