Top

Published in:

01-11-2016

Implementation of a Postpartum HPV Vaccination Program in a Southeast Texas Hospital: A Qualitative Study Evaluating Health Care Provider Acceptance

Authors: Tyra T. Gross, Mahbubur Rahman, Abigail M. Wright, Jacqueline M. Hirth, Kwabena O. Sarpong, Richard E. Rupp, Alan D. Barrett, Abbey B. Berenson

Published in: Maternal and Child Health Journal | Special Issue 1/2016

Abstract

Introduction The objective of this qualitative study was to assess healthcare providers’ acceptability of an ongoing postpartum human papillomavirus (HPV) vaccination program in Southeast Texas and its integration into everyday clinical care. Methods In 2012, the Department of Obstetrics & Gynecology at the University of Texas Medical Branch (UTMB) began offering HPV vaccination as part of standard postpartum care to increase vaccination rates among young women in Galveston County. Initial vaccine doses were offered on the postpartum unit while subsequent doses were coordinated with postpartum and well-baby visits. Thirty months after project initiation, semi-structured interviews of physicians (n = 12) and nurses (n = 6) involved in postpartum and pediatric care at UTMB were conducted. Interview transcripts were analyzed using thematic analysis in Nvivo10. Results Overall, providers demonstrated “pro-vaccine” attitudes and stated the program was an effective strategy for vaccinating hard-to-reach women. Cancer prevention was the main perceived benefit while follow-up compliance was the primary perceived patient barrier. The initial challenges with integrating postpartum HPV vaccination included miscommunication between providers regarding vaccine orders and coordination issues with well-baby visits for follow-up doses. One novel finding was providers’ beliefs that women’s personal HPV vaccine practices may positively impact their decisions about later vaccinating their children against HPV. Providers’ suggestions to improve the program included: enhancing postpartum HPV vaccine education for patients, offering more continuing education for providers, and increasing community awareness of HPV vaccination. Discussion These findings can help providers of postpartum care understand how to integrate postpartum HPV vaccination into their current practices and how to overcome perceived vaccination barriers.

Ayres, L. (2008). Semi-structured interview.The sage encyclopedia of qualitative research methods. Thousand Oaks, CA: SAGE Publications, Inc. doi:10.4135/9781412963909.n420.

Berenson, A. B., Rahman, M., Hirth, J. M., Rupp, R. E., & Sarpong, K. O. (2015). A brief educational intervention increases providers’ human papillomavirus vaccine knowledge. Human Vaccines & Immunotherapeutics, 11(6), 1331–1336. doi:10.1080/21645515.2015.1022691.CrossRef

Berenson, A. B., Rahman, M., Hirth, J. M., Rupp, R. E., & Sarpong, K. O. (2016). A human papillomavirus vaccination program for low-income postpartum women. American Journal of Obstetrics and Gynecology. doi:10.1016/j.ajog.2016.02.032.PubMed

Blake, K. D., Ottenbacher, A. J., Finney Rutten, L. J., Grady, M. A., Kobrin, S. C., Jacobson, R. M., & Hesse, B. W. (2015). Predictors of human papillomavirus awareness and knowledge in 2013: Gaps and opportunities for targeted communication strategies. American Journal of Preventive Medicine, 48(4), 402–410. doi:10.1016/j.amepre.2014.10.024.CrossRefPubMedPubMedCentral

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. doi:10.1191/1478088706qp063oa.CrossRef

Caskey, R., Stumbras, K., Rankin, K., Osta, A., Haider, S., & Handler, A. (2016). A novel approach to postpartum contraception: A pilot project of pediatricians’ role during the well-baby visit. Contraception and Reproductive Medicine, 2, 7. doi:10.1186/s40834-016-0018-1.CrossRef

Dempsey, A. F., Pyrzanowski, J., Brewer, S., Barnard, J., Sevick, C., & O’Leary, S. T. (2015). Acceptability of using standing orders to deliver human papillomavirus vaccines in the outpatient obstetrician/gynecologist setting. Vaccine, 33(15), 1773–1779. doi:10.1016/j.vaccine.2015.02.044.CrossRefPubMed

Dorell, C., Yankey, D., Kennedy, A., & Stokley, S. (2013). Factors that influence parental vaccination decisions for adolescents, 13 to 17 years old: National Immunization Survey-Teen, 2010. Clinical Pediatrics, 52(2), 162–170. doi:10.1177/0009922812468208.CrossRefPubMed

Dunne, E. F., Unger, E. R., Sternberg, M., McQuillan, G., Swan, D. C., Patel, S. S., & Markowitz, L. E. (2007). Prevalence of HPV infection among females in the United States. JAMA, 297(8), 813–819. doi:10.1001/jama.297.8.813.CrossRefPubMed

10.

