Improving HPV vaccination rates among Hispanic adolescents

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A quality improvement (QI) project conducted at a rural pediatric clinic in North Carolina aimed to increase human papillomavirus (HPV) vaccination rates among Hispanic adolescents by using a scripted nurse-led monologue. The project, presented at the 2025 NAPNAP National Conference on Pediatric Health Care, highlighted the importance of provider-driven recommendations in improving vaccine uptake.^1,2

Background and need for increased vaccination

HPV is a sexually transmitted infection linked to 6 types of vaccine-preventable cancers, including cervical, anal, vulvar, vaginal, penile, and oropharyngeal cancers. The virus affects approximately 630 million people globally, and nearly one-quarter of infections occur during adolescence. HPV disproportionately impacts minority populations, including Hispanic communities, and those living in the southern United States.

Despite the availability of a safe and effective vaccine, HPV-related cancers account for around 4,000 deaths annually in the U.S. The Centers for Disease Control and Prevention (CDC), the Advisory Committee on Immunization Practices (ACIP), and the American Academy of Pediatrics (AAP) recommend initiating the HPV vaccination series as early as age 9. Healthy People 2030 has set a target to increase HPV vaccination rates to 80% among adolescents, but vaccination rates remain low in rural settings.

A rural pediatric clinic in North Carolina reported an HPV vaccination rate of less than 25%, significantly below the national average. This low uptake prompted the need for an intervention to improve vaccination rates and reduce the long-term health risks associated with HPV infection.

Methods and intervention

The project targeted adolescent patients aged 11 to 17 who had not started or completed the HPV vaccination series. Registered nurses (RNs) were trained to deliver a consistent monologue recommending the vaccine during patient intake. The monologue emphasized the risks of HPV and the protective benefits of vaccination, aiming to increase parental consent for vaccination.

The scripted message stated:
"Today, your child is eligible for the HPV vaccine. Human papillomavirus is a common virus that causes several serious consequences, including cervical, vaginal, vulvar, penile, anal, mouth, and throat cancer, as well as genital warts. Our providers, Ricky and Mary, both highly recommend this safe and effective vaccination series as early as possible to protect your child from contracting HPV and reduce your child’s risk from certain HPV-related cancers. Is it OK to give this vaccine to your child today?"

If parents refused or had questions, they were referred to the provider for further discussion. Educational materials in Spanish and bilingual signage were also introduced to improve communication with Hispanic families. Reminder cards were provided to encourage vaccine series completion.

Results and challenges

The project included 457 vaccine-eligible adolescents with a mean age of 13.75 years. Among the sample, 73% identified as Hispanic, and 53.2% used a Spanish interpreter during their visit. More than one-fifth (21.7%) of Hispanic patients had visits conducted in English.

Following the intervention, HPV vaccination rates increased from 8.89% before the project to 10.65% post-intervention. However, no vaccines were administered during sick visits or other non-wellness visits, indicating missed opportunities for increasing uptake. A statistically significant inverse relationship was found between age and vaccination success, with each additional year of age reducing the likelihood of successful vaccination by a factor of 0.71 to 0.34.

Challenges included limited communication between RNs and providers, which may have contributed to missed opportunities for further dialogue with vaccine-hesitant parents. Additionally, some RNs were reluctant to deliver the monologue during acute care visits, reflecting workflow constraints rather than parental resistance.

Recommendations for clinical practice

The findings suggest that consistent provider-driven recommendations can positively influence HPV vaccination rates, particularly among Hispanic adolescents. The project underscores the need to integrate HPV vaccination into all types of pediatric visits, including sick visits, to avoid missed opportunities.

Adjusting clinic workflows to support nurse-provider communication and encouraging early initiation of the HPV vaccine at age 9 are critical steps toward improving vaccination rates. The CDC recommends starting the series at this age to increase the likelihood of timely completion and long-term protection against HPV-related cancers.

Future research and next steps

Future research should focus on assessing the long-term impact of early HPV vaccination and exploring additional strategies to address communication barriers and workflow challenges in rural clinics. Evaluating the effectiveness of culturally sensitive interventions and increasing staff training on vaccine communication may further improve vaccination rates in underserved populations.

Conclusion

The QI project demonstrated that a consistent provider recommendation through a scripted nurse-led monologue can increase HPV vaccination rates among Hispanic adolescents. While the increase was modest, the project highlights the importance of early vaccination and provider-driven communication in reducing HPV-related health risks. Expanding vaccine opportunities to all visit types and improving nurse-provider communication are key next steps in addressing HPV vaccination gaps in rural pediatric clinics.

References:

1. Bowman C, Connelly S. Promoting HPV Vaccination Rates in Hispanic Adolescents at a Rural Pediatric Health Clinic. Poster. Presented at: 2025 NAPNAP National Conference on Pediatric Health Care. Chicago, Illinois.

2. Bowman C, Connelly S. Promoting HPV Vaccination Rates in Hispanic Adolescents at a Rural Pediatric Health Clinic. Abstract. Presented at: 2025 NAPNAP National Conference on Pediatric Health Care. Chicago, Illinois.