Research ArticleResearch
Open Access

Utilization of the HPV Brief Motivational Interviewing Skills-Based Training Among University of Minnesota Dental Hygiene Alumni

Cynthia L. Stull, Kelly Rogers, Keeley Flavin, Rachel Thelen, Michael D. Evans and Michelle C. Arnett
American Dental Hygienists' Association June 2025, 99 (3) 24-37;

Abstract

[https://youtu.be/c3waPz43iAQ.mp4]

Purpose Despite the availability of a vaccine to prevent Human papillomavirus-related oropharyngeal cancer (HPV-OPC), its incidence has surpassed all other HPV-related cancers. Dental hygienists play an important role in patient education and vaccine counseling for the prevention of HPV-OPC. The purpose of this study was to assess the utilization of HPV Brief Motivational Interviewing (brief MI) Skills Based Training among the University of Minnesota (UMN) dental hygiene alumni.

Methods A quantitative study was conducted with a convenience sample of dental hygiene alumni (classes of 2020-2024; n=135) who completed HPV Brief MI Skills Based Training at the UMN. Multiple recruitment strategies were used including email, mail, social media, and snowball sampling. Participants completed a 37-item anonymous electronic survey via Qualtrics. The survey was adapted from previously used instruments to assess HPV knowledge, attitudes, current practices in HPV counseling, and the application of brief MI for the prevention of HPV-OPC.

Results Among the participants (n=51), 49% reported using MI strategies to counsel at least one patient on prevention of HPV-OPC infections and indicated high comfort and confidence in applying MI strategies. However, most participants (73%) acknowledged they do not routinely discuss HPV with patients. Barriers included time constraints, vaccine resistance, difficulty initiating conversations, and lack of confidence or comfort during discussions. Results indicate that knowledge retention and attitudes may be influenced by frequency of practice.

Conclusion Dental hygiene alumni from five consecutive cohorts who received HPV Brief MI Skills-Based Training reported comfort and confidence in HPV communication with patients. Findings suggest brief MI is an effective counseling strategy for HPV-OPC prevention and vaccine advocacy. Reported barriers to regular HPV-OPC prevention counseling suggest a change in dental practice culture may be needed.

Keywords
  • motivational interviewing
  • brief motivational interviewing
  • vaccine counseling
  • dental hygienists
  • skills-based training

INTRODUCTION

Human papillomavirus (HPV) is the most pervasive sexually transmitted infection.1 Nearly all sexually active people will become infected at some point in their lives.2 Although most infections are cleared by the immune system, some HPV types persist, notably types 16 and 18, leading to certain types of cancer, including oropharyngeal cancer (OPC).3 The incidence of HPV-related OPC (HPV-OPC) has steadily increased over the past several decades and now outpaces cervical cancer.4 Human papillomavirus-OPC is most often diagnosed in later stages after metastasis to cervical lymph nodes, owing to the lack of an identified precursor lesion.1 Consequently, primary prevention is imperative. The HPV vaccine has been available since 2006 for the prevention of cervical cancer in girls.5 In 2009, the vaccine was approved by the Food and Drug Administration (FDA) to include males.6 Currently, the vaccine is approved for males and females, 9-45 years old.7 In 2020, the indication for the HPV vaccine was expanded by the FDA for the prevention of HPV-related oral infections and OPCs.8 A systematic review and meta-analysis was conducted to examine the effectiveness of the HPV vaccine in reducing oral vaccine-type HPV infections (including types 16 and 18) indicated that vaccinated individuals were 46% less likely to develop oral vaccine-type infection when compared to unvaccinated individuals.9 Findings from the systematic review suggest that HPV vaccines can protect against oral vaccine-type HPV infection including high-risk HPV-16, thus reducing the incidence of HPV-OPC.9

Human papillomavirus vaccine uptake is dismal and falls below national goals in the United States (US).9 According to the National Immunization Survey - Teen (NIS-Teen), in 2023 57.3% of adolescents aged 13-15 received the recommended doses of the HPV vaccine, leaving a gap between the Healthy People 2030 target of 80% and actual completion rates.10 Further, in a 2022 survey of 2159 unvaccinated adults (18-26 years old) in the US, HPV vaccination coverage was low with 47.4% of the respondents reporting receiving one or more doses.11 These suboptimal levels vaccination rates have drawn attention to the role of alternative health care providers in HPV counseling and vaccine administration. Health care provider recommendation and lack of knowledge have been identified as the top predictors of parents/guardians’ intent to vaccinate their children against HPV.12,13 Minnesota dentists and dental hygienists have reported discomfort in HPV discussions with patients and believe patients should receive their HPV vaccine information from their medical providers only.14 However, parents of adolescents report comfort and confidence in having HPV-related discussions with their dental providers.15 Additionally, adults at risk for HPV-OPC lack knowledge and awareness a vaccine is available for these cancers.16 This emphasizes the important role and professional responsibility of dental providers in supporting and enhancing parents’ and adults’ HPV vaccine literacy for improved vaccination confidence.

