Evaluation of the Presumptively Initiating Vaccines and Optimizing Talk with Motivational Interviewing (PIVOT with MI) Intervention

推定启动疫苗和通过动机访谈优化谈话（PIVOT with MI）干预的评估

• 批准号: 10201691
• 负责人: Sean T O'Leary
• 金额: $ 60.07万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-10 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10201691
• 关键词: Academy; Address; Adherence; Adolescent; Age-Months; American; Attitude; Birth; Child; Child health care; Childhood; Colorado; Communication; Complement; Cross-Sectional Studies; Data; Decision Making; Disease; Disease Outbreaks; Dissemination and Implementation; Dose; Elements; Enrollment; Evaluation; Family Physicians; Feedback; Focus Groups; Future; Goals; Health; Health Personnel; Healthy People 2020; Human Papilloma Virus Vaccine; Immunization; Immunize; Individual; Information Systems; Intervention; Lead; Mind; Newborn Infant; Parents; Pediatric Research; Pediatrics; Perception; Physicians; Population Intervention; Primary Health Care; Process; Provider; Public Health; Randomized; Randomized Controlled Trials; Recommendation; Research; Resistance; Self Efficacy; Source; Supervision; Surveys; Techniques; Testing; Time; Training Programs; Trust; Vaccination; Vaccines; Videotape; Visit; Voice; Washington; Work; behavior change; care providers; communication behavior; design; evidence base; experience; improved; innovation; kindergarten; motivational enhancement therapy; novel; parental influence; patient oriented; post intervention; practice-based research network; preference; prevent; primary outcome; provider intervention; public trust; satisfaction; stem; transmission process; treatment arm; treatment as usual; uptake; vaccine acceptance; vaccine hesitancy

PROJECT SUMMARY This proposal addresses a significant public health problem—parental vaccine hesitancy and refusal—for which there are currently few well-designed and rigorously evaluated interventions. National estimates of the percentage of 19 – 35 month old children who are up-to-date on recommended vaccines remain below Healthy People 2020 goals. A key contributor to under-immunization is parental refusal or delay of vaccines due to vaccine concerns. Vaccine-hesitant parents (VHPs), a large, diverse group of parents who refuse and/or delay at least one recommended vaccine for their child, are an important population for interventions aimed at improving vaccine acceptance. While VHPs’ most trusted source of information is their child’s provider, providers lack confidence in communicating with VHPs and often perceive their discussions will do little to change a parent’s mind. Improved provider communication with VHPs is therefore critical to improving childhood vaccine uptake and preventing outbreaks of vaccine-preventable disease. However, there is a lack of experimental evidence for specific communication strategies for providers. In preliminary work, Opel et al. found that provider use of a presumptive (e.g. “Well we have to do some shots.”) rather than a participatory (e.g. “How do you feel about vaccines today?”) communication format to initiate the vaccine recommendation was associated with increased parental vaccine acceptance. This presumptive format, though, may lead to decreased parent satisfaction, raising concerns that a presumptive initiation will result in decreased vaccine uptake over time. In separate work, O’Leary et al. explored the use of Motivational Interviewing (MI) to increase uptake of HPV vaccine recommended for adolescents. Motivational Interviewing is a patient-centered framework for behavior change that contains elements that are consistent with known communication preferences of VHPs regarding vaccines. O’Leary et al. found that provider use of MI in discussions with parents who resisted the HPV vaccine recommendation resulted in increased parental vaccine acceptance and improved provider perceptions of their ability to influence parental vaccine decision-making. In this proposal, O’Leary and Opel aim to combine these two techniques—the Presumptively Initiating Vaccines and Optimizing Talk with Motivational Interviewing (PIVOT with MI) intervention—to achieve increased vaccine uptake, high parent visit satisfaction, and improved provider confidence in the vaccine conversation. Our specific aims will be to (1) develop a multifaceted, feasible, and culturally appropriate PIVOT with MI intervention provider training program; (2) evaluate the impact of the PIVOT with MI intervention on child immunization status at 19 months of age by randomizing 24 primary care practices in 2 states (Washington and Colorado) to control or intervention arms using a cluster randomized design; and (3) evaluate the impact of the PIVOT with MI intervention on parent and provider experience.

项目摘要 这项建议解决了一个重要的公共卫生问题-父母疫苗犹豫和再推荐-为 目前很少有精心设计和严格评估的干预措施。国家估计数 19 - 35个月大的儿童中，接受最新推荐疫苗的比例仍然低于健康水平 2020年目标。免疫不足的一个关键因素是父母拒绝或延迟接种疫苗， 疫苗问题。疫苗犹豫不决的父母（VHP），一个庞大的，多样化的父母群体，他们拒绝和/或推迟 至少为他们的孩子推荐一种疫苗，是干预措施的重要人群， 提高疫苗的接受度。虽然VHP最信任的信息来源是他们孩子的提供者， 提供者缺乏与VHP沟通的信心，并且经常认为他们的讨论对 改变父母的想法因此，改善提供商与VHP的沟通至关重要， 提高儿童的疫苗接种率，预防可用疫苗预防的疾病的爆发。 然而，缺乏实验证据，为供应商的具体沟通策略。在 在初步工作中，Opel等人发现，供应商使用推定（例如，“好吧，我们必须做一些镜头。”） 而不是参与式的（例如，“你对今天的疫苗有什么看法？”）启动的通信格式 疫苗推荐与父母疫苗接受度的增加有关。这一假定 然而，形式可能会导致父母满意度下降，这引起了人们的担忧，即假定的启动将 随着时间的推移导致疫苗摄取减少。在另一项工作中，O 'Leary等人探索了动机的使用， 面试（MI），以增加推荐给青少年的HPV疫苗的摄取。动机访谈 是一个以患者为中心的行为改变框架，包含与已知的 VHP对疫苗的沟通偏好。O 'Leary等人发现， 与抵制HPV疫苗建议的父母进行讨论， 接受和改善供应商的看法，他们的能力，影响父母的疫苗决策。 在这项建议中，奥利里和欧宝的目标是联合收割机这两种技术-推定 启动疫苗和优化谈话与动机面试（PIVOT与MI） 干预措施-提高疫苗接种率，提高家长访视满意度， 在疫苗对话中提供信心。我们的具体目标将是：（1）发展一个多方面的， 可行的，文化上适当的PIVOT与MI干预提供者培训计划;（2）评估 通过随机化24名儿童，研究PIVOT和MI干预对19个月龄儿童免疫状态的影响 2个州（华盛顿和科罗拉多）的初级保健实践，使用群集控制或干预武器 随机设计;（3）评价PIVOT与MI干预对父母和提供者的影响 体验.