Evaluating the Feasibility of a Mobile Coaching Intervention to Improve HPV Vaccine Delivery

评估移动辅导干预改善 HPV 疫苗接种的可行性

• 批准号: 9807220
• 负责人: Melissa B Gilkey
• 金额: $ 19.12万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-20 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9807220
• 关键词: 13 year old; Address; Adolescent; Adopted; Affect; Age; Behavior; Belief; Caring; Child Care; Childhood; Clinic; Clinical; Cognition; Communication; Continuing Education; Data; Dose; Effectiveness; Effectiveness of Interventions; Electronic Health Record; Environment; Evidence based intervention; Family; Feasibility Studies; Feedback; Future; Goals; Health Personnel; Healthy People 2020; Hour; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papillomavirus; Intervention; Intervention Trial; Interview; Libraries; Malignant Neoplasms; Measures; Medical Care Team; Outcome; Parents; Patients; Perception; Primary Health Care; Process Measure; Provider; Randomized Clinical Trials; Randomized Controlled Trials; Recommendation; Research; Sampling; Self Efficacy; Series; Surveys; Testing; Time; Training; United States; Vaccination; Vaccines; Woman; Work; Youth; base; clinical practice; communication behavior; dashboard; design; efficacy testing; evidence base; follow-up; improved; individualized feedback; innovation; meetings; men; mobile application; mobile computing; novel strategies; prevent; primary care setting; satisfaction; social cognitive theory; success; theories; tool; uptake; usability; vaccine delivery

PROJECT SUMMARY Widespread human papillomavirus (HPV) vaccination could prevent most HPV-related cancers, which affect over 40,000 people in the United States (US) each year. Despite this potential benefit, HPV vaccine coverage among adolescents remains low. By 2017, fewer than half (39%) of 13-year-olds had completed the 2-dose series. Research to address low coverage suggests that multi-level interventions targeting provider- parent communication and clinical environments may be especially effective. Proven intervention strategies include communication training to improve healthcare providers’ HPV vaccine recommendations, as well as assessment and feedback on clinics’ HPV vaccine coverage. However, implementing these strategies in real- world clinical settings remains challenging, in part because existing interventions are constrained by their reliance on burdensome group-based meetings. New approaches are needed to deliver the comprehensive training and ongoing data that providers require to adopt and sustain vaccine-related practice improvements. To address this need, the proposed study will enhance and evaluate Up2Date, an existing, theory- informed mobile coaching intervention to improve the delivery of HPV vaccine. Up2Date consists of a brief in- clinic training for healthcare teams, followed by 12 weeks of individualized coaching for providers via a mobile application (app). Specifically, the app supports ongoing assessment and tailored feedback aimed at improving how providers recommend HPV vaccine and address parents’ concerns, using a library of research-tested messages. In Aim 1, we will enhance Up2Date to include a dashboard of clinics’ HPV vaccine coverage that can be used to set and track shared goals for improvement. In doing so, we will create a multi-level mobile platform to support both provider-level and clinic-level assessment and feedback to improve HPV vaccination. In Aim 2, we will evaluate the feasibility of Up2Date by delivering our intervention to 20 pediatric providers in primary care clinics with HPV vaccine coverage below the national average. We will assess pre/post changes in intermediate outcomes related to clinic-level environments as well as provider-level cognitions and behaviors. We hypothesize that providers’ overall recommendation quality will increase between baseline and 12-week follow up. We will also conduct limited efficacy testing of our long-term, family-level outcomes: adolescents’ HPV vaccine coverage and parents’ satisfaction with care. Finally, we will assess process measures, including the acceptability of and demand for our intervention. These analyses will use qualitative and quantitative data from surveys, interviews, app analytics, and electronic health records. The proposed study builds on the work of a well-established team to evaluate the feasibility of an innovative, multi-level mobile coaching intervention. Results from this feasibility study will generate effect sizes to inform a future randomized controlled trial to test the effectiveness of mobile coaching. If successful, our intervention will improve HPV vaccine coverage and protect adolescents from future HPV-related cancers.

项目概要 广泛的人乳头瘤病毒 (HPV) 疫苗接种可以预防大多数与 HPV 相关的癌症， 尽管有这种潜在的好处，HPV 疫苗每年仍影响超过 40,000 人。 到 2017 年，只有不到一半 (39%) 的 13 岁青少年完成了这项计划。 解决低覆盖率问题的 2 剂系列研究表明，针对提供者的多层次干预措施 家长沟通和临床环境可能特别有效。 包括沟通培训，以改善医疗保健提供者的 HPV 疫苗建议，以及 对诊所 HPV 疫苗覆盖率的评估和反馈 然而，实际实施这些策略。 世界临床环境仍然充满挑战，部分原因是现有干预措施受到其自身条件的限制 需要依靠繁琐的小组会议来提供全面的会议。 提供者采用和维持疫苗相关实践改进所需的培训和持续数据。 为了满足这一需求，拟议的研究将增强和评估 Up2Date，这是一种现有的理论 Up2Date 旨在改善 HPV 疫苗接种的知情移动辅导干预包括简短的介绍。 为医疗团队提供临床培训，然后通过移动设备为提供者提供为期 12 周的个性化指导 具体来说，该应用程序支持旨在改进的持续评估和定制反馈。 提供者如何使用经过研究测试的库推荐 HPV 疫苗并解决家长的担忧 在目标 1 中，我们将增强 Up2Date 以包含诊所 HPV 疫苗覆盖率的仪表板。 可用于设置和跟踪共同的改进目标。这样做，我们将创建一个多层次的移动。 平台支持提供者级别和诊所级别的评估和反馈，以改善 HPV 疫苗接种。 在目标 2 中，我们将通过向 20 家儿科提供者提供干预措施来评估 Up2Date 的可行性 在 HPV 疫苗覆盖率低于全国平均水平的初级保健诊所，我们将评估前/后情况。 与诊所层面的环境以及提供者层面的认知相关的中间结果的变化 我们追求提供商的整体推荐质量将在基线之间提高。 我们还将对长期、家庭层面的结果进行有限的功效测试： 青少年的 HPV 疫苗覆盖率和家长对护理的满意度最后，我们将评估过程。 措施，包括我们干预的可接受性和需求，这些分析将使用定性。 以及来自调查、访谈、应用程序分析和电子健康记录的定量数据。 拟议的研究建立在一个完善的团队的工作基础上，以评估可行性 这项可行性研究的结果将产生创新的、多层次的移动辅导干预。 为未来测试移动辅导有效性的随机对照试验提供信息如果成功，我们的。 干预措施将提高 HPV 疫苗覆盖率并保护青少年未来免受 HPV 相关癌症的侵害。