Increasing Child Immunization Rates via Improved Provider-Parent Communication

描述(申请人提供)：父母对疫苗的接受度有所下降，越来越多的父母要求获得入学免疫法的非医疗豁免。由此导致的儿童免疫不足导致疫苗可预防的疾病持续存在，每年导致300名儿童死亡。儿科保健提供者对父母的免疫决策具有重要影响，并在提高和维持儿童免疫接种率方面发挥重要作用。候选人道格·欧佩尔是医学博士，公共卫生硕士，他的长期目标是通过更好的提供者与家长的沟通来提高儿童疫苗接种率。这一目标与医学研究所旨在维持和提高免疫覆盖率的目标以及美国卫生与公众服务部2020年健康人群建议的目标是一致的，目的是增加报告其医疗保健提供者具有令人满意的沟通技能的人的比例。为了实现这一目标，欧佩尔博士将进行正式课程、定向学习和经验培训，以提高三个具体领域的知识和技能：(1)提供者与父母沟通研究的设计、数据收集和分析；(2)疫苗开发和管理的科学、社会、政治、经济和监管方面；以及(3) 行为改变理论和设计干预措施的方法，以改善父母与提供者之间的沟通。欧佩尔博士已经确定了一名在免疫研究方面具有专业知识的主要导师(詹姆斯·泰勒博士)和三名在提供者-患者沟通、医疗服务和生物伦理学研究方面具有经验和熟练程度的联合导师(托马斯·加拉格尔博士、丽塔·曼乔内-史密斯博士和黛安·马丁博士)。他们都在西雅图的华盛顿大学工作。欧佩尔博士将每周与泰勒博士会面，以确保充分的联系，并每月与我所有的四位导师一起，这样他们就可以评估和支持我的进步。8名顾问将提供额外的指导，这些顾问具有与拟议研究计划相关的方法论或专题专业知识，包括儿科传染病、生物统计学、生物伦理学、行为科学，以及使用对话分析的定性技术来研究提供者与家长的沟通。欧佩尔博士在这一应用程序中提出了三个创新和连续的项目，以他的培训目标为基础。每个项目都将有助于更好地了解特定的和可修改的提供者免疫沟通行为，这些行为既有效地提高了父母对儿童免疫接种的接受度，也可以作为未来提供者基于沟通的干预措施的一部分。这项建议的具体目标是：(1)描述在与对疫苗犹豫不决的父母进行儿科卫生监督访问期间关键提供者免疫沟通行为的特征；(2)开发和评估家长自我报告工具在识别提供者免疫沟通行为方面的有效性；以及(3)对不愿接种疫苗的父母进行纵向前瞻性队列研究，以确定确定的提供者沟通行为是否预测随着时间的推移父母对免疫接种的接受。这一建议是新颖的，因为它涉及将录像带方法应用于健康传播研究的一个新领域，探索提供者随着时间的推移而不仅仅是在一次接触期间的传播行为，以及使用与临床相关的结果--儿童的免疫状况--来确定什么构成有效的传播。西雅图儿童研究所和华盛顿大学提供的良好研究环境，以及欧宝博士与两个将进行招募和数据收集的地点-团体健康合作社和以实践为基础的研究网络-普吉特湾儿科研究网络-建立的牢固的现有关系，将加强他的培训，促进他的项目目标。 欧佩尔博士是一名普通儿科医生，接受过医疗服务、研究和生物伦理学方面的培训。在过去的两年里，他发表了7篇关于儿童免疫、沟通和生物伦理学的论文，并获得了几笔拨款和合同，开始开发一个研究计划，旨在通过改善提供者与父母的沟通来降低父母儿童免疫拒绝率。这一奖项将使欧佩尔博士能够几乎完全专注于与改善提供者与父母之间的沟通有关的培训和研究，并将至少75%的全职专业努力投入到他的职业发展计划和活动中。此外，它还将为他寻求资金作为R01奖的一部分做好准备，以进行一项基于沟通的干预的随机对照试验，以增加提供者对疫苗犹豫不决的父母的有效沟通行为的使用。

DESCRIPTION (provided by applicant): Parental acceptance of vaccines has eroded and more parents are claiming nonmedical exemptions from school-entry immunization laws. The resultant under-immunization of children has contributed to the persistence of vaccine-preventable diseases that kill 300 children annually. Pediatric health care providers have a critical influence on parental immunization decision-making and play an important role in improving and sustaining childhood immunization rates. The long-term objective of the candidate, Doug Opel, MD, MPH, is to improve childhood vaccination rates through better provider-parent communication. This goal is consistent with the Institute of Medicine objective to sustain and improve immunization coverage rates as well as the US Department of Health and Human Services Healthy People 2020 proposed objective to increase the proportion of persons who report that their health care provider has satisfactory communication skills. To achieve this objective, Dr. Opel will pursue formal coursework, directed learning, and experiential training to improve knowledge and skills in three specific areas: (1) the design, data collection, and analysis of research on provider-parent communication; (2) the scientific, social, political, economic and regulatory aspects of vaccine development and administration; and (3) behavior change theory and approaches to the design of an intervention to improve provider-parent communication. Dr. Opel has identified a primary mentor with expertise in immunization research (Dr. James Taylor) and 3 co-mentors with experience and proficiency in research in provider-patient communication, health services, and bioethics (Drs. Thomas Gallagher, Rita Mangione-Smith, and Diane Martin). All are based in Seattle at the University of Washington. Dr. Opel will meet with Dr. Taylor weekly to ensure adequate contact and with all 4 of my mentors together monthly so they can assess and support my progress. Additional mentoring will be provided by 8 consultants with methodological or topical expertise relevant to the proposed research plan, including pediatric infectious disease, biostatistics, bioethics, behavioral science, and the use of the qualitative technique of conversation analysis to study provider-parent communication. Dr. Opel proposes three innovative and sequential projects in this application that build upon his training goals. Each project will contribute to an improved understanding of specific and modifiable provider immunization communication behaviors that are both effective in increasing parental acceptance of childhood immunizations and can be targeted as part of a future communication-based intervention for providers. The specific aims of this proposal are to: (1) characterize key provider immunization communication behaviors during pediatric health supervision visits with vaccine-hesitant parents; (2) develop and evaluate the validity of a parent self-report instrument in identifying provider immunization communication behaviors; and (3) conduct a longitudinal prospective cohort study of vaccine-hesitant parents to determine whether identified provider communication behaviors predict parental immunization acceptance over time. This proposal is novel because it involves the application of videotape methodology to a new area of health communication research, the exploration of provider communication behaviors over time and not just during a single encounter, and the use of a clinically relevant outcome-a child's immunization status-to determine what constitutes effective communication. The excellent research environments provided by Seattle Children's Research Institute and the University of Washington, as well as Dr. Opel's strong, existing relationships with 2 sites at which recruitment and data collection will occur-Group Health Cooperative and the practice-based research network, Puget Sound Pediatric Research Network-will enhance his training and facilitate his project goals. Dr. Opel is a general pediatrician with training in health services research and bioethics. He has published 7 papers in the last 2 years on the topics of childhood immunization, communication, and bioethics and has secured several grants and contracts to begin the development of a research program aimed at decreasing parental childhood immunization refusal rates by improving provider-parent communication. This award would allow Dr. Opel to focus almost exclusively on his training and research related to improving provider-parent communication and to commit at least 75% of full-time professional effort to his career development program and activities. In addition, it would prepare him to pursue funding as part of an R01 award to conduct a randomized controlled trial of a communication-based intervention for providers to increase their use of effective communication behaviors with vaccine-hesitant parents.