VCOM Carolinas Research Day 2023

Clinical Studies

An Evaluation of South Carolina Provider Knowledge of and Comfortability in Discussing HPV Vaccination Jessica Diaz Rijo, OMS IV; Jenna Magri MS,OMS IV; Alexis Stoner, PhD, MPH Edward Via College of Osteopathic Medicine, Dept. Preventive Medicine and Public Health, Spartanburg, S.C. David Redden, PhD; Lisa Carlson, MD; Karen Fradua MS, MCHE

Abstract # CLIN-18

Abstract

Results

Results

➢ The youngest age of discussion initiation is 9 years old, though the majority (49%) do so at 11-12 years old. ➢ 84.6% utilize an age dependent approach. Of risk stratification users, gender, age, and insurance status were the most common patient factors. ➢ 91.4% of providers discuss the vaccine with other childhood vaccinations. ➢ The majority knew that HPV is associated with cancers of the cervix, vagina, vulva, penis, anus, and oropharynx; 28.8% correctly selected all of these cancers. 59.3% knew the mode of HPV transmission as direct skin to skin contact and 57.6% knew that HPV screening is performed using DNA tests. ➢ 32.2% knew there is only one vaccine currently in clinical use in the U.S. All providers correctly responded that the HPV vaccine is multi-dose and provides protection against the main strains associated with HPV-related cancers.

Table 4.

➢ A cross-sectional, anonymous survey created in Qualtrics distributed to S.C. providers including pediatricians and family medicine providers. Providers included Vaccines for Children participants and those associated with Spartanburg Regional Healthcare System and South Carolina Department of Health and Environmental Control. ➢ Survey consisted of questions pertaining to current clinical practices, availability of onsite HPV vaccines, geographic data points, provider knowledge of HPV, HPV-related diseases, the HPV vaccine, level of knowledge of HPV and the HPV vaccine, provider’s comfort level in discussing the HPV vaccine with patients and their guardians, provider’s ability to provide a strong endorsement of vaccinations including the HPV vaccine, and previous formal training on discussing sex and sex related topics. Survey concluded with a section for respondents to submit comments about topics on which they would be interested in receiving further training or information. ➢ Surveys were distributed via link embedded in email, remained open for at least 1 month of response collection. ➢ Data was analyzed by VCOM statistician. HPV is the most common sexually transmitted infection in the world and known to be associated with cervical, vaginal, vulvar, penile, oropharyngeal and anal cancers (1,2). Despite the HPV vaccine’s effectiveness at preventing over 90% of HPV related cancers (3), the rates of HPV vaccination have remained low in the United States, with South Carolina repeatedly below the national average. Providers play a key role in increasing vaccination statistics as the highest level of medical authority to their patients and their families. Provider knowledge, communication methods, ability to endorse vaccines, and comfortability in addressing HPV and sex-related topics, all affect their HPV vaccination discussion with patients and their guardians. Previous studies have shown lower HPV vaccination rates when providers utilize a risk stratification model of which patients to discuss the vaccine and when providers lack comfortability in discussing sex and sex-related topics, such as HPV (4,5). Research directed toward understanding areas of weakness in the provider’s role in HPV vaccination discussions, specifically in South Carolina, is lacking. Our study aims to identify areas of insufficient knowledge about HPV, HPV-related diseases, and the HPV vaccine, as well as evaluate provider comfortability in discussing topics related to HPV, the HPV vaccine, and initiating conversations about sex. Methods HPV vaccination in adolescents is the most effective method of preventing cervical cancer and other HPV related diseases. Unfortunately, S.C. HPV vaccination rates are consistently below the national average, putting children at unnecessary risk for a preventable disease. Previous studies have highlighted that physicians and providers play a significant role in increasing these rates. However, providers must possess adequate HPV knowledge, utilize effective methods of communication, and feel comfortable addressing sex-related topics to successfully educate patients on HPV and provide vaccination endorsement. In partnership with SC-DHEC and Spartanburg Regional Healthcare System, VCOM developed a cross-sectional, anonymous survey sent to S.C. physicians including pediatricians and family medicine practitioners, as well as participants of the federal Vaccines for Children program. This survey aimed to evaluate weak areas of provider knowledge of HPV and the vaccine using fact-based multiple-choice questions. Additionally, it included self-ranking questions to evaluate provider comfortability in discussing the HPV vaccine and sex-related topics. The results of the study showed that the youngest age providers start discussing the HPV vaccine is nine years old. Of those who participated, 91.4% of physicians stated they discuss the HPV vaccine with other childhood vaccinations as opposed to separately. Overall, 78.3% of participants reported having sufficient knowledge about the HPV to discuss the disease with patients and/or their guardians and 76.3% selected having sufficient knowledge. However, only 60% of providers were able to correctly identify that HPV is transmitted by direct skin to skin contact. A percentage of providers reported feeling uncomfortable discussing sex- related topics and HPV with their patients due to the patients/guardians’ reactions to the topic or lack of time during office visits. Accordingly, they conveyed the desire for formal training in discussing these topics with patients. Most participants stated strongly endorsing childhood vaccines, including the HPV vaccine, and note having sufficient training to endorse the HPV vaccine. From the results of our study, we were able to conclude that on average, providers feel comfortable endorsing the HPV vaccine, but some do not feel comfortable initiating discussions about reproductive health with their patients and/or guardians. And although providers report feeling they have sufficient knowledge of HPV and the HPV vaccine, the results of fact-based questions on these topics do not always agree. With this information, it is our hope to aid in directing development of educational training for providers, that will ultimately lead to increased HPV vaccination rates in S.C. Introduction

