Examining parent, child, and provider experiences with early childhood immunization for an HPV vaccine trial among four to eight-year-olds: a mixed methods study
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Abstract
BACKGROUND: Since the introduction of the first vaccine against human papillomavirus (HPV) in 2006, there has been an 88% drop in HPV infection among US women, with a smaller, yet still significant, drop in men. Despite exemplary efficacy and safety data, HPV vaccine rates continue to lag far behind other routine childhood immunizations in acceptance and completion, with less than 50% of US adolescents completing the HPV vaccine series by the recommended age of 13 (Pingali, 2023).Current Efforts: To improve on-time vaccination, the American Academy of Pediatrics (AAP) has begun recommending that the vaccine be offered for boys and girls beginning at age 9.
A Gap in Knowledge: Despite national efforts, there is still much progress needed to significantly improve completion rates, especially with emerging studies suggesting a downward trend for the first time since the introduction of the vaccine.
OBJECTIVE: The primary objective of this study is to assess and adapt recruitment conversations with parents to better convey the efficacy, safety, and importance of early childhood HPV vaccination. This includes providing evidence-based information on vaccine efficacy, duration of protection, and safety to parents, while addressing misinformation, and fostering informed decision-making regarding HPV vaccination for their children aged 4–8 years.
METHODS: Our team conducted a longitudinal exploratory mixed-methods study involving qualitative interviews of a subset of participants from the larger parent study, titled "An exploratory open-label clinical trial evaluating the immunogenicity and safety of the 9vHPV 2-dose vaccine regimen in children aged 4–8 years." Interviews were complemented by a cross-sectional survey at the baseline of the larger early childhood vaccine study. This information was used to understand participants’ experience with HPV vaccination and to provide recommendations on how to improve vaccine communication strategies and increase parental confidence in HPV vaccination administered during early childhood.
Study Design: This mixed-methods study explores parent, child, and provider experiences with early childhood HPV vaccination, and identify both facilitators and barriers to vaccination at this young age.
Quantitative Analyses: Descriptive statistics were computed using SAS software for Study H-41686 Baseline Questionnaire comprising 100 children and their respective parents taken at the time of enrollment in the Pediatric HPV Study. Data analyzed included child demographic information, parent demographic information, and parent knowledge/experience.
Qualitative Analysis: Analysis of the qualitative data was achieved by collecting audio transcripts from interviews which were transcribed verbatim. Team members then identified recurrent themes within the transcript organizing and refining them until a master codebook was finalized. This codebook was then applied to every transcript.
QUANTITAVE RESULTS: The age range of the children spanned from 4 to 8 years, with a mean age of 6.01 years (SD = 1.49). Parents fell within the range of 30 to 42 years old with a mean age of 36 years (SD=8.27). Gender distribution among the children was 52% male and 47% female participants. Female parents predominated (83.33%). 57% of parents identified as African American, 15% as Hispanic, and others varied. Most parents reported that they relied solely on healthcare providers for health information, with a combination of healthcare providers and Internet/Google searches being secondary sources. QUALITATIVE RESULTS: Parents endorsed an understanding that their children are susceptible to severe diseases, including cancers that can be caused by HPV infection. The majority of parents concurred that long-term health benefits outweighed any perceived risks of vaccinating. All parents felt responsible for managing their children’s health throughout their childhood until they reached an age where they could make informed decisions on their own. Trust in providers’ expertise and benevolence was another major motivator for parents to enroll in the study. Prior provider-patient relationships and comfortability with their pediatrician also facilitated children’s acceptance of the study.
CONCLUSION: Routine HPV vaccination of children aged 4-8 is feasible for providers and acceptable to parents. Prior to enrollment parents relied on researchers to provide a foundation for their understanding of the impact of HPV and the benefits of vaccination in mitigating potentially poor outcomes. Following vaccination, parents reported that they were content with their decision and took comfort in knowing they took a necessary measure to protect their child from future disease. Children within the study demonstrated varied understanding of vaccination necessity, yet many verbalized a need to stay healthy as a primary motivator for vaccination. Providers expressed a willingness to recommend to this age and the ability to incorporate a new HPV schedule.
Description
2024
License
Attribution-NonCommercial-NoDerivatives 4.0 International