BARRIERS TO HPV VACCINATION AT KALAMAZOO, MICHIGAN’S FEDERALLY-QUALIFIED HEALTH CENTER
BACKGROUND: Human Papillomavirus (HPV) is the most common STI in the US and a cause of genital warts and cancer. Even though the HPV vaccine is safe and effective, the vaccination rate is low among the general population. Studies have shown that the underserved population has an even lower rate of vaccination, but have not elucidated the reasons for this low rate. This population presents with a unique set of obstacles, including lack of access to healthcare, that places them at a higher risk for HPV infection sequelae. Our study aims to explore the factors contributing to the low rates of HPV vaccination at the Family Health Center (FHC) in Kalamazoo, a Federally Qualified Health Center (FQHC). By determining the barriers to vaccine completion, we can improve the health of our community.
METHODS: Surveys were administered to vaccine-eligible (9-27 years old, male and female) FHC patients from September 2017 to January 2018 to elucidate self-reported vaccination status and to identify barriers influencing vaccine acquisition.
RESULTS: Survey results (n=98) indicate that 46% of respondents (patients or patients’ guardians) completed the multi-dose vaccination course, with 61.5% of those being female. Furthermore, 50% of white respondents reported being vaccinated, in contrast to 29.4% of African Americans. Of those vaccinated, common factors cited for obtaining vaccination include: “physician recommendation” (44%), “heard it was important” (37.5%), and “health” (25%). Of those not fully vaccinated, common factors cited for not starting or completing vaccination include: “vaccine is unsafe” (21.4%), “newness of the vaccine” (14.3%), “uncertainty about the vaccine and its side effects” (14.3%). Interestingly, individuals who had started, but not completed, the vaccination course reported that their provider had not spoken to them about future vaccines either at the time of the last vaccination (87.5%) or during the visit on which they completed the survey (50%).
DISCUSSION: This study reveals significant disparities in vaccination rates between the sexes and different racial groups, and also highlights the positive influence physician recommendation has on vaccination. The gender disparity in vaccination is unique to the HPV vaccine compared to other vaccines. The racial disparities and the influence of physician recommendation are in trend with nationwide rates. Interestingly, the frequently cited barrier of the vaccine's potential effect on sexual behavior was expressed by 1 patient out of 98 surveyed, while previous studies have cited concerns over the sexualization of this vaccine. Based on our results, providers’ initiation to educate and remind patients about the HPV vaccine is a significant tool to minimize missed vaccination opportunities.