Theory-based development of an implementation intervention to increase HPV vaccination in pediatric primary care practices.
Theory-based development of an implementation intervention to increase HPV vaccination in pediatric primary care practices.
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DOI：
10.1186/s13012-018-0729-6
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发表时间：
2018-03-13
期刊：
影响因子：
--
通讯作者：
Lobb R
中科院分区：
文献类型：
--
作者：
Garbutt JM;Dodd S;Walling E;Lee AA;Kulka K;Lobb R
针对人乳头瘤病毒（HPV）致癌株的疫苗使用国家指南是一种循证实践，在初级保健中执行不力。建议包括女孩和男孩在13岁生日前完成疫苗系列，在11至12岁的体检时接种第一剂，同时接种其他推荐的疫苗。增加该指南实施的干预措施几乎没有影响，预防癌症的机会继续被错过。我们使用了一种理论指导的方法来开发一种实用的干预措施，用于初级保健环境，以增加HPV疫苗指南建议的实施。在10个初级保健实践中使用并行混合方法设计，我们应用实施研究综合框架（CFIR）系统地调查和表征强烈影响疫苗使用的因素。然后，我们使用行为改变轮（BCW）和理论领域框架（TDF）来分析提供者的行为，并确定行为的目标变化和行为改变策略，包括在干预。我们确定了在五个CFIR领域使用指南的促进者和障碍：与提供者特征相关的最显著因素，他们对干预的看法，以及他们提供疫苗的过程。有针对性的行为是提供者以与其他青少年疫苗相同的方式和同时推荐HPV疫苗，自信地回答父母的问题，并实施疫苗输送系统。为此，干预措施的目标是提高提供者在执行指南建议方面的能力（知识、沟通技能）和动机（行动规划、对后果的信念、社会影响），并增加他们这样做的机会（疫苗输送系统）。行为改变策略包括提供信息和沟通技能培训，分级任务和建模，覆盖率反馈，目标设定和社会支持。这些策略被结合在实施干预中，通过实践促进、教育外展访问和周期性小型变革测试来实施。使用CFIR，BCW和TDF促进了一个务实的，多组件的实施干预的发展，以增加HPV疫苗在初级保健环境中的使用。
The national guideline for use of the vaccine targeting oncogenic strains of the human papillomavirus (HPV) is an evidence-based practice that is poorly implemented in primary care. Recommendations include completion of the vaccine series before the 13th birthday for girls and boys, giving the first dose at the 11- to 12-year-old check-up visit, concurrent with other recommended vaccines. Interventions to increase implementation of this guideline have had little impact, and opportunities to prevent cancer continue to be missed. We used a theory-informed approach to develop a pragmatic intervention for use in primary care settings to increase implementation of the HPV vaccine guideline recommendation. Using a concurrent mixed methods design in 10 primary care practices, we applied the Consolidated Framework for Implementation Research (CFIR) to systematically investigate and characterize factors strongly influencing vaccine use. We then used the Behavior Change Wheel (BCW) and the Theoretical Domains Framework (TDF) to analyze provider behavior and identify behaviors to target for change and behavioral change strategies to include in the intervention. We identified facilitators and barriers to guideline use across the five CFIR domains: most distinguishing factors related to provider characteristics, their perception of the intervention, and their process to deliver the vaccine. Targeted behaviors were for the provider to recommend the HPV vaccine the same way and at the same time as the other adolescent vaccines, to answer parents’ questions with confidence, and to implement a vaccine delivery system. To this end, the intervention targeted improving provider’s capability (knowledge, communication skills) and motivation (action planning, belief about consequences, social influences) regarding implementing guideline recommendations, and increasing their opportunity to do so (vaccine delivery system). Behavior change strategies included providing information and communication skill training with graded tasks and modeling, feedback of coverage rates, goal setting, and social support. These strategies were combined in an implementation intervention to be delivered using practice facilitation, educational outreach visits, and cyclical small tests of change. Using CFIR, the BCW and the TDF facilitated the development of a pragmatic, multi-component implementation intervention to increase use of the HPV vaccine in the primary care setting.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
DOI：
10.3122/jabfm.18.1.13
发表时间：
2005-01-01
期刊：
JOURNAL OF THE AMERICAN BOARD OF FAMILY PRACTICE
影响因子：
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作者：
Oster, NV;Mcphillips-Tangum, CA;Howell, K
通讯作者：
Howell, K
DOI：
10.1186/s13012-017-0605-9
发表时间：
2017-06-21
期刊：
Implementation science : IS
影响因子：
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作者：
Atkins L;Francis J;Islam R;O'Connor D;Patey A;Ivers N;Foy R;Duncan EM;Colquhoun H;Grimshaw JM;Lawton R;Michie S
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Michie S
DOI：
10.1111/j.1464-0597.2008.00341.x
发表时间：
2008-10-01
影响因子：
7.2
作者：
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通讯作者：
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影响因子：
33.9
作者：
Reagan-Steiner, Sarah;Yankey, David;Singleton, James A.
通讯作者：
Singleton, James A.