Strategies to improve human papillomavirus vaccination rates among adolescents in family practice settings in the United States: A systematic review

Aims and Objectives: To explore the interventions aimed at increasing human papillomavirus (HPV) vaccination rates among adolescents in family practice settings. Background: HPV is the most common sexually transmitted disease in the United States, and the cause of thousands of anogenital and oropharyngeal cancers annually. Although HPV infection can be prevented with recommended vaccination during adolescence, national HPV vaccine rates remain low. Design: Systematic review. Methods: Four databases (MEDLINE, CINAHL, EMBASE and the Cochrane Library) were searched. The search was guided by PRISMA and by the question, ‘What are targeted interventions that improve HPV vaccination rates among adolescents in family practice settings?’ Articles were reviewed for study characteristics and appraised for quality using the revised Cochrane risk of bias tools. Results: Eleven studies met inclusion and exclusion criteria. Individual study size samples ranged from 749–147,294, with a combined total from all included studies of 276,205; the largest sample reviewed to date from family practice settings. Interventions used to increase HPV vaccination rates included reminder systems; provider and staff education; sensory incentives such as hitting a gong or petting a puppy; and iPad tailored messaging programmes. Studies that employed interventions pre-, during and postvisit were most effective in increasing HPV vaccination rates. Conclusions: This review provides the largest data supporting multimodal strategies to increase HPV vaccination rates among adolescent populations. It provides strong evidence to suggest that vaccination rates can be improved using measures at varying times of the patient visit. Relevance to Clinical Practice: Adolescents seek health care in various settings. Many studies have examined interventions to increase HPV vaccination in paediatric settings, but few have examined interventions in family practice settings. This review suggests that family practices should implement multimodal measures before, during and after visits to increase HPV vaccination among adolescent patients.