Year of Publication

2020

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Elizabeth Tovar

Clinical Mentor

Lindsey Brough, APRN

Committee Member

Dr. Angela Grubbs

Committee Member

Dr. Marianne Hutti

Abstract

BACKGROUND: Nationwide more than 90% of cervical cancer cases are caused by the human papilloma virus (HPV). Cervical cancer can be largely prevented by administration of the HPV vaccine for children before becoming sexually active. However, vaccination rates in the United States, remain low at 60%, and only 39.7% through series of completion, despite the strong evidence to support the effectiveness of the HPV vaccine. Research indicates a clinician’s recommendation, providing information and opportunity for discussion about the vaccine are strong motivators for parents to vaccinate their children, regardless of ethnicity. This study addresses the barriers to parent/caregiver intent to vaccinate, and clinician time to discuss the vaccine, by implementing an RN-led educational intervention regarding the HPV vaccine for 11-17 year-old children.

Purpose: The purpose of this study is to evaluate the effect of an RN-led educational intervention on 1) parent/caregiver intent to initiate the HPV vaccination 2) to evaluate effect on HPV vaccination rates, and 3) evaluate satisfaction with the education provided in a pediatric primary care clinic.

Methods: The design was a multi-phased quasi- experimental pre/post baseline assessment study that had 4 phases: a chart review (Phase 1), a study introduction (staff meeting: Phase 2), an educational intervention (Phase 3), and an outcome evaluation (Phase 4). The RN-led education intervention focused on the caregiver of adolescent children to address questions and barriers regarding the HPV vaccine. The setting for all phases of the study were done at a pediatric primary care clinic in Southern Indiana. The clinic is responsible for the management and treatment of pediatric patients. The sample for the study included: any caregivers of 11-17 year-old children being seen in the office for a non-acute visit. These children had never received any doses of the HPV vaccine and were English speaking. Exclusion criteria was any caregiver of a 11-17 years of age being seen for a sick visit, or any that had previously received any dose of the HPV vaccine. Evaluation methods included: chart audit tool that recorded child demographics, information on HPV counseling provided, a pre- and post- educational survey to measure knowledge, intent to vaccinate, and evaluation of the educational intervention.

Results: Pre- intervention surveys indicated most parents had heard of HPV vaccinations (80%), knew that it was recommended (87%), and felt it was part of cancer prevention (100%). While scores increased, there were no significant differences between pre- versus post-educational intervention surveys in caregivers who intended to have their child receive the vaccination today (M=4.3 vs M=6.7) or in the future (M=5.9 vs 6.9). The HPV vaccination rates for the initial dose of the vaccine increased from 19.1% to 40.8%, and for any dose from 58.4% to 64.3%. These results indicate the clinic surpassed their goal of 60% after the intervention was provided. Post-survey results showed caregiver evaluation was favorable when measuring satisfaction and helpfulness with educational intervention provided. Vaccination rates improved after a 1:1 brief educational discussion between the caregiver the RN; this finding suggests that the 1:1 interaction to discuss facts and answer questions may be associated with improved vaccination rates.

Conclusion: HPV vaccination rates increased after a brief educational intervention regarding the HPV vaccine was provided to caregivers of 11-17 year-old children. This finding suggests that education may have been beneficial; however, overall vaccination rates were still low and the need for improvement remains. Future work should seek to identify which specific elements of this intervention contributed to the success and strategies to sustain the improvements as well as identify additional strategies to further improve vaccination rates. An important next step is to initiate efforts to increase vaccine series completion rates.

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