Human Papillomavirus Vaccine Education for Medical Assistants as a Strategy to Improve Vaccination Rates in 9-year-old Children
Main Article Content
Abstract
Background: The Human Papillomavirus vaccine protects patients against Human Papillomavirus-related infection and cancers, yet it is underutilized. The American Academy of Pediatrics and the American Cancer Society now recommend starting the vaccine series at age 9 years. Medical Assistants can play a pivotal role in identifying and facilitating Human Papillomavirus vaccination in 9-year-old children and are the focus of this project.
Aim Statement: This project aims to examine whether one educational session can improve the perceptions, knowledge, and comfort level of Medical Assistants regarding Human Papillomavirus vaccination, thus promoting the vaccination in the pediatric clinic setting, especially with 9-year-old patients.
Methods: The project took place at three separate clinics of one pediatric organization in Utah.
Interventions: A 10–15-minute educational session about the Human Papillomavirus vaccine was presented to the Medical Assistants at each clinic, and a pre- and post-survey method was used to analyze the effect of the education on perceptions, knowledge, and comfort level in vaccinating 9-year-old children.
Results: Post-education data showed improvements in Medical Assistants’ perceptions, knowledge, and comfort levels regarding the Human Papillomavirus vaccine. Comfort level of initiating the vaccine series at age 9 increased from 75% pre-survey to 100% post-survey. Pre-survey, 62.5% of Medical Assistants believed the Human Papillomavirus vaccine was effective; post-survey 100% of Medical Assistants believed the Human Papillomavirus vaccine was effective. When comparing pre- and post-survey results, respectively, 75% of Medical Assistants believed the Human Papillomavirus vaccine was safe compared to 100%.
Conclusions: An educational intervention on Human Papillomavirus vaccine improves perceptions, increases knowledge, and boosts comfort levels for Medical Assistants recommending the vaccine in the pediatric clinic setting.
Article Details
How to Cite
LUTHY, Karlen E. et al.
Human Papillomavirus Vaccine Education for Medical Assistants as a Strategy to Improve Vaccination Rates in 9-year-old Children.
Medical Research Archives, [S.l.], v. 13, n. 5, may 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6464>. Date accessed: 21 june 2025.
doi: https://doi.org/10.18103/mra.v13i5.6464.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. World Health Organization. Vaccines and immunization. 2023 [cited 27 September 2024]. In: World Health Organization Website [Internet]. Available from:
https://www.who.int/health-topics/vaccines-and-immunization#tab=tab_1
2. American Academy of Pediatrics. 14 diseases you almost forgot about (thanks to vaccinApril 2021 [cited 3 December 2024]. In: Healthy Children Website [Internet]. Available from:
https://www.healthychildren.org/English/safety-prevention/immunizations/Pages/Vaccination-Protects-Against-These-Diseases.aspx
3. Centers for Disease Control and Prevention. Why CDC is involved in global immunization. 4 September 2024 [cited 3 December 2024]. In: Centers for Disease Control and Prevention Website. Available from:
https://www.cdc.gov/globalhealth/immunization/why/index.html
4. Kaiser Family Foundation. The HPV vaccine: Access and use in the U.S. 8 October 2024 [cited 3 December 2024]. In: Kaiser Family Foundation Website. Available from:
https://www.kff.org/womens-health-policy/fact-sheet/the-hpv-vaccine-access-and-use-in-the-u-s/
5. Centers for Disease Control and Prevention. HPV vaccination. 20 August 2024 [cited 3 December 2024]. In: Centers for Disease Control and Prevention Website. Available from:
https://www.cdc.gov/hpv/vaccines/index.html
6. Centers for Disease Control and Prevention. Reasons to get HPV vaccine. 3 July 2024 [cited 3 December 2024]. In: Centers for Disease Control and Prevention Website. Available from:
