HPV ECHO: Increasing the adoption of evidence-based communication strategies for HPV vaccination in rural primary care practices

HPV ECHO：在农村初级保健实践中更多地采用基于证据的 HPV 疫苗接种沟通策略

• 批准号: 10398939
• 负责人: William Alexis Calo
• 金额: $ 37万
• 依托单位: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-10 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10398939
• 关键词: 17 year old; Address; Adolescent; Adoption; Age; Area; Behavioral; Caring; Clinic; Clinic Visits; Clinical; Cluster randomized trial; Communication; Community Healthcare; Community Networks; Complex; Consolidated Framework for Implementation Research; Data; Decision Making; Dose; Effectiveness; Electronic Health Record; Evaluation; Exposure to; Family Practice; Goals; Healthcare; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papilloma Virus-Related Malignant Neoplasm; Human Papillomavirus; Human papilloma virus infection; Infrastructure; Intervention; Interview; Malignant Neoplasms; Methods; Modeling; Monitor; Notification; Outcome; Parents; Penetration; Pennsylvania; Physicians; President' s Cancer Panel; Prevention Research; Primary Health Care; Provider; Public Health; Randomized; Recommendation; Reporting; Research; Research Personnel; Resources; Risk; Rural; Rural Community; Rural Population; Schedule; Scientist; Source; Structure; Surveys; System; Testing; Time; Training; Use Effectiveness; Vaccination; Vaccines; Woman; Work; arm; boys; cancer prevention; care outcomes; care providers; comparison intervention; cost; design; effective intervention; effectiveness evaluation; effectiveness testing; evidence base; experience; follow-up; girls; health inequalities; implementation framework; implementation outcomes; implementation strategy; improved; innovation; men; post intervention; prevent; primary outcome; rural America; secondary outcome; sex; social culture; social media; treatment arm; vaccine acceptance; vaccine hesitancy; video session

ABSTRACT Despite the availability of the human papillomavirus (HPV) vaccine that can prevent over 34,800 HPV-related cancers in the US every year, only 51% of girls and boys were up-to-date by 2018. Rural populations are the most impacted by HPV-related cancers. Best practices like the Announcement Approach training and systems communication have proven effective in increasing HPV vaccination, but rural providers struggle to access and implement such best practices. These data prompt the question: “How can academic centers support HPV vaccination in rural primary care practices?” Although never tested for HPV vaccination, the ECHO (Extension for Community Healthcare Outcomes) Model is a promising implementation strategy (practice facilitation) that allows “experts” at academic centers to connect with primary care providers to discuss best practices in care and complex cases managed within local practices. The objective of this R01 is to test two ECHO-delivered HPV vaccination communication interventions in rural primary care clinics. The first will provide Announcement Approach training (HPV ECHO); the second will provide this approach plus systems strategies to communicate with parents who initially decline vaccination (HPV ECHO+). The rationale for the project is that ECHO is a robust, highly-accessible platform to deliver best practices to rural providers and address the context-specific communication needs of parents. Our long-term goal is to improve HPV vaccination rates in rural clinics and reduce the health inequity rural populations experience in cancer outcomes. Aim 1 is to evaluate the impact of HPV ECHO and HPV ECHO+ on HPV vaccination among adolescents. We will conduct a 3-arm cluster randomized trial with 36 primary care clinics in rural Pennsylvania. Clinics will be randomized to: HPV ECHO, HPV ECHO+, or control. Our primary outcome will be change in HPV vaccine initiation (≥1 doses) among adolescents, ages 11-14, at 12-month follow-up. Aim 2 is to evaluate the impact of HPV ECHO and HPV ECHO+ on implementation outcomes. Guided by implementation science frameworks, we will conduct a mixed-methods evaluation to compare interventions on acceptability, adoption, cost, penetration, and sustainability. Aim 3 is to evaluate the impact of interventions’ vaccine information on secondary acceptance of HPV vaccination at the clinic level. We will also follow a subset of 200 vaccine-declining parents for up to 12 months to assess exposure to and impact of vaccine information from study arms versus naturally-occurring sources (e.g., social media) on secondary acceptance. Our expected outcome is to demonstrate the effectiveness of a highly efficient and scalable implementation strategy, ECHO, to support HPV vaccination in rural clinics. This study is innovative in leveraging existing infrastructure at academic centers to deliver best practices for HPV vaccination where they are needed most and in developing a greater understanding of the influences on decision making among vaccine-declining parents. We expect the project to have a significant impact on HPV vaccine uptake as we address the communication needs of both rural providers and parents.

摘要 尽管人类乳头瘤病毒（HPV）疫苗可以预防超过34，800例HPV相关疾病， 美国每年的癌症发病率，到2018年只有51%的女孩和男孩是最新的。农村人口是 受HPV相关癌症的影响最大。最佳实践，如公告方法培训和系统 传播已被证明在增加HPV疫苗接种方面是有效的，但农村提供者很难获得和 实施这些最佳做法。这些数据引发了一个问题：“学术中心如何支持HPV “农村基层医疗卫生工作？虽然从未进行过HPV疫苗接种测试，但ECHO（扩展 社区卫生保健成果）模式是一个有前途的实施战略（实践促进）， 允许学术中心的“专家”与初级保健提供者联系，讨论护理的最佳实践 和复杂的案件在当地的做法管理。本R 01的目的是测试两个ECHO交付的 农村初级保健诊所的HPV疫苗接种沟通干预。第一个将提供公告 方法培训（HPV ECHO）;第二个将提供这种方法和系统战略，以进行沟通 最初拒绝接种疫苗的父母（HPV ECHO+）该项目的理由是，欧共体人道处是一个 一个强大的、高度可访问的平台，向农村提供者提供最佳做法，并解决特定背景下的问题。 家长的沟通需求。我们的长期目标是提高农村诊所的HPV疫苗接种率， 减少农村人口在癌症结果方面的健康不平等。目标1是评估 HPV ECHO和HPV ECHO+在青少年中的HPV疫苗接种。我们将进行一个三臂集群 在宾夕法尼亚州农村的36个初级保健诊所进行的随机试验。诊所将随机分配至：HPV ECHO， HPV ECHO+或对照。我们的主要结局将是HPV疫苗启动（≥1剂）的变化， 青少年，11-14岁，12个月随访。目的2评价HPV ECHO和HPV 欧共体人道处+关于执行成果的报告。在实施科学框架的指导下，我们将开展一项 混合方法评价，以比较干预措施的可接受性、采用率、成本、渗透率和 持续发展目的3是评估干预措施的疫苗信息对二次接受的影响， HPV疫苗接种在临床层面我们还将跟踪200名拒绝接种疫苗的父母， 评估研究组与自然发生的疫苗信息的暴露和影响的时间 源（例如，社交媒体）二次接受。我们的预期结果是证明 一个高效和可扩展的实施战略，ECHO，以支持HPV疫苗接种的有效性， 乡村诊所这项研究在利用学术中心的现有基础设施方面具有创新性， 在最需要的地方进行HPV疫苗接种，并更好地了解 影响疫苗接种父母的决策。我们预计该项目将有一个重大的 在我们解决农村提供者和父母的沟通需求时，我们将继续关注对HPV疫苗接种的影响。