Table 1.

References 1. “STD Facts - Human Papillomavirus (HPV).” Centers for Disease Control and Prevention , Centers for Disease Control and Prevention, 12 Apr. 2022. 2. Kasymova, Salima, et al. “Knowledge and Awareness of Human Papillomavirus among College Students in South Carolina.” Infectious Diseases: Research and Treatment , vol. 12, 2019, p. 117863371882507. 3. “HPV Vaccination: What Everyone Should Know.” Centers for Disease Control and Prevention , Centers for Disease Control and Prevention, 16 Nov. 2021 4. Jennifer L. Moss, Melissa B. Gilkey, Barbara K. Rimer & Noel T. Brewer (2016) Disparities in collaborative patient provider communication about human papillomavirus (HPV) vaccination, Human Vaccines & Immunotherapeutics, 12:6, 1476-1483. 5. Alexander AB, Best C, Stupiansky N, Zimet GD. A model of healthcare provider decision making about HPV vaccination in adolescent males. Vaccine 2015; 33(33):4081-6; PMID:26143612; http://dx.doi.org/10.1016/j.vaccine.2015.06.085. Acknowledgement s South Carolina Department of Health and Environmental Control, Spartanburg Regional Healthcare System, SC-DHEC Adolescent Task Force, Dr. Lisa Carroll, Staci Roberts. VCOM IRB: 2021-034, Approved 4/20/2022 ➢ 98.2% of respondents strongly endorse the HPV vaccine and 96.4% of respondents strongly endorse childhood vaccination. ➢ No participants reported not strongly endorsing the HPV vaccine and only 1.8% selected not strongly recommending childhood vaccinations. A small percentage of 1.8% responded being unsure if they strongly endorse both childhood and HPV vaccine. Conclusions ➢ The majority of people felt comfortable or very comfortable discussing HPV/related diseases and the HPV vaccine. A small percentage of providers indicated feeling very uncomfortable. Similar results were seen with sex-related topics. Despite the majority reporting comfortability discussing these topics, there were still respondents who felt slightly uncomfortable or neutral. This is consistent with the requests for further training in discussing sex-related topics. ➢ There is a discordance between providers’ perceived knowledge level of HPV and the HPV vaccine and the percentage of correct answers on fact-based questions covering the same topics. Despite over 90% of providers stating they feel they have sufficient or excessive knowledge about HPV and the HPV vaccine, only about 60% correctly identified the route of transmission and 29% correctly identified all of the HPV-associated cancers. ➢ There are areas of weakness in provider knowledge regarding HPV and the HPV vaccine as discussed previously and there is a portion of providers that feel uncomfortable with having such discussions. ➢ The overwhelming majority of providers stated they possess the ability to strongly endorse vaccinations. ➢ Limitations include small population size (66 respondents), lack of representation from every county in SC, and routine biases encountered in a survey study. Of note, 74% of respondents were part of the Vaccines for Children federal program which may have limited the data as representation of providers across the state. ➢ Future studies could compare the HPV vaccination rates before and after providers have completed HPV training to determine if training has affected the levels of HPV vaccination in S.C.. Religion was not considered in this study and may play a role in low HPV vaccination rates in S.C.

➢ More than half of respondents selected they had sufficient knowledge of both HPV and its associated diseases, as well as the HPV vaccine (78.3% and 76.3%, respectively). ➢ No participants had no knowledge and 3.4% had little to some knowledge on the HPV vaccine. Table 2.

➢ Regarding discussions of HPV, 5.4% felt very uncomfortable, 3.6% were neutral, 57.1% felt comfortable, and 33.9% felt very comfortable. ➢ Regarding discussions of HPV-related diseases 3.6% felt very uncomfortable, 1.8% were neutral, 62.5% felt comfortable, and 32.1% felt very comfortable. ➢ Regarding discussions of the HPV vaccine, 1.8% felt very uncomfortable, 1.8% were neutral, 58.9% felt comfortable, and 37.5% felt very comfortable. Table 3.

➢ Assessment of provider comfort level in discussing sex and sex-related topics the results showed 3.6% were slightly comfortable, 5.4% were neutral, 67.9% were comfortable, and 23.2% were very comfortable.

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