Scientists use innovative methods, new technology to increase HPV vaccinations in Florida

Even though a safe HPV vaccine is available that can prevent several types of cancer, less than half of American teens youth in the U.S. receive the vaccine. Now a team of researchers, including four from the University of Florida Institute for Child Health Policy, has increased the odds of adolescents starting the vaccine series by 140 percent among girls and 60 percent among boys. The researchers not only identified key factors that influence how likely parents are to start the vaccination series, they also implemented an innovative multipronged approach that included mailings and using new technology in primary care clinics.

The findings, published in the Journal of Adolescent Health, could shape how providers approach HPV vaccination in their clinics and help prevent up to 17,500 new cancer cases per year.

"HPV is common and has serious, life-threatening consequences, but only half of girls and one in four boys in Florida are vaccinated," said Stephanie Staras, Ph.D., MSPH, the study's lead researcher, an ICHP faculty member and an assistant professor in the UF College of Medicine, part of UF Health. "In order to move the needle on vaccine initiation, especially among vulnerable populations, it is crucial that providers recommend the vaccine and address caregivers' concerns about the vaccine. New, more targeted methods can help providers protect more children."

As of 2013, the state of Florida ranks ninth lowest in the nation in the percentage of girls who begin the HPV vaccination series and 18th for the percentage of boys.

The researchers came at the problem from multiple angles, including distributing postcards and designing an automated feedback system used in clinics. Each of these angles targeted specific audiences: parents, providers and adolescents. As part of the program, titled "Protect Me from HPV," two postcards were sent between August and October 2013 to the parents of 1,387 girls and 1,764 boys enrolled in the Florida Medicaid and Children's Health Insurance Program in North Central Florida. The postcards were gender-specific and detailed vaccine benefits, costs, side effects and safety.

The mailings urged parents to discuss vaccination with their children's health care provider, and 91 percent of boys' parents and 80 percent of girls' parents who remembered receiving a postcard sought additional information. In addition, 21 percent of parents made an appointment to see a doctor after receiving a postcard. The researchers attributed a 60 percent increase in the number of girls who began the vaccine series, which requires three shots, to the receipt of a postcard.

The postcards were relatively inexpensive compared with other means of increasing vaccination rates, and can be implemented at a systemwide level (such as Medicaid, the Children's Health Insurance Program or private insurance), which reduces the administrative burden on individual clinics.

Motivating parents to discuss the vaccine with providers is an important step in increasing the number of adolescents who are vaccinated, because providers have the largest influence over parents' decisions regarding HPV vaccination. According to earlier findings by Staras' research team, providers can play a pivotal role in parents' perceptions of the vaccine. Since providers have limited time with parents during doctor's visits, Staras' team recommends they focus on discussing how safe the vaccine is and how it prevents cancer and other illnesses.

As a complement to the postcards, the researchers encouraged providers to recommend the vaccine at selected primary care practices. To make providers aware of unvaccinated patients who were interested in receiving the vaccine during the clinic visit, an electronic survey was administered when the adolescents checked into the clinic. This Health Information Technology, or HIT, system generates automatic feedback for clinic staff to easily recognize and target interested patients for vaccination.

The HIT system increased the percentage of youth starting the series by 50 percent among girls and 40 percent among boys. When the HIT system was combined with the postcard series, the researchers saw the largest improvement: a 140 percent increase in starting the vaccine among girls and 60 percent among boys.

"We had a fairly small number of youth use the HIT system, and there are indications that the system has the potential to work even better if we could recruit a greater proportion of adolescents," Staras said. "Regardless, these preliminary increases are similar to those found with other interventions, and we are currently seeking grant funds to scale up our efforts to a greater diversity of clinical sites."

The project was funded by the Society of Adolescent Health and Medicine under a grant received from Merck & Co., and the research team also included Susan T. Vadaparampil, Ph.D., M.P.H., at Moffitt Cancer Center in Tampa; Melvin D. Livingston, Ph.D., an ICHP faculty member; Lindsay A. Thompson, M.D., M.S., an associate professor in UF's department of pediatrics and ICHP's associate director of clinical research; Ashley M. Sanders, M.S., research programs assistant director in UF's department of health outcomes and policy; and Elizabeth A. Shenkman, Ph.D., chair of the department of health outcomes and policy and the director of ICHP.