Communicating with Families About HPV Vaccines

Much research has now accumulated to explain the underlying reasons why providers may not give consistent and high-quality HPV vaccine recommendations to all eligible adolescents [22]. Issues such as providers’ own knowledge about HPV-related diseases, personal beliefs about the vaccine’s safety and necessity, concern that a discussion about the vaccine will necessitate a discussion about adolescent sexuality with the parent, belief that parents will not want their child vaccinated if asked, perceptions that a provider can adequately select those patients most “in need” of HPV vaccination, and concern that raising the vaccine discussion with vaccine-hesitant parents will result in prolonged discussions have been shown to impact whether and how providers communicate about HPV vaccination during clinical visits [22,36–45]. Now that these barriers have been defined and described, there is a great need to use this knowledge to develop and evaluate interventions that help to mitigate these barriers and improve providers’ vaccine communication abilities. Such interventions are needed not only for HPV, but for all vaccines [46,47].

Possible Strategies for Helping Providers Communicate About HPV Vaccines

Before discussing these interventions, it is worth noting that several of the passive and active strategies have been shown in clinical trials to improve adolescent HPV vaccination rates. Although these are beyond the scope of this article, inclusion of these strategies should certainly be considered by any practice as a mechanism to increase vaccination levels, especially given that the most successful interventions to improve vaccination levels consist of multiple components [48]. Also useful is a recently described “taxonomy of vaccine communication interventions” that provides additional perspective on the scope and complexity of interventions to improve vaccine delivery [49]. There are several well-written review articles that describe interventions that focus on passive and active strategies at the practice or community level [50–52].

Interpersonal Communication Strategies Shown to Increase HPV Vaccination

Presumptive Communication

One of the first studies to examine the specific “way” in which providers communicate about vaccines focused not on HPV but rather on young childhood vaccines. In 2013 Opel and colleagues performed a study in which they taped clinical encounters between a pediatrician and a parent of a child aged 1 to 19 months [53]. Of the 111 encounters recorded, 50% of parents were classified as vaccine hesitant. Parents were aware they were being taped but not aware that the overall purpose of the study was to examine providers’ communication related to vaccination. The researchers found that providers generally used one of 2 communication styles to introduce the vaccine discussion. The first, called the “presumptive” style, assumed that parents would agree to vaccination and presented the vaccines as routine (ie, “We have to do some shots today”). The second style, called “participatory,” was more parent-oriented and used language suggesting shared decision-making (ie, “So what do you want to do about shots today?”). The study showed that the odds of resisting the provider’s vaccine recommendations were significantly higher when providers used a participatory approach than a presumptive one, suggesting that even small changes in language can have a major impact on the likelihood of vaccination. However, given the study design, causality between providers’ recommendation style and parents vaccination decisions could not be delineated.