Intervention to Increase Human Papillomavirus Vaccine Initiation Rates in Adolescent Males


      • Human papillomavirus (HPV) vaccine initiation rates increased by 6.5% after a 12-week multipronged quality improvement study.
      • HPV vaccine initiation rates were higher among adolescent males with publicly funded health insurance.
      • The findings from this quality improvement project offer pediatric providers an analysis of their own clinical practice of HPV vaccine initiation among adolescent males.
      • The electronic medical record prompt was a widely accepted tool by the providers who participated in the quality improvement project.


      The objective of this quality improvement project was to increase human papillomavirus (HPV) vaccine initiation rates among males aged 11 to 21 years old. A multipronged strategy was implemented at a pediatric practice, including an electronic medical record prompt, educational presentation, and monthly e-mail updates to providers. Deidentified HPV vaccine initiation rate data were collected, and a paired 2-sample t test evaluated differences in prepost vaccine initiation rates. HPV vaccine initiation rates increased by 6.5% during the project period. The medical record prompt was identified as most effective by 75% of participating providers. Small gains can be made to improve HPV vaccine initiation rates among adolescent males.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal for Nurse Practitioners
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Centers for Disease Control and Prevention
        Human papilloma virus, (hpv) for clinicians.
        (Accessed July 31, 2019)
        • Scherr C.L.
        • Augusto B.
        • Ali K.
        • Malo T.L.
        • Vadaparampil S.T.
        Provider-reported acceptance and use of the centers for disease control and prevention messages and materials to support hpv vaccine recommendation for adolescent males.
        Vaccine. 2016; 34: 4229-4234
        • Centers for Disease Control and Prevention
        You are the key to HPV cancer prevention.
        [slide presentation]. 2016; (Accessed July 31, 2019)
        • Meitas E.
        • Kempe A.
        • Markowitz L.
        Use of a 2 dose schedule for human papillomavirus vaccination-updated recommendations of the advisory committee on immunization practices.
        MMWR Morb Mortal Wkly Rep. 2016; 5: 1405-1408
        • Walker T.Y.
        • Elam-Evans L.D.
        • Yankey D.
        • et al.
        National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years-united states, 2017.
        MMWR Morb Mortal Wkly Rep. 2018; 67: 909-917
        • Landis K.
        • Bednarczyk R.
        • Gaydos L.
        Correlates of hpv vaccine initiation and provider recommendation among male adolescents, 2014 NIS-Teen.
        Vaccine. 2018; 36: 3498-3504
        • Lu P.J.
        • Yankey D.
        • Fredus B.
        • et al.
        Association of provider recommendation and human papillomavirus vaccine inititation among male adolescents aged 13-17 years-united states.
        Pediatrics. 2019; 206: 33-41
        • Kepka D.
        • Ding Q.
        • Bodson J.
        • Warner E.L.
        • Mooney K.
        Latino parents’ awareness and receipt of the hpv vaccine for sons and daughters in a state with low three-dose completion.
        J Cancer Educ. 2015; 30: 808-812
        • Burdette A.M.
        • Webb N.S.
        • Hill T.D.
        • Jokinen-Gordon H.
        Race-specific trends in HPV vaccinations and provider recommendations: persistent disparities or social progress?.
        Public Health. 2017; 142: 167-176
        • Fiks A.G.
        • Grundmeier R.W.
        • Mayne S.
        • et al.
        Effectiveness of decision support for families, clinicians, or both on hpv vaccine receipt.
        Pediatrics. 2013; 131: 1114-1124
        • Perkins R.B.
        • Zisblatt L.
        • Legler A.
        • Trucks E.
        • Hanchate A.
        • Gorin S.S.
        Effectiveness of a provider-focused intervention to improve hpv vaccination rates in boys and girls.
        Vaccine. 2015; 33: 1223-1229
        • Bundy D.G.
        • Persing N.M.
        • Solomon B.S.
        • et al.
        Improving immunization delivery using an electronic health record: the immprove project.
        Acad Pediatr. 2013; 13: 458-465
        • Meyer A.F.
        • Borkovskly N.L.
        • Brickley J.L.
        • et al.
        Impact of electronic point-of care prompts on human papillomavirus update in retail clinics.
        Am J Prev Med. 2018; 55: 822-829
        • Das J.K.
        • Salam R.A.
        • Arshad A.
        • Lassi Z.S.
        • Bhutta Z.A.
        Systematic review and meta-analysis of interventions to improve access and coverage of adolescent immunizations.
        J Adolesc Health. 2016; 59: s40-s48
        • Fu L.Y.
        • Bonhomme L.A.
        • Cooper S.C.
        • Joseph J.G.
        • Zimet G.D.
        Review: educational interventions to increase hpv vaccination acceptance: a systematic review.
        Vaccine. 2014; 32: 1901-1920


      Lisa Marchand-Ciriello, DNP, FNP-C, is a Clinical Assistant Professor at Solomont School of Nursing, University of Massachusetts Lowell in Lowell, MA. She can be contacted at [email protected]


      AnnMarie Foustoukos, MS, PNP-BC, is a Pediatric Nurse Practitioner at Pentucket Medical Associates in Haverhill, MA.


      Heidi Collins Fantasia, PhD, WHNP-BC, is an Associate Professor at Solomont School of Nursing, University of Massachusetts Lowell, MA.