Oropharyngeal cancer can be prevented by supporting patients’ positive behavior change and improving HPV vaccine confidence and vaccine uptake.14,17–19 Motivational interviewing (MI) is a person-centered collaborative counseling approach to support a positive behavior change; MI has been shown to have over 40 years of evidence on its efficacy for positive behavior change outcomes.20–29 Current evidence has identified that brief motivational interviewing (brief MI), a derivative of MI, can be an ideal communication approach for HPV education and vaccine advocacy.30–32 Applying brief MI strategies has been shown to improve dental providers’ knowledge, comfort, and confidence in HPV education and vaccine advocacy during patient care.30–32 Additionally, improving dental providers’ perceptions may reduce the barriers to HPV conversations in the dental setting.

Dental hygienists play a key role in a medical-dental integrated health care system with responsibilities expanding beyond the traditional dental hygiene care, including HPV vaccine counseling for OPC prevention. Dental hygiene curricula must prepare students with skills for expanded roles in the broader health care system.33 Specifically, the literature proposes the inclusion of HPV content in dental hygiene curriculum to improve students’ knowledge and communication skills for HPV-OPC prevention.18 In response to this charge, educators and researchers at the University of Minnesota (UMN) School of Dentistry (SOD) developed the HPV Brief MI Skills-Based Training program to prepare future oral health care providers with the knowledge, confidence, and comfort to provide HPV education and vaccine counseling for patients, through the application of brief MI.30–32 The UMN HPV Brief MI Skills Based Training focuses on the collaborative “Spirit of MI” and coaching for the application of MI principles to support patient autonomy.20 The HPV brief MI curriculum for dental hygiene students includes the utilization of eight MI strategies with a focus on open-ended questions (O), affirmations (A), reflections (R), and summaries (S) (OARS) with the technique of elicit-provide-elicit (E-P-E) to evoke change conversations.20,30–32,34,35 Additionally, the dental hygiene curriculum skills-based portion includes role-playing and feedback as students practice OARS with E-P-E to demonstrate MI RULES.30–32,34,35 The MI RULES encompass resist the righting reflux (R), understand (U) the patient’s ambivalence, listen (L) with empathy, and empower (E) the patient by building self-efficacy.20,34,36 The HPV Brief MI Skills Based Training program was launched in 2019 with the first graduating cohort to have this skill set in 2020. Since then, a total of five cohorts (Class of 2020-Class of 2024) have graduated and are currently employed in their professional DH roles.

It is unknown whether the UMN DH alumni are applying the HPV Brief MI Skills Based Training in clinical practice to counsel patients on the prevention of HPV-OPC. The purpose of this study was to determine the utilization of the HPV Brief MI Skills Based Training among UMN DH alumni by assessing HPV and HPV vaccine knowledge, determining attitudes (comfort and confidence) of HPV counseling, and assessing application of MI strategies for HPV counseling.

METHODS

This quantitative study included a convenience sample of UMN DH alumni (n=135) from the classes of 2020–2024. This study (STUDY00024281) was deemed exempt from the UMN Institutional Review Board (IRB) oversight. The inclusion criteria were UMN DH alumni from the Class of 2020-Class of 2024. Exclusion criteria were UMN DH alumni prior to the Class 2020 or members of the Class of 2025 as well as dental hygienists who were not UMN alumni.

Sample recruitment

Multiple strategies were UMN IRB approved and used for recruitment. The UMN SOD Office of Alumni Relations and Development sent an email invitation to eligible participant email addresses with an anonymous link to an electronic survey (Qualtricsxm, Provo, UT, USA) a total of three times during January-February 2025. Recruitment of alumni via their personal email addresses has historically resulted in a low response rate. Therefore, the UMN SOD Office of Alumni Relations and Development also mailed a paper invitation letter with an anonymous QR code to eligible participants’ mailing address one time in February 2025. No personal email addresses or mailing addresses were shared with the research team. Invitations to participate were also sent via the social media networks (Facebook, LinkedIn) for the classes of 2020-2024. Snowball recruitment was also done through the study team’s social media networks. Members of the class of 2024 received email invitations through their UMN student email address; all other cohorts have had their student email addresses disabled. All participants were given the opportunity to enter their email address to enter a raffle for a $50.00 gift card as an incentive for completing the survey. A total of 10 randomly selected participant email addresses received a pre-paid $50.00 gift card.

