Achieving high HPV vaccine completion rates in a pediatric clinic population

Figures & data

Figure 1. Flow chart of pediatric HPV vaccination program participants.

Table 1. Characteristics for patients approached about the pediatric HPV vaccination program (N = 2,162).

	n (%)
Gender
Female	1020 (47.2)
Male	1142 (52.8)
Race/ethnicity
Hispanic	743 (34.4)
Black	632 (29.2)
White	737 (34.1)
Asian/other	50 (2.3)
Age (mean, 12.7 ± SD2.0)
9–10	208 (9.6)
11–12	971 (44.9)
13–14	536 (24.8)
15–17	447 (20.7)
County
Galveston	2054 (95.1)
Brazoria	105 (4.9)
Missing (n = 3)
Visit type
Generalist	1740 (80.5)
Specialty care	391 (18.1)
No visit on day of approach	31 (1.4)
Preferred method of contact
Voicemail	280 (17.4)
Text	174 (10.8)
Both	509 (31.6)
No preference	647 (40.2)
Refused or already vaccinated	552
Number of children counseled for
Single child	1916 (88.6)
> 1, vaccinated on same day as counseled	187 (8.6)
> 1, vaccination scheduled later	59 (2.7)

Table 2. Determinants of completion among pediatric HPV vaccination program, vaccine initiators (N = 910).

	% completed	aOR
Gender
Male	91.9	REF
Female	93.7	1.40 (0.83–2.38)
Race/ethnicity
White	90.5	REF
Hispanic	92.3	1.73 (0.92–3.23)
Black	93.2	1.38 (0.74–2.60)
Asian/other	(100)	Excluded from analyses due to small sample size
Age group
9–10 years old	92.3	0.48 (0.21–1.12)
11–12 years old	95.9	REF
13–14 years old	94.4	0.74 (0.32–1.71)
15–17 years old	78.3	0.16 (0.08–0.28)

aOR = adjusted odds ratio, adjusted for all variables in table

Table 3. Determinants of vaccine completion among entire pediatric HPV vaccination program (N = 2079).

	% completed	aOR
Gender
Male	74.4	REF
Female	75.2	0.99 (0.80–1.22)
Race/ethnicity
White	61.8	REF
Hispanic	80.4	2.54 (1.99–3.25)
Black	84.8	3.47 (2.64–4.57)
Asian/other	68.8	1.41 (0.75–2.66)
Age group
9–10 years old	66.0	0.47 (0.32–0.69)
11–12 years old	79.0	REF
13–14 years old	74.8	0.81 (0.62–1.05)
15–17 years old	70.4	0.70 (0.54–0.93)

aOR = adjusted odds ratio, adjusted for all variables in table

Table 4. Characteristics associated with not keeping an appointment in the pediatric HPV vaccination program (N = 1582).

	% did not keep appointment	aOR
Gender
Male	44.4	REF
Female	43.9	0.99 (0.81–1.21)
Race/ethnicity
White	43.4	REF
Hispanic	42.0	0.92 (0.71–1.18)
Black	48.7	1.19 (0.92–1.54)
Asian/other	20.6	0.28 (0.10–0.74)
Age group
9–10 years old	61.8	1.92 (1.26–2.90)
11–12 years old	46.9	REF
13–14 years old	39.2	0.73 (0.57–0.94)
15–17 years old	37.4	0.69 (0.53–0.91)

aOR = adjusted odds ratio, adjusted for all variables in table

Table 5. Pediatric HPV vaccination program benefits reported by patient navigators and clinic health care providers.

Themes	Patient Navigators	Providers
A. Eliminates cost and schedule barriers	“The best part is that I’m saving somebody’s kids, another kid from getting cancer by giving them a vaccine, especially to some parents that can’t afford to give it to their kids.” (LVN)	“They [PNs] look on the schedule…see which patients so they go in and talk with them. They tell them how important it is and they go ahead and schedule that appointment for them so that they can get the vaccine on time. So that helps us a lot.” (LVN)
B. Recalling patients for appointments	“My gosh we do call the patients…we do whatever it takes in order for the patient to come back to get the second or the third dose.” (BS)	“I’ve seen the increase if they come back for another checkup or an asthma recheck. I’ve seen those HPV visits kind of scattered and I didn’t set that up, and so that’s really good because that coordination for follow-up would often get lapsed before the coordinator [PN] came on board.” (MD)
C. Improved recommendation	“It adds that the providers know and nurses know that it’s really important to basically recommend this vaccine. Before they weren’t recommending it as much as they are now.” (BS)	“…I believe they [PNs] recruit more than if just me or the doctor talk to them [patients] about it. A lot of times I don’t really push vaccines because I know people are on the fence about it and I just kind of let the doctor do that and some doctors if they get pushback from the patients then they just kind of quit… but the vaccine coordinator [PN]… she does the education and because she takes the time to talk to the parents I feel like she gets more HPV vaccine that way.” (LVN)
D. Reduced clinic workload	“They are very happy that we are doing the project now that some of the providers they don’t have to be talking to the patient about HPV because somebody did that already.” (MS)	“I think a lot of times it’s easier because the coordinator [PN] has already gone in and they said yes, so I don’t even really have to go into my whole spiel. I just order it and I say good job mom you’re going to get the HPV vaccine and move on. So it makes our lives a little bit easier.” (MD)
E. Increased education	“…we are taking the tie to fully explain…they have somebody that they can ask questions to.” (BS)	“Before the education program I just lacked education of it, so I didn’t understand the importance… and after that I realized how really important it was if it is the only vaccine to prevent cancer. That’s where I got my education from but before I was just indifferent because I didn’t know. (MD, resident)

PN = patient navigator

LVN = Licensed vaccine nurse

MD = Medical doctor

BS = Bachelors of science

MS = Masters of science