Gall, S. A., & Poland, G. A. (2011). A maternal immunization program (MIP): Developing a schedule and platform for routine immunization during pregnancy. Vaccine, 29(51), 9411–9413. doi:10.1016/j.vaccine.2011.11.009.CrossRefPubMed

11.

Geraghty, S. R., Riddle, S. W., & Shaikh, U. (2008). The breastfeeding mother and the pediatrician. Journal of Human Lactation, 24(3), 335–339. doi:10.1177/0890334408321091.CrossRefPubMedPubMedCentral

12.

Guest, G., Macqueen, K. M., & Namey, E. E. (2012). Applied thematic analysis. Thousand Oaks, CA: SAGE Publications Inc.CrossRef

13.

Head, K. J., Vanderpool, R. C., & Mills, L. A. (2013). Health care providers’ perspectives on low HPV vaccine uptake and adherence in Appalachian Kentucky. Public Health Nursing, 30(4), 351–360. doi:10.1111/phn.12044.CrossRefPubMedPubMedCentral

14.

Healy, C. M., Montesinos, D. P., & Middleman, A. B. (2014). Parent and provider perspectives on immunization: are providers overestimating parental concerns? Vaccine, 32(5), 579–584.CrossRefPubMed

15.

Healy, C. M., Rench, M. A., & Baker, C. J. (2011). Implementation of cocooning against pertussis in a high-risk population. Clinical Infectious Diseases, 52(2), 157–162. doi:10.1093/cid/ciq001.CrossRefPubMed

16.

Hechter, R. C., Chao, C., Sy, L. S., Ackerson, B. K., Slezak, J. M., Sidell, M. A., & Jacobsen, S. J. (2013). Quadrivalent human papillomavirus vaccine uptake in adolescent boys and maternal utilization of preventive care and history of sexually transmitted infections. American Journal of Public Health. doi:10.2105/AJPH.2013.301495.PubMedPubMedCentral

17.

Kester, L. M., Zimet, G. D., Fortenberry, J. D., Kahn, J. A., & Shew, M. L. (2013). A national study of HPV vaccination of adolescent girls: rates, predictors, and reasons for non-vaccination. Maternal and Child Health Journal, 17(5), 879–885. doi:10.1007/s10995-012-1066-z.CrossRefPubMedPubMedCentral

18.

Krawczyk, A., Lau, E., Perez, S., Delisle, V., Amsel, R., & Rosberger, Z. (2012). How to inform: Comparing written and video education interventions to increase human papillomavirus knowledge and vaccination intentions in young adults. Journal of American College Health, 60(4), 316–322. doi:10.1080/07448481.2011.615355.CrossRefPubMed

19.

Lefevere, E., Hens, N., Theeten, H., Van den Bosch, K., Beutels, P., De Smet, F., & Van Damme, P. (2011). Like mother, like daughter? Mother’s history of cervical cancer screening and daughter’s human papillomavirus vaccine uptake in Flanders (Belgium). Vaccine, 29(46), 8390–8396. doi:10.1016/j.vaccine.2011.08.039.CrossRefPubMed

20.

Liberto, T. L. (2012). Screening for depression and help-seeking in postpartum women during well-baby pediatric visits; and integrated review. Journal of Pediatric Health Care, 26(2), 109–117. doi:10.1016/j.pedhc.2010.06.012.CrossRefPubMed

21.

Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Newbury Park, CA: Sage.

22.

Markovitz, A. R., Song, J. Y., Paustian, M. L., & El Reda, D. K. (2014). Association between maternal preventive care utilization and adolescent vaccination: it’s not just about Pap testing. Journal of Pediatric and Adolescent Gynecology, 27(1), 29–36. doi:10.1016/j.jpag.2013.08012.CrossRefPubMed

23.

Markowitz, L. E., Dunne, E. F., Saraiya, M., Chesson, H. W., Curtis, C. R., Gee, J., et al. (2014). Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. Morbidity and Mortality Weekly Report, 63(RR05), 1–30.

24.

Markowitz, L. E., Dunne, E. F., Saraiya, M., Lawson, H. W., Chesson, H., & Unger, E. R. (2007). Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep, 56(RR-2), 1–24.PubMed

25.

Montealegre, J. R., Gossey, J. T., Anderson, M. L., Chenier, R. S., Chauca, G., Rustveld, L. O., & Jibaja-Weiss, M. L. (2014). Implementing targeted cervical cancer screening videos at the point of care. Patient Education and Counseling, 97(3), 426–429. doi:10.1016/j.pec.2014.09.003.CrossRefPubMed

26.