https://www.cdc.gov/hpv/vaccines/reasons-to-get.html?CDC_AAref_Val=https://www.cdc.gov/hpv/parents/vaccine/six-reasons.html
7. Centers for Disease Control and Prevention. Human papillomavirus (HPV) vaccine safety. 31 July 2024 [cited 3 December 2024]. In: Centers for Disease Control and Prevention Website. Available from:
https://www.cdc.gov/vaccine-safety/vaccines/hpv.html?CDC_AAref_Val=https://www.cdc.gov/vaccinesafety/vaccines/hpv-vaccine.html
8. American Cancer Society and the National HPV Vaccination Roundtable. N.D. [cited 1 May 2025]. In: HPV Roundtable Website. Available from: https://hpvroundtable.org/wp-content/uploads/2023/05/HPV_Roundtable-HPV_Why_Age_9_Sales_Sheet_WEB.pdf
9. Kong WY, Huang Q, Thompson P, Grabert BK, Brewer NT, Gilkey MB. Recommending HPV vaccination at age 9: A national survey of primary care professionals. Acad Pediatri. 2022; 22(4): 573-580. doi:10.1016/j.acap.2022.01.008
10. American Association of Medical Personnel. Registered medical assistant. 2024 [cited 3 December 2024]. In: American Association of Medical Personnel Website. Available from:
https://www.aamp.net/services/registered-medical-assistant.html
11. Commission on Accreditation of Allied Health Education Programs. Standards and guidelines for the accreditation of education programs in medical assisting. 4 April 2022 [cited 3 December 2024]. In: CAAHEP Website. Available from:
https://assets.website-files.com/5f466098572bfe97f28d59df/62f4194eb9b831023c2dd848_2022-03_MA_BoD%20Approved_FINAL%20STANDARDS%20w%20App%20A.pdf
12. Mills J, Van Winkle P, Shen M, Hong C, Hudson S. Physicians', nurses', and medical assistants' perceptions of the human papillomavirus vaccine in a large integrated health care system. Perm J. 2016;20(4):15-205. doi:10.7812/TPP/15-205
13. President’s Cancer Panel. Accelerating HPV vaccine uptake: Urgency for action to prevent cancer. A report to the President of the United States from the President’s Cancer Panel. February 2014 [cited 3 December 2024]. In: National Cancer Institute. Available from:
https://deainfo.nci.nih.gov/Advisory/pcp/annualReports/HPV/PDF/PCP_Annual_Report_2012-2013.pdf
14. Centers for Disease Control and Prevention. Fostering a culture of immunization in your practice. 12 September 2024 [cited 3 December 2024]. In: Centers for Disease Control and Prevention Website. Available from:
https://www.cdc.gov/immunization-training/hcp/courses/index.html#cdc_training_materials_section_4-fostering-a-culture-of-immunization-in-your-practice
15. Office of Disease Prevention and Health Promotion. Increase the proportion of adolescents who get recommended doses of the HPV vaccine – IID-08. Data. August 2020 [cited 3 December 2024]. In: Healthy People 2030. Available from:
https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/vaccination/increase-proportion-adolescents-who-get-recommended-doses-hpv-vaccine-iid-08/data
16. Office of Disease Prevention and Health Promotion. Increase the proportion of adolescents who get recommended doses of the HPV vaccine – IID-08. August 2020 [cited 3 December 2024]. In: Healthy People 2030. Available from:
https://health.gov/healthypeople/objectives-and-data/browse-objectives/vaccination/increase-proportion-adolescents-who-get-recommended-doses-hpv-vaccine-iid-08
17. Office of Disease Prevention and Health Promotion. Healthy People 2030 framework. August 2020 [cited 11 December 2024]. In: Healthy People 2030. Available from:
https://health.gov/healthypeople/about/healthy-people-2030-framework
18. Rositch AF, Liu T, Chao C, Moran M, Beavis AL. Levels of parental human papillomavirus vaccine hesitancy and their reasons for not intending to vaccinate: Insights from the 2019 National Immunization Survey-Teen. J Adolesc Health. 2022; 71(1):39-46. doi:10.1016/j.jadohealth.2022.01.223
19. Sonawane K, Lin YY, Damgacioglu H, et al. Trends in human papillomavirus vaccine safety concerns and adverse event reporting in the United States. JAMA Netw Open. 2021;4(9).