Instrument

The 37-item electronic survey consisted of 30 questions and seven demographic items. The survey was adapted from a previous questionnaire from Stull et al.14 This instrument was previously pilot tested for face validity and has been used as an instrument of measure for HPV knowledge, attitudes and current practices.14,31 Of the 18 knowledge, attitudes and current practice items, seven questions were on a 4-point Likert scale (strongly agree, agree, disagree, strongly disagree) to measure attitudes regarding HPV vaccination. Four questions had “yes or no” choices on current practices with two of the four questions populating additional questions based on the response. Participants who answered “yes” to the question, “Do you routinely discuss the risk factors for oropharyngeal cancer with your patients?” were asked a follow-up question, “Do you discuss HPV as a risk factor?” For the question, “Do you discuss the importance of current efforts to provide HPV vaccination with your patients?” Participants who answered “yes” were asked a follow-up question, “What are the target ages for these discussions?” Participants were able to select all that apply to the provided age brackets (9-12 years; 13-17 years; 18-26 years; 27-45 years). The follow-up question for participants who answered “no” was, “What are the two primary reasons that you would not discuss these HPV vaccination efforts with your patients?” Participants were able to select multiple responses.

A total of 12 items focused on the application of MI in professional DH practice for the prevention of HPV-OPCs. These questions were adapted from an instrument pilot tested for face validity by DH programs to evaluate their MI curriculum and students’ perceived importance and confidence of applying MI strategies.30–32,37,38 The first MI question was a “yes or no,” “Have you applied motivational interviewing strategies to counsel at least one patient for the prevention of HPV-related OPCs?” Participants who responded “yes” were asked to rate their perceived importance and confidence with the eight MI Strategies. An additional seven questions were on a 5-point Likert scale (strongly disagree, disagree, neutral, agree, and strongly agree) that focused on the participants’ perceived value of MI, time during appointments, skills of application, the UMN HPV Brief MI Skills-Based Training program, comfort and confidence applying MI for discussing HPV with patients. All participants were asked a “yes or no” question on their interest for additional continuing education (CE) courses on the application of MI for HPV counseling. Additionally, two open-ended response questions asked for participants to share any challenges they have encountered in applying MI strategies to counsel patients for HPV-OPCs and to provide information on any additional health topics they apply MI for behavior change counseling. Participants could also provide their email address if they would like to be contacted for future HPV brief MI training for the prevention of OPCs.

Data analysis

Respondent characteristics were summarized using counts and percentages. Responses to Likert scale items regarding attitudes, practices, applications, and perceptions were summarized using means and standard deviations, counts and percentages. Correct responses to knowledge items were summarized using counts and percentages for each question. Themes identified in open response questions were summarized. Analyses were conducted using R version 4.4.2.

RESULTS

A total of 51 UMN alumni completed the survey for a 38% response rate. Demographic information is provided in Table I. The majority of the participants were female (n=48, 94%), White (n=38, 75%) and graduated from the class of 2020 (n=17, 33%). Most worked in private practice (n=42, 82%), full-time (n=38, 75%) and worked >31 hours per week (n=38, 75%). Since graduation, most of the participants were employed at one clinical practice setting (n=25, 49%) or 2-3 clinical practice settings (n=20, 39%).

View this table:
Table I.

Respondent demographics (n=51)

Participants’ general knowledge of HPV and HPV prevention education (true or false responses) are provided in Table II. Most identified the following statements as false: “All types of HPV infection can lead to oropharyngeal cancer” (n=44, 86%), “HPV is a relatively uncommon sexually transmitted infection” (n=44, 86%) and “Patients with a history of HPV infection should not be offered the HPV vaccine” (n=42, 82%). Similarly, most identified the following statement as true: “Oropharyngeal cancer is associated more with males than females” (n=40, 78%). Participant responses were divided for “HPV is associated with a much-improved prognosis for patients with oropharyngeal cancer,” with n=28 (55%) selecting true, the correct response.

View this table:
Table II.

Knowledge, Attitudes and Current Practices

Participant attitudes toward the role of dental providers in HPV prevention were positive. Table II shows the summaries (mean±SD) on a 4-point Likert scale. Most responded (strongly disagree or somewhat disagree) that medical providers should be the sole source of information for patients (2.45±0.99); it is necessary to discuss sexuality before recommending the HPV vaccine (1.73±0.87); HPV vaccine is not appropriate for my practice because it cannot help my patients (1.51±0.73); safety is not established (1.29±0.61); or efficacy is not established (1.25±0.56). However, most respondents were not routinely discussing risk factors of OPCs with patients (n=37, 73.0%). Among those who were discussing the risk factors (n=14, 27%), only a few were discussing OPC’s for all age groups (n=3, 6%). Reasons for not discussing the HPV vaccination included limited time (n=18, 35%) and not remembering. However, most will discuss the vaccine if asked (n=37, 73%).

