Table 1.
Summary of studies on HPV vaccine recommendation quality (k = 28 studies)
| Author, year | HPV vaccine recommendation quality measure | Key findings by clinical and HCP characteristics |
|
|---|---|---|---|
| Higher recommendation quality among: | No difference in recommendation quality by: | ||
|
| |||
| Alcalá, 201841 | Consistent recommendation for female patients ages 11–12 (74% of the time) and male patients ages 11–12 (67% of the time) | • Female vs. male HCPs for male patients (83% vs. 39%, p=.02) • Younger vs. older HCPs for male patients (82% vs. 34%, p=.02) |
• Physicians vs. other clinical staff for female or male patients • HCP gender or age for female patients |
| Allison, 201623 | Strong recommendation for female and male patients ages 11–12 | • Pediatricians vs. family physicians for male patients • HCPs with more vs. less HPV vaccine efficacy concerns for female patients |
• Pediatricians vs. family physicians for female patients • HCPs with more vs. less HPV vaccine efficacy concerns for male patients • Locale (urbanicity), practice type (e.g., private clinics vs. hospitals), HPV vaccine knowledge and other cognitions (e.g., discussing sex), and HCP gender for female or male patients |
| Ayres, 202242 | Consistent recommendation or urgent recommendation (“almost always”) for patients ages 11–12 | Consistent recommendations: • Clinicians vs. nurses and other HCPs (odds ratio=3.31, 95% CI 1.11–9.88) • Urgent recommendations: • Clinicians vs. nurses and other HCPs (odds ratio=3.55, 95% CI 1.29–9.72) |
|
| Berkowitz, 201524 | Consistent recommendation for female patients ages 11–12 | • Pediatricians vs. internists (74% vs. 30%, p<.001) | |
| Bonville, 201743 | Consistent recommendation (“always”) for patients ages 13–18 | • Advanced practitioners vs. physicians (95% vs. 83%, p<.05) | |
| Brennan, 202225 | Strong and consistent recommendation for patients ages 9–26 | • HCPs with more vs. less positive HPV vaccination beliefs (61% vs. 31%, p=.01) • HCPs with more vs. less HPV knowledge (mean=5.4 vs. 4.9, p=.002) • HCPs with high vs. low descriptive norms about other OB/GYNs’ recommendation practice (aOR=24.33, 95% CI 2.56–231.14) • HCPs in suburban vs. urban and rural clinics (64% vs. 59% and 33%, p<.05) |
• OB-GYN vs. other gynecology specialty, FQHC status, EHR prompt, descriptive norms about other primary care providers, and HCP demographics (gender, age, race/ethnicity, or years in practice) |
| Btoush, 202226 | Consistent recommendation (“always”) for patients ages 11–13 | • HCPs in pediatrics vs. non-pediatrics specialty (aOR=1.98, 95% CI 1.09–3.57) • HCPs with more vs. less HPV vaccine knowledge (aOR=6.86, 95% CI 2.3020.43) • HCPs with fewer vs. more HPV vaccine concerns |
• Perceived HPV vaccine effectiveness, facilitators, or barriers |
| Cataldi, 202127 | Consistent recommendation for female and male patients ages 11–12 | • Pediatricians vs. family physicians for female patients in 2018 (99% vs. 96%) and for male patients in 2013–2014 (90% vs. 86%) and 2018 (99% vs. 94%, all p<.05) | • Pediatrics vs. family medicine specialty for female patients in 2013–2014 |
| Chopp, 201645 | Intention to recommend for female and male patients ages 11–12 | • HCPs with more positive HPV vaccine attitudes for female patients (t-test value=4.69, p<.0001) • HCPs with more positive self-efficacy for female patients (t-test value=9.63) and male patients (t-test value=8.32, all p<.0001) |
• HPV vaccine attitudes for male patients |
| Dempsey, 201628 | Strong recommendation for patients ages 11–12 | • HCPs in pediatrics vs. family medicine specialty (58% vs. 32%, p=.03) • HCPs in publicly funded vs. private practices (54% vs. 46%, p<.01) |
• Physicians vs. nurse practitioners vs. physician assistants, and HCP demographics (gender or years in practice) |
