ADEPT - An adaptive prenatal intervention to increase childhood vaccinations

摘要 在美国，父母决定推迟或拒绝为孩子接种疫苗， 疫苗接种不足的小块地区以及疫苗可预防疾病的反复爆发。增加 为了预防儿童疫苗接种和阻止疫情复发，我们需要有效的干预措施来建立父母的信任 对疫苗的信心，减少他们对疫苗的犹豫。第一次推荐的常规疫苗接种 孩子出生时就该生了。然而，许多父母缺乏关于儿童疫苗接种的及时或基于证据的信息 在孩子出生之前。因此，我们建议评估ADEPT -一种适应性干预措施， 在产前护理环境中，主动将父母与基于证据的儿童疫苗接种信息联系起来 在孩子出生之前。ADEPT的核心组成部分包括产前提供者培训和 对处于妊娠晚期早期（28-32周）的孕妇的建议， 在孩子出生后接种疫苗。那些尽管提供者仍然对疫苗犹豫不决的孕妇 建议将接受适应性干预组成部分，其中包括循证教育 儿童疫苗接种材料，并与疫苗导航员进行电话咨询，讨论任何剩余的 性问题在第1类有效性-实施混合研究设计的框架内，我们将使用 一项确定ADEPT与标准治疗相比的有效性的随机分组试验， 解释性顺序混合方法研究，以确定实施成果，如干预措施 可接受性、可行性和保真度。这项拟议的研究将针对那些期待怀孕的孕妇。 第一个孩子，因为研究表明，他们中的许多人依赖于疫苗接种信息从互联网或其他 非医疗保健来源，使他们容易受到错误信息和疫苗犹豫。拟议 在这项研究中，ADEPT将在北卡罗来纳州的各种产前护理实践中实施和评估。在 与外部利益相关者咨询团队合作，我们将为未来的实施制定蓝图 和评估的ADEPT在不同的产前护理设置在美国各地。我们的建议是创新的， 为产前保健期间的儿童疫苗接种教育创造了一个新的范例，并实施了一项新的 适应性干预（ADEPT），针对孕妇的犹豫状态和担忧。我们 假设在产前护理环境中实施ADEPT将主动减少疫苗犹豫 在期待第一个孩子的孕妇中，并在怀孕后及时为他们的孩子接种疫苗。 出生我们的建议是重要的，因为它符合CDC的信心疫苗优先事项， 赋予家庭权力，终结疫苗神话。我们的提案还支持2030年健康人目标 减少美国未接种疫苗或接种不足的儿童比例。圆满完成拟议的 目标将产生关于ADEPT在促进儿童疫苗接种方面的有效性的数据， 护理以及战略，其未来的实施和评估产前护理设置在美国各地。

ABSTRACT In the United States (US), parents’ decision to delay or refuse vaccines for their children has resulted in pockets of under-vaccination as well as recurring outbreaks of vaccine-preventable diseases. To increase childhood vaccinations and stem recurring outbreaks, we need effective interventions that build parents’ confidence in vaccines and reduce their vaccine hesitancy. The first recommended routine vaccination for children is due at birth. Yet, many parents lack timely or evidence-based information on childhood vaccinations prior to their child’s birth. Hence, we propose to evaluate ADEPT - an adaptive intervention that is implemented in prenatal care settings to proactively connect parents with evidence-based childhood vaccination information before their child’s birth. The core component of ADEPT includes prenatal provider trainings and a recommendation to pregnant women in their early third trimester (28-32 weeks) encouraging childhood vaccinations after the child is born. Those pregnant women who remain vaccine-hesitant despite the provider recommendation will receive adaptive intervention components, which include evidence-based educational materials on childhood vaccinations and phone consultations with a vaccine navigator to discuss any residual concerns. Within the framework of a type 1 effectiveness-implementation hybrid study design, we will use a cluster-randomized trial to determine the effectiveness of ADEPT compared to standard of care and a nested explanatory sequential mixed methods study to identify implementation outcomes such as intervention acceptability, feasibility, and fidelity. The proposed study will target pregnant women who are expecting their first child, since research suggests that many of them rely on vaccination information from the internet or other non-healthcare sources, making them susceptible to misinformation and vaccine hesitancy. In the proposed study, ADEPT will be implemented and evaluated in diverse prenatal care practices in North Carolina. In partnership with an external stakeholder advisory team, we will develop a blueprint for future implementation and evaluation of ADEPT in diverse prenatal care settings across the US. Our proposal is innovative as it creates a new paradigm for childhood vaccination education during prenatal care, and implements a novel adaptive intervention (ADEPT) that is tailored to the hesitancy status and concerns of pregnant women. We hypothesize that implementation of ADEPT in prenatal care settings will proactively reduce vaccine hesitancy among pregnant women who are expecting their first child, and increase timely vaccinations for their child post- birth. Our proposal is significant because it aligns with CDC’s Vaccinate with Confidence priorities for empowering families and stopping vaccine myths. Our proposal also supports the Healthy People 2030 goals to reduce the proportion of un- or under-immunized children in the US. The successful completion of proposed aims will yield data on ADEPT’s effectiveness in promoting childhood vaccinations compared to standard of care as well as strategies for its future implementation and evaluation in prenatal care settings across the US.