Date of Award

Spring 2026

Project Type

Clinical Doctorate

College or School

CHHS

Department

Nursing

Program or Major

DNP

Degree Name

Other

First Advisor

Marcy Ainslie

Second Advisor

Meagan Stabler

Abstract

BACKGROUND: The Human Papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States (CDC, 2024). Unlike other common STI's, persistent infection with HPV increases the risk of cancer. A Human Papillomavirus (HPV) vaccination was approved in the United States in 2006 for girls and women aged 9 to 26 and in 2009 it was approved for boys and men in this same age range. Despite 20 years of data on the efficacy and safety of the HPV vaccine, rates of completed HPV vaccine series remain low. In 2019 the Advisory Committee on Immunization Practices (ACIP) expanded the age range for the HPV vaccine to people aged 27-45 years of age who were unvaccinated or inadequately vaccinated at ages 9-26 (Meites, 2019). Unfortunately, only a small percentage of adults aged 27-45 had received the HPV vaccine since the age expansion.  There is also significant gender disparity in this age group with men having a much lower vaccination rate then women (Rincon,2024). The ACIP also recommended for patients in this age group that shared clinical decision-making (SDM) should take place between patients and their clinicians (Meites,2019). One of the barriers for clinicians addressing HPV vaccination in the expanded age range has been lack of clinician knowledge regarding engaging patients in SDM for HPV vaccination (Gidengil,2023).

METHODS: A literature review was conducted, and articles were critically appraised to identify interventions to help increase HPV vaccination rates in the expanded age range. An interventional training and toolkit were developed for clinical staff, and a Plan-Do-Study-Act (PDSA) method was utilized to implement the project.  Two pre-tests were administered to clinic staff: on knowledge of HPV vaccine in the expanded age range, and the other incorpoRATE, a measure of clinician willingness to engage in shared decision making prior to the intervention.  After the intervention, the clinical staff completed two posttests, one on HPV knowledge and the same incorpoRATE measure on SDM.

INTERVENTIONS: This project had a single intervention approach, incorporating both the development of a power point training for clinical staff on the expanded age range for the HPV vaccination and willingness to engage in SDM, coupled with the development of a written toolkit that was disseminated to the clinical staff. RESULTS: The aim of this project was met.  Post intervention, the scores of the pre and post test for knowledge of the HPV vaccine in the expanded age range using the paired t-test showed that the clinical staff demonstrated a significant increase in knowledge with the mean increase between pre and post test scores of 23.5 points (95% CI; 14.8-29.7) representing a large effect (Cohen’s d =23.5).  The Wilcoxon signed-rank test was used to measure pre and post test scores of the incorpoRATE measure regarding willingness to engage in SDM showed an increase in Median scores from 86% (IQR:77%-92%) for the pretest to 94% (IQR 88% to 98%) in the post test. Wilcoxon signed-rank test indicates this change was statistically significant (Z = -2.31, p =0.021) with a large effect size r =0.055”.

CONCLUSION: The specific aims of the quality improvement project were met. The project illustrated education and training regarding both knowledge of the HPV vaccine for the expanded age range and the importance of SDM can increase clinician knowledge of the HPV vaccine in the expanded age range and willingness to engage in SDM with patients.

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