Project 2: Testing Multi-Level Interventions to Improve HPV Vaccination

项目摘要--项目2 先前的研究表明，医疗服务提供者的推荐是最有影响力的影响因素 青少年和青壮年人乳头瘤病毒疫苗接种率和完成率。然而，许多提供商并不是 在机会主义的时候推荐疫苗，例如大多数儿童在11-12岁接种疫苗的目标年龄 TDAP和脑膜炎双球菌疫苗。提高11-12岁青少年对HPV疫苗的接种率 疾病控制和预防中心的焦点小组--一个多学科研究小组 阿巴拉契亚四个州将测试基于卫生系统的干预措施的有效性，作为 以临床为基础的综合宫颈癌预防计划(包括项目1和项目3)，分三个层次 影响-诊所、提供者和患者。在随机分组中使用延迟干预设计 实施试验，我们将检查有效性、可接受性和可持续性的结果 实施科学框架。我们还将在次要目标中测试干预措施是否针对 13-26岁的青少年增加补种。这项研究是该计划项目的一部分，该项目名为 阿巴拉契亚地区的宫颈癌预防服务“，并因此与 程序。将被测试的干预措施是与社区合作伙伴共同制定的，地址 影响HPV相关疾病差异的健康社会决定因素中的多层次因素，以及 已经在阿巴拉契亚地区的人群中试行。具体目标是：1)主要结果：测试有效性 针对诊所、提供者和患者(11-12岁儿童的父母)的多层次干预，以改善 阿巴拉契亚四个州(肯塔基州、俄亥俄州、西弗吉尼亚州和弗吉尼亚州)卫生系统中HPV疫苗的启动和完成情况 11-12岁的儿童，并评估干预计划在亚组中的有效性，例如女性 VS男性；2)次级结果：评估：a)干预的可持续性；b)成本影响 干预；c)在工作人员责任方面，由于干预而引起的诊所做法的变化 疫苗接种进程和减少错过的疫苗接种机会；以及d)干预措施是否 针对13-26岁的青少年增加补种；和3)次要结果：检查：a)变化 通过培训课程后的调查了解提供者的知识和态度，以及b)对 多层次的干预。如果有效，这种多层次的干预将传播到我们的临床和 社区合作伙伴以及阿巴拉契亚各地的其他合作伙伴，以促进采用有效的 在阿巴拉契亚的卫生系统和诊所采取干预措施，帮助减轻HPV的负担--可预防的 疾病。

PROJECT SUMMARY – PROJECT 2 Prior research has demonstrated that health care provider recommendation is the most influential factor affecting HPV vaccine uptake and completion among adolescents and young adults. However, many providers are not recommending the vaccine at opportunistic times such as the targeted ages of 11-12 when most children receive Tdap and meningococcal vaccines. To improve the uptake of the HPV vaccine among 11-12 year olds – the age group of focus for the Centers for Disease Control and Prevention (CDC) – a multi-disciplinary research team across four Appalachian states will test the effectiveness of a health system-based intervention, as part of an integrated clinic-based cervical cancer prevention program (with Projects 1 and 3), that is directed to three levels of influence – clinic, provider, and patient. Using a delayed intervention design in a group randomized implementation trial, we will examine outcomes of effectiveness, acceptability, and sustainability along the Implementation Science Framework. We will also test in a secondary aim whether interventions targeted to the 13-26 year olds increases catch-up vaccination. This study is part of the Program Project, “Improving Uptake of Cervical Cancer Prevention Services in Appalachia,” and as such, is intricately integrated with the Cores of the Program. The interventions to be tested have been developed in conjunction with community partners, address multi-level factors within the Social Determinants of Health that impact disparities in HPV-related disease, and have been piloted in Appalachian populations. Specific aims are to: 1) Primary Outcome: Test the effectiveness of a multi-level intervention directed at clinics, providers, and patients (parents of children aged 11-12) to improve HPV vaccine initiation and completion in health systems in four Appalachian states (KY, OH, WV, and VA) among children aged 11-12, and assess the effectiveness of the intervention program among subgroups, e.g., females vs males; 2) Secondary Outcomes: Assess: a) sustainability of the intervention; b) cost impacts of the intervention; c) changes in clinic practices that occur as a result of the intervention in terms of staff responsibilities for the vaccination process and reducing missed opportunities for vaccination; and d) whether interventions directed to 13-26 year olds increases catch-up vaccination; and 3) Secondary Outcomes: Examine: a) changes in knowledge and attitudes of providers via educational session pre-post surveys and b) satisfaction with the intervention at the multiple levels. If effective, this multi-level intervention will be disseminated to our clinical and community partners as well as other partners throughout Appalachia to facilitate the uptake of effective interventions throughout health systems and clinics in Appalachia to help reduce the burden of HPV-preventable diseases.