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ABSTRACT
Background: Practitioner communication is one of the most important influences and predictors of HPV vaccination uptake. The objective of this study was to conduct a latent class analysis characterizing pediatric practitioner HPV recommendation patterns.
Methods: Pediatric practitioners of the American Academy of Pediatrics’ (AAP) Pediatric Research in Office Settings (PROS) national network completed an online survey where they were presented with 5 hypothetical vignettes of well child visits and responded to questions. Questions asked about their use of communication strategies, assessments about the adolescent patient becoming sexually active in the next 2 years for decision-making about HPV vaccine recommendation, and peer norms. Latent class analysis characterized practitioner subgroups based on their response patterns to 10 survey questions. Multinomial logistic regression examined practitioner characteristics associated with each profile.
Results: Among 470 respondents, we identified three distinct practitioner HPV vaccine recommendation profiles: (1) Engagers (52%) followed national age-based guidelines, strongly recommended HPV vaccination, and perceived peers as strongly recommending; (2) Protocol Followers (20%) also strongly recommended HPV vaccination, but were less likely to engage families in a discussion about benefits; and (3) Ambivalent HPV Vaccine Recommenders (28%) delayed or did not recommend HPV vaccination and were more likely to use judgment about whether adolescents will become sexually active in the next two years. Practicing in a suburban setting was associated with twice the odds of being an Ambivalent Recommender relative to being an Engager (OR = 2.2; 95% CI:1.1–4.1).
Conclusions: Findings underscore the importance of continued efforts to bolster practitioner adoption of evidence-based approaches to HPV vaccine recommendation especially among Ambivalent Recommenders.
Acknowledgments
We thank the survey respondents from PROS for their participation.
Abbreviations
| CI | confidence interval |
| HPV | human papillomavirus |
| LCA | latent class analysis |
| OR | odds ratio |
| PROS | Pediatric Research in Office Settings |
Contributor’s Statement
Dr. Hopfer contributed to conceptualization and design of the study, developed the survey, conducted the statistical analyses, interpreted the data, and drafted the manuscript.
Dr. Wright assisted with editing the survey instrument, created it within the online survey platform, deployed the electronic survey to AAP members, and edited manuscript drafts.
Dr. Pellman contributed to discussions on conceptualization of the study design, contributed to survey development, and edited manuscript drafts.
Dr. Wasserman contributed to discussions on conceptualization of the study design, co-developed the survey instrument and focus of survey questions and clinical vignettes, and edited manuscript drafts.
Dr. Fiks contributed to discussions on conceptualization of the study design, co-developed the survey and focus of survey questions and clinical vignettes, and edited manuscript drafts.
Disclosure of potential conflicts of interest
No potential conflict of interest was reported by the authors. Dr. Fiks received an independent research grant from Pfizer for work unrelated to this manuscript. Though his research team received support, he personally took no support from this grant.