doi:10.1001/jamanetworkopen.2021.24502
20. Beavis A, Krakow M, Levinson K, Rositch AF. Reasons for lack of HPV vaccine initiation in NIS-Teen over time: Shifting the focus from gender and sexuality to necessity and safety. J Adolesc Health. 2018;63(5):652-656. doi:10.1016/j.jadohea lth.2018.06.024
21. Marshall S, Fleming A, Moore AC, Sahm LJ. Views of parents regarding human papillomavirus vaccination: A systematic review and meta-ethnographic synthesis of qualitative literature. Res Social Adm Pharm. 2019;15(4):331-337. doi:10.101 6/j.sapharm.2018.05.013
22. Kepka D, Bodson J, Lai D, et al. Diverse caregivers' HPV vaccine-related awareness and knowledge. Ethn Health. 2021;26(6):811-826. doi:10.1 080/13557858.2018.1562052
23. Adjei Boakye E, Nair M, Abouelella DK, et al. Trends in reasons for human papillomavirus vaccine hesitancy: 2010-2020. Pediatrics. 2023;151(6). doi:10.1542/peds.2022-060410
24. Lu PJ, Yankey D, Fredua B, et al. Association of provider recommendation and human papillomavirus vaccination initiation among male adolescents aged 13-17 years-United States. J Pediatr. 2019;206:33-41.e1. doi:10.1016/j.jpeds.2 018.10.034
25. Kong WY, Bustamante G, Pallotto IK, et al. Disparities in healthcare providers' recommendation of HPV vaccination for U.S. adolescents: A systematic review. Cancer Epidemiol Biomarkers Prev. 2021;30 (11):1981-1992. doi:10.1158/1055-9965.EPI-21-0733
26. Lake P, Fuzzell L, Brownstein NC, et al. HPV vaccine recommendations by age: A survey of providers in federally qualified health centers. Hum Vaccin Immunother. 2023;19(1):2181610. doi:10.10 80/21645515.2023.2181610
27. Rani U, Darabaner E, Seserman M, Bednarczyk RA, Shaw J. Public education interventions and uptake of human papillomavirus vaccine: A systematic review. J Public Health Manag Pract. 2022;28(1). doi:10.1097/PHH.0000000000001253
28. Dike SN, Cesario SK, Malecha A, Nurse R. An education intervention to increase human papillomavirus vaccination confidence and acceptability: A randomized controlled trial. Oncol Nurs Forum. 2023;50(4):423-436. doi:10.1188/2 3.ONF.423-436
29. Dixon BE, Zimet GD, Shan X, et al. An educational intervention to improve HPV vaccination: A cluster randomized trial. Pediatrics. 2019;143(1). doi:10.1542/peds.2018-1457
30. Beck A, Bianchi A, Showalter D. Evidence-based practice model to increase human papillomavirus vaccine uptake: A stepwise approach. Nurs Womens Health. 2021;25(6):430-436. doi:10.101 6/j.nwh.2021.09.006
31. Bernstein TA, Broome M, Millman J, Epstein J, Derouin A. Promoting strategies to increase HPV vaccination in the pediatric primary care setting. J Pediatr Health Care. 2022;36(2). doi:10.1016/j.pe dhc.2021.10.009
32. Centers for Disease Control and Prevention. HPV vaccination recommendations. 16 November 2021 [cited 11 December 2024]. In: Centers for Disease Control and Prevention Website. Available from: https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html
33. Lazcano-Ponce E, Torres-Ibarra L, Cruz-Valdez A, et al. Persistence of immunity when using different human papillomavirus vaccination schedules and booster-dose effects 5 years after primary vaccination. J Infect Dis. 2018;219(1):41-49. doi:10.1 093/infdis/jiy465
34. Minihan AK, Bandi P, Star J, et al. The association of initiating HPV vaccination at ages 9-10 years and up-to-date status among adolescents ages 13-17 years, 2016-2020. Hum Vaccin Immunother. 2023;19(1):2175555. doi:10.1080/21 645515.2023.2175555
35. Troiano G, Nardi A. Vaccine hesitancy in the era of COVID-19. Public Health. 2021;194:245-251. doi:10.1016/j.puhe.2021.02.025
