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

项目总结 针对父母和医疗保健提供者的多层次实施战略有可能 大幅提高目标年龄组中较低的人乳头瘤病毒(HPV)接种率 11至12岁的儿童。佛罗里达州的青少年尤其容易受到感染，因为该州的HPV感染率排名第四。 与癌症相关的诊断，但在HPV疫苗启动和最新比率方面排名第39位。解决的问题是 这项建议是需要更有效和务实的预防性干预措施，以增加提供者HPV 疫苗推荐。现有干预措施仅适度增加了HPV疫苗接种率(约为 5至15个百分点)。对提供者推荐和家长接受度的多层次关注是 由于90%的未接种疫苗的青少年确实有良好的就诊经历，提供者的建议增加了 HPV疫苗接种率是9到170倍，疫苗接种由父母决定。此外，国民健康 机构支持两种推荐方法：将HPV列为需要的青少年之一 疫苗(捆绑)或强调HPV疫苗的好处(好处)。然而，这种方法的相对有效性 建议方法和跨提供者-家长级别的方法一致性的有效性是 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 干预两种实施战略(简要的提供者培训和以家长为目标的互动文本 信息提醒)关于11至12岁男孩和女孩的HPV疫苗接种率。在指导下 整合行为模型--理性行为理论与社会认知相结合的元理论 理论和计划行为理论，中心假设是短暂的提供者培训将 增加提供者推荐HPV疫苗的意向和以家长为目标的互动文本 信息会增加父母的关注度。具体目标是：(1)测试Brief的整体有效性 提供商培训，并嵌入捆绑和收益方法的比较。(2)测试整体 嵌入捆绑和福利比较的互动短信对家长的有效性 接近了。(3)评估综合简短的提供者培训和互动文本的有效性 给父母的信息，嵌入了和谐和不同方法的比较。(4)评估 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、两层嵌套设计进行评估，以测试两个嵌套实现因素 (供应商培训和带有捆绑或福利方法的家长短信)。将有30家诊所 从One佛罗里达临床研究联盟招募。这些创新是阶乘设计的 多层次实施的价值增值测算与协调性评价 跨提供商和父级的推荐方法。其重要意义在于领导的潜力 该领域更接近于一种可持续、可扩展和有效的方法来降低HPV相关癌症发病率。

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.