Human Vaccines & Immunotherapeutics
ISSN: 2164-5515 (Print) 2164-554X (Online) Journal homepage: http://www.tandfonline.com/loi/khvi20
A brief educational intervention increases providers' human papillomavirus vaccine knowledge Abbey B Berenson, Mahbubur Rahman, Jacqueline M Hirth, Richard E Rupp & Kwabena O Sarpong To cite this article: Abbey B Berenson, Mahbubur Rahman, Jacqueline M Hirth, Richard E Rupp & Kwabena O Sarpong (2015) A brief educational intervention increases providers' human papillomavirus vaccine knowledge, Human Vaccines & Immunotherapeutics, 11:6, 1331-1336, DOI: 10.1080/21645515.2015.1022691 To link to this article: http://dx.doi.org/10.1080/21645515.2015.1022691
Accepted author version posted online: 06 May 2015.
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Date: 05 November 2015, At: 15:39
RESEARCH PAPER Human Vaccines & Immunotherapeutics 11:6, 1331--1336; June 2015; © 2015 Taylor & Francis Group, LLC
A brief educational intervention increases providers’ human papillomavirus vaccine knowledge Abbey B Berenson1,2,*, Mahbubur Rahman1,2, Jacqueline M Hirth1,2, Richard E Rupp1,3, and Kwabena O Sarpong1,3 1
Center for Interdisciplinary Research in Women’s Health; The University of Texas Medical Branch; Galveston, TX USA; 2Department of Obstetrics & Gynecology; The University of Texas Medical Branch; Galveston, TX USA; 3Department of Pediatrics; The University of Texas Medical Branch; Galveston, TX USA
Keywords: educational intervention, healthcare providers, HPV vaccine, human papillomavirus (HPV), vaccine uptake
Downloaded by [University of Wisconsin Oshkosh] at 15:39 05 November 2015
Abbreviations: HPV, Human papillomavirus; UTMB, University of Texas Medical Branch; PA, physician assistant
Recommendation by a healthcare provider is critical to increase human papillomavirus (HPV) vaccine uptake in the US. However, current deficits in providers’ knowledge of HPV and its vaccine are not fully understood and interventions to amend knowledge gaps are untested. To determine whether attending a structured presentation could increase provider knowledge of the HPV vaccine, we assessed knowledge levels of physicians, non-physician healthcare workers, and medical students before and after attending a 30-minute lecture held between October 2012 and June 2014. Paired t-test and McNemar’s test were used to compare knowledge scores and the proportion of correct responses for each question, respectively. Multiple linear regression analyses were performed to examine correlates of baseline knowledge and change in knowledge scores post-intervention. A total of 427 participants, including 75 physicians, 208 medical students, and 144 nurses or other healthcare workers, attended one of 16 presentations and responded to both pre-test and post-test surveys. Baseline knowledge was low among all groups, with scores higher among older participants and physicians/medical students. On average, knowledge scores significantly improved from 8 to 15 after the presentation (maximum possible score 16) (P < .001), irrespective of specialty, race/ethnicity, gender, and age. Although lower at baseline, knowledge scores of younger participants and non-physician healthcare workers (e.g., nurses, physician assistants (PAs), nursing students) improved the most of all groups. We conclude that a brief, structured presentation increased HPV knowledge among a variety of healthcare workers, even when their baseline knowledge was low.
