Date of Graduation


Document Type


Degree Name

Doctor of Philosophy in Community Health Promotion (PhD)

Degree Level



Health, Human Performance and Recreation


Bart Hammig

Committee Member

Ed Bengtson

Second Committee Member

Peggy Schaefer Whitby

Third Committee Member

Robert Davis


cancer, HPV vaccination, intellectual disability, patient-provider relationship, Primary health care, primary health care providers, vaccination risk


Two reasons for subpar coverage of the Human papillomavirus (HPV) vaccine are missed clinical opportunities and nonacceptance of the vaccine upon recommendation from a medical provider. The purpose of study one was to examine factors associated with access and adherence to physician’s recommendations in association with HPV vaccine uptake. Data were obtained from National Health Interview Survey (2017). Variables theoretically related to clinical opportunities and adherence to physician’s recommendations were examined in association with HPV vaccine uptake. Univariate logistic regressions were run to determine the associations between the aforementioned variables and uptake of the HPV vaccine. Multinomial logistic regressions were used to determine if the variables demonstrate different associations between those who received the vaccine between 9-16 years of age and 17-26 years of age, compared to never receiving the vaccine. The sample was limited to females aged 18-26 years. Compared to receiving no health care, receiving care from a general medical provider (GP) only was associated with higher vaccine uptake; however, there no difference in respondents who received care from an OBGYN only and respondents who saw an OBGYN and a GP had the highest vaccine uptake. These same patterns of association were present in the multinomial model for those who received the vaccine between 9-16 years of age, but not 17-18 years of age. No other variables were associated with the uptake of the HPV vaccine in either the logistic or multinomial regression models. Seeing a GP, but not an OBGYN is associated with greater protection from HPV infections. Engaging in routine and preventative measures at a younger age may result in continuing this behavior into young adulthood. In the past two decades cancer was acknowledged as a new health concern for individuals with an intellectual disability (ID). Despite such recognition, no research in the US has sought to examine their uptake of the cancer-preventing, HPV vaccine. Physicians can provide insight into the factors they consider when deciding whether to recommend the vaccine and can provide insight into the discussions they have with patients/caregivers regarding the vaccine. The purpose of this study was to examine physicians’ experiences of recommending the HPV vaccine to females with an ID. An online open-ended survey was employed. Data were analyzed using inductive content analysis. Forty-nine out of 51 participants had previously recommended the HPV vaccine to females with an ID. Physicians believed the HPV vaccine was important because of the population’s noncompliance with pap smears and risk of sexual abuse. Physicians believed the vaccine was less important for patients who were unlikely to be sexually active. Physicians generally described parents as uncertain, but receptive of the vaccine. There were some responses which implied caregivers did not believe their child would be sexually active and therefore were not at risk for contracting HPV. Both patients and parents believed immunizations generally could be traumatic for this population. Physicians were supportive of the HPV vaccine for females with an ID and perceived parents as wanting to protect their child, but uncertain about the vaccine’s necessity.