“I give the kids my warty gourd story”: A qualitative study on public health nurses’ experiences with human papillomavirus (HPV) vaccination in Montana

Authors' Names

Juthika Jayendra Thaker, The University Of MontanaFollow

Presentation Type

Oral Presentation

Category

STEM (science, technology, engineering, mathematics)

Abstract/Artist Statement

Approximately 35,000 HPV-attributable cancers are diagnosed in the United States annually. Rural communities face a higher burden of HPV-attributed infections and cancers compared to urban areas due to lower vaccination coverage. The CDC recommends a 2-dose or a 3-dose HPV vaccine series depending on the age of the initial vaccination. Only 53% of eligible adolescents in Montana had completed the HPV vaccine series. While research on vaccine delivery systems has focused mainly on private clinics, rural adolescents rely on public health facilities for their immunization needs. A thorough understanding of public health nurses’ role in improving community vaccination rates will facilitate the deployment of effective evidence-based strategies to improve HPV vaccine uptake.

We used a positive deviance approach to select the study participants. Using data from Montana’s centralized immunization information system, we identified rural public health departments with the highest and the lowest HPV vaccination rates and invited immunization nurses from these facilities to participate in a 45-minute interview. The questions in the interview guide were developed based on the literature review, the Consolidated Framework for Implementation Research (CFIR), and the study objectives. CFIR categorizes five organizational and participant-related domains that influence the successful implementation of an intervention; the study intervention being the recommendation and administration of the HPV vaccine. We used a content analysis approach to identify themes and sub-themes within the CFIR domains to report our findings.

Interviews with 21 nurses reveal that a lack of robust reminder/recall systems, beliefs about autonomy and ownership, quality improvement initiatives, and vaccine recommendation styles influence community HPV vaccination rates. Participants highlighted the need to engage adolescents through tailored vaccine messaging, create training opportunities for nurses in vaccine conversations, invest in social media campaigns to raise awareness, encourage collaborations with schools and community organizations, and promote HPV vaccination at every patient encounter.

Mentor Name

Sophia Raff Newcomer

Personal Statement

The opportunity to work with one of Asia’s biggest cancer hospitals provided me with first-hand experience of the emotional, physical, and financial toll that cancer brings upon patients and families. During my time there, I learned that rural communities faced the wrath of cancer the most because of the glaring health disparities stemming from higher cancer rates, lower vaccination rates, and limited healthcare access. Often referred to as the ‘silent killer’ and almost entirely preventable through HPV vaccination and screening, cervical cancer is termed a “disease of inequity of access” by the WHO. Mounting evidence also shows that the HPV vaccine is effective against other anogenital and oropharyngeal cancers. However, about 47% of Montana adolescents are unvaccinated and remain vulnerable to HPV-associated cancers. HPV vaccine hesitancy is rooted in the stigma attached to the HPV vaccine being a medium to protect against a “sexually transmitted disease”. There is a pressing need to implement strategies to address vaccine hesitancy and boost HPV vaccine uptake. Research on vaccine delivery systems has largely focused on pediatricians and family medicine practitioners. In rural areas, public health nurses play a crucial role in implementing programs to improve community health. Due to their close relationship with the community members, public health nurses are strategically positioned to positively influence health behaviors to achieve desired health outcomes. Our research study attempts to engage public health nurses and facilitate the exchange of ideas on improving community rates of adolescent vaccination, breaking the silos in public health decision-making, and providing public health nurses with an opportunity to have their voices heard. We have collaborated with the Immunization Program section at the Montana DPHHS for this project and are identifying appropriate channels to disseminate our findings widely to those who would benefit from it, GRADCON being one such platform.