Influence of health care provider recommendation on HPV vaccination among college students

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S. Several HPV strains are linked to various types of cancers, including nearly all cases of cervical cancer, and rates of HPV-associated cancers have increased since 1999. Nationally, HPV vaccination rates are well below the Healthy People 2020 goal of 80% and even lower in Oklahoma, where cervical cancer incidence and mortality exceed national rates. Although children are targeted for HPV vaccination, it is approved for administration up to age 26.

Unvaccinated college-aged students making health decisions are ideal for HPV vaccine recommendation. However, despite literature that indicates a health care provider’s recommendation increases vaccine uptake, the content of these conversations remains unclear. The purpose of this study was to assess the relationship between vaccination status and provider recommendation, identify themes in messaging, and assess provider influence on the vaccine decision.

Methods: In fall 2020, we surveyed 254 undergraduate college students in Oklahoma about HPV knowledge, perceived HPV risk, and vaccination status. For this study, quantitative items related to HPV vaccine status and provider recommendation. Two open-ended items asked respondents to recall provider messages about vaccination and to describe how messaging influenced their vaccination decision. We used a chi-square test and odds ratio to investigate the relationship between provider recommendation and vaccination status and examine the strength of the association. Inductive open coding was used to manually code qualitative responses for vaccinated respondents who received a provider recommendation. Coding was used to create categorical variables for messaging content (e.g., HPV causes cancer, HPV is dangerous) and provider influence (e.g., large, some, or no influence). We used frequencies to identify salient themes and influence.

Results: Vaccination status was significantly associated with provider recommendation, with the odds of being vaccinated 2.54 times greater for those with a recommendation. Just under half of vaccinated respondents with a recommendation received information beyond a simple recommendation, and 42% reported providers largely influenced their vaccination decision. Of the messaging categories, the most common related to cancer prevention (36%), followed by use of written materials (13%) and statements that the vaccine is beneficial (13%) and reduces risk of HPV infection (11%).

Conclusions: Provider communication that conveys favorable opinions of HPV vaccination combined with education about risks associated with infection (e.g., cancer) may positively sway vaccine decisions. Yet, variability among messages raises concerns about consistency of provider communication. For example, a few respondents noted providers framed messages as harmful to females only, suggesting they did not discuss risks for males. Others indicated their provider did not discuss what HPV is or its risks, and simply recommended the shot. Some respondents stated communication was directed toward their parents only. College students are prime candidates for catch-up vaccination. Supportive recommendations from their health care providers, particularly those at student health clinics, may positively influence vaccine uptake among an age group nearing their last chance for protection against HPV.