Changes in Strength of Recommendation and Perceived Barriers to Human Papillomavirus Vaccination: Longitudinal Analysis of Primary Care Physicians, 2008-2018

J Pediatr. 2021 Jul;234:149-157.e3. doi: 10.1016/j.jpeds.2021.03.002. Epub 2021 Mar 6.

Abstract

Objectives: To evaluate among pediatricians and family physicians human papillomavirus (HPV) vaccination recommendation practices for 11- to 12-year-old youth; report parental refusal/deferral of HPV vaccination; and report barriers to HPV vaccination changed over time.

Study design: We surveyed nationally representative networks of pediatricians and family physicians in 2008, 2010, 2013-2014, and 2018. Male vaccination questions were not asked in 2008; barriers and parental vaccine refusal questions were not asked in 2010.

Results: Response rates were 80% in 2008 (680/848), 72% in 2010 (609/842), 70% in 2013-2014 (582/829), and 65% in 2018 (588/908). The proportion of physicians strongly recommending HPV vaccination for 11- to 12-year-old patients increased from 53% in 2008 to 79% in 2018 for female patients and from 48% in 2014 to 76% in 2018 for male patients (both P < .0001). The proportion of physicians indicating ≥50% of parents refused/deferred HPV vaccination remained steady for female patients (24% in 2008 vs 22% in 2018, P = .40) and decreased for male patients (42% in 2014 vs 28% in 2018, P < .001). Physician barriers to providing HPV vaccination were rare and decreased over time. Increasing numbers of physicians reported perceived parental barriers of vaccine safety concerns (5% "major barrier" in 2008 vs 35% in 2018, P < .0001) and moral/religious concerns (5% in 2008 vs 25% in 2018, P < .0001).

Conclusions: Between 2008 and 2018, more primary care physicians reported recommending HPV vaccination for adolescents, fewer reported barriers, and more physicians reported parents who had vaccine safety or moral/religious concerns.

Keywords: adolescent health; human papillomavirus; immunization; vaccines.

MeSH terms

  • Adolescent
  • Attitude of Health Personnel*
  • Child
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Longitudinal Studies
  • Male
  • Papillomavirus Infections / prevention & control
  • Papillomavirus Vaccines / immunology
  • Parents / psychology
  • Pediatrics / statistics & numerical data*
  • Primary Health Care / statistics & numerical data*
  • Surveys and Questionnaires
  • Vaccination / psychology*
  • Vaccination / statistics & numerical data
  • Vaccination Refusal / psychology*
  • Vaccination Refusal / statistics & numerical data

Substances

  • Papillomavirus Vaccines