"You're never really off time": Healthcare providers' interpretations of optimal timing for HPV vaccination.
"You're never really off time": Healthcare providers' interpretations of optimal timing for HPV vaccination.
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DOI：
10.1016/j.pmedr.2016.05.002
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发表时间：
2016-12
影响因子：
2.8
通讯作者：
McRee AL
中科院分区：
文献类型：
--
作者：
Henrikson NB;Tuzzio L;Gilkey MB;McRee AL
医疗保健提供者对人乳头瘤病毒 (HPV) 疫苗接种决策有很大影响，但他们常常无法向实践指南所针对的 11 岁和 12 岁儿童推荐疫苗。我们试图了解提供者如何解释和重视基于年龄的指南。我们对两项关于医疗保健提供者 HPV 疫苗接种态度和实践的定性研究的数据进行了二次分析。参与者是分别于 2012 年和 2014 年接受采访的明尼苏达州 (n = 27) 和华盛顿州 (n = 17) 的医生、执业护士和医师助理。使用内容分析独立分析每项研究的逐字记录，然后联合分析集体发现。研究团队通过协商一致的方式得出代码并描述代表性主题。很大一部分提供者报告要么对 HPV 疫苗的完成情况缺乏担忧，要么在超过建议的目标年龄几年后才开始担忧。许多提供者认为 HPV 疫苗接种的及时性存在梯度，从 12 岁到 26 岁不等。提供者没有根据年龄提出建议，而是根据对获得护理的机会和患者风险的看法来安排建议的时间。他们经常提供“温和”的建议并推迟疫苗接种讨论，作为与家人建立信任的工具。需要采取旨在帮助提供者提供及时 HPV 疫苗接种的有效建议的干预措施。我们的研究结果表明，将提供者文化的规范改变为“追赶”时间表被视为实现疫苗接种的次优方式的规范可能是一个重要目标。许多医疗保健提供者报告称，他们对 12 岁之前完成 HPV 疫苗接种缺乏关注。提供者报告称，他们对在超过建议目标年龄几年后开始或完成 HPV 疫苗接种感到担忧。提供者描述了从 12 岁到 26 岁的按时 HPV 疫苗接种的梯度。提供者根据对获得护理和患者风险的看法完善了 HPV 疫苗建议。未来针对提供者的干预措施应强调 12 岁之前接种 HPV 疫苗的重要性的信息。
Healthcare providers have a strong influence on human papillomavirus (HPV) vaccination decisions, yet they often fail to recommend the vaccine to the 11- and 12-year-olds who are targeted by practice guidelines. We sought to understand how providers interpret and value age-based guidelines. We conducted a secondary analysis of data from two qualitative studies of healthcare providers' HPV vaccination attitudes and practices. Participants were physicians, nurse practitioners, and physician assistants in Minnesota (n = 27) and in Washington (n = 17) interviewed in 2012 and 2014 respectively. Verbatim transcripts from each study were analyzed independently using content analysis, and collective findings were then jointly analyzed. The research team worked via consensus to derive codes and describe representative themes. A high proportion of providers reported either a lack of concern about HPV vaccine completion, or concern beginning several years past the recommended target age. Many providers perceived a gradient of HPV vaccination timeliness ranging from age 12 to 26. Instead of age-based recommendations, providers timed recommendations based on perceptions of access to care and patient risk. They often offered “gentle” recommendations and deferred vaccination discussions as a tool to building trust with families. Interventions aimed at helping providers deliver effective recommendations for timely HPV vaccination are needed. Our findings suggest that changing the norm of provider culture to one in which “catch-up” schedules are seen as a suboptimal way to achieve vaccine uptake may be an important goal. Many healthcare providers report a lack of concern for HPV vaccine completion by age 12. Providers reported concern about HPV vaccine initiation or completion beginning several years past the recommended target age. Providers described a gradient of on-time HPV vaccination ranging from age 12 to age 26. Providers refined their HPV vaccine recommendations based on perceptions of access to care and patient risk. Future interventions aimed at providers should emphasize messages on the importance of HPV vaccination by age 12.