Investigating facilitator-driven, multi-level implementation strategies in Federally Qualified Health Centers to improve provider recommendation and HPV vaccination rates among Latino/a adolescents

项目总结/摘要 在美国，每年约有46，143例人乳头瘤病毒（HPV）相关癌症新发病例 在发病率和死亡率方面存在着巨大的种族、民族、社会经济、地理和性别差异， 这些癌症的死亡率。尽管有高效的HPV疫苗可以减少HPV- 与癌症相关的死亡率，德克萨斯州的HPV疫苗接种率在全国排名第48位。虽然证据显示 拉丁裔父母比非西班牙裔父母更能接受HPV疫苗接种， 率强调了理解拉丁美洲父母HPV疫苗犹豫的重要性。拉丁裔/通常 在联邦合格的卫生中心（FATHCs）接受医疗保健，这些中心通常需要支持， 改善获得循证预防服务的机会。然而，目前的文献 实施来自大型综合医疗保健系统，围绕什么问题的研究有限。 他在西太平洋医疗中心治疗拉丁美洲病人。以公平为重点的执行情况研究， 资源有限的环境，如卫生和公共卫生委员会，对于州和国家HPV的进展至关重要 疫苗接种目标。从我们以前的工作的初步数据表明，实践促进是一种可行的方法 在选择和实施提供者和实践层面的战略方面， 提高疫苗接种率。使用逐步楔形分组随机试验，我们将随机选择三名 （n=9个实践，每个社区卫生服务中心3个）接受促进者驱动的提供者-（即，教育、临床实践计划）和 实践水平（即，技术援助加评估和反馈、培训和教育， 免疫导航员）实施战略。根据我们的概念框架和i-PARIHS， 将测量有效性（即，在青少年患者中开始和完成HPV疫苗接种）， 执行成果（即，提供HPV疫苗建议和信心的供应商数量 父母为孩子接种疫苗）。我们将在每次临床实践中进行基线评估， 这将提供全面的数据，以帮助实践促进者与提供者接触， 领导层采用参与性方法，制定实施计划，并为每项活动制定战略。 沿着定量评估，我们将采用理论指导的定性调查方法，以评估 与背景相关的复杂性（包括父母对HPV疫苗的犹豫和提供者对HPV疫苗的信心） 解决这一问题）和实际参与战略执行的受援国，沿着 持续发展这项研究将促进我们对实施研究的理解 在资源有限的做法，与人口经历了巨大的差距。Findings from the 目前的研究将为国家执行工作提供信息，并有助于今后的研究确定目标 传播和扩大，重点关注卫生公平的实施研究的关键焦点。

Project Summary/Abstract Approximately 46,143 new cases of human papillomavirus (HPV) associated cancers occur annually in the U.S and there are substantial racial, ethnic, socioeconomic, geographic and gender disparities in the incidence and mortality of these cancers. Despite the availability of highly effective HPV vaccines that can reduce HPV- associated cancer mortality, HPV vaccination rates in Texas rank 48th nationwide. Although evidence shows Latino parents are more accepting of HPV vaccination than non-Hispanic parents, this disparity in vaccination rates underscores the importance of understanding Latino parental HPV vaccine hesitancy. Latinos/as typically receive healthcare at Federally Qualified Health Centers (FQHCs), which often need support implementing and improving access to evidence based preventive services. However, the current literature around implementation comes from large integrated healthcare systems and there is limited research around what works in the FQHC settings with Latino/a patients. Implementation studies, with an equity focus, in these resource-limited settings like FQHCs, are essential to make progress towards state and national HPV vaccination targets. Preliminary data from our previous work suggest practice facilitation is a feasible approach for building the capacity in FQHCs to select and implement provider- and practice-level strategies for increasing vaccination rates. Using a stepped-wedge cluster randomized trial, we will randomize three FQHCs (n=9 practices, 3 per FQHC) to receive facilitator-driven provider- (i.e., education, clinical practice plan) and practice-level (i.e., technical assistance plus assessment and feedback, training, and education of immunization navigators) implementation strategies. Informed by our conceptual framework and i-PARIHS, we will measure effectiveness (i.e., HPV vaccination initiation and completion among adolescent patients) and implementation outcomes (i.e., number of providers giving HPV vaccine recommendations and confidence among parents in vaccinating their children). We will conduct a baseline assessment at each clinical practice, which will provide comprehensive data to assist the practice facilitator in engaging with the providers and leadership using a participatory approach to develop an implementation plan with strategies for each practice. Along with quantitative evaluations, we will employ theory-guided, qualitative methods of inquiry, to assess the complexity associated with context (including parental HPV vaccine hesitancy and provider confidence in addressing it) and the recipients involved in the implementation of strategies in practices, along with sustainability. The study will advance our understanding of what it means to conduct implementation research in resource limited practices that work with populations experiencing substantial disparities. Findings from the current study will inform national implementation efforts and contribute towards future research targeting dissemination and scale-up, key foci for health equity focused implementation research.