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

项目概要-项目2 先前的研究表明，医疗保健提供者的推荐是影响患者健康的最有影响力的因素。 青少年和年轻人的HPV疫苗接种率和完成率。然而，许多供应商并不 建议在有机会的时候接种疫苗，比如11-12岁的目标年龄，因为大多数儿童都接种了疫苗。 Tdap和脑膜炎球菌疫苗。为了提高11-12奥尔兹对HPV疫苗的接受率， 疾病控制和预防中心（CDC）的重点小组-一个多学科研究小组 在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，作为一个 以诊所为基础的宫颈癌综合预防方案（项目1和3），针对三个层面 影响力-诊所，提供者和患者。在随机分组的一组中使用延迟干预设计 实施试验，我们将审查结果的有效性，可接受性和可持续性沿着 实施科学框架。我们还将在次要目标中测试是否针对 13-26奥尔兹增加追加疫苗接种。这项研究是计划项目的一部分，“提高吸收 阿巴拉契亚的宫颈癌预防服务”，因此，与 程序.将测试的干预措施是与社区合作伙伴一起制定的， 健康的社会决定因素中影响HPV相关疾病差异的多层次因素，以及 已经在阿巴拉契亚地区的人群中进行了试点。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， 四个阿巴拉契亚州（肯塔基州、俄亥俄州、西弗吉尼亚州和弗吉尼亚州）卫生系统的HPV疫苗启动和完成情况， 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 2）次要结果：评估：a）干预措施的可持续性; B） 干预; c）因工作人员职责方面的干预而发生的诊所实践变化 疫苗接种过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奥尔兹增加了追加疫苗接种;和3）次要结果：检查：a）变化 通过教育课程前后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，这种多层次的干预措施将传播到我们的临床和 社区合作伙伴以及整个阿巴拉契亚的其他合作伙伴，以促进有效的 在阿巴拉契亚的整个卫生系统和诊所进行干预，以帮助减轻HPV可预防的负担。 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.