HPV Vaccine Hesitancy

Findings From a Statewide Survey of Health Care Providers

Annie-Laurie McRee, DrPH; Melissa B. Gilkey, PhD; Amanda F. Dempsey, MD, PhD, MPH


J Pediatr Health Care. 2014;28(6):541-549. 

In This Article


Respondent Characteristics

The average age of respondents was 48 years (Table 1). Most respondents were female (72%). About half were family medicine physicians (47%), and one third were nurse practitioners (33%). Most respondents worked in either private practice (32%) or a practice network (31%) and served patient populations composed of more than 10% adolescents (60%). Respondents included in the analysis did not differ from those excluded with regard to any of the assessed sociodemographic and practice characteristics (all p > .05).

HPV Vaccine Recommendation Practices

About three quarters of health care providers (76%) reported recommending HPV vaccination to girls ages 11 to 12 years as a part of their routine care "most of the time." Providers routinely recommended the vaccine for boys less often than for girls, with fewer than half (46%) reporting that they do so "most of the time" (χ2 = 152.49, p < .001). As shown in the Figure, more pediatricians routinely recommended HPV vaccine for boys than did both family medicine physicians and nurse practitioners (67% vs. 42% and 41%, respectively, p < .001). HPV vaccine recommendations for girls did not differ by provider type (p = .06).


Percentage of providers who recommend the human papillomavirus vaccine (HPV) to adolescents ages 11 to 12 years as part of their routine care more than 75% of the time, by patient sex. Bars = 95% confidence intervals

Many providers "somewhat" or "strongly" agreed that they recommend HPV vaccine as strongly as they do other adolescent vaccines (for girls, 75%; for boys, 64%). However, most also agreed that they prefer to offer HPV vaccine as an optional vaccine for girls (62%) or for boys (69%) ages 11 to 12 years.

Parental Reactions to HPV Vaccine Recommendations for 11- to 12-year-olds

One third of providers (33%) reported that parents frequently (i.e., "often" or "most of the time") accept HPV vaccine recommendations without question, whereas half (51%) reported that parents frequently ask to delay vaccination (Table 2). One fifth (18%) indicated that parents frequently respond with concern about the HPV vaccine, and 12% reported that parents frequently refuse to get the HPV vaccine for their child. Providers had lower odds of recommending HPV vaccine to 11- to 12-years-olds "most of the time" if they reported that parents responded more frequently with requests to delay vaccination or if they more frequently refused HPV vaccine for their child. Providers who reported that parents more frequently accepted HPV vaccine without question had higher odds of recommending it "most of the time" (all p < .05). Parental reactions of anger or concern about HPV vaccine were not statistically associated with providers' HPV vaccine recommendation practices

In terms of reasons for HPV vaccine delay or refusal, most providers perceived factors that contributed "some" or "a lot" to parents' decisions as including the belief that their child is not sexually active (79%) or is unlikely to get an HPV-related disease (63%), as well as parental discomfort in talking with their child about sex (55%; Table 3). Providers perceived that concerns about short-term adverse effects, cost, or effectiveness contributed little to parents' decisions to delay or refuse HPV vaccination for their child.

Provider Responses to Parental HPV Vaccine Hesitancy

Most providers reported frequently (i.e., "often" or "most of the time") responding to parental HPV vaccine hesitancy by offering reassurance that the vaccine is safe (90%), giving standard written information (such as the CDC vaccine information sheets; 83%), or asking questions to explore parents' concerns (74%; Table 2). All assessed responses to parental HPV vaccine hesitancy were positively associated with recommending HPV vaccine to 11- to 12-year-old girls or boys "most of the time" (all p < .001) with the exception of suggesting that parents delay vaccination until a future visit, which was associated with lower odds of routine recommendation.

Most health care providers felt confident that they could address parental concerns about sexual disinhibition (86% "somewhat agreed" or "strongly agreed"; Table 4) and HPV vaccine for boys (88%). However, nearly half indicated that they did not have enough time during visits to probe parents' reasons for vaccine hesitancy (47%). Although the vast majority of providers believe that they are influential in parents' decisions about whether to get HPV vaccine for their child (91%), two thirds (55%) believed that there was not much they could say to change the minds of parents who wish to delay or refuse vaccination. All assessed self-efficacy and outcome expectations beliefs were positively associated with routinely recommending HPV vaccine to 11- to 12-year-olds (all p < .05) with the exception of believing that there is not much they can say to change parents' minds, which was not statistically significant for either girls or boys.

Tools and Strategies for Counseling HPV Vaccine-hesitant Parents

The strategies and tools that providers perceived would be most helpful (i.e., "a lot" or "somewhat") for counseling parents who are hesitant to get their adolescent children vaccinated against HPV were information tailored to specific parent concerns (74%) or to parents' cultural background (68%) and providing information about the HPV vaccine to parents prior to the clinical visit (72%; Table 3). More than half of providers also believed that it would be helpful to have a screening tool to identify specific parental concerns (58%) or a discussion guide (57%)