Physicians' Intentions to Administer HPV Vaccine

描述（由申请人提供）：宫颈癌，生殖器疣和其他与人乳头瘤病毒（HPV）相关的健康状况确切的大量发病率，死亡率和费用。2006年，美国食品和药物管理局（FDA）批准了一种适用于9-26岁女性的四价HPV疫苗，免疫实践咨询委员会（ACIP）建议对11-12岁的女孩进行常规疫苗接种。然而，迄今疫苗接种率不高，表明在扩大接种范围和遵守推荐的疫苗接种计划方面存在问题，并可能预示着在实现疫苗的公共卫生承诺方面存在困难。与疫苗实施有关的面向提供者的问题和挑战可能被低估了，并且仍然没有得到充分的研究，特别是关于初级保健医生（pcp），他们非常适合向大多数年轻女性提供疫苗。本研究的总体目标是确定与临床医生按照建议接种HPV疫苗的意向有差异的适当因素组合。我们的中心假设是临床医生的态度、主观规范和对问题的认知障碍会显著影响他们接种疫苗的意图，并最终影响他们的行为，正如计划行为理论（TPB）所预测的那样。我们提出了四个具体目标：1)开发一个理论知情的调查问卷，用于评估基于tpb和其他措施的pcp接种HPV疫苗的意图；2)在阿拉巴马州和密西西比州的pcp中实施调查问卷；3)研究不同情况下HPV疫苗接种意向的PCP特征和基于tpb的措施；4)根据tbp因子与意向性之间的功能关系模式，确定可区分的pcp群体。通过名义上的小组技术会议和其他步骤，调查工具将在pcp、家庭执业住院医生和教师中开发、预先测试和试点。我们将从pcp收集至少300份完整的调查回复，以检验我们的假设以及不同患者情况下相关变量和意向性之间的关系。意向性将通过一系列行为锚定的案例插曲来操作。pcp对ACIP建议的认识和态度也将被评估。该研究将在HPV相关疾病负担高、急性PCP短缺和HPV免疫接种率低的两个州进行。拟议的研究将产生重要的信息，以提高对理论预测因素的理解和在实际实践中基于提供者的HPV疫苗接种障碍。这也应该为制定基于提供者的战略提供有用的方向，以增加在未来研究中可以研究的疫苗接种的可能性。

DESCRIPTION (provided by applicant): Cervical cancer, genital warts, and other health conditions associated with human papillomavirus (HPV) exact substantial morbidity, mortality, and expenses. In 2006, the Food and Drug Administration (FDA) approved a quadrivalent HPV vaccine for females ages 9-26, and the Advisory Committee on Immunization Practices (ACIP) recommended routine vaccination for girls ages 11-12. Modest vaccination rates to date, however, indicate problems with increasing coverage and adherence to the recommended vaccine schedule, and may presage difficulties in realizing the vaccine's public health promise. Provider-oriented issues and challenges related to vaccine implementation may have been underestimated and remain insufficiently studied, especially with regard to primary care physicians (PCPs), who are well suited to provide vaccine to most young females. The broad objective of this study is to identify the appropriate constellation of factors that differentially relate to clinicians' stated intentions to administer HPV vaccine as recommended. Our central hypothesis is that clinicians' attitudes, subjective norms, and perceptions of issues as barriers significantly influence their intentions to administer the vaccine and, ultimately, their behavior, as predicted by the theory of planned behavior (TPB). We propose four specific aims: 1) to develop a theoretically-informed survey questionnaire for the assessment of TPB-based and other measures of PCPs' intentions to administer the HPV vaccine; 2) to implement the survey questionnaire among PCPs in Alabama and Mississippi; 3) to examine PCP characteristics and TPB-based measures regarding intention to administer HPV vaccine under different conditions; and 4) to identify groups of PCPs who can be differentiated with respect to the patterns of functional relations between the TPB-factors and intentionality. Using nominal group technique meetings and other steps, the survey instrument will be developed, pre-tested and piloted with PCPs and family practice residents and faculty. At least 300 complete survey responses will be collected from PCPs to allow examination of our hypotheses and relationships between relevant variables and intentionality under different patient conditions. Intentionality will be operationalized through a series of behaviorally anchored case vignettes. PCPs' awareness and attitudes regarding ACIP recommendations will also be evaluated. The study will be administered in two states with high HPV-associated disease burdens, acute PCP shortages, and low HPV immunization rates. The proposed research will yield important information to improve understanding of theoretical predictors and provider-based barriers to HPV vaccination in actual practice. This should also suggest useful direction for developing provider-based strategies to increase the likelihood of vaccine administration that could be studied in future research. PUBLIC HEALTH RELEVANCE: HPV vaccination offers an effective prevention strategy for reducing the substantial morbidity and healthcare costs caused by persistent HPV infection, so long as problems besetting current modest vaccination rates are better understood and overcome. The proposed study will examine factors that differentially relate to clinicians' stated intentions to administer HPV vaccine, using new measures of intentionality and clinicians' evaluative perceptions of professional recommendations. Our work will help inform future research and the design of strategies to improve the likelihood that physicians would adopt recommendations for administering HPV vaccine.