Introduction Healthcare provider recommendation is the single best predictor of adolescent vaccination against HPV,1-5 yet more than one-third of parents of eligible adolescent girls do not receive a recommendation to vaccinate their child from their doctor.5 Moreover, less than a quarter of providers always recommend this vaccine to male adolescent patients.6,7 Lack of recommendation by providers could be related to their own understanding of HPV and the vaccine that prevents it, as providers with more knowledge of these topics have been found to recommend or administer the vaccine more often or report higher intentions to do so.7-9 Conversely, deficits in HPV knowledge may be associated with lower rates of vaccine recommendation. For example, Perkins and Clark10 found in a qualitative study of 31 providers that only 2 knew that HPV vaccination offered any cancer prevention benefits to males and few offered the vaccine to boys. If provider knowledge is related to recommendation, then educating providers on HPV epidemiology and vaccine-related
issues could play an important role in improving the vaccine’s uptake among adolescent children in the US. Provider education has been shown to improve clinic behaviors with other immunizations.11 However, studies specifically exploring HPV-related educational interventions for providers are limited. In fact, a recent editorial asserts that the only study testing a providerfocused intervention explored decision support, not education.12 The objective of this study was to fill this gap in the literature by assessing whether a brief structured presentation on HPV and the HPV vaccine could increase baseline knowledge among physicians, other healthcare workers, and medical students.
Results A total of 427 clinicians, including practicing physicians (n D 75), medical students (n D 208), and other healthcare workers (n D 141; unknown 3), attended the lecture and returned both pre-test and post-test surveys. The specialties of
*Correspondence to: Abbey B Berenson; Email: [email protected] Submitted: 11/25/2014; Revised: 02/09/2015; Accepted: 02/19/2015 http://dx.doi.org/10.1080/21645515.2015.1022691
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the 75 practicing physicians were pediatricians (n D 39), obstetricians/gynecologists (n D 18), family medicine (n D 16) and unknown specialty (n D 2). Most of the respondents were less than 30 y old (74.2%), female (67.0%), white (46.6%), and enrolled in medical school (48.7%) (Table 1). Nearly 70% of the medical students were in their last 6 months of their 3rd year at the time of the lecture. The mean baseline HPV knowledge score was 8.4 (SD 2.5, range 2–15) (maximum possible 16). After adjusting for demographic characteristics, older respondents, MD/DOs, and medical students were observed to have higher baseline knowledge scores compared to their counterparts (Table 2). African-American respondents had lower adjusted baseline knowledge scores compared to whites (P D .001), while female respondents had slightly higher adjusted baseline knowledge scores than male respondents (P D .023) (Table 2). After the educational intervention, the mean score went up to 14.7 (SD 1.9, range 7–16) with significant improvement across all age groups, genders, races/ethnicities, and specialties (Table 1). Younger participants and non-physician healthcare workers such as nurses, nursing students, physician assistants (PAs), and PA students scored lower on the pre-test, but had the same level of understanding as physicians after the educational intervention. These participants exhibited the largest improvement in knowledge scores (Table 2). Depending on the question asked, 82.4% to 99.1% of participants responded correctly in the post-test survey compared to 18.0% to 99.3% correct response measured at baseline (Table 3).
Analysis by provider type and question topics showed that MD/ DOs more frequently provided correct responses to the pre-test survey questions on issues such as the necessity of HPV testing before administering the HPV vaccine, vaccination in those breastfeeding, how to continue the HPV vaccine series for those incompletely vaccinated, and the correct dosing intervals (Table 3). Both MD/DOs and medical students had more correct baseline responses than other healthcare workers to questions about the types of cancer prevented by the HPV vaccine. Medical students had more correct post-test responses to the question on whether the HPV vaccine prevents vaginal cancer, and they, along with non-physician healthcare workers, had more correct post-test responses on the race/ethnic group with the highest cervical cancer incidence in the US. HPV related knowledge and knowledge change did not differ by specialty among physician providers.
