Exploring Delivery of Adolescent Preventive Health Services During the COVID-19 Pandemic: Perceptions and Experiences Shared by Healthcare Professionals
Authors: White Brianna , Prasad Rameshwari , Kumsa Fekede , Shaban-Nejad Arash 
Published: November 2023

Abstract

Background
While unmitigated vaccine hesitancy was already growing before the emergence of COVID-19, the global pandemic has introduced additional challenges to the immunization sector. Despite the benefits, routine preventive care was forestalled by challenges related to pandemic lockdowns/quarantine, parental reluctance to seek preventative services, poor access to healthcare, loss of income and/or health insurance, and the inability of children under 12 to be immunized against the coronavirus. Considering the potential impacts caused by the pandemic’s disruption of adolescent preventative care services, we explored the experiences of adolescent healthcare providers in Tennessee and Georgia in providing care throughout the COVID-19 pandemic.

Methods
A series of in-depth qualitative interviews were conducted between December 2020 and May 2021 via the video conferencing platform, Zoom, among a diverse group of adolescent healthcare providers (n=16) representing 5 healthcare practices located within the southeastern states of Georgia and Tennessee. Audio recordings were transcribed verbatim and analyzed using a rapid qualitative analysis framework, guided by the grounded theory and inductive approach.

Results
Preventive adolescent services were adversely impacted by the COVID-19 pandemic at all participating practices. Participants highlighted an initial decrease in patients due to the pandemic, despite the implementation of protective measures such as an increase in sanitation measures, hand washing, separation of sick and wellness visits, mask mandates, and telehealth/video conferencing opportunities. While practices continued to distribute educational materials, many removed material from their waiting rooms due to sanitary concerns related to COVID-19. Participants reported that patient-provider communications; effective use of presumptive languaging; periodic reminders/recall messages; provider’s personal recommendation on vaccine safety/efficacy; early initiation of human papillomavirus (HPV) vaccination series at 9 years; community partnerships with health navigators/vaccine champions/vaccine advocates; use of standardized forms/prewritten scripts/standard operating protocols for patient-provider interactions; and vaccine promotion through social media, brochures/posters/pamphlets, as well as outreach to schools and churches, served as facilitators to adolescent HPV vaccine uptake.

Conclusions
By exploring the perceptions and experiences of adolescent healthcare providers, our research identified key factors influencing adolescent vaccination uptake and its relatedness to the COVID-19 pandemic. We argue our findings support and encourage the development of personalized patient-provider communications, trusting relationships, effective use of presumptive languaging, and counteraction of misinformation as solutions to suboptimal preventative services and vaccination coverage rates. Implementation of these comprehensive strategies could not only ameliorate routine adolescent vaccination uptake but could also aid in the expansion of COVID-19 vaccine acceptance on a sizable scale.