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

项目总结/摘要 持续性人乳头瘤病毒（HPV）感染每年导致超过30，000例新癌症病例 在美国（US）。HPV感染可以通过免疫接种来预防，但12年后， 尽管建议使用，但美国青少年的HPV免疫接种率仍然不理想。虽然吸收了 其他推荐给11-12岁儿童的疫苗接种率达到或接近90%，只有43%的青少年男孩和女孩接种了疫苗。 最新的HPV疫苗。此前提高HPV疫苗接种率的努力遵循了标准的最佳方案， 免疫规划的做法，包括为父母和青少年患者提供教育，以及 健康信念模型启发的对疾病严重程度的呼吁。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推荐这种疫苗与其他疫苗相同的强度， 青少年疫苗HPV疫苗的持续低摄取表明，新的系统级方法， 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- 包括医疗保健实践和提供者以及患者-必须设计和包装在一个 解决提供者建议的质量和上下文的方法。 我们的研究团队已经开发并试点测试了一个干预包- TweenVax -旨在改善 HPV疫苗在实践中的吸收-，提供者-和患者/父母水平。评价TweenVax确定的关键 扩展的要素，以改善供应商建议的供应和强度。方面仍然存在差距 如何最好地解决缺失或不合格的供应商建议，包括解决 每时每刻的患者和数据流以及诊所访视期间的各种干预点，包括桌面 通过临床检查和疫苗接种以及后续预约安排进行登记。增强 TweenVax干预将包括改善患者背景下的实践水平沟通， 为非临床工作人员提供流程和额外培训，为临床工作人员开发强化培训模块， 包括互动体验式培训和提供继续教育学分，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）使用人种学观察和深入访谈， 青少年医疗保健遇到的所有临床方面的最佳实践和缺陷，以及使用的结果 改进现有的干预工具，以改善11-12岁儿童的HPV疫苗接种; 2）评估疗效 我们的综合干预措施在提高11-12岁女孩和男孩的HPV疫苗接种率方面的作用， 格鲁吉亚和田纳西。通过三组试验进行的这项评估将提供评估 整体干预措施的有效性，以及确定单个组成部分的有效性 (e.g.独立于患者/家长级组件的实践/提供者级组件）。

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).