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Chadi A, Thirion DJG, David PM. Vaccine promotion strategies in community pharmacy addressing vulnerable populations: a scoping review. BMC Public Health 2023; 23:1855. [PMID: 37741997 PMCID: PMC10518112 DOI: 10.1186/s12889-023-16601-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 08/23/2023] [Indexed: 09/25/2023] Open
Abstract
CONTEXT Social determinants of health are drivers of vaccine inequity and lead to higher risks of complications from infectious diseases in under vaccinated communities. In many countries, pharmacists have gained the rights to prescribe and administer vaccines, which contributes to improving vaccination rates. However, little is known on how they define and target vulnerable communities. OBJECTIVE The purpose of this study is to describe how vulnerable communities are targeted in community pharmacies. METHODS We performed a systematic search of the Embase and MEDLINE database in August 2021 inspired by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols (PRISMA ScR). Articles in English, French or Spanish addressing any vaccine in a community pharmacy context and that target a population defined as vulnerable were screened for inclusion. RESULTS A total of 1039 articles were identified through the initial search, and 63 articles met the inclusion criteria. Most of the literature originated from North America (n = 54, 86%) and addressed influenza (n = 29, 46%), pneumococcal (n = 14, 22%), herpes zoster (n = 14, 22%) or human papilloma virus vaccination (n = 14, 22%). Lifecycle vulnerabilities (n = 48, 76%) such as age and pregnancy were most often used to target vulnerable patients followed by clinical factors (n = 18, 29%), socio-economical determinants (n = 16, 25%) and geographical vulnerabilities (n = 7, 11%). The most frequently listed strategy was providing a strong recommendation for vaccination, promotional posters in pharmacy, distributing leaflet/bag stuffers and providing staff training. A total of 24 barriers and 25 facilitators were identified. The main barriers associated to each vulnerable category were associated to effective promotional strategies to overcome them. CONCLUSION Pharmacists prioritize lifecycle and clinical vulnerability at the expense of narrowing down the definition of vulnerability. Some vulnerable groups are also under targeted in pharmacies. A wide variety of promotional strategies are available to pharmacies to overcome the specific barriers experienced by various groups.
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Affiliation(s)
- Alexandre Chadi
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada.
| | - Daniel J G Thirion
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
- McGill University Health Centre, Montreal, QC, Canada
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Koskan AM, LoCoco IE, Daniel CL, Teeter BS. Rural Americans' COVID-19 Vaccine Perceptions and Willingness to Vaccinate against COVID-19 with Their Community Pharmacists: An Exploratory Study. Vaccines (Basel) 2023; 11:vaccines11010171. [PMID: 36680016 PMCID: PMC9864964 DOI: 10.3390/vaccines11010171] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/06/2023] [Accepted: 01/08/2023] [Indexed: 01/15/2023] Open
Abstract
In early 2022 in the U.S., rural adults were the least likely to vaccinate against COVID-19 due to vaccine hesitancy and reduced healthcare access. This study explored the factors influencing rural adults' COVID-19 vaccine perceptions and their acceptance of pharmacist-administered vaccination. We utilized phone-based semi-structured interviews with 30 adults living in rural regions of one southwestern state and analyzed the data using a team-based thematic analysis approach. Vaccine-willing participants described knowing other people affected by the virus and their desired protection from the virus. They reported trusting scientific institutions and the government to provide safe vaccines. Vaccine-hesitant populations, however, feared that the COVID-19 vaccine development process had been rushed, compromising the safety of these newer vaccines. Although they differed in the news sources they preferred for receiving COVID-19 vaccine information, both vaccine-willing and vaccine-hesitant participants described trusting local authorities, such as healthcare providers and county government officials, to provide accurate COVID-19 vaccine information. Regarding the acceptability of pharmacist-administered COVID-19 vaccinations, all but one participant described their acceptance of this healthcare delivery approach. Future outreach should leverage rural adults' trust in local sources, including community pharmacists, deemed more convenient access points to healthcare, when addressing vaccine hesitancy.