Participants who reported yes to the question, “Have you applied motivational interviewing strategies to counsel at least one patient for the prevention of HPV-related OPCs” (n=25, 49%), were asked about their perceptions of importance and confidence for each of the eight MI guiding strategies (Table III). Responses were all high on a 5-point Likert scale, with the exception of the importance RULER scoring lower (3.84±0.94). Similarly, respondents’ confidence applying the eight MI guiding strategies were also high on a 5-point Likert scale, except for elicit change talk (3.88±0.73). Perceptions of MI for HPV-related OPC conversations are shown in Table IV. Respondents strongly agreed that MI was a valuable strategy (n=29, 100%); using MI helps patients understand HPV-OPC risks and prevention (n=26, 100%); the UMN HPV Brief MI Skills-Based Training was sufficient to apply brief MI for HPV discussions (n=22, 100%); and most were interested in additional continuing education courses for brief MI for HPV counseling (n=31, 61%).

View this table:
Table III.

Application of Motivational Interviewing strategies for HPV conversations

View this table:
Table IV.

Participant perceptions of MI for HPV-related OPC conversations

Participants shared challenges they have experienced applying MI strategies to counsel patients for HPV-related OPCs (n=15). Four themes emerged: time constraints, patient vaccine acceptance, difficulty initiating an HPV conversation, and provider confidence. Respondents also provided information on any health topics they apply their MI training to counsel patients for a positive behavior change (n=30). Eight topics emerged: caries, gingival diseases, tobacco cessation, home care, nutritional counseling, sleep/TMJ, treatment planning, consideration of oral health during pregnancy, cancer and injuries (Table V).

View this table:
Table V.

Selected open-ended responses

DISCUSSION

The findings of this study demonstrated that UMN dental hygiene alumni perceive brief MI as a valuable approach for HPV-OPC prevention counseling and vaccine advocacy. Additionally, participants reported the HPV Brief MI Skills Based Training they received as part of their dental hygiene education sufficiently prepared them with communication skills for HPV discussions during patient care. However, respondents reported barriers of time constraints, patient vaccine acceptance, difficulty initiating HPV conversations, and provider confidence as reasons they did not engage in HPV discussions with their patients.

Positive attitudes regarding HPV vaccination discussions in the dental setting were high among the participants in this study. However, participants’ attitudes (comfort and confidence) during HPV discussions were also influenced by noted barriers of a lack of time, low confidence in their HPV-related knowledge, forgetting to discuss HPV with their patients, difficulty in initiating HPV discussions, anti-vaccine climate, and patient resistance. In this study, patient resistance for HPV discussions was reported by 9% of the participants. Open responses suggest patient anti-vaccine beliefs may be perpetuated by the current political environment and patient resistance due to cultural or religious beliefs of vaccines. Similarly, Arnett et al. reported patient resistance as a frequently reported challenge to HPV vaccine counseling by dental hygiene students.32 However, these findings contradict the perceptions of dental patients who have reported they are indeed comfortable discussing HPV vaccines with their dental providers, particularly with the knowledge that HPV is a risk factor for oropharyngeal cancer.14,19,42–45

Lack of HPV knowledge has been reported by dental providers previously, contributing to providers’ lack of confidence and comfort for this particular health topic.19,40,41 Responses to the knowledge items indicated some confusion on the basics of oral HPV infections. When the participants in this study were students, their HPV knowledge increased.31,32 However, as practicing clinicians, these participants reported a lack of HPV-related knowledge as a barrier to initiating HPV communication. This finding suggests that HPV knowledge may not be retained if HPV discussions are not practiced on a regular basis during patient care. Chairside fact sheets may help retain knowledge and confidence in HPV vaccine information. Knowledge retention may also be achieved through continuing education to clarify, confirm, and activate previously learned HPV information.39

Although the UMN HPV Brief MI Skills-Based Training provides suggestions for opportunities to initiate HPV-related discussions, most of the respondents (75%) reported forgetting to discuss HPV. One participant noted, “One thing that helped in school was having the question on our medical form about the vaccine. It’s easier now to forget about it.” Adding a question regarding HPV to the medical history form prioritizes the importance of HPV information and prompts dental providers to discuss HPV-related topics and increases patient awareness and motivation to seek more information. Participants also reported difficulty in initiating an HPV conversation, “I often find it hard to switch my brain from yes or no questions/answers (like updating med history and CCs) to an open-ended conversation about a topic that is not often discussed at dental visits.” Perhaps respondents who were not confident in using brief MI for HPV communication have not had sufficient time to practice open-ended questions or establish trusting relationships with their patients, both foundational aspects of MI practice. Patient education materials, such as brochures or posters, have been suggested to initiate patient engagement in HPV conversations.46

