Why don't adolescents finish the HPV vaccine series? A qualitative study of parents and providers
Chigurupati, Nagasudha Laxmi
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PURPOSE: To understand why adolescents who initiate the HPV vaccine series fail to complete all three shots. METHODS: Semi-structured interviews were performed with parents/guardians of 11-17 year old daughters and pediatric primary care providers in one inner-city public clinic and three private practices to determine why girls who received at least one dose of the HPV vaccine did or did not complete the series. The number of shots received was confirmed by electronic medical record review. Content analysis was used to identify themes related to series completion. RESULTS: 65 parents/guardians participated: 37 whose daughters received 1 or 2 doses of HPV vaccine and 28 whose daughters completed 3 doses. Most (n=24, 65%) parents/guardians failed to complete the series because they thought the clinics would remind them of subsequent doses. 9 (24%) cited logistical barriers. 4 (11%) decided to stop the vaccine series. 33 providers participated: 24 physicians, 3 nurse practitioners, and 6 registered nurses. 52% of providers told parents to schedule appointments, 41% scheduled the second dose at the time the first dose was given, and 7% tried to immunize patients when they returned for other appointments; providers confirmed that few parents chose to stop the series. No practice had a system in place to ensure series completion. CONCLUSIONS: Most failure to complete the HPV vaccine series occurred because providers expected parents to make appointments while parents expected to be reminded. Increased use of reminder/recall systems and clear communication of expectations regarding appointment scheduling could improve completion rates.