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Original Investigation
May 7, 2018

Effect of a Health Care Professional Communication Training Intervention on Adolescent Human Papillomavirus Vaccination: A Cluster Randomized Clinical Trial

Author Affiliations
  • 1Adult and Child Consortium for Outcomes Research and Dissemination Science (ACCORDS), University of Colorado Denver, Aurora
  • 2Division of General Pediatrics, Department of Pediatrics, University of Colorado Denver, Aurora
  • 3Center for Public Health Practice, Colorado School of Public Health, University of Colorado Denver, Aurora
  • 4National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
  • 5Department of Biostatistics, Colorado School of Public Health, University of Colorado Denver, Aurora
  • 6Division of Infectious Diseases, Department of Pediatrics, University of Colorado Denver, Aurora
JAMA Pediatr. 2018;172(5):e180016. doi:10.1001/jamapediatrics.2018.0016
Key Points

Question  Does implementation of an intervention to improve primary care professionals’ human papillomavirus (HPV) vaccine communication lead to increases in adolescent human papillomavirus vaccination?

Finding  Among 43 132 patients at 16 practices participating in this cluster randomized clinical trial, a 5-component intervention significantly increased HPV vaccine series initiation, stopped decline of completion, and was effective for both boys and girls. Two specific intervention components, communication training and customized HPV fact sheets, were the most used and useful based on health care professionals’ report.

Meaning  Disseminating this intervention widely among primary care professionals could substantially increase national adolescent HPV vaccination levels, particularly among boys.


Importance  The incidence of human papillomavirus (HPV)–related cancers is more than 35 000 cases in the United States each year. Effective HPV vaccines have been available in the United States for several years but are underused among adolescents, the target population for vaccination. Interventions to increase uptake are needed.

Objective  To evaluate the effect of a 5-component health care professional HPV vaccine communication intervention on adolescent HPV vaccination.

Design, Setting, and Participants  A cluster randomized clinical trial using covariate-constrained randomization to assign study arms and an intent-to-treat protocol was conducted in 16 primary care practices in the Denver, Colorado, metropolitan area. Participants included 188 medical professionals and 43 132 adolescents.

Interventions  The 5 components of the intervention were an HPV fact sheet library to create customized information sheets relevant to each practice’s patient population, a tailored parent education website, a set of HPV-related disease images, an HPV vaccine decision aid, and 2½ hours of communication training on using a presumptive vaccine recommendation, followed by motivational interviewing if parents were resistant to vaccination. Each practice participated in a series of 2 intervention development meetings over a 6-month period (August 1, 2014, to January 31, 2015) before the intervention.

Main Outcomes and Measures  Differences between control and intervention changes over time (ie, difference in differences between the baseline and intervention period cohorts of patients) in HPV vaccine series initiation (≥1 dose) and completion (≥3 doses) among patients aged 11 to 17 years seen at the practices between February 1, 2015, and January 31, 2016. Vaccination data were obtained from the practices’ records and augmented with state immunization information system data.

Results  Sixteen practices and 43 132 patients (50.3% female; median age, 12.6 years [interquartile range, 10.8-14.7 years] at the beginning of the study period) participated in this trial. Adolescents in the intervention practices had significantly higher odds of HPV vaccine series initiation (adjusted odds ratio [aOR], 1.46; 95% CI, 1.31-1.62) and completion (aOR, 1.56; 95% CI, 1.27-1.92) than those in the control practices (a 9.5–absolute percentage point increase in HPV vaccine series initiation and a 4.4–absolute percentage point increase in HPV vaccine series completion in intervention practices). The intervention had a greater effect in pediatric practices compared with family medicine practices and in private practices compared with public ones. Health care professionals reported that communication training and the fact sheets were the most used and useful intervention components.

Conclusions and Relevance  A health care professional communication intervention significantly improved HPV vaccine series initiation and completion among adolescent patients.

Trial Registration  clinicaltrials.gov Identifier: NCT02456077