title: Promoting and Providing HPV Vaccination in Hawaii: Barriers Faced by Health Providers.
abstract: Despite the availability of HPV prophylactic vaccines, uptake has been suboptimal in the US. In the state of Hawaii, HPV vaccine coverage has decreased among females and remains low among males aged 13-17. The reasons for low uptake are unknown and may indicate the existence of critical barriers to HPV vaccination. The purpose of this investigation was to identify policy, system and environmental barriers and promoters of pediatric HPV vaccination in Hawaii. An online 86-item survey addressing knowledge, attitudes, beliefs, practices, and barriers to HPV vaccination was distributed to practicing physicians in Hawaii specializing in Pediatrics, Family Medicine, and Obstetrics-Gynecology. Survey responses were received from a total of 120 physicians. Private practice physicians reported more concerns with vaccine ordering and stocking costs (p < 0.0001), reimbursement levels (p < 0.0001), and insurance coverage (p < 0.0001) compared to physicians in large group practices. Eighty-three percent of providers cited lack of parent knowledge and understanding of HPV infection as a barrier. Over half of physicians (58 %) reported that completion of the 3-dose schedule was a barrier. Most physicians did not use tracking or reminder systems to ensure dose completion. A majority (58 %) of providers cited the lack of school-based vaccination requirements as a barrier. Uptake of HPV vaccination in Hawaii may be impeded by physician perception of parent knowledge and attitudes. Cost-related system barriers are particular barriers among those in private practice. Completion of the 3-dose schedule also remains a challenge.
authors.affiliation: Cancer Epidemiology Program, University of Hawaii Cancer Center, 701 Ilalo St., Honolulu, HI, 96813, USA.
authors.forename: Ashlyn
authors.initials: A
authors.lastname: Tom
authors.affiliation: Prevention and Control Program, University of Hawaii Cancer Center, Honolulu, HI, 96813, USA.
authors.forename: Hali
authors.initials: H
authors.lastname: Robinett
authors.affiliation: Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, 96813, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Buenconsejo-Lum
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, 96813, USA.
authors.forename: Reni
authors.initials: R
authors.lastname: Soon
authors.affiliation: The American Academy of Pediatrics (Hawaii Chapter), Honolulu, HI, 96813, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Hamilton
authors.affiliation: Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, 96813, USA.
authors.forename: Pia
authors.initials: P
authors.lastname: Francisco-Natanauan
authors.affiliation: Imi Hale Native Hawaiian Cancer Network, Honolulu, HI, 96813, USA.
authors.forename: May Rose Dela
authors.initials: MR
authors.lastname: Cruz
authors.affiliation: Immunization Branch, Hawaii State Department of Health, Honolulu, HI, 96813, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Balajadia
authors.affiliation: Cancer Epidemiology Program, University of Hawaii Cancer Center, 701 Ilalo St., Honolulu, HI, 96813, USA. brenda@cc.hawaii.edu.
authors.forename: Brenda Y
authors.initials: BY
authors.lastname: Hernandez
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005194:Family Practice; D005260:Female; D006254:Hawaii; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D008297:Male; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D010342:Patient Acceptance of Health Care; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: Barriers; Hawaii; Human papillomavirus; Knowledge; Vaccination