Text and Talk: A multi-level intervention to increase provider HPV vaccine recommendation effectiveness

文本和谈话：提高 HPV 疫苗推荐有效性的多层次干预

• 批准号: 10226820
• 负责人: Stephanie A S Staras
• 金额: $ 59.16万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10226820
• 关键词: 12 year old; 15 year old; Address; Adolescent; Age; Behavior; Child; Clinic; Clinic Visits; Clinical Research; Clinical effectiveness; Consolidated Framework for Implementation Research; Dose; Effectiveness; Evaluation; Florida; Goals; Health; Health Personnel; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papilloma Virus-Related Malignant Neoplasm; Human Papillomavirus; Incentives; Individual; Intervention; Lead; Malignant Neoplasms; Modeling; Parents; Planning Theory; Primary Health Care; Provider; Public Health; Randomized; Recommendation; Reporting; Research; Resources; Schedule; Sum; Teenagers; Testing; Text; Text Messaging; Training; United States; Vaccinated; Vaccines; Visit; age group; arm; boys; cancer diagnosis; cancer prevention; clinical practice; design; effectiveness evaluation; girls; health organization; implementation determinants; implementation strategy; innovation; patient oriented; practice factors; prevent; preventive intervention; provider behavior; recruit; relative effectiveness; social cognitive theory; synergism; theories; vaccine efficacy; vaccine safety

PROJECT SUMMARY Multi-level implementation strategies targeting parents and health care providers have potential to substantially increase the low human papillomavirus (HPV) vaccination rates among the targeted age group of 11- to 12-year-olds. Florida adolescents are particularly vulnerable due to the state’s rank of 4th for HPV- related cancer diagnoses, but 39th for HPV vaccine initiation and up-to-date rates. The problem addressed by this proposal is the need for more effective and pragmatic preventive interventions to increase provider HPV vaccine recommendations. Existing interventions increase HPV vaccine rates only moderately (approximately 5 to 15 percentage points). A multi-leveled focus on provider recommendations and parent receptiveness is warranted because 90% of unvaccinated teens actually had well visits, provider recommendations increase HPV vaccination rates 9- to 170-fold, and parents make vaccine decisions. Additionally, national health agencies endorse two approaches for recommendation: mentioning HPV as one of the needed adolescent vaccines (bundled) or emphasizing the HPV vaccine benefits (benefits). Yet, the relative effectiveness of recommendation approaches and effectiveness of approach concordance across provider-parent levels is unclear. The goal of the proposal is to evaluate the effectiveness of a multi-level (provider and parent) intervention of two implementation strategies (brief provider training and parent-targeted interactive text message reminders) on HPV vaccination rates among 11- to 12-year-old boys and girls. Guided by the Integrated Behavior Model, a meta-theory combining the Theory of Reasoned Action, the Social Cognitive Theory, and the Theory of Planned Behavior, the central hypotheses are that brief provider trainings will increase providers’ intentions to recommend the HPV vaccine and the parent-targeted interactive text messages will increase parents’ salience. Specific Aims are to: (1) To test the overall effectiveness of brief provider trainings with an embedded comparison of bundled and benefits approaches. (2) To test the overall effectiveness of interactive text messages for parents with an embedded comparison of bundled and benefits approaches. (3) Evaluate the effectiveness of the combined brief provider trainings and interactive text messages for parents with an embedded comparison of concordant and distinct approaches. (4) Evaluate moderation of the implementation strategies’ effectiveness by clinical practice factors. Hypotheses will be evaluated with a doubly randomized, two-level nested design for testing two nested implementation factors (provider training and parent text messaging with bundled or benefits approaches). Thirty clinics will be recruited from the OneFlorida Clinical Research Consortium. The innovations are the factorial-designed evaluation estimating the value-added of multi-level implementation and the evaluation of concordant recommendation approaches across provider- and parent-levels. The significance lies in the potential to lead the field closer to a sustainable, scalable, and efficacious approach to decreasing HPV-related cancer rates.

项目摘要 针对父母和医疗保健提供者的多层次实施策略有可能 有针对性的年龄组中的低人类乳头瘤病毒（HPV）疫苗接种率 11至12岁的孩子。佛罗里达青少年特别容易受到伤害，因为该州的HPV排名第四 相关的癌症诊断，但HPV疫苗倡议和最新率第39位。问题是由 该建议是需要更有效和务实的预防性干预措施来增加提供商HPV 疫苗建议。现有干预措施仅增加HPV疫苗率（大约 5至15个百分点）。对提供商建议和父母接受的多级关注是 有必要的原因是，90％的未接种青少年实际上有良好的访问，提供商建议增加 HPV疫苗的速度为9至170倍，父母做出疫苗的决定。此外，国家健康 代理商认可两种推荐方法：将HPV作为所需的青少年之一。 疫苗（捆绑）或强调HPV疫苗收益（收益）。但是，相对有效性 推荐方法和跨提供商级别的方法考虑的有效性是 不清楚。该提案的目的是评估多层次（提供者和父母）的有效性 干预两种实施策略（简短的提供商培训和主父互动文本 消息提醒）关于11至12岁男孩和女孩的HPV疫苗接种率。由 综合行为模型，一种结合了合理行动理论的元理论，社会认知 理论和计划行为理论，中心假设是简短的提供商培训 提高提供商的意图，以推荐HPV疫苗和父母针对父母的互动文本 消息将增加父母的显着性。具体目的是：（1）测试简短的总体效率 提供者的培训和捆绑方法的嵌入式比较。 （2）测试总体 互动文本消息对父母的有效性，并具有捆绑和福利的嵌入式比较 方法。 （3）评估合并简短提供商培训和互动文本的有效性 与一致和不同方法的嵌入式比较的父母的消息。 （4）评估 通过临床实践因素来适应实施策略的有效性。假设将是 用双重随机的两级嵌套设计评估，用于测试两个嵌套实现因子 （提供者培训和父母文本消息传递，采用捆绑或福利方法）。三十个诊所将是 从Oneflorida临床研究联盟招募。创新是段落设计的 评估估计多级实施的增值和一致的评估 推荐方法跨提供者和父母级别。意义在于潜在的潜力 该领域更接近可持续，可扩展和高效的方法，以降低与HPV相关的癌症率。