HPV VACCINE INCREASES IN ADOLESCENTS 1

Increasing Vaccinations in Adolescents

Natalie Cannella, Marina Francis, Lucy Roberts, Madisyn Rossi, Gabriella Devries

College of Nursing, University of South Florida

Increasing Vaccinations in Adolescents

The Human Papillomavirus, or HPV, is an infectious virus that is easily spread through

sexual and skin-to-skin contact. Araldi et al. (2018) state that the HPV virus accounts for “30%

of all infectious agent-related cancers”. These negative consequences of HPV infections can be

easily avoided with preventative vaccinations in adolescence. With this Quality Improvement

(QI) plan, the authors of this paper aim to increase the two-dose HPV vaccination series

completion rates in adolescents (ages 9-14) by 15% within a year in Hillsborough County. This

paper will address the stakeholders and change theory concerning the topic, any resources

needed to implement the plan, and the evaluation plan regarding outcome measures, strategies,

and timelines.

Stakeholders and Change Theory

The stakeholders needed to implement the plan include nurses and doctors at clinics

educating patients as well as staff members at schools who facilitate education about HPV

vaccinations. These stakeholders are key in ensuring that a positive message about vaccinations

is being delivered. Additionally, the parents and teenagers at the schools are stakeholders as they

are the ones receiving the education and determining if they want to explore it further and

complete the series of vaccinations.

It is important to consider various metrics when developing a QI plan. The management

structures to address include the availability of nurses at schools and whether they have events

such as health fairs to educate about receiving the vaccine. Management structure issues to

consider would be the cost of the vaccination program over the total number of programs

Hillsborough County funds. Furthermore, the number of adolescents that have contracted HPV

over the total number of adolescents who have not received the HPV vaccines. Additionally, the
HPV VACCINE INCREASES IN ADOLESCENTS 3

number of adolescents engaging in sexual behavior over the total number of adolescents who

have received HPV vaccinations.

Process issues to consider for this QI plan will greatly influence the outcomes. An

important measure is the number of adolescents who have initiated the HPV vaccine series over

the total number of adolescents ages in Hillsborough County. Secondly, the number of

adolescents who received the Tdap and HPV vaccine between ages 9-14 over the total number of

adolescents that only received the Tdap vaccine. Finally, the number of vaccination programs in

the Hillsborough County school system over the total number of schools in Hillsborough

County.

The father of social psychology, Kurt Lewin, developed the Change Theory of Nursing to

help implement, encourage, and establish changes in behavior. This theory is especially

applicable to help improve the rates of HPV vaccinations. His theory has three phases: unfreeze,

change, and refreeze. For the unfreezing phase, it is important to consider why adolescents have

not finished the vaccine series on time, and what would encourage their decision to receive it. A

study from 2019 discussed the relationship between HPV vaccinations in young women and self-

efficacy. It concluded that there is a need for increasing vaccine awareness, the risks of not

getting vaccinated, access to the vaccine, and self-efficacy to complete the series (Christ et al.,

2019). To unfreeze the situation, it is important to increase awareness of the vaccine and educate

on the timeline for the vaccine as well as increase access to it. In the change phase, the plan

would be implemented and facilitate the new change with the stakeholders, like the medical

professionals and the school staff. It is important that the staff understand the importance of the

HPV vaccine series and how to best implement the plan, like providing resources. For example,

to help educate patients and families they may require handout materials or videos that may also
HPV VACCINE INCREASES IN ADOLESCENTS 4

be needed in different languages. In the refreezing phase, the established changes need to be

sustained. To refreeze the implemented plan, ensuring patients are properly educated through

surveys, as well as ensuring information is being sent out to patients.

Resources Needed to Implement Plan

Underserved communities have been shown to have lower HPV vaccination rates and that

may be due to limited HPV vaccine knowledge. Research has shown that vaccination programs

within schools have increased HPV vaccine completion rates (Kaul et al., 2019). The HPV

vaccine educational programs were provided at health fairs, parent-teacher nights, and school

board meetings. After the study, the completion rate rose to 28.36% at the intervention school

while the comparison schools were at 20.53% (Kaul et al., 2019). HPV educational programs

should be provided at every school to increase vaccination completion rates, but receiving

adequate funding to provide these programs may serve as a barrier. To make the program budget

friendly the school nurse could receive materials from the educational program and disperse

them to the students as well as provide education to parents, teachers, and students. Overall,

providing educational programs on the HPV vaccine is effective in increasing vaccine

completion rates and school nurses could provide the education.

Evaluation Plan

To monitor the outcomes of the plan, the number of adolescents who completed the two-

dose HPV vaccination series versus those who did not during the year will have to be assessed.

These numbers will have to be compared to previous years to see if there have been any

improvements in the beginning and compliance with the HPV vaccination regimen. To

implement an ongoing reassessment strategy, surveys could be sent out to parents and school

nurses of adolescents in the county to determine if the school system is effectively implementing
HPV VACCINE INCREASES IN ADOLESCENTS 5

vaccination programs to encourage vaccines at the end of the first year and the subsequent years.

Following a democratic style of leadership would promote stakeholder feedback and input on the

plan. It will be beneficial to follow this type of leadership style because all the stakeholders have

a variety of backgrounds and can bring new ideas to implement into the plan. To reevaluate the

plan, the number of adolescents who are completing the series can be compared to previous

statistics in six-month intervals for the next three years following the first year of

implementation.

Conclusion

These findings impact patient care outcomes because the more people that are educated

on HPV completion, the more likely they are to complete the series of vaccinations and increase

their health literacy. Health professionals and caregivers should both be knowledgeable when it

comes to providing education that can be passed on to adolescents engaging in sexual

experiences. Raising awareness for HPV vaccinations through the Change Theory of Nursing

and educational programs provides adolescents with protective services to avoid the negative

consequences of the disease.

This assignment allowed the team to dive deeper into the positive outcomes of

vaccinations, solidifying that education on HPV vaccinations promotes healthy behaviors while

also identifying strengths and barriers to the completion of the three-part series. The team

learned that the role of the Registered Nurse in quality improvement is to improve patient care

outcomes by providing initiatives that reduce adverse events, improve care coordination, and

optimize health and safety within the community.

References

Araldi, R. P., Sant'Ana, T. A., Módolo, D. G., de Melo, T. C., Spadacci-Morena, D. D., de Cassia

Stocco, R., Cerutti, J. M., & de Souza, E. B. (2018). The human papillomavirus (HPV)-

related cancer biology: An overview. Biomedicine & Pharmacotherapy, 106, 1537–1556.

https://doi.org/10.1016/j.biopha.2018.06.149

Christy, Winger, J. G., & Mosher, C. E. (2019). Does Self-Efficacy Mediate the Relationships

Between Social-Cognitive Factors and Intentions to Receive HPV Vaccination Among

Young Women? Clinical Nursing Research, 28(6), 708–725.

https://doi.org/10.1177/1054773817741590

Kaul S, Do TQN, Hsu E, Schmeler KM, Montealegre JR, Rodriguez AM. (2019) School-based

human papillomavirus vaccination program for increasing vaccine uptake in an

underserved area in Texas. Papillomavirus Research. 100189. doi:

10.1016/j.pvr.2019.100189
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Appendix