Implementation of evidence-based strategies to optimize HPV vaccination in rural primary care settings
实施循证策略以优化农村初级保健机构的 HPV 疫苗接种
基本信息
- 批准号:10340429
- 负责人:
- 金额:$ 64.79万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2022
- 资助国家:美国
- 起止时间:2022-08-21 至 2027-04-30
- 项目状态:未结题
- 来源:
- 关键词:12 year oldAddressAdolescentAdolescent BehaviorAdoptedAdoptionAffectAgeCOVID-19 pandemicCharacteristicsChildChildhoodClinicalClinical TrialsCluster randomized trialCommunitiesCommunity NetworksCustomDiseaseEducational InterventionEnvironmentEvaluationFamilyFemale AdolescentsGenderGoalsGroup PracticeHealth systemHuman Papilloma Virus VaccinationHuman Papilloma Virus VaccineHuman Papilloma Virus-Related Malignant NeoplasmHuman PapillomavirusImmunizationIncidenceInsuranceInterdisciplinary StudyInterventionKnowledgeLeadLongitudinal StudiesMale AdolescentsMeasuresMedicalMethodsMonitorNeisseria meningitidisNew YorkNew York CityOutcomePatientsPerformancePersonsPertussis VaccinePhasePositioning AttributePractical Robust Implementation and Sustainability ModelPrevention educationPrimary Health CareProcessProviderRecommendationRecording of previous eventsResearchResearch DesignRuralRural CommunityRural PopulationSample SizeSiteSolo PracticesSystemTestingUnderrepresented PopulationsUnited StatesUnited States National Institutes of HealthVaccinationVisitbasecancer preventionclinical practicecommunity based practicecommunity engaged researcheffectiveness testingevidence baseexperiencegeographic disparityhealth care deliveryhealth care settingsimplementation frameworkimplementation scienceimprovedinnovationintervention effectintervention programnovelpatient populationprimary care settingprogramsrecruitrural arearural countiesrural healthcarerural settingrural underservedsocioeconomicstrial designunderserved communityurban areavaccination strategyvaccine acceptancevaccine deliveryvaccine hesitancy
项目摘要
ABSTRACT
Some of the largest disparities in human papillomavirus vaccination (HPVV) rates exist in rural communities,
which represent missed opportunities for cancer prevention since incidence of HPV associated cancers have
been increasing disproportionately in rural compared to urban areas in the U.S. While there are effective
evidence-based strategies to improve adolescent HPVV rates in clinical practices, current gaps include a lack of
interventions targeting community-based practices and rural populations. Targeted interventions are desperately
needed to expand reach to rural community-based primary care practices to increase HPVV rates and meet the
needs of underserved rural communities where HPVV rates have remained low. To address this gap, we
developed an implementation science focused intervention for rural primary care practices (PC TEACH) that
considers community, culture, and health systems as upstream factors to increase adolescent HPVV rates by
engaging the entire medical team using a practice facilitation approach. In the current proposal, we will test the
effectiveness of our innovative practice-level intervention approach (PC TEACH) to: (i) increase HPV vaccine
uptake and completion rates in adolescent boys and girls, and (ii) lower the average age at vaccination in
community-based primary care practices. We hypothesize that HPVV initiation and completion rates will be
superior after practice facilitation of evidence-based PC TEACH vaccination strategies compared to rates prior
to intervention. We will use a stepped-wedge cluster randomized trial design, which conserves sample size while
maintaining power, with an integrated implementation framework, and process and outcome evaluation, to
address the following aims: Aim 1 - Implement and test the effectiveness of practice facilitation of PC TEACH,
using an implementation science approach, on HPVV initiation and completion in rural community-based primary
care practices. Aim 2 - Measure and monitor practice-level characteristics (e.g., size, scope, socioeconomic
environment, and vaccination experiences during the COVID-19 pandemic), and patient-level characteristics
(e.g., gender, age, insurance type, HPV knowledge, child vaccination history, and vaccine hesitancy), to identify
factors that influence HPV vaccine delivery and uptake rates, and may moderate intervention effects. Aim 3 -
Evaluate the extent to which practice facilitation activities most readily lead to adoption and implementation of
the evidence-based PC TEACH vaccination strategies as delivered by the primary care practice site staff. The
proposed study is innovative in that our use of community-engaged methods enhance scalability of the
implementation science intervention in underserved rural primary care settings to enable system changes to
improve HPVV rates. Findings from this study will be essential in understanding how to implement systematic
practice-level changes in rural community-based primary care practices, and how to cultivate a practice culture
supportive of HPVV in rural communities, a population underrepresented despite the observed incongruence of
increasing incidence of HPV-associated disease and low HPVV rates in rural areas in the U.S.
摘要
人乳头瘤病毒疫苗接种率的一些最大差异存在于农村社区,
这代表了错过了预防癌症的机会,因为HPV相关癌症的发病率
与美国城市地区相比,农村地区的人口增长不成比例。
在临床实践中提高青少年HPV感染率的循证策略,目前的差距包括缺乏
针对社区做法和农村人口的干预措施。有针对性的干预措施
需要扩大农村社区初级保健实践的覆盖面,以提高HPVV率,
在HPVV感染率仍然较低的农村社区,为了弥补这一差距,我们
为农村初级保健实践制定了一项以实施科学为重点的干预措施(PC TEACH),
认为社区、文化和卫生系统是增加青少年HPV感染率的上游因素,
使用实践促进方法使整个医疗团队参与进来。在目前的提案中,我们将测试
我们的创新实践水平干预方法(PC TEACH)的有效性:(i)增加HPV疫苗
青少年男女的接种率和完成率,以及(ii)降低
以社区为基础的初级保健做法。我们假设HPVV启动率和完成率将是
与之前的比率相比,实践促进循证PC TEACH疫苗接种策略的上级
干预。我们将使用阶梯楔形分组随机试验设计,该设计保留了样本量,
通过综合执行框架以及过程和成果评价,
实现以下目标:目标1 -实施和测试PC TEACH实践促进的有效性,
使用实施科学方法,在农村社区小学开展和完成HPV疫苗接种
护理实践。目标2 -测量和监控实践层面的特征(例如,规模、范围、社会经济
环境和COVID-19大流行期间的疫苗接种经验)和患者水平特征
(e.g.,性别、年龄、保险类型、HPV知识、儿童疫苗接种史和疫苗犹豫),以确定
影响HPV疫苗输送和摄取率的因素,并可能减轻干预效果。目标3 -
评价实践促进活动在多大程度上最容易导致采用和实施
由初级保健实践现场工作人员提供的循证PC TEACH疫苗接种策略。的
拟议的研究是创新的,因为我们使用社区参与的方法提高了
在服务不足的农村初级保健环境中实施科学干预,
提高HPV感染率。这项研究的结果将是必不可少的了解如何实施系统的
农村社区基层医疗实践层面的变化,以及如何培养实践文化
支持HPVV在农村社区,人口代表性不足,尽管观察到的不一致,
美国农村地区HPV相关疾病发病率增加和HPV病毒感染率低
项目成果
期刊论文数量(0)
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Elisa Marie Rodriguez其他文献
Elisa Marie Rodriguez的其他文献
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{{ truncateString('Elisa Marie Rodriguez', 18)}}的其他基金
Implementation of evidence-based strategies to optimize HPV vaccination in rural primary care settings
实施循证策略以优化农村初级保健机构的 HPV 疫苗接种
- 批准号:
10687922 - 财政年份:2022
- 资助金额:
$ 64.79万 - 项目类别:
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