Implementation and evaluation of a multilevel intervention to increase uptake of the human papillomavirus vaccine among rural adolescents
Julie Dang, Sharon McClure, Alexandra Gori, Teresa Martens, Arzoo Mojadedi, Ulissa Smith, Chester J. Austin, Moon S. Chen
Abstract
Abstract Purpose Geographic disparities exist in uptake of the human papillomavirus vaccine (HPV). In 2020, the National Immunization Survey‐Teen reported that adolescents living in nonmetropolitan statistical areas (MSAs) had lower HPV vaccination coverage (≥ 1 dose) compared to adolescents living in MSA principal cities. This paper describes the implementation and evaluation of a multilevel pilot intervention study to increase uptake of the HPV vaccine among adolescent patients ages 11‐17 of a rural health clinic. Methods This parent, primary care team, and clinic multilevel pilot intervention was guided by evidence‐based approaches to increase HPV vaccinations, formative research, and input from the community. HPV vaccination initiation and completion rates were analyzed at baseline and 23 months follow‐up. Findings The proportion of adolescent patients ages 11‐17 who had initiated the HPV vaccine series was significantly greater at follow‐up compared to baseline, (82.7% compared to 52.4%), χ 2 (1, n = 498) = 49.2, P < .0001. The proportion of adolescent patients ages 11‐17 who had completed the HPV vaccine series was also significantly greater at follow‐up compared to baseline, (58.0% compared to 27.0%), χ 2 (1, n = 498) = 50.8, P < .0001. Conclusions The multilevel intervention significantly increased HPV initiation and completion rates among adolescent patients ages 11‐17 at this rural health clinic. This study demonstrates the feasibility of utilizing a multilevel intervention to address low HPV vaccination rates among rural adolescents and the potential of employing this strategy for a large‐scale randomizing‐controlled trial.