Feasibility and sustainability of a nurse-led intervention to integrate HPV vaccination into medical processing for active-duty Soldiers

ABSTRACT

To increase Soldiers’ access to HPV vaccination, we evaluated the feasibility and sustainability of a nurse-led intervention to integrate HPV vaccination into medical processing procedures for Soldiers. We partnered with nursing staff to introduce HPV vaccine into existing vaccination services at a nurse-led clinic that serves Soldiers at Fort Bragg, North Carolina. In addition to stocking the vaccine, the intervention included training nursing staff (n = 11) strategies for recommending HPV vaccination for Soldiers ages 18–26. We conducted surveys of nursing staff to assess their perspectives on feasibility. Nursing staff tracked HPV vaccine uptake among Soldiers for 4 weeks post-training to assess adoption and again for 2 weeks at 4-month follow-up to assess sustainability. We assessed delivery cost as the cost of personnel time, vaccine doses, and other materials during the initial 4-week intervention period. Nursing staff agreed that recommending HPV vaccination fit in with medical processing procedures (mean = 4.6 of 5.0). Of the 516 Soldiers offered HPV vaccine in the 4 weeks following the training, 198 (38%) accepted and received the vaccine. Soldier ages 18–20 more often accepted HPV vaccination than older Soldier ages 21–26 (46% versus 32%, p < .01). Vaccine uptake was similar at follow-up, with 98 of 230 eligible Soldiers (43%) receiving HPV vaccine. The total delivery cost was $12,737, with an average cost per vaccine dose delivered of $64. Our findings suggest that training nursing staff to recommend and administer HPV vaccinations to Soldiers is feasible and warrants wider-scale testing as a strategy to protect soldiers from HPV-attributable cancers.

Plain Language Summary

HPV vaccination is not required for US military service, and Soldiers’ uptake is low. We trained nursing staff at a large military clinic to recommend HPV vaccine to Soldiers using a nursing education intervention to integrate HPV vaccination into routine care for active duty Soldiers. Our findings suggest that training nursing staff to recommend and administer HPV vaccines to Soldiers is feasible and low cost, and may warrant wider-scale testing as a strategy for increasing military readiness and protecting Soldiers from HPV-attributable cancers. Until guideline and policy changes are implemented and HPV vaccine is required for military service, use of education strategies is one path to increasing HPV vaccine coverage among Soldiers to ensure protection from HPV-related diseases.

KEYWORDS:

• Health communication
• human papillomavirus infections/prevention and control
• human papillomavirus vaccine
• quality of health care

Abbreviations

MEDPROS	=	Medical Protection System®
AHLTA	=	Armed Forces Health Longitudinal Technology Application®
HPV	=	human papillomavirus
MMR	=	Measles, Mumps and Rubella
EHR	=	electronic health record
SQUIRE	=	Standards for QUality ImprovementReporting Excellence

Acknowledgment

We thank MAJ Brown, LTC DiPatrizio, COL Hing, Dr. Sheryl Bedno, and all the Medical One Stop staff.

Authors’ contributions

EP: Conceptualized study, developed one-hour training session for nursing staff, delivered training session, drafted and revised manuscript, including approval of final version.

BKG: Conceptualized study, supported development of data collection instruments, conducted statistical analyses, drafted and critically reviewed manuscript, and approved final version.

ES: Developed educational materials for nursing staff training, critically reviewed manuscript, and approved final version.

HPD: Conceptualized study, developed educational material for nursing staff training, supported development of data collection instruments, critically reviewed manuscript, and approved final version.

MW: Delivered training session, critically reviewed manuscript, and approved final version.

TK: Led data collection, supported nursing training; critically reviewed manuscript and approved final version.

MBG: Conceptualized study, supported development of data collection instruments and data analyses, critically reviewed manuscript, and approved final version.

Disclosure statement

No potential conflict of interest was reported by the authors.

Disclaimer

The views expressed herein are those of the authors and do not necessarily reflect the official policy of the Department of the Army, Defense Health Agency, Department of Defence, or the US Government.

Ethics approval and consent to participate

This project underwent review through the Womack Army Medical Center Human Research Protections Program Office for the applicability of human subjects protections regulations and was classified as a process improvement project.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website at https://doi.org/10.1080/21645515.2022.2153536.

Data availability statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This work was supported by the Cancer Control Education Program at the University of North Carolina Lineberger Comprehensive Cancer Center, under grant number [T32CA057726-30] (author BKG). The remaining authors have no funding sources to report.