The role of pharmacy in HPV vaccination of U.S. adolescents Public Deposited

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  • March 21, 2019
Creator
  • Shah, Parth
    • Affiliation: Gillings School of Global Public Health, Department of Health Behavior
Abstract
  • Purpose. Pharmacies could play a meaningful role in improving HPV vaccine uptake in US adolescents. This dissertation aimed to evaluate the intrapersonal, provider, and structural factors related to pharmacies as vaccination settings that might motivate parents to obtain pharmacist-provided HPV vaccinations for their children. Methods. Aim One: I conducted structural equation modeling to evaluate how the type of pharmacy parents (n=1,504) use to get medications for their adolescent children was associated with willingness to get these children HPV vaccine from pharmacists. Aim Two: I conducted analysis of variance and multiple regression models to examine how parents (n=1,500) perceived relative advantages of vaccine delivery in pharmacies compared to doctors’ offices. Aim Three: I conducted geospatial analyses to assess whether community pharmacists can improve access to HPV vaccination services in primary health care shortage areas in Texas, which allows pharmacists to immunize adolescents. Results. Aim One: Compared to parents who used chain pharmacies, parents who used independent pharmacies were less willing to get their adolescent children HPV vaccine from pharmacists (β=-.094; p=.001). Service quality and satisfaction suppressed this relationship. Aim Two: Parents were more willing to get their children HPV vaccine from a pharmacist if they indicated more relative advantages in vaccine delivery in pharmacies (β=.29; p<.001), and if they believed vaccine delivery features related to patient accessibility were more important than features related to the health care environment (β=.20; p<.001). Aim Three: When pharmacists were included as adolescent vaccine providers along with primary care physicians, census tracts shifted towards adequate coverage in 35% (1,055/3013) of urban tracts and in 18% (92/521) of rural tracts. Conclusion. Pharmacies could increase HPV vaccine uptake by improving parents’ perception of service quality at pharmacies they use. Pharmacies that provide adolescent vaccinations should capitalize on their relative advantages in patient accessibility over doctors’ offices, while also improving on vaccine delivery features related to the health care environment which parents believed to be superior in doctors’ offices. Pharmacists could potentially increase access to HPV vaccination for parents and adolescents in states that allow pharmacists to immunize adolescents.
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Rights statement
  • In Copyright
Advisor
  • Marciniak, Macary
  • Golden, Shelley
  • Golin, Carol E.
  • Brewer, Noel T.
  • Trogdon, Justin
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill
Graduation year
  • 2017
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