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Affiliation(s)
- Alexis M. Koskan
- College of Health Solutions, Arizona State University, 425 N 5th Street, Phoenix, AZ 85004, USA
- Correspondence:
| | - Iris E. LoCoco
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 550 E Van Buren Street, Phoenix, AZ 85006, USA
| | - Casey L. Daniel
- Department of Family Medicine, Whiddon College of Medicine, University of South Alabama, 5795 USA North Drive, Mobile, AL 36608, USA
| | - Benjamin S. Teeter
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, 4301 W Markham St., Little Rock, AR 72205, USA
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Carney PA, Bumatay S, Kuo GM, Darden PM, Hamilton A, Fagnan LJ, Hatch B. The Interface Between U.S. Primary Care Clinics and Pharmacies for HPV Vaccination Delivery: A Scoping Literature Review. Prev Med Rep 2022; 28:101893. [PMID: 35855918 PMCID: PMC9287788 DOI: 10.1016/j.pmedr.2022.101893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/14/2022] [Accepted: 07/01/2022] [Indexed: 10/31/2022] Open
Abstract
For HPV vaccine delivery to improve, shared knowledge about and comfort with HPV vaccine administration are needed for all stakeholders (clinicians, pharmacists, parents, and patients). Intervention studies were small with weak study designs, many of which revealed that pharmacists were not successful in integrating services into broader primary care systems. Challenges include getting physicians to sign standing order protocols, service delivery being poor due to engagement barriers, and low parental demand for pharmacists to administer the vaccine. Larger more discerning studies are needed to fully understand the potential of primary care and pharmacy interactions for HPV vaccination.
Completion of the Human Papilloma Virus (HPV) vaccine series remains low. Partnerships between primary care (PC) clinics and local pharmacies could boost vaccination rates. We conducted a scoping literature review to address what is known and what gaps exist on the interface between U.S. primary care clinics and pharmacies for HPV vaccination. We searched Ovid MEDLINE ALL file and Cumulative Index to Allied Health Literature for articles published between 1/1/2010 and 12/31/2020. Search subjects included: 1) Pharmacy HPV Vaccination, 2) Pharmacy/PC Collaboration, and 3) Pharmacy/PC Collaboration vaccination. We developed an abstraction form to collect information on research methods, settings, strengths, weaknesses and findings. We screened 407 articles for inclusion; 17 met inclusion criteria: 13 (76.5%) reported on observational/descriptive studies; 4 articles (23.5%) reported on intervention studies, none of which were conducted in rural areas. Observational studies focused on willingness to be vaccinated for HPV and facilitators and barriers for vaccination, especially at pharmacies. Many studies concluded that knowledge about and comfort with HPV vaccine administration were needed for all vaccination stakeholders (clinicians, pharmacists, parents, and patients). Intervention studies were small with weak study designs, many of which revealed that pharmacists were not successful in integrating services into broader primary care systems. Challenges included getting physicians to sign standing order protocols, poor service delivery due to engagement barriers, and low parental demand for pharmacists to administer the vaccine. In conclusion, larger more discerning studies are needed to fully understand the potential of primary care and pharmacy interactions for HPV vaccination.
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Mohamed R, Kelly KM, Nili M, Kelley GA. A systematic review with meta-analysis of parental interventions for human papillomavirus vaccine uptake. J Am Pharm Assoc (2003) 2022; 62:1142-1153. [DOI: 10.1016/j.japh.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/26/2022]
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Navarrete J, Yuksel N, Schindel TJ, Hughes CA. Sexual and reproductive health services provided by community pharmacists: a scoping review. BMJ Open 2021; 11:e047034. [PMID: 34312200 PMCID: PMC8314704 DOI: 10.1136/bmjopen-2020-047034] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Pharmacists are increasingly providing patient-focused services in community pharmacies, including in the area of sexual and reproductive health (SRH). Specific SRH areas have been the focus of research, but a broader perspective is needed to position pharmacists as SRH providers. This review explored research that described and evaluated professional pharmacy services across a broad range of SRH areas. DESIGN Scoping review DATA SOURCES: Medline, EMBASE, CINAHL, Web of Science, Scopus and Cochrane Library (January 2007-July 2020). STUDY SELECTION Studies reporting on the description and evaluation of professional pharmacy SRH services provided by community pharmacists. DATA EXTRACTION Two investigators screened studies for eligibility, and one investigator extracted the data. Data were analysed to primarily describe professional pharmacy services and intervention outcomes. RESULTS Forty-one studies were included. The main SRH areas and professional pharmacy services reported were sexually transmitted and bloodborne infections (63%) and screening (39%), respectively. Findings showed that pharmacists' delivery of SRH services was feasible, able to reach vulnerable and high-risk groups, and interventions were highly accepted and valued by users. However, integration into daily workflow, pharmacist remuneration, cost and reimbursement for patients, and policy regulations were some of the barriers identified to implementing SRH services. Studies were primarily in specific areas such as chlamydia screening or hormonal contraception prescribing, while studies in other areas (ie, medical abortion provision, long-acting reversible contraception prescribing and vaccine delivery in pregnant women) were lacking. CONCLUSION This scoping review highlights the expansion of pharmacists' roles beyond traditional product-focused services in a number of SRH areas. Given the potential feasibility, users' acceptability and reach, pharmacists are ideally situated to enhance SRH care access. Future research describing implementation and evaluation of professional pharmacy services in all SRH areas is needed to promote access to these services through community pharmacies and position pharmacists as SRH providers worldwide.
