1. Public Health Implications
Provider Perspectives on the Human Papillomavirus Vaccine Justin Robert Long, MA, MPH, Scott Frank, MD, MS1,2, Laura Santurri3, Ruqaiijah Yearby1,4 1Case Western Reserve University School of Medicine, 2Shaker Heights Health Department, 3University of Indianapolis College of Health Sciences, 4Case Western Reserve University School of Law
Background
The human papillomavirus (HPV), a DNA virus in the papillomavirus family, is the most common sexually transmitted infection in the United States. Globally, HPV strains 16 and 18 are responsible for an estimated 70% of all cervical cancer cases
Cervarix and Gardasil are the two major vaccines against the virus. Cervarix protects against strains 16 and 18 where the most recent Gardasil protects against seven additional strains
A fair amount of research has been done on patient perspectives regarding the vaccine but recent research suggests that providers are one of the greatest barriers to HPV vaccine uptake.
Research Questions
What are the beliefs and positions of medical professionals regarding the human papillomavirus vaccine?
Are there differences in medical provider treatment between young males and young females in terms of the human papillomavirus vaccine?
Methods
Purposeful, convenience sampling approached used for participant selection.
A semi-structured interview was built focusing on: physician perspectives on the HPV vaccine, professional use and reception, and patient reception.
Providers-participants were met in-person for audio recorded interviews that lasted roughly thirty minutes
Interviews were transcribed and coded using an inductive approach.
Study Participants
Results
Discussion
Some participants were extremely vocal proponents of the vaccine, other were lukewarm and treated it as just another vaccine for kids.
No participant articulated opposition to the vaccine.
Not all providers were up to date on CDC recommendations.
There is a fairly large difference between the way providers view themselves compared to their patients. Providers articulated a more scientific or public health-centric view where their patients were more concerned with their convenience or other viewpoints.
Gender was a concern for some providers, but not for all. Some felt this was a vaccine more for the benefit of women given the cervical cancer implications.
Public Health Implications
There was confusion expressed in terms of the CDC recommendations for the HPV vaccine. More care should be given to this communication so providers are given the most up to date information for the care of their patients.
The sex of the patient may inform the decisions of some providers regarding the HPV vaccine. As interventions are developed for providers and patients, this detail will need to be remembered so that all patients receive equal treatment.
The providers interviewed for this study did not express opposition to the use of the HPV vaccine. It will be important to include providers and patients in future interventions focused on the HPV vaccine.
Acknowledgments
The Master of Public Health Program administrative team and faculty for their ongoing advice, support, and funding for this project.
All of the participants of this study who took time out of their days to meet with me and discuss their experiences.
University Hospitals for their use of meeting spaces.
The Case Western Reserve University Main Library for their access to audio recording equipment and instruction on their use.
Vaccine Effectiveness
“I think that the trials that were done that validated its effectiveness were done very well.”
Protecting Female Partners
“If you’re having sex with women it’s nice to do things to protect your partner.”
“…but of course there are indirect benefits to women too if men are protected.”
Patient Receptiveness
“I think most… many families have an informed perspective, others their getting their information from me. But I don’t see a lot of difference in attitude or receptivity.”
Patient Resistance
“…because it paved the way to having sexual intercourse when you’re too young and so forth.”
Recommending the Vaccine
“In general I try to make it very matter-of-fact like the other vaccines they have to get. So tetanus, meningitis, and everything I just say now it’s time to get HPV vaccine. Um… you’ll need to come back and get the second one and hope that people don’t put up a fuss.”
“I’m the first one to say to both the patient and the parent; I gave this to my daughter.”
Stance on Mandates
“Well, I guess, I’m in general a relative proponent of just mandating vaccines in general.”
“Actually I’m pretty torn on it.”
Concept Map
Generated using SimpleMind Desktop Organization tool
Handouts of full map available from the presenter
Yellow – CDC Recommendations
Green – Thoughts on Mandates
9 participants total:
6 men and 3 women
6 currently practicing in their field, 1 working part-time, 2 non-practicing or retired
1 OBGYN, 2 Nurses, 6 Pediatricians/General Medicine