Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Elizabeth Tovar

Clinical Mentor

Dr. Lynne Jensen

Committee Member

Dr. Mollie Aleshire


Background: Human papillomavirus (HPV) vaccines have been shown to be effective against HPV types that are linked to cervical, vaginal, vulvar, penile, anal, and oropharyngeal cancers. Despite Advisory Committee on Immunization Practices (ACIP) recommendations that all 11-12 year old males and females in the U.S. should be vaccinated with the three-dose HPV vaccine series, vaccination rates remain low. In 2012, only 34.9% of adolescent females and 6.8% of adolescent males completed the series. Efforts to increase vaccination rates are needed, and healthcare providers have been shown to be an important part of the solution.

Purpose: This investigation was conducted to determine providers’ current practices regarding HPV vaccine recommendation, consistency with following ACIP guidelines, and perceived facilitators and barriers to recommending the HPV vaccine.

Methods: This descriptive study utilized a retrospective chart review of all 11-12 year old adolescents presenting to a primary care clinic for a well-child exam between April 23, 2013 and September 30, 2013. Charts were audited for patient demographics, whether HPV vaccination counseling was offered and by whom, patient response (accepted/declined/deferred), if the vaccine was initiated, and if it was completed. Additionally, an anonymous provider survey was administered via REDCap and a provider focus group was conducted to elicit perceived facilitators and barriers to recommending the vaccine.

Results: Chart audits (N= 60) revealed that 42% of the adolescents initiated the vaccine, and only 14% completed the series within the CDC recommended interval. Review of provider documentation revealed that counseling and/or provider recommendation was documented in only 11 of 60 charts. Barriers to vaccine initiation included recommending the vaccine more often to female than male patients, language barriers, low medical literacy, time constraints, inconsistent patient follow-up, and patient/parent concerns about long-term safety.

Recommendations: Based on focus group discussion, suggestions to improve HPV vaccination rates included offering a strong provider recommendation for HPV vaccination to all adolescent patients, standardizing documentation of HPV vaccine recommendation, and using the EMR to improve return rates for second and third vaccine dose.