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Insights from the Cancer Control Field:
Making Effective HPV Vaccine Recommendations in Iowa

At a Glance

Iowa HHS implemented Making Effective HPV Vaccine Recommendations to raise HPV vaccination rates among adolescents in Iowa. Read this case study narrative to learn how Iowa HHS used this program and how you can use Making Effective HPV Vaccine Recommendations in your setting.

Challenges and Lessons Learned

Broadening Your Reach

When recruitment plans are not working, be willing to expand your reach to implement the program in more or different settings.

Providing Clear Messaging

Providing a clear overview of your project in a one-page format (front and back) can help with the clinic recruitment process. The clinics appreciated receiving a snapshot of the project highlights that helped them understand the project’s goals, benefits, and requirements.

Public Health Challenge

In the United States, almost all men and women get the human papillomavirus (HPV) in their lifetime. HPV infection can lead to health complications, including various cancers (e.g., penile, anal, oropharyngeal) and is the cause of nearly all cervical cancer cases. HPV is the culprit behind approximately 36,000 cancer cases each year.

The HPV vaccination series can prevent cancers associated with HPV. Still, HPV vaccine completion rates remain low, especially when compared with other adolescent vaccination rates.

Increasing HPV vaccination rates is especially important in Iowa, because Iowa has the highest age-adjusted incidence rate of oral cavity and pharynx cancer in the United States, and HPV is thought to be linked to about 70% of cases of oropharyngeal cancer (a type of oral cavity and pharynx cancer) in the nation.

In Iowa, the Department of Health and Human Services (HHS) wanted to improve HPV vaccination rates among 13- to 15-year-olds in areas where these rates were low. With the help of a grant, Iowa HHS decided to implement Making Effective HPV Vaccine Recommendations in Iowa to improve HPV vaccination uptake.

The Setting

Iowa HHS chose to implement Making Effective HPV Vaccine Recommendations due to the program’s ease of implementation and the evidence supporting its effectiveness.

The program was implemented in 11 clinics across the state of Iowa, including public health clinics serving rural and micropolitan populations.

The webinar was an important refresher, and the training caused [the clinics] to do more one-on-one education.

—Participating Clinics

The Approach

Efforts to increase HPV vaccination completion rates among adolescents have been going on for years within Iowa. For example, in 2018, the Iowa Cancer Consortium (Iowa’s cancer coalition), with funding from Iowa HHS, provided an implementation grant to the American Cancer Society–Midwest affiliate (ACS) to bring Dr. Noel Brewer (program developer) to Des Moines University to train health care providers on the intervention’s "announcement" approach. This initial training with Dr. Brewer led Iowa HHS to implement this program a few years later.

In 2020, the Iowa Comprehensive Cancer Control Program at Iowa HHS received a grant from the Centers for Disease Control and Prevention to improve HPV vaccination rates among adolescents. Working with partners including ACS and the University of Iowa Cancer Prevention and Control Network, Iowa HHS was connected with a physician champion who had already been trained on the intervention’s announcement approach to assist with the project.

Iowa HHS planned to implement the program in ZIP codes with lower-than-average HPV vaccination rates. Implementation began in these areas, but due to recruitment challenges, the implementers broadened their scope to reach their target audience of primary care providers (physicians and mid-level providers) who had not yet been trained in the announcement approach. Ultimately, 11 clinics primarily in rural and micropolitan areas participated, and a total of 46 providers (physicians, nurses, nurse practitioners, and physician assistants) attended the training. The clinics were deemed eligible to participate if they actively vaccinated adolescents ages 9 to 13; were willing to engage leadership to prioritize HPV vaccination; attended the required training; and agreed to report data to the implementers, encourage broad staff participation, and participate in the evaluation.

In May 2021, the implementers hosted one virtual webinar, and one clinic attended. Then in August 2021, the implementers hosted a second virtual webinar, and 10 clinics attended. The one-hour trainings focused on the importance of the announcement approach, shared the evidence that supports using this method, and trained providers on the research-tested messaging. The training informed providers on how to speak with hesitant parents and overcome common concerns (e.g., age, sex, safety). The trainer emphasized the importance of recommending vaccination as early as 9 years old.

As in the original program, the trainer reviewed local HPV vaccination rates and the effectiveness of the HPV vaccine and taught providers how to use the announcement strategy and how to implement the program at their clinic. In the interest of time, providers did not practice the announcement strategy during the training but were instructed to start using the approach at their practice immediately.

As an incentive for participating in the training, providers received Continuing Medical Education credits or Continuing Education Units. They also received $500 for participating in the training and sending baseline data and an additional $500 for sending implementation data.

The final evaluation showed that clinics found the training to be a valuable experience that allowed for more provider education and consistent messaging. Participants reported that the approach would fit easily into their well-child visits and their clinic’s workflow. Further, the evaluation revealed an increase in participants’ confidence in addressing parents’ concerns as well as in their intention to routinely recommend the HPV vaccine. Five of the 11 participating clinics were interviewed following implementation, and all stated they would continue to implement the announcement approach in their clinic.

Questions and Answers

Could Iowa have implemented Making Effective HPV Vaccine Recommendations without the in-person support from the developer?

I think we could have implemented it because Dr. Brewer has a lot of great resources available through his website, and there are resources available on EBCCP as well, but it was very helpful meeting Dr. Brewer in person and seeing his presentation live in 2018.

What makes Making Effective HPV Vaccine Recommendations easy to implement?

It’s a relatively simple intervention, but many health care providers are still unfamiliar with it. Many health care providers think they’re giving a strong recommendation for the HPV vaccine without realizing the research behind the wording that really has been shown to work.

Find Out More

To learn more about Making Effective HPV Vaccine Recommendations and how to use the program at your organization, view the program summary at:


The Implementer

Katie Jones, MS, CHES
Iowa Department of Health and Human Services

The Developer

Noel Brewer, PhD
University of North Carolina at Chapel Hill