Despite most participants acknowledging that they do not routinely discuss HPV as a risk factor for OPC with patients (73%), nearly half (49%) reported applying MI strategies to counsel at least one patient for the prevention of HPV-OPC. These respondents strongly perceived the importance of applying brief MI for HPV counseling and reported high confidence in applying MI strategies. However, the noted challenges regularly encountered by practicing clinicians hindered the regular utilization of the HPV Brief MI Skills-Based Training participants received as a student. This supports the existing literature showing HPV-related communication in dental settings is rare.40,47

Lack of time has been reported as a common barrier to HPV communication across previous studies14,40,48 as well as in the current study. This finding is surprising as brief MI is tailored for use in time-constrained settings. Brief MI emphasizes short encounters of less than five minutes. However, unless HPV prevention is prioritized by practice culture, it is understandable that practicing clinicians would perceive a lack of time. In this study respondents were divided, with 54% agreeing with the statement that “Medical professionals should remain the sole appropriate source of information regarding the HPV vaccine.” This is in contrast to previous research which showed dental hygiene students perceived their role in oral HPV prevention as important.31 This change in perception may be a reflection of the dental practice culture prioritizing traditional billable dental hygiene services rather including the prevention of HPV-related OPC with HPV prevention counseling. Perhaps the dental hygiene workforce shortage has compelled practices to reduce time for services considered as non-essential.41 Flynn et al. found that dentists who perceived adequate office infrastructure, including sufficient staffing, were 2.5 times more willing to recommend and administer the vaccine.41

Although over half (59%) reported consistently using their MI training to counsel patients, the majority reported using MI for caries, periodontal disease, and home care counseling. One potential solution to the lack of “chair time” is to utilize teledentistry for time-intensive health counseling sessions.49 Ben-Omran et al. conducted a scoping review to explore the current uses of teledentistry for oral health services in older adults. They found that oral cancer education could be delivered successfully via teledentistry showing improved patient knowledge using a cancer risk assessment tool.49 Further, using brief MI in conjunction with an oral cancer risk assessment tool may improve comfort and confidence in targeted approaches for HPV-OPC prevention counseling.

Study limitations include the small sample size of UMN DH alumni which does not reflect the general population of DH practitioners. Additionally, the UMN DH program has an extensive MI curriculum thread encompassing training (coaching, role-playing, and feedback) with peers and patients.30–32,50 Further, the participants had been evaluated as students during an Objective Structured Clinical Examination (OSCE) with standardized patients (SP) to measure brief MI competency and receive feedback.32

Collectively, this study highlights the need for professional standards of care for HPV communication practices in the dental setting. Continuing education for all oral health providers is needed to improve practice culture, retain knowledge of HPV infections and prevention, and improve providers’ confidence and comfort for HPV discussions. Continuing education should focus on brief MI (five minutes or less) with the application of OARS and E-P-E for HPV communication.

Future investigations should examine HPV Brief MI Skills Based Training within predoctoral dental programs and with licensed oral health care providers (dentists, dental therapists, and dental hygienists) from a wide-range of educational backgrounds and clinical practice experiences to determine the impact of the training on their knowledge, attitudes (comfort and confidence), and practice culture toward HPV counseling. Another direction would be to study the use of brief MI with oral cancer risk assessment tools for targeted approaches to HPV-OPC prevention for improved engagement. This evidence may inform larger-scale future studies for sustainable HPV vaccination counseling. Additionally, future research should investigate the impact of a HPV Brief MI Skills Based Training program for the entire dental team on practice culture for enhancing HPV-OPC prevention counseling.

CONCLUSION

This investigation demonstrated that dental hygiene alumni from five consecutive cohorts who received HPV Brief MI Skills Based Training as part of their dental hygiene education program reported comfort and confidence in HPV communication. Findings suggest brief MI is an effective counseling strategy for HPV-OPC prevention and HPV vaccine advocacy. Reported barriers to regular HPV-OPC prevention counseling suggest that a change in dental practice culture may be needed for increased engagement.

IMPLICATIONS FOR DENTAL HYGIENE PRACTICE

  • Dental hygienists play a pivotal role in HPV-OPC prevention through patient education and vaccine advocacy.

  • Brief Motivational Interviewing (MI) training appears to equip practicing dental hygiene graduates with the skills, confidence, and comfort needed to engage in sensitive conversations about HPV and vaccination with patients.

  • Embedding brief MI approaches into standard dental hygiene practice and fostering a culture that normalizes HPV communication can enhance the preventive role of dental hygienists in reducing the burden of HPV-related oropharyngeal cancers.

ACKNOWLEDGEMENTS

The authors wish to acknowledge the University of Minnesota School of Dentistry Office of Alumni Relations and Development for sending the survey invitation to eligible dental hygiene alumni in the UMN University listserv.

Footnotes

  • NDHRA priority area, Professional development: Education (educational models).

