The survey response rate of 57% was similar to the average response rate of physicians to surveys of 54%.9
Surprisingly, 83% of respondents chose to return a hard copy of the survey by mail, rather than completing the survey online, which we thought would be more convenient. However, the original mailing contained a copy of the survey, as well as a preaddressed, postage-paid envelope, which might have made this option more appealing than having to take the extra step to access the online survey. Most respondents were older than 45 years of age and lived in small communities, which might have affected computer proficiency or Internet access. The mailed survey also provided the physician with more control over his or her answers, and many opted to write in comments or qualifying statements, which was not possible in the online format.
This group of physicians was highly supportive of the HPV vaccine. Two-thirds of respondents had received some CME training about the HPV vaccine, which might have been a factor in the high proportion (88%) of respondents who either always or sometimes recommended the HPV vaccine to eligible girls. Owing to the small sample size, however, a statistical association between CME training and recommendation of the HPV vaccine could not be established. Most of those who only sometimes recommended the vaccine, or who did not respond, provided an explanation as to why this was the case (such as they did not see this patient demographic, or they did not work in the community). This support makes it clear that the physician buy-in exists, but it has not been effectively capitalized on. Similarly, only 62% of physicians were very aware of the provincial vaccination program in BC. As these physicians are often a first contact point for parents, there needs to be increased communication between public health and private practice sectors. It is impossible for physicians to support or buy into a program if they are not aware of it, and this serves as a lost opportunity to maximize the success of an important public health program.
Although almost all of the respondents stated that they had working relationships with other family physicians and pharmacists in their communities, only 62% stated this was so with their local health units. Communication among different health care providers in communities is essential to ensuring streamlined health promotion activities. Specifically, communication between health units (which typically design and roll out public health programs) and private practices is a necessary first step to achieving physician support and buy-in for public health programs, which will serve to increase their success; physicians will be better able to care for their patients’ health when they are aware of all of the programs that are offered. Indeed, a move to a more integrated and holistic health care system, where health authorities and physicians interact, will be mutually beneficial to all health care professionals involved, as well as to the health of all British Columbians.
In terms of resources, 42% of respondents noted they would like more information on statistics about HPV infection rates, cervical cancer rates, or genital wart rates. There was at least some need for more information indicated in every suggested category. As physicians are considered experts on the topic, it is important to meet these information needs immediately. Other resources suggested were an informational video and materials such as brochures and pamphlets with comprehensive information that was targeted to parents. Further research could focus on what resources would be the most effective.
The overarching goal of this study was to identify specific opportunities to involve GPOs in the promotion of the HPV vaccine. Almost half of the respondents agreed to have their contact information, as well as the activities that they were willing to participate in to promote the vaccine, shared with their local health units. This is an important outcome not only functionally for the health units who will now have a contact list for physicians who they can contact as resources for publicly supporting the vaccine, but also structurally for the field of public health, which has typically been thought of as separate or at times even counter to the practices of private physicians. This study has demonstrated that physicians are willing and have a desire to be involved with public health programs, and it has identified specific ways in which they are willing to be involved in promotion of the HPV vaccine. In this case, these particular physicians were identified to be surveyed, as by virtue of their specialty they were considered to already have a vested interest in the HPV vaccination program and were, therefore, important stakeholders in the program. Future public health programs would likely also benefit by identifying potential health care professional stakeholders before the roll-out of a program, in an effort to achieve buy-in and support from the people who will likely have great influence on the program’s success. Indeed, it is likely that if GPOs had been more involved in the planning or roll-out of the publicly funded school-based HPV vaccination program, the program might have been met with more support initially. Regardless, now that these public supporters have been identified, it will be imperative to act on their offered support to ensure the maximum uptake of this vaccine to help decrease the morbidity and mortality associated with HPV infection, genital warts, and cervical cancer.
Given the authority that physicians have with the public on health care decisions, achieving physician support of public health programs has the potential to increase the success and effects of these programs. These results are encouraging but further research is necessary to evaluate the effects of physician support on public health program success as well as which means of physician support are the most effective. Additionally, further research should aim to survey a larger population of physicians that is more generalizable to see if this interest in participation also exists among other groups of physicians. Owing to the small sample size of this study, it was not possible to test for associations between certain demographic factors and HPV vaccine attitudes, practices, and knowledge. Additionally, this survey was conducted on a specific specialty of physicians, and the results might not be generalizable to all physicians.