Discussion We observed that physicians, medical students, and other healthcare workers had inadequate baseline knowledge of HPV epidemiology and the HPV vaccine. For example, only one-third knew that the vaccine protects against vulvar and vaginal cancers and only one-half knew that it protects against anal cancer, even though the vaccine is indicated to protect against these diseases. These findings are in agreement with several prior studies that have identified inadequate levels of knowledge about HPV
Table 1. Characteristics of participants and impact of presentation on HPV vaccine knowledge score (n D 427) Characteristics Overall Age categories
ISSN: 2164-5515 (Print) 2164-554X (Online) Journal homepage: http://www.tandfonline.com/loi/khvi20
A brief educational intervention increases providers' human papillomavirus vaccine knowledge Abbey B Berenson, Mahbubur Rahman, Jacqueline M Hirth, Richard E Rupp & Kwabena O Sarpong To cite this article: Abbey B Berenson, Mahbubur Rahman, Jacqueline M Hirth, Richard E Rupp & Kwabena O Sarpong (2015) A brief educational intervention increases providers' human papillomavirus vaccine knowledge, Human Vaccines & Immunotherapeutics, 11:6, 1331-1336, DOI: 10.1080/21645515.2015.1022691 To link to this article: http://dx.doi.org/10.1080/21645515.2015.1022691
Accepted author version posted online: 06 May 2015.
Submit your article to this journal
Article views: 59
View related articles
View Crossmark data
Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=khvi20 Download by: [University of Wisconsin Oshkosh]
Date: 05 November 2015, At: 15:39
RESEARCH PAPER Human Vaccines & Immunotherapeutics 11:6, 1331--1336; June 2015; © 2015 Taylor & Francis Group, LLC
A brief educational intervention increases providers’ human papillomavirus vaccine knowledge Abbey B Berenson1,2,*, Mahbubur Rahman1,2, Jacqueline M Hirth1,2, Richard E Rupp1,3, and Kwabena O Sarpong1,3 1
Center for Interdisciplinary Research in Women’s Health; The University of Texas Medical Branch; Galveston, TX USA; 2Department of Obstetrics & Gynecology; The University of Texas Medical Branch; Galveston, TX USA; 3Department of Pediatrics; The University of Texas Medical Branch; Galveston, TX USA
Keywords: educational intervention, healthcare providers, HPV vaccine, human papillomavirus (HPV), vaccine uptake
Downloaded by [University of Wisconsin Oshkosh] at 15:39 05 November 2015
Abbreviations: HPV, Human papillomavirus; UTMB, University of Texas Medical Branch; PA, physician assistant
Recommendation by a healthcare provider is critical to increase human papillomavirus (HPV) vaccine uptake in the US. However, current deficits in providers’ knowledge of HPV and its vaccine are not fully understood and interventions to amend knowledge gaps are untested. To determine whether attending a structured presentation could increase provider knowledge of the HPV vaccine, we assessed knowledge levels of physicians, non-physician healthcare workers, and medical students before and after attending a 30-minute lecture held between October 2012 and June 2014. Paired t-test and McNemar’s test were used to compare knowledge scores and the proportion of correct responses for each question, respectively. Multiple linear regression analyses were performed to examine correlates of baseline knowledge and change in knowledge scores post-intervention. A total of 427 participants, including 75 physicians, 208 medical students, and 144 nurses or other healthcare workers, attended one of 16 presentations and responded to both pre-test and post-test surveys. Baseline knowledge was low among all groups, with scores higher among older participants and physicians/medical students. On average, knowledge scores significantly improved from 8 to 15 after the presentation (maximum possible score 16) (P < .001), irrespective of specialty, race/ethnicity, gender, and age. Although lower at baseline, knowledge scores of younger participants and non-physician healthcare workers (e.g., nurses, physician assistants (PAs), nursing students) improved the most of all groups. We conclude that a brief, structured presentation increased HPV knowledge among a variety of healthcare workers, even when their baseline knowledge was low.
