ASPO Abstracts
Recommending inequality? Patterns of US healthcare providers' HPV vaccine recommendations
Category: Behavioral Science & Health Communication
Conference Year: 2021
Abstract Body:
Purpose: Infrequent provider recommendations continue to be a key barrier to human papillomavirus (HPV)
vaccination, including among adolescents at higher risk for future HPV cancers. To inform future provider-
training programs, our study sought to synthesize the findings of existing studies of disparities in provider
recommendation of HPV vaccination among adolescents.
Methods: We conducted a systematic review of studies that quantitatively assessed the prevalence of provider
recommendation of HPV vaccination among US parents of adolescents aged 9–17. We excluded studies that
were not empirical, not peer-reviewed, or collected data before 2012. Following PRISMA guidelines, two
independent coders extracted and screened 3,158 unique titles and abstracts from multiple databases. Next,
two independent coders reviewed the full text of eligible studies, systematically collecting data using a
standardized abstraction form. We resolved coding disagreements via discussion with the whole team.
Results: Fifty-four of 252 reviewed studies met eligibility criteria, including 33 studies of parents and 21 studies
of providers. Parental report of receiving a provider recommendation for HPV vaccination ranged from 22% to
78%. These studies most often assessed disparities by adolescents' sex, with almost all finding that provider
recommendations were less common for boys vs. girls. Most studies of provider reports confirmed disparate
recommendations by sex. Fewer studies stratified recommendation disparities by income or race/ethnicity;
these studies found that recommendations were less common among lower-income households, but reported
mixed findings by race/ethnicity. Geographic assessments found variation across states and urbanicity, with
recommendations being lower including in some Southern states and in rural areas.
Conclusion: Findings suggest differences in provider recommendation by sex, household income, geography,
and possibly race/ethnicity, in spite of national guidelines for routine HPV vaccination. National efforts to
improve provider communication about HPV vaccination should focus on improving recommendation
consistency, especially for populations such as lower-income and rural adolescents who are at higher risk for
future HPV cancers.
Keywords: provider recommendation, inequities, HPV vaccine