Running Head: HPV Vaccine Recommendation Practices in a Suburban Family Practice Clinic

Background:Human Papillomavirus (HPV) vaccination is an effective method for preventing 9 types of HPV infection which cause the vast majority of HPV-related cancers. However, Utah maintains consistently poor HPV vaccination rates among adolescents aged 13 to 17. The National Institutes of Health identified increasing provider HPV vaccine recommendation rates as a priority for increasing HPV vaccine uptake in the United States.The purpose of this project was to assess barriers to HPV vaccination recommendation, and to increase the self-reported frequency of primary care provider adolescent HPV vaccination recommendations. The Health Belief Model guided this project, suggesting that perceptions of susceptibility, severity, benefits, barriers, and self-efficacy are core influencers for preventive health actions and are affected by cues to action that prompt engagement in health-promoting behavior. Aprovider recommendation isa cue to action for HPV vaccinationand research has indicated that methods to increase HPVvaccination rates should be directed at providers and the recommendation process.Methods:This quality improvement project was implemented in a suburban family practice clinic within a primarily Caucasian community with overall low HPV vaccination rates per health department reports. A pre/post survey approach assessedproviders' HPV vaccine knowledge and self-reported HPV vaccine recommendation practices surrounding an educational in-service.Results:Of the 10 clinic providers, 7participated in the pre-survey and 3participated in the post-survey. Participants were mostly male, non-Hispanic white nurse practitioners and physicianswithgreater than 10 years of experience. Minor HPV knowledge deficits and perceived discomfort with discussing HPV vaccination were identified in the pre-survey. Other barriers to HPV vaccine recommendationidentified in the pre-survey and in-service discussionincluded lack of time to discuss HPV vaccination and cultural barriersregarding topics surrounding sexual conduct.Average provider HPV knowledge scores were 88.57% pre-survey and 93.33% post-survey. Though 71.43% of pre-survey participants and 100% of post-survey participants reported "almost always" recommending HPV vaccinationaccording to CDC guidelines,reported rates of HPV vaccine uptakewere similarly varied among pre-and post-survey participants.Survey results and in-service discussion also revealedthat patients and parents were primarilynotified of recommended HPV vaccinations by the medical assistant (MA). Conclusions: This projectcontributes to ongoing HPV vaccine research in Utah.Despite limitationsdue to the volunteer nature of project participation (e.g. possible bias, and low post-survey response rates), this project demonstrated that greater HPV vaccine knowledge and more frequent HPV vaccine recommendation did not necessarily lead to increased vaccine uptake. It also highlighted the fact that future studies and projects should include the role of the MA in HPV vaccine recommendation processes. This project also emphasized the importance of including culturally sensitive approaches when designing HPV vaccination educationand social media campaigns as a way to provide accurate information to providers, parents and patients regarding HPV vaccination. Overall,this project has shown room for improvement and possible avenues to explore to enhance HPVvaccine recommendation processes in a suburban family practice clinic.