Changes in Strength of Recommendation and Perceived Barriers to HPV Vaccination: Longitudinal Analysis of Primary Care Physicians, 2008-2018.

Abstract

OBJECTIVES\nTo evaluate among pediatricians and family physicians how human papillomavirus (HPV) vaccination recommendation practices for 11-12 year-old youth; report parental refusal/ deferral of HPV vaccination; and report barriers to HPV vaccination changed over time.\n\n\nSTUDY DESIGN\nWe surveyed nationally representative networks of pediatricians and family physicians in 2008, 2010, 2013-2014 and 2018. Male vaccination questions were not asked in 2008; barriers and parental vaccine refusal questions were not asked in 2010.\n\n\nRESULTS\nResponse rates were 80% in 2008 (680/848), 72% in 2010 (609/842), 70% in 2013-2014 (582/829), and 65% in 2018 (588/908). The proportion of physicians strongly recommending HPV vaccination for 11-12 year-old patients increased from 53% in 2008 to 79% in 2018 for female patients, and from 48% in 2014 to 76% in 2018 for male patients (both p<0.0001). The proportion of physicians indicating ≥50% of parents refused/deferred HPV vaccination remained steady for female patients (24% in 2008 vs. 22% in 2018, p=0.40) and decreased for male patients (42% in 2014 vs, 28% in 2018, p<0.001). Physician barriers to providing HPV vaccination were rare and decreased over time. Increasing numbers of physicians reported perceived parental barriers of vaccine safety concerns (5% major barrier in 2008 vs 35% in 2018, p<0.0001) and moral/religious concerns (5% in 2008 vs. 25% in 2018, P < .0001).\n\n\nCONCLUSIONS\nBetween 2008 and 2018, more primary care physicians reported recommending HPV vaccination for adolescents, fewer reported barriers, and more physicians reported parents had vaccine safety or moral/religious concerns.