Ortiz, F. M., Jimenez, E. Y., Boursaw, B., & Huttlinger, K. (2016). Postpartum care for women with gestational diabetes. The American Journal of Maternal/Child Nursing, 41(2), 116–122. doi:10.1097/NMC.0000000000000215.CrossRef

27.

Palys, T. (2008). Purposive Sampling. In Lisa M. Given (Ed.), The Sage Encyclopedia of Qualitative Research Methods (pp. 698–699). Thousand Oaks, CA: SAGE Publications Inc. doi:10.4135/9781412963909.n349.

28.

Rama, C. H., Villa, L. L., Pagliusi, S., Andreoli, M. A., Costa, M. C., Thomann, P., et al. (2010). Opportunity for catch-up HPV vaccination in young women after first delivery. Journal of Epidemiology and Community Health, 64(7), 610–615. doi:10.1136/jech.2008.086439.CrossRefPubMed

29.

Spencer nee Pilkington, A. M., Brabin, L., Verma, A., & Roberts, S. A. (2013). Mothers’ screening histories influence daughters’ vaccination uptake: an analysis of linked cervical screening and human papillomavirus vaccination records in the North West of England. European Journal of Cancer, 49(6), 1264–1272. doi:10.1016/j.ejca.2012.12.001.CrossRefPubMed

30.

Taveras, E. M., Blackburn, K., Gillman, M. W., Haines, J., McDonald, J., Price, S., & Oken, E. (2011). First steps for mommy and me: A pilot intervention to improve nutrition and physical activity behaviors of postpartum mothers and their infants. Maternal and Child Health Journal, 15(8), 1217–1227. doi:10.1007/s10995-010-0696-2.CrossRefPubMedPubMedCentral

31.

Williams, W. W., Lu, P. J., Saraiya, M., Yankey, D., Dorell, C., Rodriguez, J. L., et al. (2013). Factors associated with human papillomavirus vaccination among young adult women in the United States. Vaccine, 31(28), 2937–2946. doi:10.1016/j.vaccine.2013.04.041.CrossRefPubMed

32.

Wright, J. D., Govindappagari, S., Pawar, N., Cleary, K., Burke, W. M., Devine, P. C., et al. (2012). Acceptance and compliance with postpartum human papillomavirus vaccination. Obstetrics and Gynecology, 120(4), 771–782. doi:10.1097/AOG.0b013e31826afb56.CrossRefPubMed

33.

Yeh, S., Mink, C., Kim, M., Naylor, S., Zangwill, K. M., & Allred, N. J. (2014). Effectiveness of hospital-based postpartum procedures on pertussis vaccination among postpartum women. American Journal of Obstetrics and Gynecology, 210(3), 237 e231–236.CrossRef

34.

Ylitalo, K. R., Lee, H., & Mehta, N. K. (2013). Health care provider recommendation, human papillomavirus vaccination, and race/ethnicity in the US National Immunization Survey. American Journal of Public Health, 103(1), 164–169. doi:10.2105/ajph.2011.300600.CrossRefPubMedPubMedCentral

35.

Zhan, F. B., & Lin, Y. (2014). Racial/Ethnic, socioeconomic, and geographic disparities of cervical cancer advanced-stage diagnosis in Texas. Women’s Health Issues, 24(5), 519–527. doi:10.1016/j.whi.2014.06.009.CrossRefPubMed

Title: Implementation of a Postpartum HPV Vaccination Program in a Southeast Texas Hospital: A Qualitative Study Evaluating Health Care Provider Acceptance
Authors: Tyra T. Gross
Mahbubur Rahman
Abigail M. Wright
Jacqueline M. Hirth
Kwabena O. Sarpong
Richard E. Rupp
Alan D. Barrett
Abbey B. Berenson
Publication date: 01-11-2016
Publisher: Springer US
Published in: Maternal and Child Health Journal / Issue Special Issue 1/2016
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI: https://doi.org/10.1007/s10995-016-2030-0

At a glance: The STEP trials

Springer Medicine

Implementation of a Postpartum HPV Vaccination Program in a Southeast Texas Hospital: A Qualitative Study Evaluating Health Care Provider Acceptance

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Special Issue 1/2016

Application of Implementation Science Methodology to Immediate Postpartum Long-Acting Reversible Contraception Policy Roll-Out Across States

Enhancing Breastfeeding Through Healthcare Support: Results from a Focus Group Study of African American Mothers

Guidelines and Interventions Related to the Postpartum Visit for Low-Risk Postpartum Women in High and Upper Middle Income Countries

Maternal Health Risk Assessment and Behavioral Intervention in the NICU Setting Following Very Low Birth Weight Delivery

The Effect of Stressful Life Events on Postpartum Depression: Findings from the 2009–2011 Mississippi Pregnancy Risk Assessment Monitoring System

National Initiatives to Improve Systems for Postpartum Care