Problem/Significance: In the United States, HPV is the most predominant sexually transmitted infection (CDC, 2016). HPV causes cervical cancer, genital warts, penile cancer, vaginal cancer, anal cancer, and oropharyngeal cancer (CDC, 2016). Gardasil 9 is a vaccine given twice over a six to 12 month period that prevents individuals from contracting the most prevalent HPV strains (NCI, 2016). At present, there is no legislative mandate requiring eligible individuals to be vaccinated for HPV in most of the United States. The CDC predicts that increasing vaccination rates to 80% will prevent 53,000 women from developing cervical cancer (Merck, 2014). In the United States in 2010, the estimated costs for cervical cancer treatments and screening measures totaled eight billion dollars (Chesson et al., 2012).
Literature Review: A comprehensive search of the literature was conducted via the online library services of Saint Mary’s College. EBSCO host was used to search within the CINAHL-FT and PubMed databases. The John Hopkins Evidenced-Based Model was used to critique each article. The literature review included four randomized controlled trials, one quasi-experimental study, three qualitative studies, and nine cross-sectional studies of which three were Grade A and 14 were Grade B. A majority of the literature found that males and minorities have significantly lower uptake levels of the HPV vaccine. There was an overall consensus between the studies that a generalized educational leaflet versus a video is the best educational intervention to improve HPV knowledge vaccination initiation. A qualitative interview identified the importance of portraying the message to adolescents that Gardasil 9 prevents cancer and genital warts, and that the vaccine is safe.
Study Design: Convenience sampling was used to recruit potential candidates. 80 subjects participated in the study. Thirty-five were Black, 43 were Hispanic, one was White, and one identified herself as “other.” Sixty-two were English speakers, and 18 were Spanish speakers. Participants were given an educational leaflet to review prior to their exam visit. Participants completed a demographic data form. The Medical Assistant then indicated at the end of the exam visit if the patient declined or accepted the vaccine.
Results: Thirty-two participants initiated the vaccine. There was a 1500% increase in the initiation rate of Gardasil 9 vaccines during the study compared to a four week period prior to the study. No statistical difference was found between the variables of the demographic data including language, schooling, race, and age for initiation of the vaccine using chi-square analysis. Twenty-two English speakers and 10 Spanish speakers initiated the vaccine. Of the initiators, 13 were Black and 19 were Hispanic.
Implications: Implementation of an evidenced-based practice into a clinic setting to improve Gardasil 9 uptake rates amongst adolescents prior to sexual activity has the potential to decrease healthcare costs, deaths, diseases, and emotional ramifications related to treatments and procedures for HPV disease causing cancers. Short of achieving a legislative mandate, healthcare providers need to respond to the need to create herd immunity against the most prevalent HPV strains. This study supports previous research that an educational leaflet is an effective tool to educate patients about HPV. Further studies need to identify framing messages to address each demographic population in order to identify the best leaflet to provide to each subset group. Additional quality improvement projects should include multifactorial methods to increase the number of patients getting vaccines. Research should evaluate the best teaching tools for males and parents of adolescents. Further studies need to evaluate the best methods to ensure patients complete the vaccine series.