Human Papillomavirus (HPV) Vaccines

Randomized Controlled Trial to Evaluate an Implementation Strategy to Increase Optimal Use of HPV Vaccine in Primary Care

We will complete a single site cluster-randomized trial to evaluate the effectiveness of a multi-component implementation strategy to increase use of the HPV vaccine according to CDC guidelines. Twenty practices will be randomized into two groups, the 2-year intervention group (n=10) or a wait-list control group (n=10). The intervention includes: 1) an educational video to increase the provider’s knowledge about guideline recommendations and patient and practice benefits of vaccination by age 13; 2) audit and feedback of vaccine coverage to increase motivation to engage in practice change; 3) a communication strategy to improve providers’ communication skills and their self-efficacy to address parental hesitation; and 4) practice facilitation to support practice change to develop a sustainable HPV vaccine delivery system. The intervention will be delivered through a series of brief practice visits with the facilitator that occur every 1-4 weeks over 2-years.

The wait-list control group practices will be offered the intervention in years 3 and 4 of the project.

Current Status

  • NIH R01 grant: Randomized Controlled Trial to Evaluate an Implementation Strategy to Increase Optimal Use of HPV Vaccine in Primary Care
  • Pilot testing of intervention completed.

Theory-Based Intervention Development

The national guideline recommend completion of the 2-dose human papillomavirus (HPV) vaccine series before the 13th birthday; however, this recommendation is poorly implemented in primary care, and interventions to increase implementation of this guideline have had little impact. We used a theory-informed approach to identify facilitators and barriers for implementation of the HPV vaccine guideline in primary care practices, and to identify strategies to address these behaviors. The intervention targets provider behavior change and was designed to be delivered using practice facilitation, educational outreach visits, and cyclical small tests of change.

Garbutt JM, Dodd S, Walling E, Lee AA, Kulka K, Lobb R. Theory-based development of an implementation intervention to increase HPV vaccination in pediatric primary care practices. Implement Sci. 2018 Mar 13;13(1):45.


  • Resource videos for Human Papillomavirus Vaccine (HPV)
  • Centers for Disease Control and Prevention
  • Selected Literature
    • Holman DM, Benard V, Roland KB, Watson M, Liddon N, Stokley S. Barriers to human papillomavirus vaccination among US adolescents: a systematic review of the literature. JAMA pediatrics. 2014;168(1):76-82. [PMID: 24276343] [PMCID: PMC4538997] [PDF]
    • Niccolai LM, Hansen CE. Practice- and Community-Based Interventions to Increase Human Papillomavirus Vaccine Coverage: A Systematic Review. JAMA pediatrics. 2015;169(7):686-692. [PMID: 26010507] [Full-Text]
    • Perkins RB, Clark JA, Apte G, Vercruysse JL, Sumner JJ, Wall-Haas CL, et al. Missed opportunities for HPV vaccination in adolescent girls: a qualitative study. Pediatrics. 2014;134(3):e666-674. [PMID: 25136036] [PDF]
    • Perkins RB, Zisblatt L, Legler A, Trucks E, Hanchate A, Gorin SS. Effectiveness of a provider-focused intervention to improve HPV vaccination rates in boys and girls. Vaccine. 2015;33(9):1223-1229. [PMID: 25448095] [PDF]
    • Sanders Thompson VL, Arnold LD, Notaro SR. African American parents' HPV vaccination intent and concerns. Journal of health care for the poor and underserved. 2012;23(1):290-301. [PMCID: PMC3498955] [PDF]
    • Thompson VL, Arnold LD, Notaro SR. African American parents' attitudes toward HPV vaccination. Ethnicity & disease. 2011;21(3):335-341. [PMID: 21942167] [PMCID: PMC3498955] [PDF]
Children's Hospital St. Louis
Wash U School of Medicine
Institute of Clinical and Translational Sciences