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: 10457314
• 负责人: Sean T O'Leary
• 金额: $ 58.2万
• 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 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10457314
• 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; unvaccinated; uptake; vaccine acceptance; vaccine hesitancy; vaccine refusal

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 该提案解决了一个重大的公共卫生问题 - 父母的疫苗犹豫和拒绝 - 目前很少有精心设计和严格评估的干预措施。国家估计 最新的建议疫苗的最新儿童的19至35个月大的儿童的百分比保持在健康之下 人民2020目标。免疫不足的关键因素是父母垃圾或疫苗延迟 疫苗的问题。疫苗藏匿处的父母（VHP），一个拒绝和/或延迟的大型父母群体 至少一种推荐给孩子的疫苗，是针对干预措施的重要人群 改善疫苗的接受度。虽然VHPS最值得信赖的信息来源是孩子的提供者，但 提供者对与VHP沟通不信心，并且经常认为他们的讨论对 改变父母的主意。因此，改进的提供商与VHP的沟通对 改善儿童疫苗的摄取并防止疫苗可预防的疾病爆发。 但是，缺乏针对提供者的特定交流策略的实验证据。 初步工作，Opel等。发现提供者使用推定（例如，“好吧，我们必须做一些照片。”） 而不是参与（例如，“您今天对疫苗的感觉如何？”）沟通格式发起 疫苗建议与父母疫苗的接受度增加有关。这个假定 不过，格式可能会导致父母满意度下降，这引起了人们对假定启动的担忧 随着时间的流逝，疫苗摄取减少。在单独的工作中，O’Leary等人。探索激励性的使用 采访（MI）以增加推荐青少年推荐的HPV疫苗的摄取。励志面试 是以患者为中心的行为改变框架，其中包含与已知的元素一致的元素 VHP关于疫苗的沟通偏好。 O’Leary等。发现提供商在 与抵制HPV疫苗建议的父母的讨论导致父母疫苗增加 接受和改善了提供者对影响父母疫苗决策能力的看法。 在此提案中，O'Leary和Opel旨在结合这两种技术 - 大概是 发起疫苗并通过动机访谈优化谈话（MI枢轴） 干预措施 - 增加疫苗的吸收，高母亲访问满意度并提高 提供者对疫苗对话的信心。我们的具体目的是（1）开发一个多方面的， 通过MI干预提供商培训计划可行，并且在文化上适合枢纽； （2）评估 通过MI干预的枢轴对19个月大的儿童免疫状况的影响通过随机化24 在两个州（华盛顿和科罗拉多州）的初级保健实践，用于使用集群控制或干预武器 随机设计； （3）通过MI干预评估枢轴对父母和提供者的影响 经验。

项目成果

"It's Like 1998 Again": Why Parents Still Refuse and Delay Vaccines.

• DOI: 10.1177/2333794x211042331
• 发表时间: 2021
• 期刊: Global pediatric health
• 影响因子: 2.2
• 作者: Ugale JL;Spielvogle H;Spina C;Perreira C;Katz B;Pahud B;Dempsey AF;Robinson JD;Garrett K;O'Leary ST;Opel DJ
• 通讯作者: Opel DJ

Development of PIVOT with MI: A motivational Interviewing-Based vaccine communication training for pediatric clinicians.

PIVOT with MI 的开发：针对儿科临床医生的基于动机访谈的疫苗沟通培训。

• DOI: 10.1016/j.vaccine.2023.02.010
• 发表时间: 2023
• 期刊: Vaccine
• 影响因子: 5.5
• 作者: O'Leary,SeanT;Spina,ChristineI;Spielvogle,Heather;Robinson,JeffreyD;Garrett,Kathleen;Perreira,Cathryn;Pahud,Barbara;Dempsey,AmandaF;Opel,DouglasJ
• 通讯作者: Opel,DouglasJ

Parent Attitudes Towards Childhood Vaccines After the Onset of SARS-CoV-2 in the United States.

• DOI: 10.1016/j.acap.2022.06.014
• 发表时间: 2022-11
• 期刊: ACADEMIC PEDIATRICS
• 影响因子: 3.1
• 作者: Opel, Douglas J.;Furniss, Anna;Zhou, Chuan;Rice, John D.;Spielvogle, Heather;Spina, Christine;Perreira, Cathryn;Giang, Jessica;Dundas, Nicolas;Dempsey, Amanda;Pahud, Barbara;Robinson, Jeffrey;O'Leary, Sean
• 通讯作者: O'Leary, Sean