Persistence improves HPV vaccine uptake

Will continuing the conversation with parents hesitant to have their adolescent vaccinated with human papilloma virus vaccine result in eventual vaccination?

Don't give up when parents initially express questions, concerns, or simply refuse the human papilloma virus (HPV) vaccine for their pre-teen. In this small study, most parents of adolescents had either questions, concerns, and/or a generally negative reaction to the idea of HPV vaccination. But persistence paid off: When clinicians gently persisted, answering questions, addressing concerns, and/or offering evidence when parents expressed disagreement with vaccination, more than half (51%) of the kids were vaccinated that day. The median time spent was 1 minute longer with a persistent approach. (LOE = 4)

Shay LA, Baldwin AS, Betts AC, et al. Parent-provider communication of HPV vaccine hesitancy. Pediatrics 2018;141(6):e20172312.  [PMID:29765009]

Case series

Government

Outpatient (primary care)

Routine vaccinations are no longer the slam-dunk of well-child visits; parents have been cautioned through social media to be wary of vaccines. Although some parents are passionate "anti-vaxxers," many are simply unsure and correspondingly indecisive. As a result, how clinicians introduce and recommend vaccines is robustly associated with vaccination rates. To get a handle on how best to discuss the HPV vaccine, these authors audio-recorded 43 visits with unvaccinated adolescents at 6 pediatric clinics in which parents were undecided about HPV vaccination (they did not include encounters with parents who were strongly against vaccination). They coded each type of parental hesitancy using 1 of 3 response types (or "other"). The majority (8 of 11) of the clinicians were women. Of the 37 encounters in which the parent(s) expressed at least one type of hesitancy, most (73%) were an "assertive" response, in which the parent stated a preference, disagreed with the suggestion, or didn't see the necessity. This assertive response was the first reaction during 57% of visits. Outright concern (eg, "I'm just scared of it") was expressed by 32% of parents, and 43% of parents asked questions without indicating a strong position. Nearly three-fourths of parents who had a question (71%) or expressed concern (75%) went on to have their child vaccinated; one-third of parents with an assertive response allowed vaccination at that visit. Persistence took an extra minute (median 3.8 minutes vs 2.8 minutes for immediate acquiescence).