36. Peretti-Watel P, Larson HJ, Ward JK, Schulz WS, Verger P. Vaccine hesitancy: Clarifying a theoretical framework for an ambiguous notion. PLoS Curr. 2015;7. doi:10.1371/currents.outbreaks.6 844c80ff9f5b273f34c91f71b7fc289
37. Crawford R. Healthism and the medicalization of everyday life. Int J Health Serv. 1980;10(3):365-388. doi:10.2190/3H2H-3XJN-3KAY-G9NY
38. Johnson BB, Swedlow B. Cultural Theory’s contributions to risk analysis: A thematic review with directions and resources for further research. Risk Anal. 2021;41(3):429-455. doi:10.1111/risa.13 299
39. Taylor AC, Hopkins LW, Moore G. Increasing human papillomavirus immunization in the primary care setting. Nurse Pract. 2021;46(10):37-42. doi:10.1 097/01.NPR.0000790528.06533.66
40. Vu M, King AR, Jang HM, Bednarczyk RA. Practice-, provider- and patient-level facilitators of and barriers to HPV vaccine promotion and uptake in Georgia: A qualitative study of healthcare providers' perspectives. Health Educ Res. 2020;35(6):512-523. doi:10.1093/her/cyaa026
41. Sackey ME, Markey K, Grealish A. Healthcare professional’s promotional strategies in improving human papillomavirus (HPV) vaccination uptake in adolescents: A systematic review. Vaccine. 2022;40 (19):2656-2666. doi:10.1016/j.vaccine.2022.03.054
42. Schmuhl NB, Mooney KE, Zhang X, et al. No association between HPV vaccination and infertility in U.S. females 18-33 years old. Vaccine. 2020;38(24): 4038-4043. doi:10.1016/j.vaccine.2020.03.035
43. Wubu A, Balta B, Cherie A, Bizuwork K. Perception about human papillomavirus vaccination among middle adolescent school girls in Addis Ababa, Ethiopia 2023: Qualitative study. BMC Womens Health. 2023;23(1):520. doi:10.1186/s12905-023-02660-1
44. Berenson AB, Hirth JM, Fuchs EL, Chang M, Rupp RE. An educational intervention to improve attitudes regarding HPV vaccination and comfort with counseling among US medical students. Hum Vaccin Immunother. 2020;16(5):1139-1144. doi:10.1 080/21645515.2019.1692558
45. Shekhar R, Sheikh AB, Upadhyay S, et al. COVID-19 vaccine acceptance among health care workers in the United States. Vaccines. 2021;9(2): 119. doi:10.3390/vaccines9020119
https://www.who.int/health-topics/vaccines-and-immunization#tab=tab_1
2. American Academy of Pediatrics. 14 diseases you almost forgot about (thanks to vaccinApril 2021 [cited 3 December 2024]. In: Healthy Children Website [Internet]. Available from:
https://www.healthychildren.org/English/safety-prevention/immunizations/Pages/Vaccination-Protects-Against-These-Diseases.aspx
3. Centers for Disease Control and Prevention. Why CDC is involved in global immunization. 4 September 2024 [cited 3 December 2024]. In: Centers for Disease Control and Prevention Website. Available from:
https://www.cdc.gov/globalhealth/immunization/why/index.html
4. Kaiser Family Foundation. The HPV vaccine: Access and use in the U.S. 8 October 2024 [cited 3 December 2024]. In: Kaiser Family Foundation Website. Available from:
https://www.kff.org/womens-health-policy/fact-sheet/the-hpv-vaccine-access-and-use-in-the-u-s/
5. Centers for Disease Control and Prevention. HPV vaccination. 20 August 2024 [cited 3 December 2024]. In: Centers for Disease Control and Prevention Website. Available from:
https://www.cdc.gov/hpv/vaccines/index.html
6. Centers for Disease Control and Prevention. Reasons to get HPV vaccine. 3 July 2024 [cited 3 December 2024]. In: Centers for Disease Control and Prevention Website. Available from:
https://www.cdc.gov/hpv/vaccines/reasons-to-get.html?CDC_AAref_Val=https://www.cdc.gov/hpv/parents/vaccine/six-reasons.html
7. Centers for Disease Control and Prevention. Human papillomavirus (HPV) vaccine safety. 31 July 2024 [cited 3 December 2024]. In: Centers for Disease Control and Prevention Website. Available from:
