TweenVax: A comprehensive practice-, provider-, and parent/patient-level intervention to improve adolescent HPV vaccination

项目摘要/摘要 持续的人类乳头瘤病毒(HPV)感染每年导致超过30,000例新的癌症病例 在美国(美国)。HPV感染可以通过免疫预防，但12年后 推荐使用，美国青少年中的HPV接种率仍然处于次优状态。在吸收的同时 其他推荐给11-12岁儿童的疫苗使用率为90%或接近90%，只有43%的青少年男孩和女孩 HPV疫苗接种的最新情况。之前提高HPV疫苗接种率的努力一直遵循最好的标准 免疫方案的做法，包括为父母和青少年患者提供教育，以及 受健康信念模式启发的疾病严重性呼吁。提高HPV疫苗接种率的一个关键障碍是 医疗保健提供者通常不会像推荐其他疫苗那样推荐这种疫苗 青少年疫苗。HPV疫苗接种率持续较低表明，新的系统层面的方法， 除了标准的公共卫生教育活动之外，还需要。这些系统级方法- 将医疗保健实践和提供者以及患者结合在一起-必须设计和包装在 解决提供商建议的质量和背景的方法。 我们的研究团队已经开发并试点测试了一套干预方案-TweenVax-旨在改善 在实践、提供者和患者/家长层面采用HPV疫苗。TweenVax标识密钥的评估 扩大的要素，以改善提供商建议的提供和力度。差距仍然存在 关于如何最好地解决缺失或不符合标准的提供商建议的条款，包括 就诊过程中的即时患者和数据流以及各种干预点(包括前台) 通过临床检查和疫苗接种以及后续预约安排入住。增强功能 TweenVax干预将包括在患者环境中改进实践层面的沟通 流动和对非临床工作人员的额外培训，为临床工作人员开发增强的培训单元， 包括互动体验培训和提供持续教育学分，以及更新 TweenVax平板电脑和基于网络的教育计划的内容和演示。 拟议的多阶段研究将1)利用人种学观察和深入访谈，评估 青少年保健遭遇的所有临床方面的最佳做法和不足之处，以及使用的研究结果 改进现有的干预工具，以改进11-12岁儿童的HPV疫苗接种；以及2)评估效果 年，我们在提高11-12岁女孩和男孩HPV疫苗接种率方面的综合干预措施 乔治亚州和田纳西州。这项评估将通过三臂试验提供机会，以评估 整个干预方案的效力，以及确定个别组成部分的效力 (例如，实践/提供者级组件独立于患者/父级组件)。

PROJECT SUMMARY/ABSTRACT Persistent human papillomavirus (HPV) infection is responsible for over 30,000 new cases of cancer annually in the United States (US). HPV infection can be prevented by immunization, but 12 years after being recommended for use, HPV immunization rates among US adolescents remain suboptimal. While uptake of other vaccines recommended for 11-12 year-olds is at or near 90%, only 43% of adolescent boys and girls are up-to-date for HPV vaccination. Prior efforts to improve HPV vaccine uptake have followed standard best practices for immunization programs, including education provision for parents and adolescent patients, and Health Belief Model-inspired appeals to disease severity. One key barrier to improving HPV vaccine uptake is that healthcare providers often do not recommend this vaccine with the same strength as they do for other adolescent vaccines. Continued low uptake of HPV vaccine indicates that new systems-level approaches, beyond standard public health education campaigns, are needed. These systems-level approaches – incorporating the healthcare practice and provider as well as the patient - must be designed and packaged in a way to address the quality of, and context around, provider recommendations. Our research team has developed and pilot-tested an intervention package – TweenVax – designed to improve HPV vaccine uptake at the practice-, provider-, and patient/parent-level. Evaluation of TweenVax identified key elements for expansion to improve the provision and strength of provider recommendations. Gaps remain in terms of how best to address missing or substandard provider recommendations, including addressing moment-to-moment patient and data flow and various points of intervention during the clinic visit including desk check-in through clinical examination and vaccination and follow-up appointment scheduling. Enhancements to the TweenVax intervention will include improvements in practice-level communication in the context of patient flow and additional training for non-clinical staff, development of enhanced training modules for clinical staff, including interactive experiential training and provision of continuing education credits, and updates to the content and presentation of the TweenVax tablet- and web-based educational program. The proposed multi-phase study will 1) assess, using ethnographic observations and in-depth interviews, both best practices and deficiencies in all clinical aspects of the adolescent healthcare encounter, with findings used to refine existing intervention tools to improve HPV vaccination of 11-12 year-olds; and 2) evaluate the efficacy of our comprehensive intervention in improving HPV vaccine uptake among 11-12 year-old girls and boys in Georgia and Tennessee. This assessment, through a three-arm trial, will provide the opportunity to assess the efficacy of the intervention package as a whole, as well as to determine the efficacy of individual components (e.g. practice-/provider-level components independent of patient/parent-level components).