Clinician-to-Clinician Update Clinician-to-Clinician Update

Study Undertakes Systems-Based Approach to Increasing HPV Vaccination Rates

April 2016

Contributed by Linda F. Carson, MD, FACOG

Research suggests that improving communication about HPV vaccination between primary care providers and parents of patients is the most important strategy for increasing vaccination rates in the United States.1,2 When providers positively, or strongly, recommend the vaccine, patients are four to five times more likely to pursue vaccination than they are when a weak recommendation is given.3,4 Unfortunately, primary care providers often give a weak HPV vaccine recommendation5,6 or no recommendation at all.7 When over 3,000 primary care providers in the United States were asked about the barriers to communicating about HPV vaccination with parents, 47% of primary care providers reported that discussing parental concerns took more time than was available at the appointment. Over half (55%) of providers agreed with the statement, “There was nothing I could say to change the minds of parents who wish to delay or refuse vaccination.”8

— A CDC poster promotes use of the HPV vaccine.

To address these concerns, Minnesota HPV has launched an ongoing research study to identify a systems-based approach to reversing the low HPV vaccination rates in Minnesota. The initiative seeks to engage healthcare providers where they are—in clinics, schools, pharmacies and other places in the community— and has created a toolkit designed to equip providers with information needed to help promote the HPV vaccine.


To bring the toolkit to healthcare providers across the state, Minnesota HPV has teamed up with University of Minnesota Medical School’s Rural Physician Associate Program (RPAP). RPAP enables third-year medical students to live and train for 9 months in non-metropolitan communities, working under the supervision of preceptors who are family physicians. Partnering with Minnesota HPV, RPAP students are being trained to work with rural providers to identify barriers to HPV vaccination uptake (including difficulties in communicating with parents) and to help implement evidence-based solutions. Data on vaccination rates gathered before and after implementation of the program will be tracked and reported. Information on vaccination rates in communities without Minnesota HPV-partnered RPAP students will be tracked as comparative data.


  1. Brewer NT, et al. Longitudinal predictors of human papillomavirus vaccine initiation among adolescent girls in a high-risk geographic area. Sex Transm Dis. 2011;38:197-204.
  2. Reiter, et al. Longitudinal predictors of human papillomavirus vaccination among a national sample of adolescent males. Am J Public Health. 2013;103:1419-1427.
  3. Rosenthal SL, et al. Predictors of HPV vaccine uptake among women aged 19-26: importance of a physician’s recommendation. Vaccine. 2011;29:890-895.
  4. Ylitalo KR, et al. Health care provider recommendation, human papillomavirus vaccination, and race/ethnicity in the US National Immunization Survey. Am J Public Health. 2013;103:164-169.
  5. Hughes CC, et al. HPV vaccine decision making in pediatric primary care: a semistructured interview study. BMC Pediatr. 2011;11:74.
  6. Gilkey MB, et al. Quality of physician communication about human papillomavirus vaccine: findings from a national survey. Cancer Epidemiol Biomarkers Prev. 2015;24:1673-1679.
  7. Stokley S, et al. Human papillomavirus vaccination coverage among adolescents, 2007–2013, and postlicensure vaccine safety monitoring, 2006–2014—United States. MMWR Morb Mortal Wkly Rep. 2014;63(29):620-624.
  8. McRee AL, et al. HPV vaccine hesitancy: findings from a statewide survey of health care providers. J Pediatr Health Care. 2014;28:541-549.
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