Doctoral Dissertations

Date of Award

8-2024

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Public Health

Major Professor

Cristina Barroso

Committee Members

Samantha Ehrlich, Jill Maples, Justin Gatwood, Kristina Kintziger

Abstract

Over 47,000 new HPV-related cancers are diagnosed annually in the United States, yet vaccination rates are below desirable levels. Tennessee has one of the highest incidence rates of HPV associated cancer in the country. Limited research has focused on understanding why young adults refuse or accept the HPV vaccine. Additionally, little research has focused on understanding healthcare providers’ perspectives regarding adult vaccination, particularly in Tennessee. Therefore, the overall objective of this research project is to describe critical factors that may influence HPV vaccine uptake among adults in Tennessee by exploring both patient and healthcare provider perspectives.

To accomplish research objectives, this dissertation focused on three unique aims. Aim 1 is the qualitative phase of an exploratory sequential mixed methods design, which involves utilizing semi-structured interviews to describe young adults’ perspectives and experiences around HPV vaccination. Aim 2 is the quantitative phase of the exploratory sequential mixed methods design, which involves utilizing an online survey to investigate predictors of HPV vaccine uptake among young adults. Aim 3 involves a qualitative study design using semi-structured interviews to understand healthcare providers' experiences regarding HPV vaccination among adults.

Findings from interviews among young adults identified lack of knowledge and awareness as a factor preventing HPV vaccine uptake. Participants (young adults) also described some facilitators of HPV vaccination, including healthcare provider recommendations and family support, and perceived future benefits of receiving the HPV vaccine. Suggestions for promotion strategies included promotion through college health centers, community education, and awareness campaigns. Survey findings identified predictors associated with HPV vaccination among young adults in this study including perceived risk, perceived barriers, HPV knowledge, and receipt of provider recommendations. Results from healthcare provider interviews identified some factors preventing recommendation of the HPV vaccine, such as limited time during patient visits, forgetting to recommend, biases or assumptions, and lack of knowledge or comfort level.

Overall, this research project enhanced our understanding of influential factors related to HPV vaccination among adults. Findings from these studies provide valuable insights which will be useful for shaping future interventions and programs focused on improving HPV vaccination rates among adults in Tennessee.

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