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Affiliation(s)
- Javiera Navarrete
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Nese Yuksel
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Theresa J Schindel
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Christine A Hughes
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
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Koskan A, Brennhofer SA, Helitzer D. Administering the HPV Vaccine to People Living with HIV: Providers' Perspectives. J Prim Prev 2021; 41:349-362. [PMID: 32613520 DOI: 10.1007/s10935-020-00598-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
HIV-positive patients suffer disproportionate burden of anal cancer, a disease which is primarily caused by persistent infection with human papillomavirus (HPV) and is potentially preventable with the completion of the HPV vaccine series. Past research qualitatively explored HIV-positive patients' perspectives about the HPV vaccine. However, little is known about their healthcare practitioners' vaccine recommendation behaviors, the strongest influence on vaccine uptake. This study reports on in-depth interviews conducted with 25 healthcare practitioners who provide care for HIV-positive patients. Qualitative themes that emerged from the study included clinicians' HPV vaccination behaviors, HIV patient's willingness to get the HPV vaccine, the role of HIV-positive patients' immune functioning in terms of timing of HPV vaccine administration, and vaccinating HIV-positive patients over age 26. The majority of providers offered the vaccine at their healthcare facility. Participants varied in their opinions related to the importance of patients' CD4 count in terms of timing of HPV vaccine administration; some believed that patients' immune functioning should first be stabilized to receive the most benefit from the vaccine series. They also differed in the perceived benefit of offering the vaccine to patients over age 26. In light of the U.S. Food and Drug Administration's recent approval to extend HPV vaccination to adults up to age 45 years, more HIV-positive adults may benefit by receiving this vaccine series. Future efforts should ensure that providers regularly promote the HPV vaccine to their adult HIV-positive patients. Vaccinating HIV-positive patients may help reduce the burden of HPV-related cancers, particularly anal cancer.
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Affiliation(s)
- Alexis Koskan
- College of Health Solutions, Arizona State University, 425 N. 5th Street, Phoenix, AZ, USA.
| | | | - Deborah Helitzer
- College of Health Solutions, Arizona State University, 425 N. 5th Street, Phoenix, AZ, USA
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Koskan A, Vizcaino M, Brennhofer SA, Lee CD, Roberto AJ. Human papillomavirus vaccine administration behaviors and influences among Arizona pharmacists and pharmacy interns. Hum Vaccin Immunother 2021; 17:3090-3095. [PMID: 33886423 DOI: 10.1080/21645515.2021.1905469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
This study assessed 27 Arizona community pharmacists' and pharmacy interns' human papillomavirus (HPV) vaccine administration behaviors and influences. We recruited community pharmacists and pharmacy interns from a statewide pharmacy conference to complete a 40-item cross-sectional survey. Informed by the Theory of Planned Behavior, the survey assessed pharmacists' HPV vaccine-related behaviors, intentions, attitudes, subjective norms, and perceived behavioral control to vaccinate against HPV. We analyzed all data using descriptive statistics and correlations. Overall, most pharmacists held positive attitudes about the HPV vaccine. However, the majority rarely administered the HPV vaccine. Intentions to vaccinate and subjective norms positively correlated with vaccine administration behavior. Pharmacists' positive attitudes about the vaccine, subjective norm to vaccinate, and behavioral control or self-efficacy to recommend the vaccine impacted their intentions to vaccinate against HPV. Most surveyed pharmacists believed that the most substantial HPV vaccine administration barriers include parental consent and parental stigma against the vaccine. The most common pharmacy-related barrier was the lack of a tracking and reminder system to encourage patients to return for additional HPV vaccine doses. This work highlights the need to increase public awareness that pharmacists can administer vaccines to adolescents. Study authors recommend offering communication training to increase pharmacists' perceived behavioral control to recommend the HPV vaccine.
