Table 2.

Literature review key findings

Key Finding	Qualifications
System factors are a major determinant of receiving HPV vaccination.	Primary parental determinants of HPV vaccination initiation among adolescents were talking with a doctor, having enough time to discuss the vaccine, having a healthcare provider recommend it, and having a healthcare visit in the past year.25–28 Parents express a strong preference to receive information about HPV vaccination directly from trusted healthcare providers.29–31
The research on provider attitudes and practices describes several sources of provider hesitancy to recommend or discuss the HPV vaccine with parents.	Common sources of provider hesitancy include providers’ “perception that younger adolescents are less at risk of HPV so vaccination can be delayed,” providers’ perceptions of parental hesitancy and ambivalence, misunderstanding parental barriers to vaccination,22,32 and limited time with patients.33–38 Furthermore, delaying discussion of HPV vaccination leads to missed opportunities39 because younger adolescents (11–14 years) are 3 times more likely to attend preventive visits than older adolescents.40
Physician recommendation remains an important determinant in parents’ decision to vaccinate their child.29,41–43	The CDC estimates that HPV vaccination initiation would reach over 90% if providers’ recommendations for HPV vaccination were similar to their recommendations for other adolescent vaccines.5 Commensurate with this is that providers convey vaccine recommendations consistent with evidence-based guidelines; provide accurate, evidence-based information about HPV and HPV vaccine; reassure patients of high vaccine safety due to ongoing postlicensure safety surveillance; and reinforce the message that the HPV vaccine is recommended despite not being required for school.