Providers' Perceptions of Parental Human Papillomavirus Vaccine Hesitancy: Cross-Sectional Study

"Study findings can be used to develop interventions that assist providers in effectively engaging HPV vaccine hesitant parents to improve acceptance and vaccination outcomes."

In 2017, only 49% of adolescents aged 13 to 17 years in the United States (US) completed the recommended doses of the human papillomavirus (HPV) vaccine. Parental vaccine hesitancy toward the HPV vaccine is a major contributor to low uptake of the vaccine. A few studies have explored what providers perceive as parents' reasons for HPV vaccine hesitancy and how these perceptions correlate with HPV vaccination outcomes. The research question guiding the present study was: "What are the provider and clinic characteristics associated with perceived parental hesitancy among pediatric providers within community-based pediatric clinics in Middle Tennessee [US], surveyed from January to March 2018?"

Motivating this study is the belief that provider perceptions of parental barriers may influence their likelihood to recommend the vaccine and how they communicate the recommendation, which is a major issue, as their recommendation is the strongest predictor of HPV vaccine uptake, and parents are influenced by a strong provider recommendation. A previous study found that routine provider recommendations for the HPV vaccine were more likely to occur with providers who had a high confidence in their ability to recommend the vaccine and address parental concerns (i.e., high context-specific self-efficacy). Providers with high expectations of their recommendations resulting in parents accepting the vaccine for their children (i.e., high outcome expectations) were also more likely to recommend the HPV vaccine routinely. Hence, the idea is that strategies are needed to effectively reduce provider-perceived barriers to parental HPV vaccine hesitancy and to assist providers in addressing these barriers in patient-provider communication. This study aims to make a contribution.

The cross-sectional study used secondary data collected from January to March 2018 from 137 paediatricians, nurse practitioners (NPs), and physician assistants (PAs) who provide care in 23 community-based paediatric clinics in Middle Tennessee. The most common parental barriers to HPV vaccination they perceived were concerns about HPV vaccine safety (88%), child being too young (78%), low risk of HPV infection for child through sexual activity (70%), and mistrust in vaccines (59%). In adjusted mixed models, perceived parental HPV vaccine hesitancy was significantly associated with several provider-level factors: self-efficacy (P=.001), outcome expectations (P<.001), and confidence in HPV vaccine safety (P=.009). No significant association was found between perceived parental HPV vaccine hesitancy and confidence in HPV vaccine effectiveness. Including clinic-level variables in the model revealed no significant association between the clinic-level characteristics and perceived parental HPV vaccine hesitancy.

This study observed significant differences in perceived barriers (e.g., concern of their child getting too many shots during a visit and being too young to get the vaccine) by provider type. These findings suggest parental perceived barriers can vary across providers, with physicians more likely than NPs or PAs to perceive these as a major barrier. A possible explanation for this variation could be the differing types of educational training related to vaccine hesitancy. Also, physicians may have experienced different interactions with parents compared with other providers, which may lead to differences in perceived parental barriers. Hence, tailored strategies or messages by provider type could be used in interventions to assist them in addressing HPV vaccine parents.

The results suggest intervention targets to improve provider perceptions of parental barriers by addressing specific factors that may influence their perceptions. Particularly, intervention developers are advised to consider addressing providers' self-efficacy, perceived outcome expectations, and confidence in HPV vaccine safety. Ultimately, addressing these provider-level factors may improve recommendation practices and communication strategies among providers for addressing hesitancy, to increase HPV vaccination rates among children of HPV vaccine-hesitant parents.