Introduction Healthcare provider recommendation is the single best predictor of adolescent vaccination against HPV,1-5 yet more than one-third of parents of eligible adolescent girls do not receive a recommendation to vaccinate their child from their doctor.5 Moreover, less than a quarter of providers always recommend this vaccine to male adolescent patients.6,7 Lack of recommendation by providers could be related to their own understanding of HPV and the vaccine that prevents it, as providers with more knowledge of these topics have been found to recommend or administer the vaccine more often or report higher intentions to do so.7-9 Conversely, deficits in HPV knowledge may be associated with lower rates of vaccine recommendation. For example, Perkins and Clark10 found in a qualitative study of 31 providers that only 2 knew that HPV vaccination offered any cancer prevention benefits to males and few offered the vaccine to boys. If provider knowledge is related to recommendation, then educating providers on HPV epidemiology and vaccine-related
issues could play an important role in improving the vaccine’s uptake among adolescent children in the US. Provider education has been shown to improve clinic behaviors with other immunizations.11 However, studies specifically exploring HPV-related educational interventions for providers are limited. In fact, a recent editorial asserts that the only study testing a providerfocused intervention explored decision support, not education.12 The objective of this study was to fill this gap in the literature by assessing whether a brief structured presentation on HPV and the HPV vaccine could increase baseline knowledge among physicians, other healthcare workers, and medical students.
Results A total of 427 clinicians, including practicing physicians (n D 75), medical students (n D 208), and other healthcare workers (n D 141; unknown 3), attended the lecture and returned both pre-test and post-test surveys. The specialties of
*Correspondence to: Abbey B Berenson; Email: [email protected] Submitted: 11/25/2014; Revised: 02/09/2015; Accepted: 02/19/2015 http://dx.doi.org/10.1080/21645515.2015.1022691
www.tandfonline.com
Human Vaccines & Immunotherapeutics
1331
Downloaded by [University of Wisconsin Oshkosh] at 15:39 05 November 2015
the 75 practicing physicians were pediatricians (n D 39), obstetricians/gynecologists (n D 18), family medicine (n D 16) and unknown specialty (n D 2). Most of the respondents were less than 30 y old (74.2%), female (67.0%), white (46.6%), and enrolled in medical school (48.7%) (Table 1). Nearly 70% of the medical students were in their last 6 months of their 3rd year at the time of the lecture. The mean baseline HPV knowledge score was 8.4 (SD 2.5, range 2–15) (maximum possible 16). After adjusting for demographic characteristics, older respondents, MD/DOs, and medical students were observed to have higher baseline knowledge scores compared to their counterparts (Table 2). African-American respondents had lower adjusted baseline knowledge scores compared to whites (P D .001), while female respondents had slightly higher adjusted baseline knowledge scores than male respondents (P D .023) (Table 2). After the educational intervention, the mean score went up to 14.7 (SD 1.9, range 7–16) with significant improvement across all age groups, genders, races/ethnicities, and specialties (Table 1). Younger participants and non-physician healthcare workers such as nurses, nursing students, physician assistants (PAs), and PA students scored lower on the pre-test, but had the same level of understanding as physicians after the educational intervention. These participants exhibited the largest improvement in knowledge scores (Table 2). Depending on the question asked, 82.4% to 99.1% of participants responded correctly in the post-test survey compared to 18.0% to 99.3% correct response measured at baseline (Table 3).
Analysis by provider type and question topics showed that MD/ DOs more frequently provided correct responses to the pre-test survey questions on issues such as the necessity of HPV testing before administering the HPV vaccine, vaccination in those breastfeeding, how to continue the HPV vaccine series for those incompletely vaccinated, and the correct dosing intervals (Table 3). Both MD/DOs and medical students had more correct baseline responses than other healthcare workers to questions about the types of cancer prevented by the HPV vaccine. Medical students had more correct post-test responses to the question on whether the HPV vaccine prevents vaginal cancer, and they, along with non-physician healthcare workers, had more correct post-test responses on the race/ethnic group with the highest cervical cancer incidence in the US. HPV related knowledge and knowledge change did not differ by specialty among physician providers.
Discussion We observed that physicians, medical students, and other healthcare workers had inadequate baseline knowledge of HPV epidemiology and the HPV vaccine. For example, only one-third knew that the vaccine protects against vulvar and vaginal cancers and only one-half knew that it protects against anal cancer, even though the vaccine is indicated to protect against these diseases. These findings are in agreement with several prior studies that have identified inadequate levels of knowledge about HPV
Table 1. Characteristics of participants and impact of presentation on HPV vaccine knowledge score (n D 427) Characteristics Overall Age categories
