Form 9017-0036 HPV Survey

Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery: IHS Customer Service Satisfaction and Similar Surveys

HPV Questionnaire_6.10.19

Dental Professionals & Human Papillomavirus (HPV) Prevention Survey

OMB: 0917-0036

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Dental Professionals & Human Papillomavirus (HPV) Prevention Survey

The purpose of this survey is to find new avenues for HPV prevention through oral health. Thank you in advance for your contribution.

Please complete sections 1 and 2 prior to the presentation. After the presentation, please complete section 3.







SECTION 1: SOCIODEMOGRAPHICS

1) What is your racial background?

American Indian/Alaskan Native

Asian

Black/African American

Native Hawaiian/Pacific Islander

White/Caucasian

Other (please specify): ____________


2) How old are you?

18 to 30  51 to 60

31 to 40  >60

41 to 50


3) What is your sex?

Female  Male


4) What is the person's highest level of education and current job?

Secondary/high school/GED equivalent

Vocational/technical school

Bachelor's Degree

Graduate/Professional Degree

Other (please specify):

5) Current job:

Dentist  Dental Therapist

Dental Hygienist  Other (please specify):

Dental Assistant


6) Which of the following identifies your facility?

IHS/Federal  Urban

Tribal  Other 


7) In which of the following IHS Areas do you work? 

Alaska  Navajo

Albuquerque  Oklahoma City

Bemidji  Phoenix

Billings  Portland

California  Tucson

Great Plains  HQ

Nashville  Other (please specify):


8) Have you already participated on any educational activities on HPV prevention in the last 2 years? Select all that apply.

Yes, IHS webinar/training  No

Yes, non-HIS webinar/training



SECTION 2: PRE-QUESTIONNAIRE

1) Did you hear of human papillomavirus (HPV) before today?

Yes No I don’t know


2) Is HPV infection rare?

Yes No I don’t know


3) Is HPV a Sexually Transmitted Infection (STI)?

Yes No I don’t know


4)Which of the following cancers may be caused by HPV? (check all that apply)

Cervical cancer Breast cancer

Anal cancer Penile cancer

Vulvar cancer Vaginal cancer

Head and neck (oropharyngeal) cancer


5)What percent of sexually active women and men are infected with HPV?

5% 20% 10% 80%


6) The HPV vaccine is recommended by the Advisory Committee on Immunization Practices for (check all that apply)

30 y.o. woman with cervical cancer Girls 9-12 years

25 y.o. woman with an abnormal pap Boys 9-12 years


7) If someone has HPV, they will develop cancer at some point.

True False It depends


8) Do you think that HPV would go away on its own without treatment?

Yes No I don’t know


9) Do you think that HPV can be prevented?

Yes No I don’t know


10) Do you think that HPV can cause genital warts?

Yes No I don’t know




11) Which of these do you think the HPV vaccine can reduce or prevent? (check all that apply)

Cervical cancer Head and neck cancers

Chlamydia Genital warts

HIV

12) How comfortable do you feel talking to patients about the HPV vaccine?

Very comfortable Not very comfortable

A little comfortable Not at all comfortable


13) I currently discuss the connection between HPV and oropharyngeal cancer with my patients or their parents?

No, and I do not intend to start

No, but I have considered it

Yes, but only with some patients 

Yes, with all or most (75% or more) of my patients

Other (please specify):


14) Why do you not currently discuss the connection between HPV and oropharyngeal cancer with your patients?

I don’t have enough information

Practice setting is not sufficiently private

Discomfort discussing sexual history with my patients

I cannot provide an HPV vaccine to my patients

Concern with safety of vaccine

Not my role as oral health provider

Appointments not long enough

Liability Reasons

No professional policies/guidelines

Other (please specify):­­­­­­­­­­

I discuss the connection between HPV and oropharyngeal cancer with my patients


15) Which of the following tools for increasing education and acceptance of HPV vaccination are most useful to you? Select all that apply.

Informational flyers or brochures tailored to specific parental concerns

Information for parents provided before clinic visit

Discussion guide or health script for oral health professionals

Information catered to cultural or ethical preferences

Education for oral health professionals regarding HPV

Other (please specify):

None



16) What are the current policies/practices in your facility regarding the discussion of the link between HPV and oral cancer?


___________________________________________

___________________________________________

___________________________________________

___________________________________________

___________________________________________


17) At your facility have you received education/ trainings about HPV?

Yes No I don’t know


18) If training could be provided, what format of training would be beneficial to your facility? Select all that apply.

In person Offline self-study

Webinar Other (please specify):

Online self-study


19) Do you have any other suggestions for how to improve HPV vaccination and the possible role of the oral health community in this?


___________________________________________

___________________________________________

___________________________________________

___________________________________________

___________________________________________





SECTION 3: POST-QUESTIONNAIRE

1) Do you think HPV infection is rare?

Yes No I don’t know


2) Do you think HPV is a Sexually Transmitted Infection (STI)?

Yes No I don’t know


3)Which of the following cancers may be caused by HPV (check all that apply)

Cervical cancer Breast cancer

Anal cancer Penile cancer

Vulvar cancer Vaginal cancer

Head and neck (oropharyngeal) cancer


4)What percent of sexually active women and men are infected with HPV?

5% 20% 10% 80%


5) The HPV vaccine is recommended by the Advisory Committee on Immunization Practices for (check all that apply)

30 y.o. woman with cervical cancer Girls 9-12 years

25 y.o. woman with an abnormal pap Boys 9-12 years


6)If someone has HPV, they will develop cancer at some point.

True False It depends


7) Do you think that HPV would go away on its own without treatment?

Yes No I don’t know


8) Do you think that HPV can be prevented?

Yes No I don’t know


9) Do you think that HPV can cause genital warts?

Yes No I don’t know


10) Which of these do you think the HPV vaccine can reduce or prevent? (Check all that apply)

Cervical cancer Head and neck cancers

Chlamydia Genital warts

HIV


11) How comfortable do you feel talking to patients about the HPV vaccine?

Very comfortable Not very comfortable

A little comfortable Not at all comfortable


12) How likely are you to use the information in the HPV toolkit in your clinic?


not at all 1 2 3 4 5 extremely likely


13) This seminar improved my HPV knowledge.

Strongly Agree Somewhat Disagree

Somewhat Agree Strongly Disagree

Neutral


14) I am more likely to recommend the HPV vaccine after this seminar.

Strongly Agree

Somewhat Agree

Neutral

Somewhat Disagree

Strongly Disagree


15) Do you have ideas/recommendations to improve HPV education/outreach in your tribal community?


___________________________________________

___________________________________________

___________________________________________

___________________________________________

___________________________________________


16) The information presented today was valuable to me


not at all 1 2 3 4 5 extremely likely


17) The information presented today was new to me


not at all 1 2 3 4 5 extremely likely


18) The information presented today was easy to understand


not at all 1 2 3 4 5 extremely likely



19) Would you feel comfortable administering the HPV vaccine if it is within your scope of practice as a dentist?

Very comfortable Not very comfortable

A little comfortable Not at all comfortable




(please continue on next page) 


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