Provider communication and HPV vaccination: The impact of recommendation quality
Provider communication and HPV vaccination: The impact of recommendation quality
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DOI：
10.1016/j.vaccine.2016.01.023
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发表时间：
2016-02-24
期刊：
影响因子：
5.5
通讯作者：
Brewer, Noel T.
中科院分区：
文献类型：
--
作者：
Gilkey, Melissa B.;Calo, William A.;Brewer, Noel T.
背景资料：接受医疗保健提供者的建议是HPV疫苗接种的一个强有力的预测因素，但关于哪种类型的建议最有影响力的经验知之甚少。因此，我们试图调查推荐质量和HPV疫苗接种之间的关系在美国青少年。方法：在2014年，我们进行了一项全国性的，1495 11-17岁的青少年的父母的在线调查。父母报告了提供者是否强烈支持HPV疫苗接种，鼓励当天接种疫苗，并讨论了癌症预防。使用这些质量指标的指数，我们将父母分类为没有收到HPV疫苗接种的低质量或高质量建议。单独的多变量logistic回归模型评估了推荐质量和HPV疫苗接种开始（>= 1剂），后续（3剂，发起人），拒绝和delay.Results之间的关联：近一半（48%）的父母报告没有提供者的HPV疫苗接种建议，而16%收到低质量的建议和36%收到高质量的建议。与没有推荐相比，高质量的推荐与HPV疫苗启动几率的9倍以上（23% vs. 74%，OR= 9.31，95% CI，7.10-12.22）和随访几率的3倍以上（17% vs. 44%，012=3.82，95% CI，2.39-6.11）相关。低质量的建议与启动（OR= 4.13，95%CI，2.99-5.70）相关性更小，但不与后续活动相关。接受高质量与低质量建议的父母较少报告HPV疫苗拒绝或延迟。结论：高质量的建议与HPV疫苗接种行为密切相关，但只有约三分之一的父母接受了HPV疫苗接种。需要采取干预措施，不仅要改善提供者是否推荐青少年接种HPV疫苗，而且要改善提供者如何推荐青少年接种HPV疫苗。(C)2016爱思唯尔有限公司版权所有
Background: Receiving a healthcare provider's recommendation is a strong predictor of HPV vaccination, but little is known empirically about which types of recommendation are most influential. Thus, we sought to investigate the relationship between recommendation quality and HPV vaccination among U.S. adolescents.Methods: In 2014, we conducted a national, online survey of 1495 parents of 11-17-year-old adolescents. Parents reported whether providers endorsed HPV vaccination strongly, encouraged same-day vaccination, and discussed cancer prevention. Using an index of these quality indicators, we categorized parents as having received no, low-quality, or high-quality recommendations for HPV vaccination. Separate multivariable logistic regression models assessed associations between recommendation quality and HPV vaccine initiation (>= 1 dose), follow through (3 doses, among initiators), refusal, and delay.Results: Almost half (48%) of parents reported no provider recommendation for HPV vaccination, while 16% received low-quality recommendations and 36% received high-quality recommendations. Compared to no recommendation, high-quality recommendations were associated with over nine times the odds of HPV vaccine initiation (23% vs. 74%, OR= 9.31, 95% CI, 7.10-12.22) and over three times the odds of follow through (17% vs. 44%, 012=3.82, 95% CI, 2.39-6.11). Low-quality recommendations were more modestly associated with initiation (OR= 4.13, 95% CI, 2.99-5.70), but not follow through. Parents who received high- versus low-quality recommendations less often reported HPV vaccine refusal or delay.Conclusions: High-quality recommendations were strongly associated with HPV vaccination behavior, but only about one-third of parents received them. Interventions are needed to improve not only whether, but how providers recommend HPV vaccination for adolescents. (C) 2016 Elsevier Ltd. All rights reserved.