Investigating facilitator-driven, multi-level implementation strategies in Federally Qualified Health Centers to improve provider recommendation and HPV vaccination rates among Latino/a adolescents

调查联邦合格健康中心中促进者驱动的多层次实施策略，以提高拉丁裔/非裔青少年的医疗服务提供者推荐和 HPV 疫苗接种率

• 批准号: 10737168
• 负责人: Daisy Yvette Morales-Campos
• 金额: $ 62.28万
• 依托单位: UNIVERSITY OF TEXAS AT AUSTIN
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10737168
• 关键词: 12 year old; 17 year old; Address; Adolescent; Advisory Committees; Age; Characteristics; Child; Cluster randomized trial; Collaborations; Data; Disparity; Education; Equity; Ethnic Origin; Evidence based intervention; Federally Qualified Health Center; Feedback; Female Adolescents; Funding; Future; Goals; Health Services; Healthcare; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papilloma Virus-Related Malignant Neoplasm; Hybrids; Immunization; Improve Access; Incidence; Individual; Integrated Health Care Systems; Intervention; Interview; Latina; Latina Population; Latino; Latino Population; Leadership; Literature; Male Adolescents; Malignant Neoplasms; Methods; Not Hispanic or Latino; Outcome; Parents; Patients; Persons; Pilot Projects; Policies; Politics; Population; Preventive service; Process; Provider; Qualitative Methods; Quantitative Evaluations; Race; Randomized; Readiness; Recommendation; Research; Research Personnel; Resource-limited setting; Resources; Site; Structure; Surveys; System; Targeted Research; Testing; Texas; Training; Vaccinated; Vaccination; Vaccines; Vulnerable Populations; Woman; Work; adolescent patient; clinical practice; cluster randomized design; contextual factors; disparity reduction; effectiveness evaluation; effectiveness measure; effectiveness outcome; ethnic minority; evidence base; experience; gender disparity; geographic disparity; health disparity; health equity; implementation efforts; implementation evaluation; implementation outcomes; implementation research; implementation science; implementation strategy; implementation study; improved; men; mortality; practice setting; racial minority; rural dwellers; scale up; socioeconomic disparity; sustainability framework; task analysis; theories; uptake; vaccine hesitancy

Project Summary/Abstract Approximately 46,143 new cases of human papillomavirus (HPV) associated cancers occur annually in the U.S and there are substantial racial, ethnic, socioeconomic, geographic and gender disparities in the incidence and mortality of these cancers. Despite the availability of highly effective HPV vaccines that can reduce HPV- associated cancer mortality, HPV vaccination rates in Texas rank 48th nationwide. Although evidence shows Latino parents are more accepting of HPV vaccination than non-Hispanic parents, this disparity in vaccination rates underscores the importance of understanding Latino parental HPV vaccine hesitancy. Latinos/as typically receive healthcare at Federally Qualified Health Centers (FQHCs), which often need support implementing and improving access to evidence based preventive services. However, the current literature around implementation comes from large integrated healthcare systems and there is limited research around what works in the FQHC settings with Latino/a patients. Implementation studies, with an equity focus, in these resource-limited settings like FQHCs, are essential to make progress towards state and national HPV vaccination targets. Preliminary data from our previous work suggest practice facilitation is a feasible approach for building the capacity in FQHCs to select and implement provider- and practice-level strategies for increasing vaccination rates. Using a stepped-wedge cluster randomized trial, we will randomize three FQHCs (n=9 practices, 3 per FQHC) to receive facilitator-driven provider- (i.e., education, clinical practice plan) and practice-level (i.e., technical assistance plus assessment and feedback, training, and education of immunization navigators) implementation strategies. Informed by our conceptual framework and i-PARIHS, we will measure effectiveness (i.e., HPV vaccination initiation and completion among adolescent patients) and implementation outcomes (i.e., number of providers giving HPV vaccine recommendations and confidence among parents in vaccinating their children). We will conduct a baseline assessment at each clinical practice, which will provide comprehensive data to assist the practice facilitator in engaging with the providers and leadership using a participatory approach to develop an implementation plan with strategies for each practice. Along with quantitative evaluations, we will employ theory-guided, qualitative methods of inquiry, to assess the complexity associated with context (including parental HPV vaccine hesitancy and provider confidence in addressing it) and the recipients involved in the implementation of strategies in practices, along with sustainability. The study will advance our understanding of what it means to conduct implementation research in resource limited practices that work with populations experiencing substantial disparities. Findings from the current study will inform national implementation efforts and contribute towards future research targeting dissemination and scale-up, key foci for health equity focused implementation research.

项目概要/摘要 美国每年约有 46,143 例新发人乳头瘤病毒 (HPV) 相关癌症病例 并且在发病率和发病率方面存在巨大的种族、民族、社会经济、地理和性别差异。 这些癌症的死亡率。尽管有高效的 HPV 疫苗可以减少 HPV- 与癌症死亡率相关，德克萨斯州的 HPV 疫苗接种率在全国排名第 48 位。尽管有证据表明 拉丁裔父母比非西班牙裔父母更接受 HPV 疫苗接种，这种疫苗接种差异 比率强调了了解拉丁裔父母对 HPV 疫苗犹豫的重要性。拉丁裔/通常 在联邦合格健康中心 (FQHC) 接受医疗保健，这些中心通常需要支持实施和 改善获得基于证据的预防服务的机会。然而，目前的文献围绕 实施来自大型综合医疗保健系统，并且围绕什么进行的研究有限 在 FQHC 环境中与拉丁裔/非裔患者一起工作。以公平为重点的实施研究 FQHC 等资源有限的环境对于在州和国家 HPV 方面取得进展至关重要 疫苗接种目标。我们之前工作的初步数据表明，促进实践是一种可行的方法 建设 FQHC 的能力，以选择和实施提供者和实践层面的战略 提高疫苗接种率。使用阶梯楔形聚类随机试验，我们将随机分配三个 FQHC （n=9 个实践，每个 FQHC 3 个）接受促进者驱动的提供者（即教育、临床实践计划）和 实践层面（即技术援助加上评估和反馈、培训和教育） 免疫导航器）实施策略。根据我们的概念框架和 i-PARIHS，我们 将衡量有效性（即青少年患者中 HPV 疫苗接种的开始和完成）以及 实施结果（即提供 HPV 疫苗建议和信心的提供者数量 父母为孩子接种疫苗）。我们将在每次临床实践中进行基线评估， 这将提供全面的数据，以协助实践促进者与提供者接触， 领导层采用参与式方法制定实施计划，并为每种实践制定策略。 除了定量评估外，我们还将采用理论指导的定性调查方法来评估 与背景相关的复杂性（包括父母对 HPV 疫苗的犹豫和提供者对疫苗的信心） 解决这个问题）和参与实践战略实施的接收者，以及 可持续性。这项研究将加深我们对实施研究意义的理解 在资源有限的实践中，与经历巨大差异的人群一起工作。调查结果来自 当前的研究将为国家实施工作提供信息，并为未来的研究目标做出贡献 传播和扩大规模是卫生公平重点实施研究的关键焦点。