Pragmatic trial of an intervention to increase human papillomavirus vaccination in safety-net clinics.
Human papillomavirus (HPV) infection has been causally linked to six cancers, and many disproportionately affect minorties. This study reports on the development and effectiveness of an intervention aimed at increasing HPV vaccine uptake among African American and Hispanic pediatric patients in safety-net clinics.



Formative research, community engagement, and theory guided development of the intervention. A clustered, non-randomized controlled pragmatic trial was conducted in four clinics providing healthcare for the underserved in Tennessee, U.S., with two intervention sites and two usual care sites. Patients aged 9-18 years (N = 408) and their mothers (N = 305) enrolled, with children clustered within families. The intervention consisted of two provider/staff training sessions and provision of patient education materials, consisting of a video/flyer promoting HPV vaccine. Medical records were reviewed before/after the initial visit and after 12 months.



At the initial visit, provision of patient education materials and provider recommendation were higher at intervention sites versus usual care sites, and receipt of HPV vaccine was higher at intervention sites (45.4% versus 32.9%) but not significantly after adjusting for patient's age and mother's education. Provider recommendation, but not education materials, increased the likelihood of vaccine receipt at the initial visit, although over one-third of intervention mothers cited the flyer/video as motivating vaccination. Completion of the 3-dose series at follow-up was lower in the intervention arm.



Future interventions should combine patient education, intensive provider/staff education, and patient reminders. Research should compare patient education focusing on HPV vaccine only versus all adolescent vaccines.



Retrospectively registered with ClinicalTrials.gov NCT02808832 , 9/12/16.
Department of Family and Community Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN, 37208, USA. msanderson@mmc.edu.
Maureen
0000-0002-3914-6870
M
Sanderson
Department of Family and Community Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN, 37208, USA.
Juan R
JR
Canedo
Departments of Obstetrics and Gynecology and Cancer Biology, Vanderbilt University Medical Center, Nashville, TN, USA.
Dineo
D
Khabele
Department of Family and Community Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN, 37208, USA.
Mary K
MK
Fadden
Department of Family and Community Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN, 37208, USA.
Cynthia
C
Harris
Matthew Walker Comprehensive Health Center, Nashville, TN, USA.
Katina
K
Beard
Memphis Health Center, Memphis, TN, USA.
Marilyn
M
Burress
Southside/Dodson Avenue Community Health Centers, Chattanooga, TN, USA.
Helen
H
Pinkerton
Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA.
Cynthia
C
Jackson
Department of Family and Community Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN, 37208, USA.
Tilicia
T
Mayo-Gamble
Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA.
Margaret K
MK
Hargreaves
Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA.
Pamela C
PC
Hull
D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data*; D002648:Child; D016000:Cluster Analysis; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D033182:Intention; D008297:Male; D009042:Motivation; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010353:Patient Education as Topic / Q000379:methods*; D012189:Retrospective Studies; D064876:Safety-net Providers / Q000379:methods*; D013714:Tennessee
D053918:Papillomavirus Vaccines
African American; HPV vaccine; Hispanic; Provider intervention; Safety-net clinics; Underserved