  • DISCLOSURES

    The authors have no conflicts of interest to disclose.

    This research was supported by the National Institutes of Health’s National Center for Advancing Translational Sciences, grant UM1TR004405. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health’s National Center for Advancing Translational Sciences.

  • Received April 1, 2025.
  • Accepted May 5, 2025.

This article is open access and may not be copied, distributed or modified without written permission from the American Dental Hygienists’ Association.

REFERENCES

  1. 1.
    1. Guo T,
    2. Eisele DW,
    3. Fakhry C.
    The potential impact of prophylactic human papillomavirus vaccination on oropharyngeal cancer. Cancer. 2016 Aug;122(15):2313–23.
  2. 2.
    1. Centers for Disease Control and Prevention
    . Human Papillomavirus (HPV). Reasons to Get Vaccinated. [Internet]. Atlanta (GA): Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2024 [cited 2025 Jan 3]. Available from: https://www.cdc.gov/hpv/vaccines/reasons-to-get.html
  3. 3.
    1. National Cancer Institute
    . HPV and Cancer [Internet]. Bethesda (MD): National Cancer Institute; 2023 [cited 2025 Jan 3]. Available from: https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer
  4. 4.
    1. Centers for Disease Control and Prevention
    . HPV associated cancer statistics [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2018 [cited 2019 Mar 25]. Available from: https://www.cdc.gov/cancer/hpv/statistics/index.htm 3.
  5. 5.
    1. Markowitz LE,
    2. Dunne EF,
    3. Saraiya M, et al.
    Quadrivalent human papillomavirus vaccine: Recommendations of the advisory committee on immunization practices (ACIP) [Internet]. Atlanta (GA): Center for Disease Control; 2007- [cited 2025 Mar 27]. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5602a1.htm
  6. 6.
    1. Centers for Disease Control and Prevention
    . FDA Licensure of quadrivalent Human Papillomavirus Vaccine (HPV4, Gardasil) for use in males and guidance from the Advisory Committee on Immunization Practices (ACIP). Atlanta (GA): Morbidity and Mortality Weekly Report (MMWR) 2010 May; 59(20): 630-632.
  7. 7.
    1. U.S. Food & Drug Administration
    . Gardasil 9. [Internet]. Silver Spring (MD): U.S. Food & Drug Administration; 2025 Mar. [cited 2025 March 31]. Available from https://www.fda.gov/vaccines-blood-biologics/vaccines/gardasil-9
  8. 8.
    1. Merck & Co.
    FDA approves Merck’s GARDASIL 9 for the prevention of certain HPV-related head and neck cancers [Internet]. Kenilworth (NJ): Merck & Co., Inc; 2020 Jun 12 [cited 2025 Mar 27]. Available from: https://www.merck.com/news/fda-approves-mercks-gardasil-9-for-the-prevention-of-certain-hpv-related-head-and-neck-cancers/
  9. 9.
    1. Tsentemeidou A,
    2. Fyrmpas G,
    3. Stavrakas M, et al.
    Human papillomavirus vaccine to end oropharyngeal cancer. A systematic review and meta-analysis. Sex Transm Dis. 2021 Sep;48(9):700–7.
  10. 10.
    1. Office of Disease Prevention and Health Promotion
    . Vaccination. Increase the proportion of adolescents who get recommended doses of the HPV vaccine - IID-08 [Internet]. Washington DC: U.S. Department of Health and Human Services; 2024 [cited 2024 Sept 1]. Available from https://health.gov/healthypeople/objectives-and-data/browse-objectives/vaccination/increase-proportion-adolescents-who-get-recommended-doses-hpv-vaccine-iid-08
  11. 11.
    1. Sonawane K,
    2. Garg A,
    3. Meissner EG, et al.
    Human papillomavirus vaccination among young adults before and during the COVID-19 pandemic. JAMA Netw Open. 2024 Feb 20;7(2):e2356875.
  12. 12.
    1. Oh NL,
    2. Biddell CB,
    3. Rhodes BE, et al.
    Provider communication and HPV vaccine uptake: A meta-analysis and systematic review. Prev Med. 2021 Jul;148:106554.
  13. 13.
    1. Kong WY,
    2. Bustamante G,
    3. Pallotto IK, et al.
    Disparities in healthcare providers’ recommendation of HPV vaccination for U.S. adolescents: A systematic review. Cancer Epidemiol Biomarkers Prev. 2021 Nov 1;30(11):1981–92.
  14. 14.
    1. Stull CL,
    2. Lunos S.