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Affiliation(s)
- Alexis Koskan
- Arizona State University College of Health Solutions, Phoenix, AZ, USA
| | | | | | - Chong D Lee
- Arizona State University College of Health Solutions, Phoenix, AZ, USA
| | - Anthony J Roberto
- Hugh Downs School of Human Communication, Arizona State University, Tempe, AZ, USA
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Koskan AM, Dominick LN, Helitzer DL. Rural Caregivers' Willingness for Community Pharmacists to Administer the HPV Vaccine to Their Age-Eligible Children. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:189-198. [PMID: 31493172 DOI: 10.1007/s13187-019-01617-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Human papillomavirus (HPV) vaccination uptake varies by geographic regions with rural, often medically underserved areas, lagging behind more urban regions in terms of vaccine initiation and completion. In these regions, pharmacies may serve as an additional location for HPV vaccine administration. Little is known about rural caregivers' willingness to have their HPV vaccine age-eligible children obtain this vaccine from their local pharmacist. First and second authors conducted 26 in-depth interviews with caregivers of HPV vaccine age-eligible children living in rural regions of a southwestern state to explore their perceptions of the HPV vaccine and their willingness for pharmacist-administered HPV vaccination. They analyzed interview data using an inductive qualitative content analyses approach. The majority of caregivers were unaware that pharmacists could offer adolescent vaccines. However, most were willing to allow their children to receive the vaccine from this non-traditional source. Comments related to obtaining vaccinations from pharmacists related mostly to concerns about proper training and their certification to vaccinate against HPV. Caregivers believed that having a pharmacist administer the HPV vaccine would not affect their relationship with their primary care provider. Caregivers preferred print health education resources and were interested in also receiving health information via social media to learn more about the HPV vaccine and pharmacists' role in HPV vaccine administration. Pharmacies may serve as an additional site to increase HPV vaccine initiation and completion. Rural regions need additional health information about the HPV vaccine and pharmacists' abilities to administer this cancer prevention resource.
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Affiliation(s)
- Alexis M Koskan
- College of Health Solutions, Arizona State University, 425 N. 5th Street, Phoenix, AZ, USA.
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Cebollero J, Walton SM, Cavendish L, Quairoli K, Cwiak C, Kottke MJ. Evaluation of Human Papillomavirus Vaccination After Pharmacist-Led Intervention: A Pilot Project in an Ambulatory Clinic at a Large Academic Urban Medical Center. Public Health Rep 2020; 135:313-321. [PMID: 32228133 PMCID: PMC7222962 DOI: 10.1177/0033354920914340] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objectives Despite the safety and efficacy of the human papillomavirus (HPV) vaccine,
many persons are still not receiving it. The purpose of this pilot project
was to evaluate the number of first doses of the 9-valent HPV (9vHPV)
vaccination administered after a pharmacist-led intervention in the Adult
Family Planning Clinic at Grady Health System (GHS), a large academic urban
medical center in Atlanta, Georgia. Methods The pilot project had 3 phases: pre-intervention (November 15, 2016, through
March 31, 2017), active intervention (November 15, 2017, through December
29, 2017), and post-intervention (December 30, 2017, through March 31,
2018). The pre-intervention phase was used as a historical control. The
active intervention phase consisted of pharmacist interventions in the
clinic and patient and health care provider education. The post-intervention
phase evaluated the durability of pharmacist-led interventions performed and
education provided during the active phase. Results Eighty-nine first-dose 9vHPV vaccines (of the 3-dose series) were
administered to young adults aged 18-26 during the project period (November
15, 2017, through March 31, 2018); none were administered during the
pre-intervention phase. Of 89 patients who received a first 9vHPV vaccine
dose, 20 patients also received a second 9vHPV vaccine dose. During the
project period, 166 doses of 9vHPV vaccine (first, second, or third doses)
were administered. Conclusion This pharmacist-led intervention led to an increase in the number of young
adult patients receiving their first dose of the 9vHPV vaccination series.
With the support of other health care providers, pharmacist-led initiatives
can expand vaccine-related health literacy and facilitate access to
immunization services.
