Identifying the multi-level factors influencing provider recommendations of adolescent vaccines: A mixed methods study

项目总结 医疗保健提供者(HCP)的推荐是影响父母 接受青少年疫苗。大量文献，涉及定性、观察性和干预性 研究表明，接受医疗保健提供者推荐的疫苗的父母 更有可能给他们的孩子接种疫苗。然而，提供商的建议并不普遍和高- 质量建议甚至更不常见。供应商对青少年疫苗的建议可以 在强度、一致性和及时性方面各不相同，但影响这些的频率和质量的因素 建议还没有得到很好的探索。 疫苗决策过程受多个层面的因素影响，包括个人， 人际层面和社区层面。提供者的疫苗建议可以在相同的概念中 Way-HCP不仅受到他们自己对疫苗的态度和知识的影响，而且还受到他们 对他们执业的病人和社区的看法和知识。此外，这些因素也会 不是孤立地工作，可以跨级别交互以影响推荐。 在拟议的项目中，我们将进行顺序混合方法研究，以探索提供者如何 建议因个人、人际关系和社区层面的因素而异。首先，我们将进行多方面的 对来自NIS-Teen的具有全国代表性的邮政编码级别数据进行级别分析，以检查提供商如何 建议因人际因素而异(即患者特征-种族/民族、教育水平、 保险覆盖面)和社区一级的因素(即城市化、贫困程度)以及这些因素如何 互动(具体目标1)。为了更好地了解AIM 1的调查结果，我们将对 探索个人层面的因素(即提供者态度)如何影响人际关系和 社区一级的变化(具体目标2)。这些采访将在纽黑文县进行 既代表社会人口结构多样化的人口，又为其提供服务的初级卫生政策机构。 通过这种顺序的混合方法，我们将确定提供商建议在以下两个方面有何不同 以及探索指导提供商推荐实践的基本信念和偏见。到目前为止, 研究主要集中在提供者对HPV疫苗的建议的影响；检查 这项提案中的整个青少年疫苗平台将允许我们扩大这一有限的文献正文。我们的 结果将为制定和确定干预措施提供基础，以提高教育质量 提供者建议扩大所有青少年疫苗的覆盖面。

PROJECT SUMMARY Healthcare provider (HCP) recommendations are one of the most important factors influencing parents’ acceptance of adolescent vaccines. A large body of literature across qualitative, observational and intervention studies has demonstrated that parents who receive a vaccine recommendation from a healthcare provider are much more likely to vaccinate their child. However, provider recommendations are not universal and high- quality recommendations are even more uncommon. Provider recommendations for adolescent vaccines can vary in strength, consistency, and timeliness, but the factors that influence the frequency and quality of these recommendations have not been well explored. The vaccine decision making process is influenced by factors at multiple levels including the individual, interpersonal, and community levels. Provider vaccine recommendations can be conceptualized in the same way–HCPs are influenced not only by their own attitudes and knowledge about the vaccine, but also their perceptions and knowledge of the patient and community in which they practice. Additionally, these factors do not work in isolation and can interact across levels to influence recommendations. In the proposed project, we will conduct a sequential mixed-methods study to explore how provider recommendations vary by individual, interpersonal and community level factors. First, we will conduct a multi- level analysis of nationally-representative zip code level data from NIS-Teen to examine how provider recommendations vary by interpersonal factors (i.e. patient characteristics - race/ethnicity, education level, insurance coverage) and community-level factors (i.e. urbanicity, poverty level) as well as how these factors interact (Specific Aim 1). To better understand our findings from Aim 1, we will conduct in-depth interviews with adolescent HCPs to explore how individual-level factors (i.e. provider attitudes) inform interpersonal and community level variation (Specific Aim 2). These interviews will be conducted in New Haven County among HCPs who both represent and provide service to a socio-demographically diverse population. Through this sequential mixed-methods approach, we will identify both how provider recommendations vary as well as explore the underlying beliefs and biases that guide provider recommendation practices. So far, research has primarily focused on the impact of provider recommendations for the HPV vaccine; examining the entire adolescent vaccine platform in this proposal will allow us to expand this limited body of literature. Our results will provide a foundation for the development and targeting of interventions to improve the quality of provider recommendations for greater coverage for all adolescent vaccines.