    Knowledge, attitudes and practices regarding human papilloma virus communication and vaccine advocacy among Minnesota dentists and dental hygienists. J Dent Hyg. 2019 Feb;93(1):33–42.
  15. 15.
    1. Stull C,
    2. Freese R,
    3. Sarvas E.
    Parent perceptions of dental care providers’ role in human papillomavirus prevention and vaccine advocacy. J Am Dent Assoc. 2020 Aug 1;151(8):560-7.
  16. 16.
    1. Bloom JC,
    2. Kaufmann N,
    3. Koss S, et al.
    Deciphering knowledge and opinions of human papillomavirus and human papillomavirus vaccination for facilitation of point-of care vaccination in adults. JAMA Otolaryngol Head Neck Surg 2023; 149(10):870-77.
  17. 17.
    1. Reno JE,
    2. Thomas J,
    3. Pyrzanowski J, et al.
    Examining strategies for improving healthcare providers’ communication about adolescent HPV vaccination: Evaluation of secondary outcomes in a randomized controlled trial. Hum Vaccin Immunother. 2019 Jan;15(7-8):1592-8.
  18. 18.
    1. Thompson EL,
    2. Daley EM,
    3. Vamos CA, et al.
    Health literacy approaches to improving communication between dental hygienists and patients for HPV-related oral cancer prevention. J Dent Hyg. 2017 Aug;91(4):37-45.
  19. 19.
    1. Daley EM,
    2. Thompson EL,
    3. Vamos CA, et al.
    HPV related knowledge among dentists and dental hygienists. J Cancer Educ. 2018 Aug;1–6.
  20. 20.
    1. Miller WR,
    2. Rollnick S.
    Motivational interviewing helps people change. 3rd ed. New York (NY): Guilford Press, 2013. 482p.
  21. 21.
    1. Gao X,
    2. Lo EC,
    3. Kot SC, et al.
    Motivational interviewing in improving oral health: a systematic review of randomized controlled trials. J Periodontol 2014 Mar;85(3):426–37.
  22. 22.
    1. Lundahl B,
    2. Kunz C,
    3. Brownell C, et al.
    A meta-analysis of motivational interviewing: Twenty-five years of empirical studies. Res Soc Work Pract. 2010;Mar 20(2):137-60.
  23. 23.
    1. Lindson-Hawley N,
    2. Thompson TP,
    3. Begh R.
    Motivational interviewing for smoking cessation. Cochrane Database Syst Rev. 2015 Mar 2;(3):CD006926.
  24. 24.
    1. Brand VS,
    2. Bray KK,
    3. MacNeill S, et al.
    Impact of single-session motivational interviewing on clinical outcomes following periodontal maintenance therapy. Int J Dent Hyg. 2013;11:134–41.
  25. 25.
    1. Arnett MC,
    2. Blue CM,
    3. Ahmann L, et al.
    Impact of brief motivational interviewing on periodontal clinical outcomes: A randomized blinded clinical trial. J Dent Hyg. 2022 Oct;96(5):13-22.
  26. 26.
    1. Arnett MC,
    2. Paulson DR,
    3. Evans MD, et al.
    Health topics emerged from brief motivational interviewing: A randomized clinical trial. J Dent Hyg. 2023 Oct;97(5):116-27.
  27. 27.
    1. Miller WR,
    2. Yahne CE,
    3. Moyers TB, et al.
    A randomized trial of methods to help clinicians learn motivational interviewing. J Consult Clin Psychol. 2004;72:1050–62.
  28. 28.
    1. DiClemente CC,
    2. Corno CM,
    3. Graydon MM, et al.
    Motivational interviewing, enhancement, and brief interventions over the last decade: A review of reviews of efficacy and effectiveness. Psychol Addict Behav. 2017 Dec;31(8):862-87.
  29. 29.
    1. Arnett MC,
    2. Rogers KM,
    3. Evans MD, et al.
    Effectiveness of brief motivational interviewing on periodontal patients’ interest, importance, and self-efficacy: A randomized clinical trial. PEC Innov. 2022 Oct 15:1:100092.
  30. 30.
    1. Arnett MC,
    2. Evans MD,
    3. Stull CL.
    Students’ perceptions of the “importance” of and “confidence” with applying brief motivational interviewing during HPV patient counseling. J Dent Hyg. 2022 Apr 96(2):50-9.
  31. 31.
    1. Stull C,
    2. Evans MD,
    3. Arnett MC.
    Examining the role of HPV communication training in dental hygiene students’ knowledge, attitudes, confidence, and comfort. J Dent Hyg. 2021 Oct;95(5):47-55.
  32. 32.
    1. Arnett MC,
    2. Evans MD,
    3. Stull CL.
    Brief motivational interviewing: Evaluation of skills-based education program. J Dent Hyg. 2022 Aug;96(4):46-56.
  33. 33.
    1. Fried JL,
