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

dc.contributor.authorCunningham-Erves, Jennifer
dc.contributor.authorKoyama, Tatsuki
dc.contributor.authorHuang, Yi
dc.contributor.authorJones, Jessica
dc.contributor.authorWilkins, Consuelo H.
dc.contributor.authorHarnack, Lora
dc.contributor.authorMcAfee, Caree
dc.contributor.authorHull, Pamela C.
dc.identifier.citationunningham-Erves J, Koyama T, Huang Y, Jones J, Wilkins CH, Harnack L, McAfee C, Hull PC Providers’ Perceptions of Parental Human Papillomavirus Vaccine Hesitancy: Cross-Sectional Study JMIR Cancer 2019;5(2):e13832 DOI: 10.2196/13832 PMID: 31267976 PMCID: 6632100en_US
dc.description.abstractBackground: Human papillomavirus (HPV) vaccine hesitancy among parents contributes to low vaccination coverage in adolescents. To improve health care provider communication and vaccine recommendation practices with hesitant parents, it is important to understand how providers perceive parental HPV vaccine hesitancy. Objective: This study aimed to characterize perceived reasons for parental HPV vaccine hesitancy and identify factors associated with perceived parental hesitancy among providers at community-based pediatric clinics. Methods: In 2018, providers in 23 community-based pediatric clinics in Tennessee were invited to complete a Web-based baseline survey as part of a larger quality improvement study focused on HPV vaccine uptake. These survey data were used for a cross-sectional, secondary data analysis. Scale scores ranging from 0 to 100 were calculated for provider self-efficacy (confidence in ability to recommend HPV vaccine), provider outcome expectations (expectations that recommendation will influence parents' decisions), and perceived parental HPV vaccine hesitancy. Provider confidence in HPV vaccine safety and effectiveness were categorized as high versus low. Clinic-level exposures examined were clinic size and rural-urban location. Descriptive analyses were used to characterize perceived parental barriers by provider type. Mixed-effects linear regression models were fit taking one exposure variable at a time, whereas controlling for provider type, age, gender, and race to identify provider- and clinic-level factors associated with perceived parental barriers to HPV vaccination. Results: Of the 187 providers located in the 23 clinics, 137 completed the survey. The majority of physician providers were white and female, with a higher percentage of females among nurse practitioners (NPs) and physician assistants (PAs). The most common parental barriers to HPV vaccination perceived by providers 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 associations were observed between perceived parental HPV vaccine hesitancy and clinic-level factors clinic size nor location. Conclusions: Researchers developing provider-focused interventions to reduce parental HPV vaccine hesitancy should consider addressing providers' self-efficacy, outcome expectations, and confidence in HPV vaccine safety to help providers communicate more effectively with HPV vaccine hesitant parents.en_US
dc.description.sponsorshipThe authors would like to thank CPF and its members that allowed us to conduct this study. This project was made possible via National Cancer Institute-funded grant 5R01CA207401.en_US
dc.publisherJMIR CANCERen_US
dc.subjectpapillomavirus infectionsen_US
dc.subjectpapillomavirus vaccinesen_US
dc.subjectprimary preventionen_US
dc.subjecthealth care provideren_US
dc.subjectvaccine hesitancyen_US
dc.subjectprovider barriers to HPV vaccinationen_US
dc.titleProviders' Perceptions of Parental Human Papillomavirus Vaccine Hesitancy: Cross-Sectional Studyen_US

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