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Affiliation(s)
| | | | | | | | - Carrie Cwiak
- 1365 Grady Health System, Atlanta, GA, USA.,23033 Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Melissa J Kottke
- 1365 Grady Health System, Atlanta, GA, USA.,23033 Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
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Bouza E, Ancochea-Bermúdez J, Campins M, Eirós-Bouza JM, Fargas J, García Rojas A, Gracia D, Gutiérrez Sánchez A, Limia A, López JA, Magro MC, Mirada G, Muñoz P, Olier E, Ortiz de Lejarazu R, Urbiztondo L, Palomo E. The situation of vaccines for the prevention of infections in adults: An opinion paper on the situation in Spain. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2019; 32:333-364. [PMID: 31345005 PMCID: PMC6719651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/23/2019] [Accepted: 05/07/2019] [Indexed: 11/17/2022]
Abstract
The childhood immunization schedule is well known and generally well implemented in developed countries. For various reasons, the same is not true of vaccines aimed at preventing infections in adults, in which vaccination coverage is incomplete and generally very deficient. In order to assess the situation of adult vaccination in Spain, the Fundación de Ciencias de la Salud has brought together a series of experts in different fields, including doctors, nurses, representatives of patient associations, health managers and economists, health authorities and journalists to deal with this issue. The format was that of a round table in which a series of questions previously formulated by the coordinators were to be answered and debated. The document presented is not an exhaustive review of the topic, nor is it intended to make recommendations, but only to give a multidisciplinary opinion on topics that could be particularly debatable or controversial. The paper reviews the main vaccine-preventable adult diseases, their clinical and economic impact, the possibilities of reducing them with vaccination programmes and the difficulties in carrying them out. The role of nursing, pharmacy services, patient associations and the health administration itself in changing the current situation was discussed. Prospects for new vaccines were discussed and we speculated on the future in this field. Finally, particularly relevant ethical aspects in decision-making regarding vaccination were discussed, which must be faced by both individuals and states. We have tried to summarize, at the end of the presentation of each question, the environment of opinion that was agreed with all the members of the table.
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Affiliation(s)
- E Bouza
- Emilio Bouza, Instituto de Investigación Sanitaria Gregorio Marañón. C/ Dr. Esquerdo, 46, 28007 Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Palomo
- Esteban Palomo. Director. Fundación de Ciencias de la Salud. C/ Severo Ochoa, 2, 28760 Tres Cantos. Madrid, Spain. Phone +34 91 3530150
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Tolentino V, Unni E, Montuoro J, Bezzant-Ogborn D, Kepka D. Utah pharmacists' knowledge, attitudes, and barriers regarding human papillomavirus vaccine recommendation. J Am Pharm Assoc (2003) 2018; 58:S16-S23. [PMID: 29739667 DOI: 10.1016/j.japh.2018.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 03/31/2018] [Accepted: 04/10/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To evaluate Utah community pharmacists' knowledge and attitudes toward recommendation of human papillomavirus (HPV) vaccine, to determine whether the knowledge and attitude of pharmacists regarding the HPV vaccine influence their recommendation behaviors, and to capture any self-identified barriers to recommending the HPV vaccine. DESIGN A cross-sectional anonymous 73-item survey was developed and administered to community, outpatient, and ambulatory care pharmacists. SETTING Utah. PARTICIPANTS Utah community pharmacists. MAIN OUTCOME MEASURES Recommendation of the HPV vaccine by the pharmacist, knowledge and attitude of pharmacists regarding HPV vaccine, and barriers to vaccine receipt. RESULTS The mean HPV vaccine knowledge score was 7.45 ± 2.15 (out of 13), and scores were higher when pharmacists had 4 to 6 technicians per day in the pharmacy and when they were residency trained. The mean attitude score was 24.26 ± 3.16 (out of 30). Positive attitudes were found if they had more than 1 pharmacist and 4 to 6 pharmacy technicians working at any given time in the pharmacy. Those who identified with "other Christianity" had a more positive attitude than Latter Day Saints. Although positive attitude toward the HPV vaccine was a predictor for recommending the vaccine to both boys and girls, higher knowledge was a significant predictor only in recommending the HPV vaccine for boys. Female pharmacists were more likely to recommend the HPV vaccine. The top 3 reported barriers included lack of parental knowledge, parental concerns and opposition, and lack of educational materials to provide parents. CONCLUSION Although the majority of respondents perceived HPV vaccination as useful for preventing certain types of cancer, and more than one-half of respondents reported being comfortable in recommending the vaccine, only one-third actually recommended the vaccine for girls and for boys. The results indicate the need for improving knowledge about the HPV vaccine for pharmacists, patients, and parents.
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