Less is more: Impact of a provider-based educational intervention on HPV vaccination rates

Introduction: Human papillomavirus (HPV) vaccination coverage remains low in the United States. In 2014 the Chicago Department of Public Health initiated an educational intervention targeting adolescent healthcare providers in Chicago using the “less is more” approach to recommending HPV vaccines to increase coverage rates. This approach emphasizes that providers strongly recommend the HPV vaccine with the same minimal dialogue and attention that other pediatric and adolescent vaccines are given. To assess its effectiveness, HPV vaccination rates were compared before and after the intervention.

Methods: “Less is more” education was provided to 42 Chicago clinics that provide care to at least 200 patients age 13-17 years. Clinic-level HPV vaccination data for 13-17 year olds were abstracted from the Illinois Comprehensive Automated Immunization Registry Exchange (I-CARE) and analyzed in CDC’s Comprehensive Clinic Assessment Software Application (CoCASA). Pre-intervention (January 2014) and post-intervention HPV vaccination rates to date (January 2015) were compared using Pearson’s chi-square test and considered significant at an alpha of 0.05. HPV vaccination rates during the same time period were also compared to a control sample of Illinois clinics located outside of Chicago.

Results: Among Chicago clinics, coverage for ≥1 HPV and ≥3 HPV doses increased significantly from the pre-intervention period to January 2015 from 50.2% to 57.4% (p-value <0.0001) and 15.4% to 21.2% (p-value <0.0001), respectively. Among females, coverage for ≥1 HPV and ≥3 HPV doses increased significantly from 52.6% to 59.1% (p-value <0.0001) and 19.4% to 24.6% (p-value <0.0001), respectively. Coverage rates also increased among control clinics outside of Chicago: 43.6% to 51.7% for ≥1 HPV dose and 14.0% to 17.8% for ≥3 HPV doses. Among females in control clinics, coverage rates increased from 48.3% to 55.0% for ≥1 HPV dose and 18.7% to 21.5% for ≥3 HPV doses.

Conclusions: Results to date indicate that healthcare provider use of the “less is more” approach when recommending the HPV vaccine to parents may improve HPV vaccination rates. The similar increase in coverage among Illinois control clinics may be a result of the intervention reaching providers located outside of Chicago (e.g. through statewide webinars). Coverage rates will continue to be analyzed to further assess the impact of the “less is more” approach.