Degree

Doctor of Nursing Practice (DNP)

Department

Nursing

Document Type

Dissertation

Abstract

Background: Human papillomavirus (HPV) remains one of the most common vaccine-preventable infections, with vaccination rates among young adults aged 17 to 26 remaining below Healthy People 2030 targets. University health settings represent a critical opportunity to improve vaccine uptake. Prior to this quality improvement (QI) initiative, student health services (SHS) at a public university in the southern United States did not routinely offer HPV vaccination, resulting in missed opportunities for prevention. Evidence supports provider recommendation, clinical decision support, and improved access as key drivers of HPV vaccination uptake. Purpose: The purpose of this QI project was to increase HPV vaccination uptake, including initiation and completion, among young adults aged 17 to 26 by implementing a multilevel, multicomponent, evidence-based intervention within SHS. Methods: A pre-post intervention design was used. Provider confidence was evaluated using a five-item Likert-scale survey administered before and after an educational “Lunch and Learn” session. A retrospective chart review of 2024 data and an implementation-period chart review of 2025 data were conducted to assess vaccination initiation, completion, and missed opportunities. The intervention included provider education, an HPV-specific global alert in the electronic health record (EHR), targeted student outreach, and expanded access. Results: Thirteen SHS personnel attended the educational session; 7 providers and nurses (100% of eligible clinical staff) completed matched pre- and post-surveys. Survey results demonstrated statistically significant improvements in confidence recommending HPV vaccination, discussing risks and benefits, and addressing vaccine hesitancy (p < 0.05). HPV vaccination initiation increased from 57% to 69%, and completion increased from 42% to 59%. Vaccination was offered in 96% of eligible encounters; however, 87.2% of students did not receive the vaccine, with patient declination as the primary contributor to missed opportunities. Point-of-care uptake remained low: 4% initiated vaccination, and 26.5% completed the series when offered. Conclusion: This multilevel, multicomponent, evidence-based QI intervention improved provider confidence and increased HPV vaccination initiation and completion among young adults. Despite improved provider practices, patient-level factors, particularly vaccine hesitancy and declination, remain the primary barrier to uptake. Future efforts should focus on improving vaccine acceptance while sustaining provider education, EHR-based CDS, and targeted outreach. Keywords: HPV vaccination; young adults; clinical decision support; provider education; quality improvement

Date

2-6-2026

DOI

https://proquest.com/docview/3347826084

First Committee Chair

Christy Lenahan

First Committee Member

Jennifer Sittig

Second Committee Member

Madeline Husband-Ardoin

Third Committee Member

Roger Rholdon

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