Improving HPV Vaccination Through Provider Voices: Lessons from Southern California Tribal Health Clinics

By Dakota Jones (Lumbee), MPH

As the nation’s most populous state, California is home to over 2.3 million rural residents that face distinct challenges in accessing preventive health care. Between 2019 and 2022, California experienced a 21% decline in HPV vaccine completion for adolescents aged 11–13 years underscoring critical setbacks of preventive care utilization across the state. While statewide HPV vaccine series completion rates remained between 57% and 61%, disparities persisted in rural and Native-serving clinic settings, where limited infrastructure, transportation barriers, and mistrust of healthcare systems contribute to lower uptake.

In Riverside and San Bernardino counties, where large American Indian and Alaska Native populations receive care through the Riverside–San Bernardino County Indian Health Clinic system, these barriers were especially evident. To better understand the dynamics driving these disparities, our team at the University of Southern California partnered with the Riverside–San Bernardino County Indian Health Clinic system and interviewed health care providers across eight rural tribal clinics to identify barriers and effective strategies to improve HPV vaccination within Native communities.

Others stressed that rebuilding trust requires relationships beyond transactional care: 

Despite these barriers, health care providers identified several practical strategies. They emphasized normalizing HPV vaccination as routine cancer prevention and integrating vaccination into sick visits, follow-ups, or lab appointments rather than relying on annual well-child visits. Several called for structured vaccine communication training so providers and staff can role-play difficult conversations and build confidence.

One strategy mentioned repeatedly was the Announcement Approach, which presents HPV vaccination as a standard part of adolescent care alongside required immunizations. Providers reported that this framing reduces resistance and increases vaccine acceptance. Clinics interested in this method can explore training resources available through HPV IQ, and the St. Jude HPV Cancer Prevention Program team also offers Announcement Approach Trainings in-person and virtually. Email PreventHPV@stjude.org to inquire. 

The burden of HPV cancers remains concentrated in California’s most rural counties with Riverside County (9.8%) and San Bernardino County (9.3%) among those with the highest rates. These patterns demonstrate how rural communities, including Native-serving clinic systems, carry a disproportionate burden of disease despite representing a much smaller subset of the state’s population. Providers in these regions are on the frontlines of prevention yet often implement new vaccine guidelines without additional training or culturally-adapted implementation methods. These perspectives underscore that improving HPV vaccination requires more than access, but depends on trust, clear communication, and continuity of care at the provider level.

To meet this need, our team is building a multi-level training model that integrates provider and parent perspectives into future HPV training materials. This approach reflects the strength of mixed-methods research combined with implementation science ensuring interventions are grounded in community lived experiences. Models like this can be utilized across rural and marginalized populations nationally, where context-specific strategies are essential to closing persistent gaps in HPV vaccination and cancer outcomes.

Dakota Jones is an enrolled citizen of the Lumbee Tribe of North Carolina and a second-year PhD student in Health Behavior Research at the University of Southern California. Her work spans several projects within the Initiative for California American Indian Health Research and Evaluation (I-CAIHRE) and the Cancer Care Delivery and Implementation Science team, including collaborations with the Riverside–San Bernardino County Indian Health Clinic system and the Toiyabe Indian Health Project. Dakota’s research focuses on advancing cancer prevention and HPV vaccination uptake among Native and other underserved communities through community-engaged and implementation science approaches that promote Indigenous data sovereignty and health equity.