Educational Intervention Improves HPV Vaccination

Teen patient and parent
Teen patient and parent
Educational interventions delivered in a clinical setting may improve vaccination behaviors.

Educational interventions delivered in a clinical setting may improve vaccination behaviors, according to study results published in Pediatrics.

Human papillomavirus (HPV) is the most commonly sexually-transmitted infection in the United States with approximately 79 million individuals infected and 14 million new cases each year. HPV is a significant threat to public health as it is a casual factor for serious health issues, including cervical, vaginal, and vulvar cancers in women; anal and oropharyngeal cancers, as well as genital warts and recurrent respiratory papillomatosis in both men and women; and penile cancer in men.

Despite the availability of effective vaccines that can prevent up to 90.0% of cervical cancers and genital warts, vaccination rates in the United States are suboptimal and remain well below the Healthy People 2020 goals. In 2016, of adolescents aged 13 to 17 years, only 65.1% of girls and 56.0% of boys received >1 dose of the vaccine. However, previous research on interventions aimed on improving HPV vaccination rates have focused primarily on decision aids that target providers. Although evidence for interventions at the consumer levels is positive, it is weak.

This intervention contributes data on whether and how information technologies can increase awareness and support parental decision-making regarding prevention behaviors such as vaccination.

Study participants were parents or guardians of adolescents aged 11 to 17 who were either unvaccinated or partially vaccinated. During the 7-month study, 1596 adolescents were observed; one-third visited an intervention clinic and two-thirds visited control clinics. In the intervention clinic, parents watched a digital video outlining the risks and benefits of the vaccine on a tablet in the examination room. The primary outcome of interest was HPV vaccine uptake, which was defined as a change in vaccination status 2 weeks after a clinic visit. Vaccination status was recorded as one of four potential states:  the patient (1) lacked documentation on starting the series, (2) had a documented first dose, (3) had a documented second dose, or (4) had a documented third or final dose. An intention‑to‑treat analysis for the primary outcome used generalized estimating equations to accommodate the potential cluster effect of clinics.

Adolescents who attended an intervention clinic tended to be younger (72.4% were aged 11 to 12 years) than adolescents who attended a control clinic (49.8%; P <.001). Further, there was a higher percentage of adolescents with an observed change in vaccine status who visited an intervention clinic vs a control clinic (64.8% vs 50.1%, respectively; P <.001). Adolescents whose parents watched the video had 3-fold greater odds of receiving a dose of the HPV vaccine (78.0%; P =.003).

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Overall, the study authors concluded that, “Patient-centered education strategies delivered in a clinic setting via information technology platforms can positively impact the adoption of preventive health behaviors.”


Dixon BE, Zimet GD, Xiao S, Tu W, Lindsay B, Church A, Downs SM. An educational intervention to improve HPV vaccination: a cluster randomized trial. Pediatrics. 2019;143(1):e20181457.