https://www.cdc.gov/vaccine-safety/vaccines/hpv.html?CDC_AAref_Val=https://www.cdc.gov/vaccinesafety/vaccines/hpv-vaccine.html
8. American Cancer Society and the National HPV Vaccination Roundtable. N.D. [cited 1 May 2025]. In: HPV Roundtable Website. Available from: https://hpvroundtable.org/wp-content/uploads/2023/05/HPV_Roundtable-HPV_Why_Age_9_Sales_Sheet_WEB.pdf
9. Kong WY, Huang Q, Thompson P, Grabert BK, Brewer NT, Gilkey MB. Recommending HPV vaccination at age 9: A national survey of primary care professionals. Acad Pediatri. 2022; 22(4): 573-580. doi:10.1016/j.acap.2022.01.008
10. American Association of Medical Personnel. Registered medical assistant. 2024 [cited 3 December 2024]. In: American Association of Medical Personnel Website. Available from:
https://www.aamp.net/services/registered-medical-assistant.html
11. Commission on Accreditation of Allied Health Education Programs. Standards and guidelines for the accreditation of education programs in medical assisting. 4 April 2022 [cited 3 December 2024]. In: CAAHEP Website. Available from:
https://assets.website-files.com/5f466098572bfe97f28d59df/62f4194eb9b831023c2dd848_2022-03_MA_BoD%20Approved_FINAL%20STANDARDS%20w%20App%20A.pdf
12. Mills J, Van Winkle P, Shen M, Hong C, Hudson S. Physicians', nurses', and medical assistants' perceptions of the human papillomavirus vaccine in a large integrated health care system. Perm J. 2016;20(4):15-205. doi:10.7812/TPP/15-205
13. President’s Cancer Panel. Accelerating HPV vaccine uptake: Urgency for action to prevent cancer. A report to the President of the United States from the President’s Cancer Panel. February 2014 [cited 3 December 2024]. In: National Cancer Institute. Available from:
https://deainfo.nci.nih.gov/Advisory/pcp/annualReports/HPV/PDF/PCP_Annual_Report_2012-2013.pdf
14. Centers for Disease Control and Prevention. Fostering a culture of immunization in your practice. 12 September 2024 [cited 3 December 2024]. In: Centers for Disease Control and Prevention Website. Available from:
https://www.cdc.gov/immunization-training/hcp/courses/index.html#cdc_training_materials_section_4-fostering-a-culture-of-immunization-in-your-practice
15. Office of Disease Prevention and Health Promotion. Increase the proportion of adolescents who get recommended doses of the HPV vaccine – IID-08. Data. August 2020 [cited 3 December 2024]. In: Healthy People 2030. Available from:
https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/vaccination/increase-proportion-adolescents-who-get-recommended-doses-hpv-vaccine-iid-08/data
16. Office of Disease Prevention and Health Promotion. Increase the proportion of adolescents who get recommended doses of the HPV vaccine – IID-08. August 2020 [cited 3 December 2024]. In: Healthy People 2030. Available from:
https://health.gov/healthypeople/objectives-and-data/browse-objectives/vaccination/increase-proportion-adolescents-who-get-recommended-doses-hpv-vaccine-iid-08
17. Office of Disease Prevention and Health Promotion. Healthy People 2030 framework. August 2020 [cited 11 December 2024]. In: Healthy People 2030. Available from:
https://health.gov/healthypeople/about/healthy-people-2030-framework
18. Rositch AF, Liu T, Chao C, Moran M, Beavis AL. Levels of parental human papillomavirus vaccine hesitancy and their reasons for not intending to vaccinate: Insights from the 2019 National Immunization Survey-Teen. J Adolesc Health. 2022; 71(1):39-46. doi:10.1016/j.jadohealth.2022.01.223
19. Sonawane K, Lin YY, Damgacioglu H, et al. Trends in human papillomavirus vaccine safety concerns and adverse event reporting in the United States. JAMA Netw Open. 2021;4(9).
