Year of Award


Document Type

Professional Paper

Degree Type

Master of Science (MS)

Degree Name

Health and Human Performance (Community Health Option)

Department or School/College

Health and Human Performance

Committee Chair

Dr. Sophia Newcomer

Commitee Members

Dr. Annie Sondag, Dr. Allison Young


human papillomavirus, behavior theory, hpv, vaccine, health behavior


University of Montana

Subject Categories

Community Health and Preventive Medicine


Human papillomavirus (HPV) is the most common sexually transmitted disease in adults in the United States (US). Persistent HPV infection can cause several cancers, including cervical, oropharyngeal, and anal cancer. To prevent these cancers, the U.S. Advisory Committee on Immunization Practices recommends that all adolescents start the HPV vaccine series at ages 11-12 years. Despite the safety and efficacy of available HPV vaccines, vaccine uptake rates remain lower than public health goals. In the US, only 51.1% of eligible adolescents have completed the vaccine series, a rate lower than the Healthy People 2020 goal of 80% coverage for series completion. In Montana, only 53% of females and 43.9% of males have completed the series. Suboptimal HPV vaccine uptake rates and existent disparities must be addressed to decrease HPV-attributable cancer risk. This paper describes which interventions may be effective in increasing HPV vaccination rates in Montana through a review of the literature on HPV vaccination interventions and their use of health behavior theories, and an analysis of local parent and adolescent feedback about HPV vaccination. The literature review focused on education interventions, provider communication interventions, and health systems interventions to increase HPV vaccine uptake. I found that the use of health behavior theories to inform HPV vaccination interventions was inconsistently reported in published studies of interventions; however, several health behavior theories did support the potential for effectiveness of certain interventions. For example, stage behavior theories may provide tools to move a parent from hesitancy to willingness to vaccinate. The behavior theory constructs of subjective norms and cues to action support provider recommendation and reminder/recall interventions. Most HPV vaccination interventions that I identified were conducted in urban populations, which limits their generalizability to rural populations like those in Montana. However, local parents emphasized the importance of reminders to complete the HPV vaccine series. Provider recommendations were also highly valued. This literature review and analysis of local parent and adolescent feedback provides valuable information for stakeholders seeking to increase HPV vaccine uptake in adolescents.



© Copyright 2020 Gretchen Elizabeth Neal