Date of Award

Spring 5-21-2016

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Dr. Susan Instone

Second Advisor

Dr. Joseph Burkard


Project Purpose: The purpose of the project was to improve the rate of Human Papillomavirus (HPV) vaccination compliance among military women aged 18-26 years utilizing clinical reminder via text messages.

Background: Specific populations have been particularly effected by low HPV vaccine completion rates including active duty military women. The incidence of high risk sexual behavior in this population is noted to be higher than the general public and sexually transmitted infection (STI) rates are seven times higher in active duty military women compared to the general public. In addition, HPV is the most prevalent STI in this population with an incidence rate of 333.9 per 10,000 person-years. In 2011, research at the Naval Medical Center San Diego (NMCSD) found that the vaccine series completion rate in active duty military members was only 16%. The use of reminders for multi-dose vaccine series has demonstrated effective increases in compliance rates since the 1980s.

Practice Change: Clinical reminders via text message were sent out to each woman who received her first dose of HPV vaccine in November or December 2014 and January 2015. The text was sent to all women who had not yet returned to the clinic to receive the second or third dose. The reminder notified them that their next vaccine dose was due and to obtain it within the next month. The Iowa model was used as a framework for this project. Project effectiveness was evaluated based on changes in HPV immunizations series compliance rates before and after the text message intervention.

Outcomes: There was an increase in vaccination rates among the women receiving the text message reminders for both the second and third dose. This project followed an initial effort three months before to educate patients about need for the HPV vaccine and the provider to offer a strong recommendation for obtaining the vaccine. An increase from the previously reported rate of HPV vaccine series compliance among active duty military women was achieved. However, even with the education and provider recommendation, the rates were below the national averages. With the implementation of the clinical reminders via text message, there was an increase from 50% to 65% for the 2nd dose after the text message reminder with 17 out of 26 women receiving at least 2 HPV vaccine doses. In addition, the completion rate for all 3 doses increased from 34% to 42% (11 out of 26 women) exceeding the national average of 39.7% for HPV vaccine completion by U.S. girls according to the CDC (2015).

Implications and Conclusions: Clinical reminders, specifically text message reminders, increased HPV vaccination rates for active duty military women in addition to patient education and provider recommendation. Long-term benefits will include a decrease in HPV infection rates, a decrease in HPV-related medical costs, and a decrease in the incidence of cervical cancer in this population.


Grant funding: Jonas Military-Veteran Scholarship Grant, Jonas Nurse Scholars, NURSS5050, School of Nursing, Student Aid, 00, S5050