Communicating with Families About HPV Vaccines

In 2015 Moss and colleagues performed a study that examined the use of these 2 communication styles with regard to HPV vaccination [54]. This study used data from the 2010 National Immunization Survey–Teen, a national survey on childhood vaccination that includes provider verification of vaccines given [16]. Researchers categorized provider vaccine communication styles into “provider-driven,” which was similar to the presumptive style described Opel, and “patient-driven,” which was similar to Opel’s permissive style. Parents who received a more provider-driven style of HPV vaccine recommendation were far more likely to have allowed their adolescent to be vaccinated than those receiving patient-driven recommendations [54]. Further supporting this communication approach are results from a qualitative study done by Hughes and colleagues in which triads of mothers, adolescents, and providers were interviewed after a preventive care visit to assess the communication that occurred regarding HPV vaccination [39]. Providers’ communication style was categorized into 1 of 3 groups: paternalistic (clinician makes the vaccination decision and communicates this to the family); informed (patient and family gathers information from the clinician and other sources to reach a vaccination decision); and shared (medical and personal information is exchanged between the provider and family and then a decision is reached jointly). Providers who typically adopted the paternalistic approach perceived that they had the highest success in convincing parents to vaccinate—a perception that was confirmed in quantitative assessments of vaccination status among adolescents in the study sample [39]. Our own research demonstrates that learning and implementing a presumptive/paternalistic HPV vaccine recommendation style is easy for primary care providers to do and is perceived as often shortening the time taken during clinical visits to discuss the vaccine [55,56]. Thus, providers should consider opening the HPV vaccine conversation using this approach, and then turning to some of the other communication techniques described below when met with parental resistance or questions.

Motivational Interviewing

A second communication technique that seems effective for promoting HPV vaccination, especially for vaccine hesitant parents, is motivational interviewing. Motivational interviewing describes a communication technique in which the provider leverages a parents’ or patients’ intrinsic motivation to engage in a preferred health behavior [57]. Motivational interviewing was originally developed to combat substance abuse [58,59] but has subsequently been successfully applied to a number of other health issues [60–64]. There is growing interest from public health and medical providers in using this technique for increasing vaccination [39,65–68]. Our research group performed a large, cluster-randomized controlled trial of 16 pediatric and family medicine clinics to examine the impact of a provider communication “toolkit” on adolescent HPV vaccine series initiation and completion [50,69]. The toolkit consisted of motivational interviewing training for providers related to HPV vaccination and training on 3 tangible resources providers could also use with parents—an HPV fact sheet, an HPV vaccine decision aid, and an educational website. Results from the study demonstrated that motivational interviewing was the toolkit component most widely utilized by providers and was also perceived as being the most useful. More importantly, HPV vaccine series initiation levels were significantly higher among adolescents in practices receiving the toolkit than in control practices. There was no impact on HPV vaccine series completion (unpublished results). The usefulness of motivational interviewing for vaccination is further supported by a small study in which community pharmacists receiving motivational interviewing training for adult vaccination reported significantly higher patient readiness to receive vaccines following their interaction with the pharmacist than those who did not receive the training [70]. Finally, Perkins et al performed a cluster randomized controlled trial that evaluated the impact of a provider-focused intervention on adolescent HPV vaccination rates. The intervention included frequent provider support meetings, education on HPV infection and vaccination, feedback on providers’ individual HPV vaccination rates, provider incentives, and “basic motivational interviewing principles with vaccine-hesitant parents.” HPV vaccination series initiation and completion rates were significantly higher in intervention practices than controls, and this effect was sustained for at least 6 months after the active intervention period was over [67]. However, it was unknown how much the motivational interviewing contributed to these results. Based on the above information, and the long history of success of motivational interviewing for improving patient compliance with other recommended health behaviors, this technique appears to have a reasonable evidence base and should be considered for communicating with families that express resistance to HPV vaccination.