TweenVax: A comprehensive practice-, provider-, and parent/patient-level intervention to improve adolescent HPV vaccination

TweenVax：一种综合实践、提供者和家长/患者层面的干预措施，以改善青少年 HPV 疫苗接种

• 批准号: 10227049
• 负责人: Robert A. Bednarczyk
• 金额: $ 50.45万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-04 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10227049
• 关键词: 12 year old; 13 year old; Academy; Address; Adolescent; Affect; American; Appointments and Schedules; Attention; Award; Cancer Control; Childhood; Clinic; Clinic Visits; Clinical; Clinical Trials; Cluster randomized trial; Communication; Continuing Education; Data; Education; Elements; Ethnography; Evaluation; Family Physicians; Family Practice; Female Adolescents; Health Personnel; Healthcare; Healthy People 2020; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papillomavirus; Human papilloma virus infection; Immunization; Immunization Programs; Individual; Information Systems; Intervention; Interview; Male Adolescents; Malignant Neoplasms; Modeling; Online Systems; Parents; Patient Education; Patients; Pediatrics; Pilot Projects; Policies; Provider; Public Health Education; Quantitative Evaluations; Randomized; Recommendation; Registries; Research; Research Project Grants; Series; Services; Severity of illness; Solid; Staff Development; Standardization; System; Tablets; Tennessee; Testing; Training; Training Activity; Transact; Treatment Efficacy; United States; Update; Vaccination; Vaccines; adolescent health; adolescent patient; arm; base; boys; cancer prevention; clinical examination; design; efficacy evaluation; evidence base; follow-up; girls; health belief; implementation research; improved; prevent; programs; standard of care; theories; therapy design; therapy development; three-arm trial; tool; uptake; vaccine acceptance; vaccine delivery

PROJECT SUMMARY/ABSTRACT Persistent human papillomavirus (HPV) infection is responsible for over 30,000 new cases of cancer annually in the United States (US). HPV infection can be prevented by immunization, but 12 years after being recommended for use, HPV immunization rates among US adolescents remain suboptimal. While uptake of other vaccines recommended for 11-12 year-olds is at or near 90%, only 43% of adolescent boys and girls are up-to-date for HPV vaccination. Prior efforts to improve HPV vaccine uptake have followed standard best practices for immunization programs, including education provision for parents and adolescent patients, and Health Belief Model-inspired appeals to disease severity. One key barrier to improving HPV vaccine uptake is that healthcare providers often do not recommend this vaccine with the same strength as they do for other adolescent vaccines. Continued low uptake of HPV vaccine indicates that new systems-level approaches, beyond standard public health education campaigns, are needed. These systems-level approaches – incorporating the healthcare practice and provider as well as the patient - must be designed and packaged in a way to address the quality of, and context around, provider recommendations. Our research team has developed and pilot-tested an intervention package – TweenVax – designed to improve HPV vaccine uptake at the practice-, provider-, and patient/parent-level. Evaluation of TweenVax identified key elements for expansion to improve the provision and strength of provider recommendations. Gaps remain in terms of how best to address missing or substandard provider recommendations, including addressing moment-to-moment patient and data flow and various points of intervention during the clinic visit including desk check-in through clinical examination and vaccination and follow-up appointment scheduling. Enhancements to the TweenVax intervention will include improvements in practice-level communication in the context of patient flow and additional training for non-clinical staff, development of enhanced training modules for clinical staff, including interactive experiential training and provision of continuing education credits, and updates to the content and presentation of the TweenVax tablet- and web-based educational program. The proposed multi-phase study will 1) assess, using ethnographic observations and in-depth interviews, both best practices and deficiencies in all clinical aspects of the adolescent healthcare encounter, with findings used to refine existing intervention tools to improve HPV vaccination of 11-12 year-olds; and 2) evaluate the efficacy of our comprehensive intervention in improving HPV vaccine uptake among 11-12 year-old girls and boys in Georgia and Tennessee. This assessment, through a three-arm trial, will provide the opportunity to assess the efficacy of the intervention package as a whole, as well as to determine the efficacy of individual components (e.g. practice-/provider-level components independent of patient/parent-level components).

项目概要/摘要 持续性人乳头瘤病毒 (HPV) 感染每年导致超过 30,000 例新发癌症病例 在美国（US），HPV感染可以通过免疫接种来预防，但要在接种12年后。 尽管建议使用，但美国青少年的 HPV 免疫率仍然不理想。 推荐用于 11-12 岁儿童的其他疫苗接种率达到或接近 90%，只有 43% 的青春期男孩和女孩接种了 此前为提高 HPV 疫苗接种率所做的努力均遵循最佳标准。 免疫规划的实践，包括为父母和青少年患者提供教育，以及 健康信念模型启发的疾病严重程度是提高 HPV 疫苗接种率的一个主要障碍。 医疗保健提供者通常不推荐这种疫苗，其强度与其他疫苗的强度相同 HPV 疫苗的持续低使用率表明新的系统级方法， 除了标准的公共卫生教育活动之外，还需要这些系统级方法—— 结合医疗保健实践和提供者以及患者 - 必须设计和包装在一个 解决提供商建议的质量和背景的方法。 我们的研究团队开发并试点了一个干预方案 – TweenVax – 旨在改善 TweenVax 的评估确定了实践、提供者和患者/家长层面的 HPV 疫苗接种情况。 差距依然存在 如何最好地解决缺失或不合格的提供商建议的条款，包括解决 就诊期间的即时患者和数据流以及各个干预点（包括办公桌） 通过临床检查和疫苗接种以及后续预约安排进行登记。 TweenVax 干预措施将包括改善患者在实践层面的沟通 非临床人员的流程和额外培训，为临床人员开发增强的培训模块， 包括互动体验式培训和提供继续教育学分，以及更新 基于 TweenVax 平板电脑和网络的教育计划的内容和演示。 拟议的多阶段研究将 1) 使用民族志观察和深入访谈来评估 青少年医疗保健的所有临床方面的最佳实践和缺陷，以及所使用的发现 完善现有干预工具以改善 11-12 岁儿童的 HPV 疫苗接种；2) 评估效果； 我们在提高 11-12 岁女孩和男孩 HPV 疫苗接种率方面的综合干预措施 佐治亚州和田纳西州将通过三组试验进行评估。 整个干预方案的功效，以及确定各个组成部分的功效 （例如，实践/提供者级别的组件独立于患者/家长级别的组件）。