Text and Talk: A multi-level intervention to increase provider HPV vaccine recommendation effectiveness

项目摘要 针对父母和卫生保健提供者的多层次实施战略有可能 大幅度提高目标年龄组中人乳头瘤病毒（HPV）疫苗接种率 11-给12岁的孩子由于佛罗里达州的HPV感染率排名第四，佛罗里达州的青少年尤其容易受到感染- 相关癌症诊断，但HPV疫苗启动和最新率为39。解决的问题 这一建议是需要更有效和务实的预防干预措施，以增加供应商HPV 疫苗建议。现有的干预措施只能适度提高HPV疫苗接种率（大约 5至15个百分点）。多层次地关注提供者的推荐和父母的接受程度， 由于90%的未接种疫苗的青少年实际上有良好的访问，提供者的建议增加 HPV疫苗接种率为9至170倍，父母决定接种疫苗。此外，国民健康 机构认可两种推荐方法：将HPV列为青少年所需的 疫苗（捆绑）或强调HPV疫苗的好处（好处）。然而， 建议的方法和方法的有效性， 不清楚该提案的目标是评估多层次（提供者和家长）的有效性 两种实施策略的干预（简短的提供者培训和针对家长的互动文本 信息提醒）关于11至12岁男孩和女孩的HPV疫苗接种率。为指导 整合行为模型是一种结合理性行为理论、社会认知理论和行为理论的元理论， 理论和计划行为理论，中心假设是，简短的提供者培训将 增加提供者推荐HPV疫苗和针对父母的互动文本的意愿 信息会增加父母的注意力。具体目的是：（1）检验简报的整体有效性 提供商培训，并对捆绑和收益方法进行嵌入式比较。(2)为了测试整体 互动式短信对父母的有效性，并嵌入了捆绑和福利的比较 接近。(3)评估提供者简短培训和互动文本相结合的有效性 父母的信息与一致的和不同的方法嵌入式比较。(4)评价 临床实践因素对实施策略有效性的调节作用。假设将是 采用双随机、两水平嵌套设计进行评估，以测试两个嵌套的实施因素 （提供者培训和父母短信与捆绑或福利的方法）。30家诊所将 从OneFlorida临床研究联盟招募的。创新是工厂设计的， 评估评估多层次实施的附加值和一致性评估 跨提供者和父母级别的推荐方法。其意义在于领导潜力 该领域更接近于一种可持续的，可扩展的，有效的方法来降低HPV相关的癌症发病率。

PROJECT SUMMARY Multi-level implementation strategies targeting parents and health care providers have potential to substantially increase the low human papillomavirus (HPV) vaccination rates among the targeted age group of 11- to 12-year-olds. Florida adolescents are particularly vulnerable due to the state’s rank of 4th for HPV- related cancer diagnoses, but 39th for HPV vaccine initiation and up-to-date rates. The problem addressed by this proposal is the need for more effective and pragmatic preventive interventions to increase provider HPV vaccine recommendations. Existing interventions increase HPV vaccine rates only moderately (approximately 5 to 15 percentage points). A multi-leveled focus on provider recommendations and parent receptiveness is warranted because 90% of unvaccinated teens actually had well visits, provider recommendations increase HPV vaccination rates 9- to 170-fold, and parents make vaccine decisions. Additionally, national health agencies endorse two approaches for recommendation: mentioning HPV as one of the needed adolescent vaccines (bundled) or emphasizing the HPV vaccine benefits (benefits). Yet, the relative effectiveness of recommendation approaches and effectiveness of approach concordance across provider-parent levels is unclear. The goal of the proposal is to evaluate the effectiveness of a multi-level (provider and parent) intervention of two implementation strategies (brief provider training and parent-targeted interactive text message reminders) on HPV vaccination rates among 11- to 12-year-old boys and girls. Guided by the Integrated Behavior Model, a meta-theory combining the Theory of Reasoned Action, the Social Cognitive Theory, and the Theory of Planned Behavior, the central hypotheses are that brief provider trainings will increase providers’ intentions to recommend the HPV vaccine and the parent-targeted interactive text messages will increase parents’ salience. Specific Aims are to: (1) To test the overall effectiveness of brief provider trainings with an embedded comparison of bundled and benefits approaches. (2) To test the overall effectiveness of interactive text messages for parents with an embedded comparison of bundled and benefits approaches. (3) Evaluate the effectiveness of the combined brief provider trainings and interactive text messages for parents with an embedded comparison of concordant and distinct approaches. (4) Evaluate moderation of the implementation strategies’ effectiveness by clinical practice factors. Hypotheses will be evaluated with a doubly randomized, two-level nested design for testing two nested implementation factors (provider training and parent text messaging with bundled or benefits approaches). Thirty clinics will be recruited from the OneFlorida Clinical Research Consortium. The innovations are the factorial-designed evaluation estimating the value-added of multi-level implementation and the evaluation of concordant recommendation approaches across provider- and parent-levels. The significance lies in the potential to lead the field closer to a sustainable, scalable, and efficacious approach to decreasing HPV-related cancer rates.