• Assessing Barriers to Recommendation of HPV Vaccination in Adolescent Females

      Badger, Terry A.; McGowan, Suzana; Prettyman, Allen; McArthur, Donna B. (The University of Arizona., 2021)
      Background: Cervical cancer ranks as the fourth most common form of cancer in women worldwide. Cervical cancer is caused by a sexually acquired infection with the human papillomavirus (HPV). The HPV vaccine can prevent HPV transmission and protect people against HPV causing diseases. Unfortunately, HPV vaccination rates remain low among adolescent females aged 11-17 years. Influential provider communication and recommendation of the HPV vaccine to adolescent female patients and parents are directly correlated to HPV vaccine uptake rates. A limited body of evidence is available on the topic of nurse practitioner (NP) perceived barriers and facilitators towards recommendation of the HPV vaccine.Objective: The purpose of this quality improvement (QI) project was to determine perceived barriers and facilitators among NPs towards HPV vaccination recommendation in adolescent females aged of 11-17 years. Methods: A descriptive study design was utilized. Participants were 31 NPs recruited through an invitational announcement posted on the Southern Arizona Advanced Practice Nurse Practitioner Council/Nurse Practitioner Society (SAZAPN/NPS) networking group web page. The 10-question HPV Vaccination Recommendation Survey was utilized to assess participant characteristics and perceived facilitators and barriers. Results: The majority of the sample was masters degree prepared NPs (76.7%) in the family NP specialty (87.1%). NPs reported five major facilitator, including organization or practice level, provider knowledge, incorporation into routine visits, guidelines, and sharing personal experiences. Provider knowledge pertaining to HPV and the HPV vaccine was the most frequently perceived facilitator (n=13). In contrast, the most frequently identified barrier was parental fear, assumptions, or misinformation (n=17). Additional barriers included family belief systems or organization/practice level barriers. 32.3% of participants reported no perceived barriers to recommendation. Conclusion: NPs reported various perceived barriers and facilitators to HPV vaccine recommendation. Provider knowledge was the most reported facilitator, while parental assumptions, fear, or misinformation was identified as the greatest barrier to recommendation. To date, minimal research exists on the topic of HPV vaccine recommendation and perceived facilitators and barriers specific to NPs. Future research should focus on development of QI projects and interventions geared at mitigating perceived barriers, as well as supporting the use of facilitators to HPV vaccine recommendation.
    • Increasing HPV Vaccine Provider Recommendations in a Rural Southwest Clinic

      McArthur, Donna B.; Reveal, Jacqueline Marie; McArthur, Donna B.; Owen-Williams, Eileen A.; Peek, Gloanna (The University of Arizona., 2016)
      Human papillomavirus (HPV) is one of the most common sexually transmitted infections in the United States, however vaccination uptake remains low. One of the known barriers of low vaccination rates is lack of a health care provider recommendation. The purpose of this project was to implement a practice change to increase the number of HPV vaccine recommendations provided by primary care providers (PCPs) to patients aged 9-26 years. The setting for this project was the Little Colorado Physician’s Office, a primary care clinic in rural northern Arizona. Four PCPs, including three family physicians and one family nurse practitioner, and members of the QI team participated in the project. The project was designed as a quality improvement project, guided by the Model for Improvement framework. The needs of the individual practice and their population were assessed by a quality improvement (QI) team using a fishbone diagram for root-cause analysis. A practice change was then implemented by the QI team and evaluated for its effectiveness in improving HPV vaccination recommendations. Outcome measures included the number of HPV vaccine recommendations made by a primary care provider to eligible patients and the number of HPV vaccines administered to patients. In a four-week period of practice change implementation, eight patients were considered eligible for the HPV vaccine. Of these patients, 100% were offered the HPV vaccine by their healthcare provider. The practice change was successful in promoting HPV vaccination recommendations by PCPs, and the QI team reported the change was beneficial to their practice.