Factors associated with the quality of pediatricians’ recommendation of the human papillomavirus vaccine for 11-to-12-year-old adolescents
Creators: name: Toler, Lindsey Olevia
Publisher: name: No Publisher Supplied
Year: 2022

description: Background: Receiving a healthcare provider’s recommendation is a strong predictor of HPV vaccination, and yet recommendations remain understudied. Thus, we sought to describe pediatricians’ recommendation quality and the predisposing and enabling factors associated with it. Purpose: The purpose of this study was to understand the quality of pediatricians’ recommendation of the HPV vaccine and evaluate how it may differ by patient sex. This study has three aims: (1) assess pediatricians’ overall recommendation quality; (2) examine the prevalence of the four recommendation quality indicators (timeliness, consistency, urgency, and strength of endorsement); and (3) identify predisposing and enabling factors correlated with the four quality indicators and overall recommendation quality. Methods: Pediatricians (n = 298) of 11- and 12-year-old adolescents completed our cross-sectional, national online survey in 2018. We assessed the quality of their HPV vaccine recommendations on timeliness (i.e., recommending it by ages 11–12), consistency (i.e., recommending it routinely versus using a risk-based approach), urgency (i.e., recommending same-day vaccination), and strength of endorsement (i.e., saying the vaccine is important). Using an index of these quality indicators, we categorized pediatricians as having delivered low-quality or high-quality recommendations for HPV vaccination. Separate multivariable logistic regression models were used to examine predisposing and enabling factors associated with each recommendation quality indicator. We then assessed the association between each predisposing and enabling factor and overall quality. Results: Slightly more than half (54%) of pediatricians reported delivering high-quality recommendations. Recommendation quality did not vary significantly by patient sex, but there are sex differences in which factors correlate with recommendation quality. Pediatricians concerned about the lack of adequate reimbursement were less likely to deliver high-quality recommendations to their female patients (aOR=0.12, 95% CI 0.03, 0.47), but not to their male patients. Pediatricians with negative attitudes about HPV and the vaccine—believing sexually active adolescents did not need the vaccine (aOR=0.07, 95% CI 0.01, 0.59) and that HPV caused too few cancers to warrant vaccination (aOR=0.11, 95% CI 0.01, 0.96)—were less likely to deliver high-quality recommendations to their female patients. No attitudes were associated with recommendation quality for male patients. Conclusion: Around half of pediatricians in our national sample reported delivering high-quality recommendations. Negative attitudes and perceived barriers were rare but have the potential to negatively impact the way pediatricians communicate about the HPV vaccine. To improve recommendation quality, medical education should counteract misinformation pertaining to HPV vaccine efficacy and emphasize the need for vaccination.