Examining strategies for improving healthcare providers’ communication about adolescent HPV vaccination: evaluation of secondary outcomes in a randomized controlled trial

Figures & data

Table 1. Demographics across surveys.

	Baseline		Post-Intervention
	Control (N = 75)	Intervention (N = 74)	Control (N = 79)	Intervention (N = 108)
Respondents	All	All	62% (49)	78% (79)
Respondents with ≥ 1 HPV vaccine eligible visit	Not assessed	Not assessed	Not assessed	84% (66)
Type of Practice
Private	77% (58)	50% (37)	80% (63)	52% (53)
Public	23% (17)	50% (37)	20% (16)	48% (48)
Gender
Female	77% (57)	78% (58)	76% (60)	75% (76)
Role
MD	56% (42)	73% (54)	52% (41)	75% (76)
DO			13% (10)	10% (10)
Nurse Practitioner	20% (15)	9% (7)	27% (21)	15% (15)
Physician Assistant	24% (18)	18% (13)	9% (7)	0% (0)

Results reported as column-% (N).

Table 2. Percentage of providers who reported using motivational interviewing (MI) skills most of the time (> 75%), post-intervention.

Use of MI Techniques	Control	Intervention	p-value
Reflections (e.g. What I hear you saying is….)
Most of the time (> 75%)	12% (6)	28% (19)	0.05
Affirmation (e.g. you’re not the type of person who just rushes into a decision; That’s a very good question! You are right about that. Nobody knows your child like you do.)
Most of the time (> 75%)	10% (5)	28% (19)	0.02
Ruler (e.g. on a scale of 0–10 with 0 meaning you are not at all ready and 10 meaning you are completely ready to vaccinate, where would you say you are? Why not a lower number?)
Most of the time (> 75%)	2% (1)	4% (3)	0.64
Metaphors or hypothetical scenarios (e.g. when you are riding a bicycle when do you put on your helmet, before you get on the bike or after you’ve crashed?)
Most of the time (> 75%)	12% (6)	16% (11)	0.57
Open-ended questions (e.g. what questions, if any, do you have?; What information would be most helpful for you right now)
Most of the time (> 75%)	61% (30)	55% (38)	0.51
Get Permission (e.g. Is it OK if I share with you why I think the vaccine is important?)
Most of the time (> 75%)	10% (5)	20% (14)	0.14

Bolded items highlight statistically significant differences between study arms.

Table 3. Time spent discussing HPV vaccination with hesitant parents.

	Control			Intervention
	%(n)			%(n)
	Baseline	Post	∆	Baseline	Post	∆	p*
Substantial concerns
≤4 minutes	36% (27)	39% (19)	+ 3%	34% (25)	37% (29)	+ 3%	0.77
5–9 minutes	55% (41)	53% (26)	−2%	59% (43)	51% (40)	−8%
>9 minutes	9% (7)	8% (4)	−1%	7% (5)	12% (9)	5%
Typical
≤4 minutes	88% (66)	90% (44)	+ 2%	86% (63)	96% (75)	+ 10%	0.18
>4 minutes	12% (9)	10% (5)	−2%	14% (10)	4% (3)	−10%

*p-value indicates comparisons of changes over time (∆) between control and intervention.

Table 4. Providers’ self-efficacy for communicating about the HPV vaccine.

	Control			Intervention
	%(n)			%(n)
	Baseline	Post	∆	Baseline	Post	∆	p*
I am usually able to convince hesitant parents to accept HPV vaccination for their child.
Strongly agree/Somewhat agree	93% (54)	90% (44)	−3%	82.5% (66)	88% (69)	+ 5.5%	0.28
Strongly disagree/Somewhat disagree	7% (4)	10% (5)	+ 3%	17.5% (14)	12% (9)	−5.5%
When parents wish to delay or refuse HPV vaccination for their child there is not much I can say to change their minds.
Strongly agree/Somewhat agree	43% (25)	45% (22)	+ 2%	47% (38)	33% (26)	−14%	0.21
Strongly disagree/Somewhat disagree	57% (33)	55% (27)	−2%	53% (43)	67% (52)	+ 14%

*p-value indicates comparisons of changes over time (∆) between control and intervention.

Table 5. Parent reactions to providers’ HPV vaccine recommendation, post-intervention.

	Control	Intervention	p-value
Parents expressed concerns about HPV vaccination
Most of the time (>75%)	–	–	< 0.01
Often (51–75%)	29% (14)	14% (11)
Sometimes (26–50%)	53% (26)	42% (33)
Rarely/Never (0–25%)	18% (9)	44% (34)
Parents appeared offended or angry that you brought up the topic
Most of the time (>75%)	–	–	0.21
Often (51–75%)	–	1% (1)
Sometimes (26–50%)	6% (3)	1% (1)
Rarely/Never (0–25%)	94% (45)	98% (76)
Requested to delay the HPV vaccination until a future visit
Most of the time (>75%)	6% (3)	4% (3)	0.44
Often (51–75%)	16% (8)	14% (11)
Sometimes (26–50%)	57% (28)	49% (38)
Rarely/Never (0–25%)	20% (10)	33% (26)
Refused HPV vaccination for their child
Most of the time (>75%)	–	1% (1)	0.96
Often (51–75%)	2% (1)	3% (2)
Sometimes (26–50%)	35% (17)	36% (28)
Rarely/Never (0–25%)	63% (31)	60% (47)