Conversation: A Powerful Motivator to Get More People Vaccinated

Despite universal recommendations for clinicians to routinely immunize 11-to-12 year olds against human papillomavirus (HPV), Healthy People 2020 reports that only 28% of girls and 7% of boys complete the series. Primary care providers must provide effective recommendations to address low HPV vaccine coverage.

Researchers from University of North Carolina, Chapel Hill, North Carolina and the Harvard Medical School collaborated to determine if training providers to alter their approaches could increase HPV immunization rates. Their study, published in the December 2016 issue of Pediatrics, indicates that using presumptive “announcements” might increase rates significantly.

Providers often use 1 of 2 approaches with patients and their families. With many vaccines, they assume parents are ready to vaccinate and make brief statements to indicate that it’s the appropriate time for vaccination. In a previous study, researchers concluded that announcements led to higher vaccine uptake. On the other hand, some providers use a conversational approach that includes open-ended discussions in an effort to collaborate with parents and increase transparency.

Researchers randomized 30 pediatric and family medicine clinics to receive no training (control), physician-led announcement training, or physician-led conversation training.

North Carolina's immunization registry recorded 17,173 adolescents aged 11 or 12 were vaccinated in the 29 clinics that remained open 6 months after the training. Clinics that received the announcement training improved HPV vaccination coverage more robustly than control clinics did, with increases of about 5%.

Patients who were seen in clinics receiving conversation training or who were seen in control clinics were immunized at rates similar to baseline.

Increasing HPV vaccine initiation among young adolescents is an important goal. Patients are most likely to agree to HPV vaccination if clinicians deliver the information confidently, and with authority, according to the researchers.

Reference

Brewer NT, Hall ME, Malo TL, et al. Announcements Versus Conversations to Improve HPV Vaccination Coverage: A Randomized Trial. Pediatrics. 2016; pii: e20161764. [Epub ahead of print] PubMed PMID: 27940512.