A Mixed-Methods Examination of Factors Related to HPV Vaccination Promotion in Private Dental Settings, Iowa, 2019

Natoshia Askelson, MPH, PhD; Grace Ryan, MPH; Susan McKernan, MS, DMD, PhD; Aaron Scherer, MA, PhD; Eliza Daly, BA; Lejla Avdic, BA


Prev Chronic Dis. 2021;18(3):e26 

In This Article

Abstract and Introduction


Introduction: Human papillomavirus (HPV)-associated oropharyngeal cancer rates are rising, particularly in males, although rates of other HPV-related cancers are decreasing. Although the HPV vaccine is safe and effective, vaccination rates remain below the Healthy People 2030 goal of 80% coverage. Engaging dental providers, who have experience with patient education and oropharyngeal cancer, may prove useful in efforts to increase vaccination rates. Our research explores dental providers' (dentists, dental hygienists) willingness to participate in continuing education about HPV, educate parents of adolescents, recommend the vaccine for adolescents, and refer parents to medical providers.

Methods: We used a mixed-methods approach and conducted a survey with dental hygienists and semistructured interviews with dental providers. We produced frequencies and descriptive statistics for all variables and used regression modeling to explore factors related to willingness to promote the HPV vaccine. We used a deductive approach to code interview transcripts.

Results: Regression models using survey data (n = 470) showed that after controlling for demographic and practice-level characteristics, higher levels of willingness were associated with thinking that parents would act on a recommendation and thinking that engaging in HPV promotion is within the scope of practice. Interview data reflected willingness of dental providers to work on HPV vaccination, but revealed barriers (eg, time, knowledge) that need to be addressed.

Discussion: Overall, dental providers expressed a willingness to participate in HPV vaccine promotion, and future efforts should focus on addressing barriers to doing so. Engaging dental providers in HPV vaccine recommendation and referral can help prevent future HPV-related cancers.


Human papillomavirus (HPV) causes an estimated 34,800 cases of cancer annually in the United States.[1] Although rates of HPV-associated cervical cancers have fallen, HPV-associated oropharyngeal cancer rates are increasing. Males are disproportionately affected, experiencing an increased rate of 2.7% per year between 1999 and 2015.[2] In 2020, the Food and Drug Administration (FDA) expanded its approval of the HPV vaccine to include prevention of HPV-related oropharyngeal cancer.[3] The HPV vaccine prevents multiple types of cancer; however, uptake falls short compared with other adolescent vaccines, particularly for males,[4] and rates remain below the Healthy People 2030 goal of 80% completion.[5]

The increase in HPV-associated oropharyngeal cancer and little progress in vaccination rates raises questions about current approaches to vaccine promotion and highlights the need to seek new partners. Dental hygienists and dentists (collectively called dental providers) have been identified as a group to enlist in HPV vaccine promotion.[6,7] The American Dental Association (ADA) released a statement that "urges dentists, as well as local and state dental societies, to support the use and administration of the HPV vaccine".[8] Moreover, dental providers have long been essential in providing preventive health care, with documented success helping patients understand diabetes management[9] and tobacco cessation.[10]

Despite these professional recommendations, most dental providers lack the formal education or experience to ensure that they can be successful partners in vaccine promotion.[11,12] We designed our study to expand our understanding of the factors that contribute to dental providers' willingness to implement routine HPV vaccine promotion. We used a mixed-methods approach to answer the following formative research questions about dental providers in private practice: 1) In what HPV vaccine promotion activities do dental providers currently engage? 2) How willing are dental providers to engage in HPV vaccine promotion? 3) What factors are related to dental providers' willingness to engage in HPV vaccine promotion?