Physician Recommendations for HPV Vaccine Can Affect Parents’ Choices

Clear, strong endorsement most likely to persuade reluctant parents

​PHILADELPHIA — The language a physician uses when recommending the human papillomavirus (HPV) vaccine appears to influence parents’ willingness to have their children vaccinated, according to a study published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

HPV causes most cases of cervical cancer and a large proportion of vaginal, vulvar, anal, penile, and oropharyngeal cancers. The U.S. Centers for Disease Control and Prevention (CDC) recommend that boys and girls receive the three-dose HPV vaccination beginning at age 11 or 12. However, as of 2015, only 42 percent of girls and 28 percent of boys ages 13 to 17 had completed the HPV vaccine series, according to CDC statistics. Teri L. Malo, PhD, MPH

Previous research has shown that recommendations from physicians are one of the strongest factors influencing parents’ decisions to have their adolescents receive the HPV vaccine. In this study, Teri L. Malo, PhD, MPH, a postdoctoral research associate at the UNC Lineberger Comprehensive Cancer Center and the Department of Health Behavior, Gillings School of Global Public Health, at the University of North Carolina at Chapel Hill, evaluated whether the specific language used by physicians would influence parents’ decisions. At the same time, Malo and colleagues evaluated physicians’ willingness to use certain language when recommending the vaccine. Noel Brewer, PhD, professor of health behavior at UNC Gillings School of Global Public Health and member of UNC Lineberger Comprehensive Cancer Center, is senior author of the research.

The researchers conducted national surveys of 1,504 parents of adolescents ages 11-17 and 776 primary care physicians. Parents were asked whether specific messages, including nine longer messages developed by the CDC and six brief messages developed by the study team, would persuade them to get the HPV vaccine for their adolescents. Physicians read only the six brief messages and indicated whether they would use them to persuade parents to get the HPV vaccine for their children.

The most persuasive brief message, with 65 percent of parents and 69 percent of physicians endorsing it, was: “I strongly believe in the importance of this cancer-preventing vaccine for [child’s name].”

Overall, parents were most likely to support messages that emphasized the effectiveness of the vaccine (70 percent support), cancers prevented by the vaccine (67 percent support), and safety of the vaccine (65 percent support). Three of the brief messages and eight of the longer messages were supported by at least half of the parents who responded, and there were no significant differences in support across demographic groups.

Physicians were most likely to endorse messages that emphasized the fact that the vaccine can prevent cancer (64 percent support).

Malo said she was surprised to discover that some parents who initially said they did not intend to vaccinate their children against HPV ultimately said that at least one of the messages would motivate them to agree to vaccination. Among this group, the most persuasive messages were those that emphasized the parent’s role in preventing the child from getting HPV-related cancers and those that emphasized their role in whether their child becomes infected with HPV.

Malo said that existing research has shown that most parents who avoid the HPV vaccine do so due to lack of information, a belief that the vaccination is unnecessary or unsafe, or not receiving a strong recommendation from their child’s physician.

“Each of these concerns can be addressed by talking with a provider, and so it’s important to understand what drives parents’ hesitation so that we can help improve provider communication to decrease hesitancy about HPV vaccine,” Malo said. “This finding really highlights the important role that parent-provider communication can play in increasing HPV vaccination.”

Malo said one limitation of the study is that it is based on self-reporting and does not account for clinical context, which could include non-verbal cues or modifications in the messages. She said further research would be required to determine whether parents’ support of the messages resulted in higher HPV vaccination rates.

This study was supported by grants from Pfizer and the National Cancer Institute. Malo declares no conflicts of interest. Brewer has received commercial research grants from Merck and Pfizer, has received speaker’s fees from Merck, and is a consultant/advisory board member for Merck.