doi:10.1001/jamanetworkopen.2021.24502
20. Beavis A, Krakow M, Levinson K, Rositch AF. Reasons for lack of HPV vaccine initiation in NIS-Teen over time: Shifting the focus from gender and sexuality to necessity and safety. J Adolesc Health. 2018;63(5):652-656. doi:10.1016/j.jadohea lth.2018.06.024
21. Marshall S, Fleming A, Moore AC, Sahm LJ. Views of parents regarding human papillomavirus vaccination: A systematic review and meta-ethnographic synthesis of qualitative literature. Res Social Adm Pharm. 2019;15(4):331-337. doi:10.101 6/j.sapharm.2018.05.013
22. Kepka D, Bodson J, Lai D, et al. Diverse caregivers' HPV vaccine-related awareness and knowledge. Ethn Health. 2021;26(6):811-826. doi:10.1 080/13557858.2018.1562052
23. Adjei Boakye E, Nair M, Abouelella DK, et al. Trends in reasons for human papillomavirus vaccine hesitancy: 2010-2020. Pediatrics. 2023;151(6). doi:10.1542/peds.2022-060410
24. Lu PJ, Yankey D, Fredua B, et al. Association of provider recommendation and human papillomavirus vaccination initiation among male adolescents aged 13-17 years-United States. J Pediatr. 2019;206:33-41.e1. doi:10.1016/j.jpeds.2 018.10.034
25. Kong WY, Bustamante G, Pallotto IK, et al. Disparities in healthcare providers' recommendation of HPV vaccination for U.S. adolescents: A systematic review. Cancer Epidemiol Biomarkers Prev. 2021;30 (11):1981-1992. doi:10.1158/1055-9965.EPI-21-0733
26. Lake P, Fuzzell L, Brownstein NC, et al. HPV vaccine recommendations by age: A survey of providers in federally qualified health centers. Hum Vaccin Immunother. 2023;19(1):2181610. doi:10.10 80/21645515.2023.2181610
27. Rani U, Darabaner E, Seserman M, Bednarczyk RA, Shaw J. Public education interventions and uptake of human papillomavirus vaccine: A systematic review. J Public Health Manag Pract. 2022;28(1). doi:10.1097/PHH.0000000000001253
28. Dike SN, Cesario SK, Malecha A, Nurse R. An education intervention to increase human papillomavirus vaccination confidence and acceptability: A randomized controlled trial. Oncol Nurs Forum. 2023;50(4):423-436. doi:10.1188/2 3.ONF.423-436
29. Dixon BE, Zimet GD, Shan X, et al. An educational intervention to improve HPV vaccination: A cluster randomized trial. Pediatrics. 2019;143(1). doi:10.1542/peds.2018-1457
30. Beck A, Bianchi A, Showalter D. Evidence-based practice model to increase human papillomavirus vaccine uptake: A stepwise approach. Nurs Womens Health. 2021;25(6):430-436. doi:10.101 6/j.nwh.2021.09.006
31. Bernstein TA, Broome M, Millman J, Epstein J, Derouin A. Promoting strategies to increase HPV vaccination in the pediatric primary care setting. J Pediatr Health Care. 2022;36(2). doi:10.1016/j.pe dhc.2021.10.009
32. Centers for Disease Control and Prevention. HPV vaccination recommendations. 16 November 2021 [cited 11 December 2024]. In: Centers for Disease Control and Prevention Website. Available from: https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html
