Executive Summary
While public health officials advocate for vaccination against human papillomavirus (HPV) in girls and boys ages 11-12, they also call for vaccination of young women ages 13-26 and males ages 13-21 who have not been previously vaccinated or did not complete the three-dose series.
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A 2014 report released by the President’s Cancer Panel says the catch-up period for adolescents and young adults not previously vaccinated is an “important window for cancer prevention.”
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National statistics from the Centers for Disease Control and Prevention indicate only 30.7% of young women and 0.6% of young men have received at least one dose of the HPV vaccine.
While public health officials advocate for vaccination against human papillomavirus (HPV) in girls and boys ages 11-12, they also call for vaccination of young women ages 13-26 and males ages 13-21 who have not been previously vaccinated or did not complete the three-dose series.
A 2014 report released by the President’s Cancer Panel says the catch-up period for adolescents and young adults not previously vaccinated is an “important window for cancer prevention.”1
“If failure to vaccinate 11- to 12-year-olds is the first missed opportunity, failure to vaccinate young women ages 13-26 who were not previously vaccinated or did not complete the three-dose series and males ages 13-21 is an additional missed opportunity,” the report says.1
National statistics from the Centers for Disease Control and Prevention indicate only 30.7% of young women and 0.6% of young men have received at least one dose of the HPV vaccine.2
Consider how two university health services have raised awareness and HPV vaccine uptake in their student populations.
Results of an early 2014 survey indicated students at Salem (MA) State University were typical of most U.S. young adults when it came to HPV vaccination. Less than 50% of students who visited the student health center had received even one dose of HPV vaccination, and only about 35% reported completion of the three-dose series. Fewer than 7% of male students seen in the health center had completed the vaccine series, and 80% reported having never received any HPV vaccine.
Kimberly Daly, MSN, FNP, DNPc, associate director of Student Health Services, spearheaded an effort to improve the suboptimal HPV vaccine rates. With grant funding from the New England College Health Association, a campus-wide promotion project was developed to increase student HPV vaccination rates. The outreach project was designed to prevent missed opportunities for providing HPV vaccine during all clinical encounters by doing the following:
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utilizing the electronic medical record (EMR) for providers and appointment reminders for patients;
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increasing the frequency of provider recommendations for HPV vaccine during all patient encounters using targeted messaging;
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increasing community exposure to HPV vaccine awareness and accessibility through multi-component marketing strategies.
The program and intervention were held through the fall 2014 semester, and they included internal health communication between providers and students to encourage HPV vaccine uptake as well as campus-wide health education strategies. A social norming campaign using the slogan, “Spread Love Not Warts” was used in multimedia, print, social media, and outreach programs on campus. The program was launched at a “Spread Love not Warts” concert held during the annual September block party.
Chart audits using electronic medical records tracked provider engagement during the campaign, with reports looking at provider acknowledgement of HPV vaccine history (preventing missed opportunities to vaccinate), clinician provision of a strong HPV vaccine recommendation at each visit, and scheduling of follow-up appointments at the clinical visit to ensure activation of future visit reminder systems for patients.
The program met all of its objectives but one; only 92% of patients received scheduled follow-up appointments, instead of the stated 100% goal, says Daly. The overall outcome was “substantial,” she notes.
“In the previous semester, we administered a total of 12 HPV vaccines to students in our health services,” she reports. “At the conclusion of our program, 16 weeks over fall 2014, we reported a total of 158 administered vaccines to a total of 120 unique patients.”
Feedback from patients was very positive, says Daly. Nurse practitioner recommendation for HPV vaccine was the most impactful, followed by strategically placed informational posters with the “Spread Love not Warts” logo in all student campus bathroom stalls, she says.
Amy Wongsarnpigoon, MSN, ANP, an adult nurse practitioner at Raleigh, NC-based North Carolina State University (NCSU) Student Health, became a champion for change after noting that many of her male patients were unfamiliar with the HPV vaccine. A review of the center’s electronic medical record data found providers were recommending the HPV vaccine to just 9% of males during student health physicals, compared to 70% of females.
Why the low number? Wongsarnpigoon explains that the student health center has two general clinics: a women’s clinic and a medical clinic. The women’s clinic generally sees females for their well woman visits and already had interventions in its electronic medical records to identify women who might need the HPV vaccine. The medical clinic, on the other hand, did not have a process to remind clinicians to assess and address male HPV vaccination status, nor were there any educational materials geared toward males to inform them about the importance of HPV vaccination, she notes.
A team approach involving personnel from information technology and health promotion, as well as nurses, medical assistants, nursing assistants, nurse practitioners, physician assistants, and physicians, was utilized to implement the quality improvement effort, says Wongsarnpigoon. The staff members added an HPV section for each provider to complete in the EMR during all physicals, and they developed new literature about HPV that was specifically written for males.
The result? Research indicates a 58% increase in the number of HPV vaccines given to males at the student health center during the study period (October 2013 to March 2014). The quality improvement project was awarded one of two 2014 Bernard A. Kershner Innovations in Quality Improvement Awards given by the Institute for Quality Improvement at the Accreditation Association for Ambulatory Health Care.
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National Cancer Institute. Accelerating HPV Vaccine Uptake: Urgency for Action to Prevent Cancer. A Report to the President of the United States from the President’s Cancer Panel. Bethesda, MD; 2014.
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Centers for Disease Control and Prevention (CDC). Adult vaccination coverage — United States, 2010. MMWR 2012; 61(4):66-72.
