Characterizing safety-net providers’ HPV vaccine recommendations to undecided parents: A pilot study

•Used audio-recorded visits to characterize strength of provider HPV vaccine recommendations.•Most providers gave weak recommendations (used passive voice, added qualifications).•Qualifications to HPV vaccine recommendation included not school-required, not necessary today, optional.•HPV vaccine rationales focused on cancer prevention and timing during early adolescence.

ObjectiveAlthough provider recommendation is a key predictor of HPV vaccination, how providers verbalize recommendations particularly strong ones is unknown. We developed a tool to describe strength and content of provider recommendations.MethodsWe used electronic health records to identify unvaccinated adolescents with appointments at six safety-net clinics in Dallas, Texas. Clinic visit audio-recordings were qualitatively analyzed to identify provider recommendation types (presumptive vs. participatory introduction; strong vs. weak), describe content communicated, and explore patterns between recommendation type and vaccination.ResultsWe analyzed 43 audio-recorded discussions between parents and 12 providers. Most providers used a participatory introduction (42 discussions) and made weak recommendations (24 discussions) by using passive voice or adding a qualification (e.g., not school required). Few providers (11 discussions) gave strong recommendations (clear, personally-owned endorsement). HPV vaccination was lowest for those receiving only weak recommendations and highest when providers coupled the recommendation with an adjacent rationale.ConclusionOur new tool provides initial evidence of how providers undercut their recommendations through qualifications or support them with a rationale. Most providers gave weak HPV vaccine recommendations and used a participatory introduction.Practice implicationsProviders would benefit from communication skills training on how to make explicit recommendations with an evidence-based rationale.