Meers JM
Short MB
Zimet GD
Rosenthal SL
Auslander BA
Publication Date
December 30, 2017

University of Houston (Meers); University of Houston-Clear Lake (Short); Indiana University School of Medicine (Zimet); Columbia College of Physician and Surgeons (Rosenthal, Auslander)

Human papillomavirus (HPV) vaccination is recommended for all adolescents aged 11 and 12; however, parental hesitancy about HPV vaccination contributes to lower than anticipated rates of uptake. This study sought to describe provider-parent communications about HPV vaccination in a sample of vaccine-hesitant parents in the United States (US). This included descriptions of the content and style of the recommendation delivery and their overall satisfaction with the communication.

Research indicates that a healthcare provider's recommendation of the vaccine is associated with increased parental vaccine intentions and uptake. This is particularly true when parents perceive the recommendation to be "strong", which entails the provider using a presumptive format and pursuing the recommendation, even in the face of parent hesitancy. Nonetheless, recent studies have shown that providers often fail to use this approach. Instead, many treat the vaccine as optional or easily delayed and fail to pursue recommendations when faced with parental dissent.

Participants were recruited from a group of 445 parents of adolescents who participated in a previous study designed to promote HPV vaccine intentions among parents of adolescents eligible to receive services at a School-Based Health Center (SBHC). Twenty-eight vaccine-hesitant parents (100% female) completed qualitative interviews regarding HPV vaccination planning and follow-through. The mean age was 44.6 years for parents and 15.13 for referenced adolescents (56% male). The sample was racially and ethnically diverse (36% Non-Hispanic White, 31% Non-Hispanic Black, 27% Hispanic, and 5% other).

Key findings:

  • Category 1 - Unsure, but subsequently vaccinated (n = 10) - Most parents in Category 1 noted that they had spoken with their provider about the HPV vaccine. The majority of these parents stated that the provider "suggested," "supported," or "highly" recommended the vaccine. Aspects of the provider's style of communication that helped them make the decision included: The provider listened to their concerns, quickly corrected misinformation, did not vacillate, and provided reassurance in terms of safety and efficacy of the vaccine. Content of the conversation that provided them comfort or put them at ease included: The provider discussed the benefits and safety of vaccine. For those parents who expressed concern about side effects, their providers assured them that the SBHC would assist in monitoring the adolescent for any potential side effects.
  • Category 2 - Unsure, did not vaccinate (n = 13) - The majority of parents in this category had not discussed HPV vaccine with a provider. Several parents stated they would expect the provider to initiate the discussion about the vaccine, and one noted that she relies on her provider's recommendation to know which vaccines to receive. Several of these parents noted trust in their providers, both in providing recommendations as well as imparting all important information about their healthcare. Of the parents who had a discussion with a provider, one noted that she was supported in her desire to put off decision-making until later. Others said their provider did not question or argue when they declined the vaccine. Further, a couple noted that the provider's lack of pursuit of recommendation was "appreciated" because it "respected me as a parent".
  • Category 3 - No intention, did not vaccinate (n = 5) - Two parents had never discussed the vaccine with their provider. One parent mentioned that she sought out information from her provider and received very little. The remaining two had been asked by a provider about their desire to vaccinate. In these cases, their providers spoke with them about the background and/or benefits of the vaccine. Within these interactions, the provider used a persuasive strategy, either expressing their personal belief in vaccine or noting their own involvement in HPV vaccine research. Regarding vaccine refusal, two of these parents described the provider as being "fine" or "okay" with their decision not to vaccinate.

These data provide support for the influence of provider recommendation on parents HPV vaccine decisions, while highlighting the importance of the provider's approach to recommendations. Parents who ultimately initiated vaccination had providers that were quick to provide a recommendation, self-assured and firm, but also acknowledged and addressed concerns. Recommendations that are unequivocal, reassuring, and responsive to parent concerns could reduce some parents' anxiety and thereby persuade them to vaccinate. Parents who never received a recommendation, or who were supported in their refusal or delay, were the parents who had still not vaccinated.

The researchers suggest that a provider may need to first begin with a firm presumptive style, but in the face of hesitancy take a more balanced approach. This may include moving towards techniques in line with motivational interviewing. Providers may begin by providing information about the vaccine, using a guiding style of communication. They then might seek to identify how responsive the parent is to change and encourage parents to discuss their own motivations to vaccinate. Throughout the discussion, the researchers stress, it is vital that the provider respects the parent's autonomy to make the decision.

In terms of future research and directions, the researchers propose that other factors that influence parent experience of provider recommendation be explored, e.g., a provider's body language and non-verbal cues. Providers should be taught how to adapt their communication strategies to best fit the needs of all patients, in terms person-level (e.g., response style) as well as group-level (e.g., cultural) differences in approach to healthcare. Finally, provider communication strategies that respect a parent's autonomy in decision making while also influencing their beliefs and ultimate behaviours should be developed.


International Archives of Public Health and Community Medicine, Volume 1, Issue 1. DOI: 10.23937/iaphcm-2017/1710004. Image credit: Johns Hopkins Medicine