Abstract
The Advisory Committee on Immunization Practices recommends human papillomavirus (HPV) vaccination for inadequately vaccinated adults aged 27-45 based on shared clinical decision-making (SCDM). However, little is known about awareness and barriers to SCDM among US healthcare providers (HCPs), especially in Texas, where HPV vaccination rates are below the national average. Between January and April 2021, we conducted a population-based cross-sectional survey (12% response rate) of HCPs licensed in Texas to assess the prevalence and factors associated with awareness of the SCDM recommendation. HCPs were asked if they were aware and if they foresaw any barriers in implementing SCDM for HPV vaccine recommendation. Among the 1,279 respondents, 54.26% were aware of this recommendation. HCPs practicing as gynecologists/obstetricians (adjusted odds ratio [aOR]: 6.12; 95%CI: 2.60-14.40, p < .001), those working in Federally Qualified Health Centers (aOR: 2.13, 95%CI: 1.24-3.65, p = .006) or group practices (aOR: 1.68, 95%CI: 1.22-2.30, p = .001), those seeing ≤ 100 patients/week (aOR: 1.70, 95%CI: 1.15-2.51, p = .008), those who had received formal training on HPV vaccination promotion and counseling within the past two years (aOR: 3.42, 95%CI: 2.29-5.10, p = < 0.001), between two and five years ago (aOR: 2.35, 95%CI: 1.67-3.30, p = < 0.001), and more than five years ago (aOR: 1.70, 95%CI: 1.16-2.50, p = .006) had significantly higher odds of awareness of SCDM recommendation. HCPs practicing as nurse practitioners/advanced nurse practitioners (aOR: 0.56; 95%CI: 0.38-0.82, p = .003), physician assistants (aOR: 0.62; 95%CI: 0.41-0.94, p = .023), aged 55 years or older (aOR: 0.57; 95%CI: 0.32-0.99, p = .046), Asian (aOR: 0.59, 95%CI: 0.43-0.81, p = .001) and non-Hispanic Black (aOR: 0.62, 95%CI: 0.40-0.97, p = .037) had significantly lower odds of awareness of SCDM recommendation. Overall, 44.96% of HCPs anticipated no barriers and planned to engage in SCDM, while 18.32% cited time commitment as an anticipated barrier. Internists cited time commitment (39.13%) as an anticipated barrier more frequently than other specialties, while physician assistants were more frequently unclear about how to implement SCDM (12.36%). We found limited awareness of the SCDM recommendation guideline for HPV vaccination among Texas HCPs. Therefore, training HCPs to use decision aids to actively engage patients in the SCDM process could improve HPV vaccination rates among unvaccinated adults aged 27-45.