Impact of Clinicians' Knowledge, Attitudes and Beliefs on HPV Vaccination Rates Among Wisconsin Adolescents

Frances Rose Lendacki
University of Illinois at Chicago

Frances Rose Lendacki, Huong Q. McLean, and Jeffrey VanWormer
Center for Clinical Epidemiology & Population Health

Research area:  Epidemiology

Background: Since introduction in 2009, human papillomavirus (HPV) vaccines have remained underutilized, for reasons not well-understood. While provider recommendation has been shown to facilitate acceptance among patients, little is known about how clinicians’ knowledge, attitudes or beliefs impact HPV vaccination rates.  Previous studies have considered physicians’ influence on rates of vaccine recommendation or intent, but not actual rates of vaccine receipt. This study examined primary care clinicians’ attitudes surrounding HPV vaccine, and associations with vaccination rates among their adolescent patients.

Methods: In 2016, Marshfield Clinic providers and clinical staff serving patients age 11-17 years were surveyed about HPV and HPV vaccine. Knowledge score was based on seven questions related to the virus and vaccine. Perceived barriers to vaccination, abilities to influence vaccination and address parental concerns were quantified in Likert Scale assessments; mean scores were generated. Survey data were linked to provider-level and department-level (for staff) HPV vaccination rates (≥1 dose, “HPV coverage”). Linear regression was used to investigate associations between survey data and HPV coverage in 2016, adjusted for prior year coverage. Providers and staff were analyzed separately. Those with few adolescent patients or without coverage data were excluded.

Results: Surveys were sent to 163 providers and 222 staff, with response rates of 70% and 72%, respectively. After exclusions, the analytical sample consisted of 98 providers and 102 staff. Among providers, mean self-efficacy score was the only factor associated with HPV coverage in 2016 (p<.0001). Among staff, none of the factors examined were associated with HPV coverage in 2016. 

Conclusions: Self-efficacy was a significant independent predictor of HPV coverage among providers, but not staff. Knowledge of HPV vaccine and perceived barriers to use were not associated with HPV coverage for either group. Systems-level initiatives may benefit from focusing on empowering providers to address HPV vaccination concerns with hesitant parents.