The human papillomavirus (HPV) vaccine will only have an impact on cervical cancer disparities in Texas if the populations who suffer disproportionately from mortality (minority, low-income, and medically underserved) use this primary prevention strategy. Safety-net clinics are an important medical home for underserved adolescents and have tremendous potential for delivering the vaccine to those who need it most.

Our medical record review in Parkland community clinics (Dallas County safety-net system) showed suboptimal rates of vaccine initiation (1 dose) and completion (3 doses). Parkland responded by implementing electronic standing immunization orders to increase provider recommendation a...

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The human papillomavirus (HPV) vaccine will only have an impact on cervical cancer disparities in Texas if the populations who suffer disproportionately from mortality (minority, low-income, and medically underserved) use this primary prevention strategy. Safety-net clinics are an important medical home for underserved adolescents and have tremendous potential for delivering the vaccine to those who need it most.

Our medical record review in Parkland community clinics (Dallas County safety-net system) showed suboptimal rates of vaccine initiation (1 dose) and completion (3 doses). Parkland responded by implementing electronic standing immunization orders to increase provider recommendation and an automated reminder system to help patients keep appointments. Our project proposes to evaluate additional evidence-based strategies targeted to adolescent girls and their parents that stimulate patient demand and compliment clinic-directed strategies.

The project has three specific aims— 1) Determine if mailed reminder and educational materials delivered prior to clinic visit increases HPV vaccine initiation; 2) Determine if a telephone recall delivered 2 weeks post-visit increases initiation among patients who declined the vaccine; and 3) Determine if telephone recalls to those who miss appointments for 2nd or 3rd doses increase completion.

To evaluate effectiveness, we will compare a randomly selected group receiving usual care plus this 3-part intervention with another randomly selected group receiving usual care. We will use the behavioral model of healthcare utilization and Precaution Adoption Process Model to guide our evaluation and examine for whom the intervention works and why. Our rigorous evaluation design harnesses Parkland’s electronic record system to monitor effectiveness.

If these minimal-effort strategies are shown to be effective over and above the systems approaches already adopted, they could be easily incorporated into Parkland’s standard of care and disseminated to other clinic systems. Findings will improve our understanding of how to best promote the HPV vaccine in underserved populations.

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