    2. Maxey HL,
    3. Battani K, et al.
    Preparing the future dental hygiene workforce: Knowledge, skills, and reform. J Dent Educ. 2017 Sep; 81(9): eS45 – eS52.
  34. 34.
    1. Ramseier CA,
    2. Suvan JE.
    1. Catley D,
    2. Goggin K,
    3. Lynam I.
    Motivational interviewing (MI) and its basic tools. In: Ramseier CA, Suvan JE. Health behavior change in the dental practice. Ames (IA): Wiley-Blackwell; 2010. p. 59-92.
  35. 35.
    1. Wyatt J,
    2. Singer A.
    Clinical conversations about cannabis: Using Elicit – Provide – Elicit [Internet]. Columbus (OH): Higher Education Center for Alcohol and Drug Misue Prevention and Recovery; 2023 [cited 2025 Feb 15]. Available from: https://hecaod.osu.edu/clinical-conversations-about-cannabis-using-elicit-provide-elicit/
  36. 36.
    1. Rollnick S,
    2. Mason P,
    3. Butler C.
    Health behavior change: A guide for practitioners. Edinburgh (UK): Churchill Livingstone; 1999. 225p.
  37. 37.
    1. Arnett M,
    2. Korte D,
    3. Richards PS, et al.
    Effect of faculty development activities on dental hygiene faculty perceptions of and teaching about motivational interviewing: A pilot study. J Dent Educ. 2017 Aug;81(8):969-77.
  38. 38.
    1. Mills A,
    2. Kerschbaum WE,
    3. Richards PS, et al.
    Dental hygiene students’ perceptions of importance and confidence in applying motivational interviewing during patient care. J Dent Hyg. 2017 Feb;91(1):15-23.
  39. 39.
    1. Rosenshine B.
    Principles of instruction. Am Educ. 2012; Spring:12–39.
  40. 40.
    1. Casey SM,
    2. Paiva T,
    3. Perkins RB, et al.
    Could oral health care professionals help increase human papillomavirus vaccination rates by engaging patients in discussions? J Am Dent Assoc. 2023 Jan;154(1):10-23.e17.
  41. 41.
    1. Flynn P,
    2. Stull CL,
    3. Jain V, et al.
    A national cross-sectional study of dentists’ vaccine hesitancy and intention to provide HPV vaccines following emergency COVID-19 vaccination authorization. Vaccine. 2025 Apr 19; 53 (127035):1-9.
  42. 42.
    1. Naavaal S,
    2. Demopoulos CA,
    3. Kelly A, et al.
    Perceptions about human papillomavirus vaccine and oropharyngeal cancers, and the role of dental care providers in human papillomavirus prevention among US adults. J Am Dent Assoc. 2023 Apr;154(4):321–9.
  43. 43.
    1. Steinbaum S,
    2. Jagannath J,
    3. Seymour L, et al.
    Oral healthcare providers play a vital role in vaccination efforts: Patient perspectives. Clin Exp Dent Res. 2023 Dec;9(6):1169-79.
  44. 44.
    1. Darisi RD,
    2. Hillier B,
    3. Buckland AJ, et al.
    Patient receptivity to receiving vaccinations in the dental clinic at a rural federally qualified health center. J Am Dent Assoc. 2024 Jan;155(1):17–25.
  45. 45.
    1. Dean TC,
    2. Gilliland AE,
    3. Cameron JE.
    Parents’ receptiveness to oral health clinic-based vaccination. Vaccine. 2020 Jun;38(27):4226–9.
  46. 46.
    1. Griner SB,
    2. Thompson EL,
    3. Vamos CA, et al.
    Dental opinion leaders’ perspectives on barriers and facilitators to HPV-related prevention. Hum Vaccin Immunother. 2019 Aug 3;15(7–8):1856–62.
  47. 47.
    1. Jordan KH,
    2. Stephens JA,
    3. Niles K, et al.
    STEPS (Study To Examine Parent, Patient/Dental Provider Systems) to prevent human papillomavirus (HPV)-related cancers: A piloted dental patient and provider evaluation of current and future HPV education. J Cancer Educ. 2025 Feb;40(1):44–53.
  48. 48.
    1. Kline N,
    2. Vamos C,
    3. Thompson E, et al.
    Are dental providers the next line of HPV-related prevention? Providers’ perceived role and needs. Papillomavirus Res. 2018 Jun;5:104–8.
  49. 49.
    1. Ben-Omran MO,
    2. Livinski AA,
    3. Kopycka-Kedzierawski DT, et al.
    The use of teledentistry in facilitating oral health for older adults. J Am Dent Assoc. 2021 Dec;152(12):998-1011.e17.
  50. 50.
    1. Rogers KM,
    2. Arnett MC,
    3. Mays KA, et al.
    Dental hygienists’ use of motivational interviewing and perceptions of effectiveness in changing patient behaviors. J Dent Educ 2022 Aug;86(8):909-17.