ReMARk: A multi-level strategy to address disparities in rural HPV-related cancer prevention

ReMARk：解决农村 HPV 相关癌症预防差异的多层次战略

• 批准号: 10708885
• 负责人: Stephanie A S Staras
• 金额: $ 80.81万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-22 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10708885
• 关键词: 12 year old; 15 year old; Academy; Address; Affect; Age; Agriculture; American; American Cancer Society; Area Health Education Centers; Behavior; Cancer Center; Child; Clinic; Clinic Visits; Clinical; Clinical Research; Clinical Sciences; Cluster randomized trial; Code; Communities; County; Disparate; Disparity; Dose; Effectiveness; Ethnic Origin; Florida; Food; Health; Healthcare; Home; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papilloma Virus-Related Malignant Neoplasm; Incidence; Insurance; Intervention; Licensing; Malignant Neoplasms; Measures; Misinformation; Mission; Modeling; Motivation; Parents; Patients; Pediatrics; Physicians; Prevention; Public Health; Race; Randomized; Recommendation; Research; Resources; Rural; Rural Community; Rural Health; Rural Population; Schedule; Science; Series; Telephone; Training; Translational Research; Transportation; United States; United States National Institutes of Health; Universities; Vaccination; arm; biological sex; boys; cancer health disparity; cancer prevention; community center; community engagement; cost effective; cost effectiveness; cost-effectiveness evaluation; demographics; effectiveness evaluation; evidence base; experience; girls; health care availability; implementation strategy; improved; innovation; motivational enhancement therapy; prevent; primary outcome; programs; rural area; rural health network; rural setting; social determinants; social vulnerability; success; transportation access; urban area

The low rates of human papillomavirus (HPV) vaccination within rural areas of the United States present a substantial and disparate missed opportunity to prevent cancer. Florida is a particular concern with the second highest number of HPV-related cancers, yet a rank among the 50 states of 44th in HPV vaccine initiation (≥ 1 dose) and 41st for up to date (i.e., 2 doses when starting the series before age 15 years; 3 doses when starting at 15 years or older). Even greater disparity is present within the 11 rural North Central Florida counties that are the focus of this proposal. Due to the myriad of factors preventing boys and girls living in rural areas from receiving the HPV vaccine, a multilevel approach is needed to increase HPV vaccination. Guided by the Integrated Behavior Model, the overall objective of this proposal is to address the multilevel barriers to HPV vaccination among 9- to 12-year-olds living in rural areas by using a three-arm cluster randomized trial to assess the added clinical- and associated cost-effectiveness on HPV vaccination of each additional nested evidence-based implementation strategy: (1) clinician-targeted recommendation training, (2) parent-targeted motivational aids via facilitation of clinic staff sending reminder/recall messages and conducting phone-based motivational interviewing, when needed, to encourage follow through, (3) community-targeted healthcare access to transportation assistance, mobile vaccination clinics, and navigation to healthcare insurance. Eight community-focused organizations with experience in rural settings will support implementation: University of Florida (UF) Institute of Food and Agricultural Sciences Extension, UF Clinical and Translational Science Institute Community Engagement Program, UF Cancer Center Community Advisory Board, UF OneFlorida Clinical Research Consortium, Suwannee River Area Health Education Center, CommunityHealth IT, a federally designated Rural Health Network, and the Florida Department of Health. The specific aims are: (1) Estimate the added clinical- and associated cost-effectiveness of parent-targeted motivational aids (reminder/recall and phone-based MI) alone and when combined with community-targeted healthcare access assistance beyond the effects of clinician-targeted training; (2) Estimate the differential effectiveness of the implementation strategies by patient-level factors (age, race/ethnicity, biologic sex, distance from home to clinic, social vulnerability); and (3) Measure moderation of implementation strategy effectiveness by clinic-level factors. The proposed research is significant for its potential to prevent cancer by increasing HPV vaccination rates among 9- to 12-year-olds living in rural areas. The project is innovative by: (1) Evaluating effectiveness and cost-effectiveness of layered evidence-based strategies; and (2) Addressing social determinants preventing vaccination in addition to clinician recommendation effectiveness and parent motivation. The proposed approach of layering nested evidence-based implementation strategies to prevent HPV-related cancers can be expanded to prevention of other cancers disproportionately affecting rural areas.

美国农村地区人乳头瘤病毒（HPV）疫苗接种率低， 大量和不同的机会，以防止癌症。佛罗里达是一个特别关注的第二个 HPV相关癌症数量最多，但在HPV疫苗启动的50个州中排名第44位 （≥ 1剂）和41日（即，在15岁之前开始该系列时，2剂; 从15岁或以上开始）。在佛罗里达中北部的11个农村地区， 这些县是本提案的重点。由于各种因素阻碍生活在农村的男孩和女孩 因此，为了避免接种HPV疫苗，需要采取多层次的方法来增加HPV疫苗接种。指导 根据综合行为模型，本提案的总体目标是解决多层次的障碍， 农村地区9- 12岁儿童HPV疫苗接种的三组随机试验， 评估每增加一个巢式HPV疫苗接种的临床和相关成本效益 循证实施策略：（1）以临床医生为目标的推荐培训，（2）以家长为目标的 通过促进诊所工作人员发送提醒/召回信息和进行基于电话的 在需要时进行动机性访谈，以鼓励坚持到底，（3）针对社区的医疗保健 获得交通援助、移动的疫苗接种诊所和医疗保险导航。八 具有农村经验的社区组织将支持执行工作： 佛罗里达（UF）食品和农业科学推广研究所，UF临床和转化科学 研究所社区参与计划，UF癌症中心社区咨询委员会，UF OneFlorida 临床研究联盟，萨旺尼河地区健康教育中心，社区健康IT，a 联邦指定的农村卫生网络和佛罗里达卫生部。具体目标是：（1） 估计针对父母的激励性辅助工具的附加临床和相关成本效益 （提醒/召回和基于电话的MI）单独使用以及与针对社区的医疗服务结合使用时 （2）在临床医生目标培训的影响之外提供援助;（3）评估 患者层面因素（年龄、种族/民族、生物性别、离家距离）的实施策略 临床、社会脆弱性）;（3）按临床水平衡量实施战略有效性的适度性 因素这项拟议的研究对于通过增加HPV疫苗接种来预防癌症的潜力具有重要意义 生活在农村地区的9至12岁儿童的发病率。该项目的创新之处在于：（1）评估效果 分层循证战略的成本效益;（2）解决社会决定因素 预防接种除了临床医生建议的有效性和父母的动机。的 分层嵌套循证实施策略的拟议方法，以预防HPV相关 癌症可扩大到预防影响农村地区的其他癌症。