HPV Vaccination Uptake Study in a Rural Oklahoma Family Medicine Clinic

Background: HPV is the most common STI in the U.S. and is linked to several cancers. Among females, the most prevalent HPV-associated cancer is cervical cancer, and among males, it is oropharyngeal cancer. Additionally, HPV is linked to about 90% of anal cancers, 70% of vaginal and vulvar cancer, and 60% of penile cancers. While HPV vaccination rates have been steadily increasing over the past few years, they are still lower than other childhood vaccines and remain below the Healthy People 2020 goal of 80%. Moreover, Oklahoma, which ranks near the top of all states for cervical cancer, has one of the lowest rates of HPV vaccination. The purpose of this study was to understand HPV knowledge and attitudes about the vaccine among patients at a rural Oklahoma clinic.

Methods: We surveyed primary caregivers of children ages 9-17 and young adults ages 18-26 on HPV knowledge (5 T/F items scored and summed); health care provider vaccine recommendation; vaccination status (vaccinated, unvaccinated, unsure); reasons for vaccination decisions; and demographics. Data were analyzed using descriptive statistics. Survey items were a mix of multiple choice and open-ended questions, where patients/caregivers could express their concerns and opinions regarding the HPV vaccine.

Results: The survey yielded 28 respondents, with 50% (n=14) parents/caregivers and 57% (n=15) YA. Mean knowledge score was 4.6. All respondents correctly answered the items “HPV can cause several types of cancer” and “HPV can cause cervical cancer.” Four incorrectly answered “HPV is rare” and “Men cannot get HPV.” Regarding vaccination status, 79% (n=11) of parents reported receiving a vaccine recommendation from a provider for their child; of these, 74% (n=8) vaccinated their children. Among YAs, 67% (n=10) received a provider recommendation; of these, 80% were vaccinated. Two YAs were vaccinated but did not receive a provider recommendation for a total of 10 vaccinated YAs. Regarding reasons for not getting the vaccine, 33% (n=6) of parents of unvaccinated children indicated they were afraid of side effects and 17% felt their child was not the right age. Among unvaccinated YAs (n=4), half were afraid of side effects and half felt they were not the right age. Of the 18 respondents who were themselves or had their children vaccinated, 50% indicated their health care provider was the reason for getting vaccinated, and 44% indicated a family or friend recommendation helped convince them. More YAs than parents relied on family or friend recommendations.

Conclusion: This study aligns with literature pointing to the role of provider recommendation in vaccine uptake. It also opens a line of inquiry into the role of family and/or friends in promoting the vaccine. Of concern is the finding that some respondents did not understand vaccination age eligibility. This combined with concerns about side effects demonstrates the importance of education and messaging to increase HPV knowledge and vaccination.