Multi-level Approaches to Reducing HPV Vaccine Hesitancy in Rural Michigan

Why is HPV vaccination the focus of this study?

  • In the United States, 13,800 new cases of invasive cervical cancer (CC) are estimated for 2020, and 4,290 women may die of this disease.
  • Almost all cervical cancers are caused by persistent infections with oncogenic, or high- risk, types of human papillomavirus (HPV).
  • Due to the rise in human papillomavirus (HPV)-associated oropharyngeal (oral cavity and pharynx) cancer, this cancer is increasing in incidence; men are more than twice as likely as women to be diagnosed.
  • Residents in rural areas experience a higher incidence of both cervical and oropharyngeal cancers cancers than urban residents, as well as lower HPV vaccination rates.

This study aims to assess HPV vaccine hesitancy, “the reluctance or refusal to vaccinate despite the availability of vaccines.”

  • This is an observational study, that will collect data across 50 primary care practices about HPV vaccine hesitancy.
  • We will interview (10) medical directors (organizational leaders), recruit four focus groups of primary care physicians or mid-level providers (6-10 members, each).
  • We will request consent for four focus groups of children, adolescents, and young adults, ages 9-14, 15-26, male or female and two focus groups with their caregivers.

What are the criteria for inclusion in the study?

PCP criteria. PCPs will include:

  1. MD and DO physicians in family and general medicine, internal medicine, obstetrics and gynecology, adolescent medicine and pediatrics;
  2. Advanced Practice Providers (including Nurse Practitioners, Physicians Assistants). Medical Directors, who may be specialist clinicians, will be eligible for the study based on their position in the organization.
  3. Practice in a rural county of Michigan.

Patient criteria. Patients will be eligible to participate:

  1. if they are a patient of one of the eligible PCPs;
  2. are age 9 to 26;
  3. have had at least one visit to their PCP within the prior 12 months;
  4. have not had any HPV vaccinations;
  5. speak English; and
  6. consent/assent (if applicable) to participate.

Caregiver criteria. Caregivers will be eligible to participate:

  1. if they are a legal caregiver of an enrolled patient (under age 18) of an eligible PCP;
  2. are age 18 or older;
  3. have accompanied the enrolled patient to at least one visit to the patient’s PCP within the prior 12 months;
  4. speak English;
  5. consent to participate.

What is the long-term goal of the study?

The long-term goal of this study is to reduce HPV vaccine hesitancy as a risk factor for cervical, oral cavity, and pharynx cancers among rural adolescents, by influencing the vaccination behaviors of their primary care providers, and by changing the work flow. We will develop a digital intervention with these study findings that can increase HPV vaccine—and other vaccine- - uptake.