title: Provider communication and HPV vaccination: The impact of recommendation quality.
abstract: BACKGROUND
  Receiving a healthcare provider's recommendation is a strong predictor of HPV vaccination, but little is known empirically about which types of recommendation are most influential. Thus, we sought to investigate the relationship between recommendation quality and HPV vaccination among U.S. adolescents.
  
  
  METHODS
  In 2014, we conducted a national, online survey of 1495 parents of 11-17-year-old adolescents. Parents reported whether providers endorsed HPV vaccination strongly, encouraged same-day vaccination, and discussed cancer prevention. Using an index of these quality indicators, we categorized parents as having received no, low-quality, or high-quality recommendations for HPV vaccination. Separate multivariable logistic regression models assessed associations between recommendation quality and HPV vaccine initiation (≥ 1 dose), follow through (3 doses, among initiators), refusal, and delay.
  
  
  RESULTS
  Almost half (48%) of parents reported no provider recommendation for HPV vaccination, while 16% received low-quality recommendations and 36% received high-quality recommendations. Compared to no recommendation, high-quality recommendations were associated with over nine times the odds of HPV vaccine initiation (23% vs. 74%, OR=9.31, 95% CI, 7.10-12.22) and over three times the odds of follow through (17% vs. 44%, OR=3.82, 95% CI, 2.39-6.11). Low-quality recommendations were more modestly associated with initiation (OR=4.13, 95% CI, 2.99-5.70), but not follow through. Parents who received high- versus low-quality recommendations less often reported HPV vaccine refusal or delay.
  
  
  CONCLUSIONS
  High-quality recommendations were strongly associated with HPV vaccination behavior, but only about one-third of parents received them. Interventions are needed to improve not only whether, but how providers recommend HPV vaccination for adolescents.
authors.affiliation: Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, 133 Brookline Ave., Boston, MA 02215, USA. Electronic address: gilkey@unc.edu.
authors.forename: Melissa B
authors.initials: MB
authors.lastname: Gilkey
authors.affiliation: Department of Health Policy and Management, University of North Carolina, CB 7411, Chapel Hill, NC 27599, USA. Electronic address: wacalo@live.unc.edu.
authors.forename: William A
authors.initials: WA
authors.lastname: Calo
authors.affiliation: Department of Health Behavior, University of North Carolina, CB 7440, Chapel Hill, NC 27599, USA. Electronic address: jlmoss@live.unc.edu.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Moss
authors.affiliation: Department of Health Behavior, University of North Carolina, CB 7440, Chapel Hill, NC 27599, USA. Electronic address: pdshah@live.unc.edu.
authors.forename: Parth D
authors.initials: PD
authors.lastname: Shah
authors.affiliation: Eshelman School of Pharmacy, University of North Carolina, CB 7355, Chapel Hill, NC 27599, USA. Electronic address: macary_marciniak@unc.edu.
authors.forename: Macary W
authors.initials: MW
authors.lastname: Marciniak
authors.affiliation: Department of Health Behavior & Lineberger Comprehensive Cancer Center, University of North Carolina, CB 7440, Chapel Hill, NC 27599, USA. Electronic address: ntb@unc.edu.
authors.forename: Noel T
authors.initials: NT
authors.lastname: Brewer
mesh_terms: D000293:Adolescent; D002648:Child; D003142:Communication; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010290:Parents; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D053918:Papillomavirus Vaccines
keywords: Adolescent health; Health communication; Human papillomavirus infections/prevention and control; Human papillomavirus vaccine; Quality of health care
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