| Deupree, 201746 | Consistent recommendation for female and male patients ages 11–26 | • HCPs with vs. without HPV cancer knowledge for male patients (37% vs. 3%, p<.05) • HCPs with vs. without HPV vaccine knowledge for male patients (39% vs. 1%, p<.05) • HCPs with vs. without perceived parental barrier for male patients (36% vs. 5%, p<.05) |
• HPV cancer or vaccine knowledge and perceived parental barrier for female patients • Other HPV vaccine cognitions (e.g., vaccine efficacy and safety concerns) for female or male patients |
| Finny Rutten, 201729 | Strong recommendation or consistent recommendation for female and male patients ages 11–12 | • Strong recommendations: • HCPs in pediatrics vs. family medicine vs. OB-GYN or internal medicine clinics for female patients (95% vs. 67% vs. 50%) and male patients (88% vs. 52% vs. 25%, all p<.001) • HCPs with pediatrics vs. family medicine board certification for female patients (95% vs. 67%) and male patients (87% vs. 53%, all p<.01) • Consistent recommendations: • HCPs in pediatrics vs. family medicine vs. OB-GYN or internal medicine clinics for female patients (98% vs. 76% vs. 20%) and male patients (93% vs. 57% vs. 0%, all p<.001) • HCPs with pediatrics vs. family medicine board certification for female patients (97% vs. 75%) and male patients (95% vs. 55%, all p<.01) |
• Physicians vs. advanced practitioners, and HCP demographics (gender, age, race/ethnicity, or years in practice) for female or male patients |
| Gilkey, 201530 | Strong recommendation (“extremely” or “very” important) for patients ages 1112 | • Pediatricians vs. family physicians (77% vs. 69%, p<.05) | |
| Hansen, 202031 | Consistent recommendation (“always”) for female and male patients ages 11–12 | • Pediatrics vs. family medicine vs. OB-GYN residents for female patients (76% vs. 16% vs. 0%, p<.05) • Pediatrics vs. family medicine residents for male patients (67% vs. 10%, p<.05) |
• Residency year for female or male patients |
| Hofstetter, 201732 | Consistent recommendation (“always” or “sometimes”) for adolescent patients with chronic medical conditions (patient age range not specified) | • HCPs in hematology/oncology vs. rheumatology, pulmonology, and endocrinology (66% vs. 46%, 31% and 26%, p<.001) • HCPs without vs. with discomfort discussing sex • HCPs without vs. with adequate HPV vaccine information • HCPs with higher vs. lower patient volume (aOR=1.01, 95% CI 1.00, 1.02) |
• Locale (urbanicity or U.S. region), practice type (e.g., private clinics vs. community health centers), HPV knowledge, HPV vaccine efficacy beliefs, and HCP demographics (gender, age, or years in practice) |
| Hopfer, 201938 | Strong and urgent recommendation by “engagers” and “protocol followers” (patient age range not specified) | • HCPs in suburban vs. non-suburban clinics (64% vs. 77%, p<.05) | • HCP demographics (gender, age, race/ethnicity, or years in practice) |
| Hswen, 201747 | Strong, consistent, timely, and urgent recommendation for female and male patients ages 11–12 | • HCPs who were vs. were not aware of their professional organizations’ HPV vaccination guidelines for female patients (52% vs. 25%) and male patients (54% vs. 26%, both p<.001) | |
| Kempe, 201922 | Consistent recommendation for female and male patients ages 11–12 | • Pediatricians vs. family physicians for female patients (99% vs. 96%) and male patients (99% vs. 94%, both p<.05) | |
| Kong, 202221 | Timely recommendation for patients ages 9–10 | • Physicians vs. advanced practitioners (23% vs. 16%, p<.05) • HCPs who were black vs. Asian and white (32% vs. 29% and 20%, p<.05) • HCPs in publicly funded practices vs. hospitals, solo and group practices (32% vs. 26%, 20% and 18%, p<.05) • HCPs in urban vs. rural and suburban clinics (26% vs. 21% and 18%, p<.05) |
