In an online survey conducted in 2010, parents of adolescent males, as well as the adolescents themselves, said that they would be most comfortable with doctors’ offices as the setting for administration of the human papillomavirus (HPV) vaccine.1 However, they reported moderate levels of comfort with alternative settings—public clinics, schools and pharmacies. For both parents and adolescents, some comfort ratings were related to whether the youth had seen a regular health care provider within the previous year.
To assess vaccine delivery preferences, researchers recruited a national sample of parents of 11–17‐year‐old males and asked them to solicit their sons’ participation in the survey. Parents who had more than one son aged 11–17 were asked to invite the one who had most recently had a birthday to participate. The analytic sample consisted of 506 parents whose sons had not been vaccinated and were not home‐schooled, and 391 adolescents who met these criteria. Examining parents’ and sons’ responses separately, researchers used analysis of variance for mixed designs to assess comfort with vaccination in alternative settings, and McNemar's test to assess differences in concerns about and perceived benefits of these settings.
Parents were about evenly divided by gender, education (categorized as at least some college vs. less schooling) and household income (less than $60,000 vs. more); three‐fifths were younger than 45. Sons were roughly evenly divided among 11–12‐year‐olds, 13–15‐year‐olds and 16–17‐year‐olds; 79% of adolescents had seen a regular health care provider in the previous year. The majority of both parents and sons were white (67% and 61%, respectively); the rest were predominantly black (12% of each) or Hispanic (15–16%).
Similarly worded survey items asked parents and adolescents how comfortable they would be with each of four HPV vaccination settings if the parent and son decided that the youth would get vaccinated. Responses were scored on a scale of 1–5, corresponding to "very uncomfortable" to "very comfortable." Both groups gave high ratings to a doctor's office (means, 4.6 and 4.2, respectively), and significantly lower ratings to a public clinic (3.1 and 2.9), school (2.9 and 2.6) and pharmacy (2.9 and 2.6). Parents whose sons had not seen their regular health care provider in the last year were more comfortable than other parents with the idea of HPV vaccination at a public clinic or school. Similarly, youth who had not visited a regular provider in the previous year gave higher ratings than other adolescents to a clinic, school or pharmacy.
In response to a closed‐ended question that permitted multiple responses, nine in 10 parents noted some concern about schools and pharmacies as vaccination settings; the main one, cited by two‐thirds, was that parents want their son's doctor to keep his complete health records. Roughly 30–40% expressed concern about staff's expertise, would want to be with their son and had questions about insurance coverage; smaller proportions reported other concerns. Eight in 10 adolescents had concerns about these two settings; the most common, noted by three in 10, were wanting their own doctor to keep their health records, staff expertise, wanting a parent to be with them and embarrassment. Both groups were more concerned about staff expertise at pharmacies than at schools. Privacy concerns and a feeling that the setting was not appropriate, while relatively uncommon, were expressed more in regard to schools than to pharmacies.
The most commonly cited benefit of HPV vaccination at schools or pharmacies was convenience; 36–37% of parents and 23–26% of sons selected this feature in response to a closed‐ended question. Other commonly reported benefits were that many people could be vaccinated in these settings and that young males could go with their friends; parents and sons considered schools to have more benefits than pharmacies. Close to half of participants saw no benefits to vaccination services in these settings.
Survey data also revealed that if vaccination occurs at a doctor's office, 40% of parents and 67% of sons preferred that all three injections be administered by a nurse during a brief visit. In addition, 53% and 37%, respectively, would be willing to have the youth receive other vaccinations at the same time as the HPV vaccination if a doctor recommended doing so.
The researchers caution that their sample may not have been nationally representative, that the survey predated the national recommendation for routine HPV vaccination of young males and that the findings may not apply to young females. These limitations notwithstanding, they suggest that their results offer insights into strategies that might help increase HPV vaccination among young males overall and, notably, among those who do not make regular health care visits.—D. Hollander