Implementation of a Postpartum HPV Vaccination Program in a Southeast Texas Hospital: A Qualitative Study Evaluating Health Care Provider Acceptance
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Introduction The objective of this qualitative study was to assess healthcare providers’ acceptability of an ongoing postpartum human papillomavirus (HPV) vaccination program in Southeast Texas and its integration into everyday clinical care. Methods In 2012, the Department of Obstetrics & Gynecology at the University of Texas Medical Branch (UTMB) began offering HPV vaccination as part of standard postpartum care to increase vaccination rates among young women in Galveston County. Initial vaccine doses were offered on the postpartum unit while subsequent doses were coordinated with postpartum and well-baby visits. Thirty months after project initiation, semi-structured interviews of physicians (n = 12) and nurses (n = 6) involved in postpartum and pediatric care at UTMB were conducted. Interview transcripts were analyzed using thematic analysis in Nvivo10. Results Overall, providers demonstrated “pro-vaccine” attitudes and stated the program was an effective strategy for vaccinating hard-to-reach women. Cancer prevention was the main perceived benefit while follow-up compliance was the primary perceived patient barrier. The initial challenges with integrating postpartum HPV vaccination included miscommunication between providers regarding vaccine orders and coordination issues with well-baby visits for follow-up doses. One novel finding was providers’ beliefs that women’s personal HPV vaccine practices may positively impact their decisions about later vaccinating their children against HPV. Providers’ suggestions to improve the program included: enhancing postpartum HPV vaccine education for patients, offering more continuing education for providers, and increasing community awareness of HPV vaccination. Discussion These findings can help providers of postpartum care understand how to integrate postpartum HPV vaccination into their current practices and how to overcome perceived vaccination barriers.
KeywordsHPV vaccination, postpartum care Qualitative Women’s health
The authors would like to thank our program coordinators and staff for their work on the project as well as our colleagues at UTMB for their participation. Dr. Tyra Gross is currently an Assistant Professor in the Department of Public Health Sciences at Xavier University of Louisiana.
The Postpartum HPV Vaccination Program and this study were funded by the Cancer Prevention & Research Institute of Texas (Award ID: PP120150, PD: Dr. Abbey Berenson). Federal support for manuscript preparation was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) to Tyra Gross as a National Research Service Award postdoctoral fellow under an institutional training Grant (T32HD055163; PI/PD: Abbey Berenson). Dr. Jacqueline Hirth was supported by a research career development award (K12HD052023: Building Interdisciplinary Research Careers in Women’s Health Program-BIRCWH, PI/PD: Abbey Berenson) from NICHD and the Office of the Director (OD) at the National Institutes of Health (NIH). The study was also supported by a Clinical and Translational Science Award (UL1 TR001439) from the National Center for Advancing Translational Sciences (NCATS), NIH, through the Institute for Translational Sciences at UTMB. The content is solely the responsibility of the authors and does not necessarily represent the official views of CPRIT, NICHD, OD, NCATS, or the NIH.
- 4.Blake, K. D., Ottenbacher, A. J., Finney Rutten, L. J., Grady, M. A., Kobrin, S. C., Jacobson, R. M., & Hesse, B. W. (2015). Predictors of human papillomavirus awareness and knowledge in 2013: Gaps and opportunities for targeted communication strategies. American Journal of Preventive Medicine, 48(4), 402–410. doi: 10.1016/j.amepre.2014.10.024.CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Dempsey, A. F., Pyrzanowski, J., Brewer, S., Barnard, J., Sevick, C., & O’Leary, S. T. (2015). Acceptability of using standing orders to deliver human papillomavirus vaccines in the outpatient obstetrician/gynecologist setting. Vaccine, 33(15), 1773–1779. doi: 10.1016/j.vaccine.2015.02.044.CrossRefPubMedGoogle Scholar
- 16.Hechter, R. C., Chao, C., Sy, L. S., Ackerson, B. K., Slezak, J. M., Sidell, M. A., & Jacobsen, S. J. (2013). Quadrivalent human papillomavirus vaccine uptake in adolescent boys and maternal utilization of preventive care and history of sexually transmitted infections. American Journal of Public Health. doi: 10.2105/AJPH.2013.301495.PubMedPubMedCentralGoogle Scholar
- 17.Kester, L. M., Zimet, G. D., Fortenberry, J. D., Kahn, J. A., & Shew, M. L. (2013). A national study of HPV vaccination of adolescent girls: rates, predictors, and reasons for non-vaccination. Maternal and Child Health Journal, 17(5), 879–885. doi: 10.1007/s10995-012-1066-z.CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Krawczyk, A., Lau, E., Perez, S., Delisle, V., Amsel, R., & Rosberger, Z. (2012). How to inform: Comparing written and video education interventions to increase human papillomavirus knowledge and vaccination intentions in young adults. Journal of American College Health, 60(4), 316–322. doi: 10.1080/07448481.2011.615355.CrossRefPubMedGoogle Scholar
- 19.Lefevere, E., Hens, N., Theeten, H., Van den Bosch, K., Beutels, P., De Smet, F., & Van Damme, P. (2011). Like mother, like daughter? Mother’s history of cervical cancer screening and daughter’s human papillomavirus vaccine uptake in Flanders (Belgium). Vaccine, 29(46), 8390–8396. doi: 10.1016/j.vaccine.2011.08.039.CrossRefPubMedGoogle Scholar
- 21.Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Newbury Park, CA: Sage.Google Scholar
- 22.Markovitz, A. R., Song, J. Y., Paustian, M. L., & El Reda, D. K. (2014). Association between maternal preventive care utilization and adolescent vaccination: it’s not just about Pap testing. Journal of Pediatric and Adolescent Gynecology, 27(1), 29–36. doi: 10.1016/j.jpag.2013.08012.CrossRefPubMedGoogle Scholar
- 23.Markowitz, L. E., Dunne, E. F., Saraiya, M., Chesson, H. W., Curtis, C. R., Gee, J., et al. (2014). Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. Morbidity and Mortality Weekly Report, 63(RR05), 1–30.Google Scholar
- 25.Montealegre, J. R., Gossey, J. T., Anderson, M. L., Chenier, R. S., Chauca, G., Rustveld, L. O., & Jibaja-Weiss, M. L. (2014). Implementing targeted cervical cancer screening videos at the point of care. Patient Education and Counseling, 97(3), 426–429. doi: 10.1016/j.pec.2014.09.003.CrossRefPubMedGoogle Scholar
- 29.Spencer nee Pilkington, A. M., Brabin, L., Verma, A., & Roberts, S. A. (2013). Mothers’ screening histories influence daughters’ vaccination uptake: an analysis of linked cervical screening and human papillomavirus vaccination records in the North West of England. European Journal of Cancer, 49(6), 1264–1272. doi: 10.1016/j.ejca.2012.12.001.CrossRefPubMedGoogle Scholar
- 30.Taveras, E. M., Blackburn, K., Gillman, M. W., Haines, J., McDonald, J., Price, S., & Oken, E. (2011). First steps for mommy and me: A pilot intervention to improve nutrition and physical activity behaviors of postpartum mothers and their infants. Maternal and Child Health Journal, 15(8), 1217–1227. doi: 10.1007/s10995-010-0696-2.CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Ylitalo, K. R., Lee, H., & Mehta, N. K. (2013). Health care provider recommendation, human papillomavirus vaccination, and race/ethnicity in the US National Immunization Survey. American Journal of Public Health, 103(1), 164–169. doi: 10.2105/ajph.2011.300600.CrossRefPubMedPubMedCentralGoogle Scholar