33. Lazcano-Ponce E, Torres-Ibarra L, Cruz-Valdez A, et al. Persistence of immunity when using different human papillomavirus vaccination schedules and booster-dose effects 5 years after primary vaccination. J Infect Dis. 2018;219(1):41-49. doi:10.1 093/infdis/jiy465
34. Minihan AK, Bandi P, Star J, et al. The association of initiating HPV vaccination at ages 9-10 years and up-to-date status among adolescents ages 13-17 years, 2016-2020. Hum Vaccin Immunother. 2023;19(1):2175555. doi:10.1080/21 645515.2023.2175555
35. Troiano G, Nardi A. Vaccine hesitancy in the era of COVID-19. Public Health. 2021;194:245-251. doi:10.1016/j.puhe.2021.02.025
36. Peretti-Watel P, Larson HJ, Ward JK, Schulz WS, Verger P. Vaccine hesitancy: Clarifying a theoretical framework for an ambiguous notion. PLoS Curr. 2015;7. doi:10.1371/currents.outbreaks.6 844c80ff9f5b273f34c91f71b7fc289
37. Crawford R. Healthism and the medicalization of everyday life. Int J Health Serv. 1980;10(3):365-388. doi:10.2190/3H2H-3XJN-3KAY-G9NY
38. Johnson BB, Swedlow B. Cultural Theory’s contributions to risk analysis: A thematic review with directions and resources for further research. Risk Anal. 2021;41(3):429-455. doi:10.1111/risa.13 299
39. Taylor AC, Hopkins LW, Moore G. Increasing human papillomavirus immunization in the primary care setting. Nurse Pract. 2021;46(10):37-42. doi:10.1 097/01.NPR.0000790528.06533.66
40. Vu M, King AR, Jang HM, Bednarczyk RA. Practice-, provider- and patient-level facilitators of and barriers to HPV vaccine promotion and uptake in Georgia: A qualitative study of healthcare providers' perspectives. Health Educ Res. 2020;35(6):512-523. doi:10.1093/her/cyaa026
41. Sackey ME, Markey K, Grealish A. Healthcare professional’s promotional strategies in improving human papillomavirus (HPV) vaccination uptake in adolescents: A systematic review. Vaccine. 2022;40 (19):2656-2666. doi:10.1016/j.vaccine.2022.03.054
42. Schmuhl NB, Mooney KE, Zhang X, et al. No association between HPV vaccination and infertility in U.S. females 18-33 years old. Vaccine. 2020;38(24): 4038-4043. doi:10.1016/j.vaccine.2020.03.035
43. Wubu A, Balta B, Cherie A, Bizuwork K. Perception about human papillomavirus vaccination among middle adolescent school girls in Addis Ababa, Ethiopia 2023: Qualitative study. BMC Womens Health. 2023;23(1):520. doi:10.1186/s12905-023-02660-1
44. Berenson AB, Hirth JM, Fuchs EL, Chang M, Rupp RE. An educational intervention to improve attitudes regarding HPV vaccination and comfort with counseling among US medical students. Hum Vaccin Immunother. 2020;16(5):1139-1144. doi:10.1 080/21645515.2019.1692558
45. Shekhar R, Sheikh AB, Upadhyay S, et al. COVID-19 vaccine acceptance among health care workers in the United States. Vaccines. 2021;9(2): 119. doi:10.3390/vaccines9020119