Community-based interventions for human papillomavirus (HPV) vaccination
Community-based interventions supporting HPV vaccination are usually multi-component, often combining information about HPV and the benefits of vaccinating against it with efforts to support vaccine initiation and series completion. Components may include community-wide education campaigns, outreach to specific populations, navigation support, referrals to vaccine providers, and vaccine provision. Community-based interventions take place in non-clinical, trusted community settings such as schools, and are provided by public health professionals, community health workers, or other trusted medical professionals.
HPV vaccines protect against HPV and HPV-associated diseases, including some cancers. Vaccines are recommended for individuals ages 11-26 and are most effective in those who receive all doses and have no previous exposure to HPV (CDC MMWR-Meites 2019).
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
- Increased vaccination
What does the research say about effectiveness? -+
There is some evidence that community-based interventions increase vaccination rates (Kaul 2019, Molokwu 2019, Parra-Medina 2015, Niccolai 2015). However, additional evidence is needed to confirm effects.
School-based vaccine clinics can increase initiation among adolescent girls (Niccolai 2015). At a middle school in a medically underserved area, pairing a vaccine clinic with doctors providing education for parents, school nurses, staff, and other pediatric/family providers increased vaccination initiation and completion more than education alone (Kaul 2019). Culturally competent multi-component interventions led by community health workers, called promotoras, may increase vaccine initiation (Molokwu 2019) and completion (Molokwu 2019, Parra-Medina 2015), particularly among Mexican immigrants (Molokwu 2019). Culturally competent community forums may increase HPV knowledge in Black communities (Teteh 2019). Community-based social marketing campaigns aimed at parents, done by county health departments in primarily rural areas, may increase vaccine initiation (Niccolai 2015).
Parental reminders, through letters or text messaging, from non-clinical sources may increase HPV vaccine initiation or completion. For example, a study by the New York State Department of Health suggests that reminder letters sent to the parents or guardians of adolescents due for the first dose of the HPV vaccine appeared to increase vaccine initiation (Coley 2018). A small pilot study among parents attending the HealthWindow program at the New York City Mexican consulate suggests that HPV education in a trusted community setting and follow-up text message vaccination reminders may increase vaccine series completion (Aragones 2015). In general, clinic or health care system-based reminder and recall systems (including telephone calls, letters, text messages, and outreach visits) can increase vaccine receipt (Niccolai 2015, Staras 2015).
Experts recommend using multiple strategies to increase HPV vaccination, including education, improved access to the vaccine, reminder and recall systems, and other clinic-based efforts (Rodriguez 2019, Jacobson 2016). Provider recommendation of the vaccine increases acceptability (Brewer 2007) and uptake (Kester 2013, Kessels 2012).
The National Association of County & City Health Officials (NACCHO) recommends coordination, collaboration and communication among public health, healthcare providers, parents and caregivers, and community partners at all levels to increase HPV vaccination (NACCHO-HPV).
Implementation Examples -+
As of 2018, HPV vaccine administration is available at some schools in some states; for example, it is available at approximately one quarter of surveyed high schools in Delaware, but not at surveyed high schools in Hawaii or Pennsylvania (CDC-School health profiles 2018). The HPV vaccine is required for school attendance in Hawaii, Rhode Island, Virginia, and Washington, D.C. (NCSL-Skinner 2021).
Implementation Resources -+
CDC-Preteen and teen immunization resources - Centers for Disease Control and Prevention (CDC). Preteen and Teen Immunization Resources.
Citations -+
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Aragones 2015 - Aragones A, Bruno DM, Ehrenberg M, Tonda-Salcedo J, Gany FM. Parental education and text messaging reminders as effective community based tools to increase HPV vaccination rates among Mexican American children. Preventive Medicine Reports. 2015;2(2015):554-558.
Brewer 2007* - Brewer NT, Fazekas KI. Predictors of HPV vaccine acceptability: A theory-informed, systematic review. Preventive Medicine. 2007;45(2-3):107-114.
CDC MMWR-Meites 2019 - Meites E, Szilagyi PG, Chesson HW, et al. Human papillomavirus vaccination for adults: Updated recommendations of the Advisory Committee on Immunization Practices. Morbidity and Mortality Weekly Report (MMWR). 2019;68:698-702.
CDC-School health profiles 2018 - Centers for Disease Control and Prevention (CDC). School health profiles 2018: Characteristics of health programs among secondary schools. Atlanta, Georgia. 2019.
Coley 2018* - Coley S, Hoefer D, Rausch-Phung E. A population‐based reminder intervention to improve human papillomavirus vaccination rates among adolescents at routine vaccination age. Vaccine. 2018;36(32):4904-4909.
Jacobson 2016 - Jacobson RM, Agunwamba AA, St. Sauver JL, Rutten LJF. The most effective and promising population health strategies to advance human papillomavirus vaccination. Expert Review of Vaccines. 2016;15(2):257-269.
Kaul 2019 - Kaul S, Do TQN, Hsu E, et al. School-based human papillomavirus vaccination program for increasing vaccine uptake in an underserved area in Texas. Papillomavirus Research. 2019;8(September):100189.
Kessels 2012* - Kessels SJ, Marshall HS, Watson M, et al. Factors associated with HPV vaccine uptake in teenage girls: A systematic review. Vaccine. 2012;30(24):3546-3556.
Kester 2013 - Kester LM, Zimet GD, Fortenberry JD, Kahn JA, Shew ML. A national study of HPV vaccination of adolescent girls: Rates, predictors, and reasons for non-vaccination. Maternal and Child Health Journal. 2013;17(5):879-885.
Molokwu 2019* - Molokwu J, Dwivedi A, Mallawaarach I, Hernandez A, Shokar N. Tiempo de Vacunarte (time to get vaccinated): Outcomes of an intervention to improve HPV vaccination rates in a predominantly Hispanic community. Preventive Medicine. 2019;121(February):115-120.
NACCHO-HPV - National Association of County & City Health Officials (NACCHO). Statement of policy: Human papillomavirus. 2018.
NCSL-Skinner 2021 - Skinner E. Vaccine policy toolkit: Routine child vaccination. National Conference of State Legislatures (NCSL). 2021.
Niccolai 2015 - 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.
Parra-Medina 2015 - Parra-Medina D, Morales-Campos DY, Mojica C, Ramirez AG. Promotora outreach, education and navigation support for HPV vaccination to Hispanic women with unvaccinated daughters. Journal of Cancer Education. 2015;30(2):353-359.
Rodriguez 2019* - Rodriguez AM, Do TQN, Goodman M, et al. Human papillomavirus vaccine interventions in the U.S.: A systematic review and meta-analysis. American Journal of Preventive Medicine. 2019;56(4):591-602.
Staras 2015 - Staras SAS, Vadaparampil ST, Livingston MD, et al. Increasing human papillomavirus vaccine initiation among publicly insured Florida adolescents. Journal of Adolescent Health. 2015;56(5):S40-S46.
Teteh 2019 - Teteh DK, Dawkins-Moultin L, Robinson C, et al. Use of community forums to increase knowledge of HPV and cervical cancer in African American communities. Journal of Community Health. 2019;44(3):492-499.