• Physicians vs. nurses, pediatrics vs. family medicine specialty, locale (U.S. region), practice/system size (with vs. without affiliation with health systems), patient volume, and HCP demographics (gender or years in practice) |
| Lake, 201933 | Strong recommendation or consistent recommendation for patients ages 11–12 | • Strong recommendations: • HCPs who were vs. were not VFC providers (aOR=2.62, 95% CI 1.23, 5.59) • Consistent recommendations: • HCPs who were vs. were not VFC providers (aOR=2.84, 95% CI 1.26, 6.39) • HCPs who received vs. did not receive reminders from healthcare team members (aOR=2.26, 95% CI 1.23, 4.16) |
• Specialty (e.g., pediatrics vs. family medicine), patient volume, other vaccine-related quality improvement strategies (e.g., EHR reminders), and HCP demographics (gender, age, or race/ethnicity) |
| Lu, 201939 | Receipt of a provider recommendation | • Parents visiting private vs. publicly funded clinics (67% vs. 55%, p<.05) | • Private clinics vs. hospitals |
| McRee, 201434 | Consistent recommendation (“most of the time”) for female and male patients ages 11–12 | • Pediatricians vs. family physicians and nurse practitioners for male patients (67% vs. 42% and 41%, p<.001) • HCPs with more vs. less positive self-efficacy for female and male patients |
• Clinical role/specialty for female patients |
| Mills, 201635 | Strong recommendation (“very strong” or “somewhat strong”) for patients (patient age range not specified) | • Pediatrics vs. family/internal medicine vs. OB-GYN, and physicians vs. nonphysicians | |
| Roberts, 202044 | Consistent recommendation (“75%” or “>90%” of the time) for patients (patient age range not specified) | • Clinicians vs. nurses | |
| Rohrbach, 201740 | Consistent recommendation (“always”) for eligible patients (patient age range not specified) | • HCPs who see >21 patients/week vs. 1120, 6–10, and 1–5 patients/week (74% vs. 70%, 60% and 56%, p=.01) | • Locale (urbanicity) |
| Soon, 201536 | Strong recommendation for female and male patients ages 11–12 | • HCPs who did not vs. did perceive parental or patient concern about HPV vaccine efficacy as a barrier for female patients (64% vs. 100%, p=.025) • HCPs who did not vs. did perceive the need to discuss sexuality before recommending for male patients (78% vs. 42%, p=.005) |
• Pediatrician vs. family physicians, patient volume, other HPV vaccine cognitions (e.g., association with sex, vaccine safety concerns), and HCP demographics (gender, age, or years in practice) for female or male patients |
| Suryadevara, 201548 | Consistent recommendation for adolescent patients (patient age range not specified) | • HCPs without vs. with HPV vaccine misperception of increased risky sexual behavior (figures not reported, p=.002) | |
| Vadaparampil, 201637 | Strong and consistent recommendation for male patients ages 11–12 | • HCPs who were vs. were not VFC providers (aOR=3.80, 95% CI 1.70–8.54) • HCPs in urban vs. non-urban clinics (aOR=2.08, 95% CI 1.08–4.02) HCPs with fewer vs. more HPV vaccine safety concerns HCPs in non-private vs. private practices |
• Pediatrics vs. non-pediatrics specialty, practice/system size (e.g., single vs. multispecialty practices), patient volume, vaccine-related quality improvement strategies (e.g., EHR prompts), HPV knowledge, other HPV vaccine cognitions (e.g., vaccine efficacy concerns, associations with sex, perceived parental barriers), and HCP demographics (gender, age, race/ethnicity, or years in practice) |
aOR = adjusted odds ratio, CI = confidence interval, EHR = electronic health record, FQHC = federally qualified health center, HCPs = healthcare professionals, HPV = human papillomavirus, OB-GYNs = obstetricians/gynecologists, VFC = Vaccines for Children.