Elsevier

Vaccine

Volume 36, Issue 26, 18 June 2018, Pages 3830-3835
Vaccine

An innovative medical school curriculum to address human papillomavirus vaccine hesitancy

https://doi.org/10.1016/j.vaccine.2018.05.014Get rights and content

Highlights

Abstract

Background

Vaccination rates against Human Papillomavirus (HPV) in the US remain alarmingly low. Physicians can significantly influence a parent’s decision to vaccinate their children. However, medical education often lacks training on specific strategies for communicating with vaccine hesitant parents.

Methods

We created an innovative curriculum designed to teach medical students how to address HPV vaccine hesitancy. The curriculum consisted of (1) a presentation on the epidemiology, biology, and disease morbidity associated with HPV, (2) a video that teaches specific communication strategies and (3) role-playing simulations. This curriculum was delivered to medical students at two separate sites. Medical students were surveyed before and after completing the educational curriculum. The surveys assessed student comfort talking to HPV vaccine hesitant parents and their likelihood to recommend the HPV vaccine.

Results

Pre- and post-intervention surveys were completed by 101 of the 132 participants (77% response rate). After the intervention, student awareness of the benefits of the HPV vaccine increased by a mean of 0.82 points (Likert scale 1–5, p < 0.01) and student comfort talking to vaccine hesitant parents increased by a mean of 1.37 points (p < 0.01). Prior to the intervention, students more strongly recommended the HPV vaccine to females compared to males, but this gender disparity was eliminated after the intervention (p < 0.01). Personal vaccination status was independately associated with a higher likelihood of recommending the HPV vaccine both before and after the intervention.

Conclusion

Our innovative curriculum improved medical student comfort level discussing HPV vaccination with hesitant parents and increased the perceived likelihood of recommending HPV vaccination. The intervention is easy to implement, scalable, and requires minimal resources. Educating future providers on this important topic has the potential to improve vaccination rates nationwide and thus should be considered for all medical students.

Introduction

Human Papillomavirus (HPV) is the most common sexually transmitted infection in the US, with approximately 14 million new cases occurring each year [1]. It is associated with the development of pre-invasive and invasive cancers of the cervix, vulva, vagina, anus, penis and oropharynx with over 38,000 HPV-associated cancers diagnosed in the US each year [2]. HPV vaccination holds promise for reduction of disease burden in the US and worldwide.

HPV vaccination was first approved for young women in the US in 2006. Since then, its approval has been expanded to both males and females. The newest 9-valent HPV vaccine protects against up to 73.5% of HPV-associated cancers [3]. Unfortunately, HPV vaccination rates in the US remain low, with completion rates of 49.5% for females and 37.5% for males nationwide [4]. Furthermore, HPV vaccination is becoming increasingly important as the prevalence of HPV-containing oropharyngeal squamous cell carcinomas has increased dramatically and is now the most common HPV associated cancer [5].

Vaccine hesitancy has become a concerning issue among healthcare providers, as many parents refuse or choose to delay vaccines for their children [6]. Vaccine refusal happens for many reasons, including social influences and concerns about vaccine safety, necessity, and cost [7]. Notably, lack of physician recommendation is frequently cited as the primary reason parents choose not to vaccinate [7], [8], [9], [10]. Physicians influence parental beliefs and attitudes and it is well established that provider recommendation improves vaccination rates [11]. Results from US national immunization survey found that female adolescents who received a provider recommendation for the HPV vaccine were almost 5 times more likely to initiate the HPV vaccine series compared to adolescents who did not receive this recommendation, and this association persisted across all races and sociodemographic groups [12].

Many providers report inadequate training and low comfort levels responding to questions from vaccine hesitant parents [13], [14]. Improving provider comfort and teaching communication strategies is key to addressing low vaccination rates [15]. Providing a curriculum that addresses vaccine hesitancy during medical school has the potential to reach a broad population of future physicians. In this study we hypothesized that applying a multi-modal curriculum (including evidence-based lecture, communication methodology, and simulation training) targeted at medical students would improve medical student confidence in addressing the concerns of vaccine hesitant parents. Improving confidence in addressing vaccine hesitant parents is an important step towards improving vaccination rates nationwide and thus should be a part of medical school training.

Section snippets

Materials and methods

All medical students at the University of Minnesota were eligible to participate in this educational curriculum and research study. This study was conducted at the University of Minnesota Medical School, Twin Cities (UMTC) and Duluth (UMD) campuses. Announcements were emailed to all medical school students at both campuses. On the day of the study pre-clinical students were notified by an in class announcement. After obtaining informed consent, medical students completed a pre-intervention

Demographics

In our study, 132 medical students participated in the HPV vaccine training session (14% of the student body). Of these, 101 completed the pre- and post-intervention surveys, yielding an overall response rate of 77%. Of the respondents, 83 (82%) were in pre-clinical training, 13 (13%) were in clinical training years, and 5 (5%) did not specify. 67 (66%) of the students self-identified as female, 33 (33%) self-identified as male, and 1 (1%) did not specify (Table 1). Of the 101 respondents, 71

Discussion

In this study we demonstrated that our novel HPV vaccine hesitancy curriculum increased students’ awareness of the benefits of the HPV vaccine, perceived likelihood of recommending the vaccine to both females and males, and comfort level in talking to vaccine hesitant parents. This curriculum was performed at two different locations with similar results, supporting its applicability to other medical schools. Vaccine hesitancy continues to be a difficult problem to address, yet evidence clearly

Conclusions

Educating all future physicians to recommend vaccination and respond compassionately to vaccine hesitant parents is a core responsibility of medical training. Though most of this training is expected to happen in residency, vaccine training thus far has not been consistently provided to residents. This study is unique in that it targets medical students at an earlier stage of training by providing a multi-modal educational curriculum involving didactic teaching, video instruction, and role-play

Conflicts of interest

The authors do not have any commercial or other associations that might pose a conflict of interest.

Financial support

This work was supported by Hub and Spoke Initiative Focused on Improving HPV Rates, AAP Chapter MN, ND, SD. Research support in this publication to KMT was supported by NIH grant P30 CA77598 utilizing the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota and by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR000114. Research support to BKE was from the Eunice Kennedy Shriver

Author contributions

Schnaith, Evans, Vogt, Tinsay, Schmidt, and Erickson all contributed to the design and implementation of the HPV training curriculum. Schnaith and Erickson obtained IRB approval and Evans obtained grant funding. Tessier completed the statistical analysis. All authors contributed to writing and editing the manuscript. All authors have given final approval of the submitted manuscript.

Acknowledgments

We would like to thank the entire Hands-On Advocacy 2016-2017 team for their work on this project and other projects in their campaign to increase Minnesota's vaccination rates. We would like to thank Juliana Milhofer and the Minnesota Medical Association for providing graphic design of curriculum materials. We would like to thank Robert Jacobson, MD; Eric Schnaith, MD; and Suzanne van den Hoogenhof, PhD. for reviewing and editing the curriculum and pre-/post-intervention surveys.

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