Health Care Professional Communication about STI Vaccines with Adolescents and Parents

"Health care professionals (HCPs) have been shown to have a strong beneficial effect on STI [sexually transmitted infection] vaccine uptake, yet studies demonstrate that many HCPs fail to discuss or recommend them to adolescent patients."

From the abstract: "This review article focuses on HCP communication about STI vaccines with adolescents and their parents. It describes STI vaccine message content and delivery as well as the context in which HCPs formulate their messaging approach." STI vaccines include human papillomavirus (HPV) vaccine, which is currently recommended for girls in early adolescence, prior to being sexually active, based upon research showing that it may prevent cervical cancer. The review "also examines other contextual factors that may shape communication about STI vaccines. Studies from many countries indicate that HCPs often possess misinformation about adolescents, including their sexual risk behaviors, as well as STIs, vaccine safety and efficacy, and STI vaccination recommendations. They also have misconceptions of parental barriers to STI vaccination. These may impact STI vaccine communication and have a negative influence on STI vaccine uptake. These findings highlight the critical need for improved HCP education related to adolescent health, sexuality, and STI vaccination. This may be particularly important in settings without an existing infrastructure or expertise in caring for this unique patient population." [Footnotes have been removed by the editor.]

According to the authors, a range of HCPs, including physicians, nurse practitioners, midwives, and school nurses, provide primary care services to adolescents, and they are a trusted and influential source of vaccine information. Several studies show that their recommendations increase vaccine acceptance among adolescents and young adults and may be especially important among minorities, those with cultural barriers, including religious, to access to care, and those with chronic conditions. Settings for HCP communication may include school-based and clinic-based delivery models.

Studies suggest that HCPs believe they are recommending vaccines more often than parents report hearing those recommendations. For HCPs who engage in a conversation about STI vaccines with their patients, it is important to understand what they are communicating and how it influences STI vaccine uptake. In terms of how the topic is approached: "Several studies have explored whether messages should emphasize universal infection risk and/or non-sexual transmission modes in order to de-stigmatize STI vaccination." In one study, uptake of Hepatitis-B vaccine rose due to de-stigmatisation in the messaging on the vaccine. "Similarly, many HCPs have chosen to emphasize cancer prevention when discussing HPV vaccination. It remains unclear if this is warranted based upon adolescent and parental concerns. While one study revealed greater patient acceptability when the HPV vaccine was described as preventing cancer rather than an STI , other studies have shown greater acceptability of it preventing both cancer and genital warts rather than cancer alone or genital warts alone. Another study of hypothetical vaccine scenarios demonstrated that parental willingness to vaccinate their adolescent did not differ between STI and non-STI vaccines."

HCP communication should address simultaneously the informational needs of adolescents and their parents, particularly since they prefer to receive the HCP message together, taking into account the different messages those two groups wish to hear. The review discusses influences on the kinds of messaging that HCPs develop based upon their sources of information for knowledge about the specific vaccine, knowledge about STI vaccination recommendations, and perceptions about parental barriers to STI vaccination of adolescents, as well as their practice infrastructure.

Recommendations for future directions include:

• Further examination of the role that other members of the adolescent health care team play in STI vaccine uptake, their communication with patients and families, and barriers and facilitators of appropriate communication is needed.
• HCP-directed outreach, particularly in resource-poor areas, including workshops among physicians, nurses, community health workers, social workers, scientists, and students, and brief educational sessions in clinical settings, may be a valuable strategy for educating health care delivery teams.
• Other approaches may include: patient reminder-recalls; annual immunisation campaigns that increase interactions between HCPs, adolescents, and their parents; and reducing missed opportunities for vaccination during these encounters.
• An electronic system of medical records might include flagging of patient records with alerts on vaccination needs that contain vaccine information useful for educating both HCPs and their patients.

Click here to read the full text of this document online.