Use of a Novel Parent-Report Measure to Improve Childhood Vaccine Uptake

 说明(由申请者提供)：国家对19-35个月大儿童接种最新推荐疫苗的百分比的估计仍低于2020年健康人口目标。免疫不足的一个重要原因是父母由于对疫苗的严重担忧而拒绝或推迟儿童疫苗接种。有证据表明，儿科提供者对父母的疫苗决策有重要影响，他们与父母的疫苗讨论可以提高疫苗接受度。然而，改善疫苗讨论的几个家长和提供者层面的障碍仍然存在，例如在卫生监督访问期间没有足够的时间来讨论父母对疫苗的关注，父母很难披露疫苗关注的问题，以及提供者在确定哪些父母有疫苗担忧时不准确。因此，父母对疫苗的关注往往被忽视，错过了提高疫苗接种率的机会。该项目的主要目标是评估旨在解决这些障碍的创新干预措施的有效性-筛选犹豫不决以优化谈话(SHOT)干预-在改善提供者与父母之间的疫苗讨论和提高疫苗接受度方面。Shot干预包括向父母实施有效的父母报告测量，即父母对儿童疫苗的态度(PACV)调查，并在孩子2个月和6个月的健康监督访问之前将他们的分数和具体项目的反应传达给孩子的提供者。PACV包含15个关于健康信念模型概念的问题，这些概念影响父母的疫苗接种行为，并已被证明可预测免疫不足。我们假设，在接种疫苗的卫生监督访问之前，使用PACV征求父母对疫苗的担忧和犹豫状态将提高提供者充分解决父母对疫苗的担忧的能力，并提高父母对疫苗的接受度。我们的具体目标将是(1)使用配对、整群随机对照试验设计来评估疫苗干预对儿童免疫状况的影响，在该设计中，我们将位于华盛顿州西雅图的团体卫生保健提供系统内的16家初级保健诊所分配到控制臂或疫苗臂，并招募160名对疫苗犹豫不决的父母，他们的新生儿在研究诊所接受健康监督；(2)评估父母对他们与孩子的提供者讨论的疫苗的评级如何作为疫苗干预的功能而改变；以及(3)比较研究前和研究后对与父母讨论高质量疫苗的障碍的看法，在接种和控制手臂的提供者之间。这一R21应用程序解决了一个重大的公共卫生问题--父母疫苗迟疑和拒绝接种--目前几乎没有精心设计和严格评估的干预措施。它将为在初级保健环境中应用PACV的可行性和有效性提供证据，并将为未来由R01资助的多地点随机对照试验的设计和评估提供信息。

 DESCRIPTION (provided by applicant): National estimates for the percentage of 19 - 35 month old children who are up-to-date on recommended vaccines remain below the Healthy People 2020 goal. An important contributor to under-immunization is parental refusal or delay of childhood vaccines due to significant vaccine concerns. Evidence suggests pediatric providers are an important influence on parental vaccine decision-making and that their vaccine discussions with parents can increase vaccine acceptance. However, several parent- and provider-level barriers to improving the vaccine discussion exist, such as insufficient time to discuss parental vaccine concerns during health supervision visits, parental difficulty in disclosing vaccine concerns, and provider inaccuracy in identifying which parents have vaccine concerns. Consequently, parental vaccine concerns are often neglected and opportunities to improve vaccine uptake are missed. The primary goals of this project are to evaluate the effectiveness of an innovative intervention designed to address these barriers-the Screening for Hesitancy to Optimize Talk (SHOT) intervention-in improving provider-parent vaccine discussions and increasing vaccine acceptance. The SHOT intervention involves administering a validated parent-report measure, the Parent Attitudes about Childhood Vaccines (PACV) survey, to parents and communicating their score and item-specific responses to their child's provider before their child's 2 and 6 month health supervision visits. The PACV contains 15 questions regarding Health Belief Model concepts that influence parent vaccination behavior and has been shown to predict under-immunization. We hypothesize that using the PACV to solicit parental vaccine concerns and hesitancy status prior to health supervision visits in which vaccines are administered will improve providers' ability to adequately address parental vaccine concerns and increase parental vaccine acceptance. Our specific aims will be to (1) evaluate the impact of the SHOT intervention on a child's immunization status using a matched-pair, cluster randomized controlled trial design in which we assign 16 primary care clinics within the Group Health healthcare delivery system based in Seattle, WA to a control arm or the SHOT arm and enroll 160 vaccine-hesitant parents whose newborns receive health supervision at study clinics; (2) assess how parents' ratings of their vaccine discussions with their child's provider change as a function of the SHOT intervention; and (3) compare pre- and post-study perceptions of barriers to quality vaccine discussions with parents between providers in the SHOT and control arm. This R21 application addresses a significant public health problem-parental vaccine hesitancy and refusal-for which there are currently few well-designed and rigorously evaluated interventions. It will provide evidence for the feasibility and efficacy of administering the PACV in a primary care setting and will inform the design and evaluation of a future R01-funded multi-site randomized controlled trial.