HPV ECHO: Increasing the adoption of evidence-based communication strategies for HPV vaccination in rural primary care practices

HPV ECHO：在农村初级保健实践中更多地采用基于证据的 HPV 疫苗接种沟通策略

• 批准号: 10617721
• 负责人: William Alexis Calo
• 金额: $ 36.27万
• 依托单位: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-10 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10617721
• 关键词: 17 year old; Address; Adolescent; Adoption; Age; Area; Behavioral; Caring; Case Management; Clinic; Clinic Visits; Clinical; Cluster randomized trial; Communication; Community Healthcare; Community Networks; Complex; Consolidated Framework for Implementation Research; Data; Decision Making; Dose; Effectiveness; Electronic Health Record; Evaluation; Exposure to; Family Practice; Goals; Healthcare; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papilloma Virus-Related Malignant Neoplasm; Human Papillomavirus; Human papilloma virus infection; Inequity; Infrastructure; Intervention; Interview; Malignant Neoplasms; Methods; Modeling; Monitor; Notification; Outcome; Parents; Penetration; Pennsylvania; Physicians; President' s Cancer Panel; Prevention Research; Provider; Public Health; Randomized; Recommendation; Reporting; Research; Research Personnel; Resources; Risk; Rural; Rural Community; Rural Population; Schedule; Scientist; Source; Structure; Surveys; System; Testing; Time; Training; Use Effectiveness; Vaccination; Vaccines; Woman; Work; arm; boys; cancer prevention; care outcomes; comparison control; comparison intervention; cost; design; effective intervention; effectiveness evaluation; effectiveness testing; evidence base; experience; follow-up; girls; health inequalities; implementation framework; implementation outcomes; implementation strategy; improved; innovation; men; post intervention; prevent; primary care clinic; primary care practice; primary care provider; primary outcome; rural America; rural health clinic; secondary outcome; sex; social media; sociocultural determinant; treatment arm; vaccine acceptance; vaccine hesitancy; video session

ABSTRACT Despite the availability of the human papillomavirus (HPV) vaccine that can prevent over 34,800 HPV-related cancers in the US every year, only 51% of girls and boys were up-to-date by 2018. Rural populations are the most impacted by HPV-related cancers. Best practices like the Announcement Approach training and systems communication have proven effective in increasing HPV vaccination, but rural providers struggle to access and implement such best practices. These data prompt the question: “How can academic centers support HPV vaccination in rural primary care practices?” Although never tested for HPV vaccination, the ECHO (Extension for Community Healthcare Outcomes) Model is a promising implementation strategy (practice facilitation) that allows “experts” at academic centers to connect with primary care providers to discuss best practices in care and complex cases managed within local practices. The objective of this R01 is to test two ECHO-delivered HPV vaccination communication interventions in rural primary care clinics. The first will provide Announcement Approach training (HPV ECHO); the second will provide this approach plus systems strategies to communicate with parents who initially decline vaccination (HPV ECHO+). The rationale for the project is that ECHO is a robust, highly-accessible platform to deliver best practices to rural providers and address the context-specific communication needs of parents. Our long-term goal is to improve HPV vaccination rates in rural clinics and reduce the health inequity rural populations experience in cancer outcomes. Aim 1 is to evaluate the impact of HPV ECHO and HPV ECHO+ on HPV vaccination among adolescents. We will conduct a 3-arm cluster randomized trial with 36 primary care clinics in rural Pennsylvania. Clinics will be randomized to: HPV ECHO, HPV ECHO+, or control. Our primary outcome will be change in HPV vaccine initiation (≥1 doses) among adolescents, ages 11-14, at 12-month follow-up. Aim 2 is to evaluate the impact of HPV ECHO and HPV ECHO+ on implementation outcomes. Guided by implementation science frameworks, we will conduct a mixed-methods evaluation to compare interventions on acceptability, adoption, cost, penetration, and sustainability. Aim 3 is to evaluate the impact of interventions’ vaccine information on secondary acceptance of HPV vaccination at the clinic level. We will also follow a subset of 200 vaccine-declining parents for up to 12 months to assess exposure to and impact of vaccine information from study arms versus naturally-occurring sources (e.g., social media) on secondary acceptance. Our expected outcome is to demonstrate the effectiveness of a highly efficient and scalable implementation strategy, ECHO, to support HPV vaccination in rural clinics. This study is innovative in leveraging existing infrastructure at academic centers to deliver best practices for HPV vaccination where they are needed most and in developing a greater understanding of the influences on decision making among vaccine-declining parents. We expect the project to have a significant impact on HPV vaccine uptake as we address the communication needs of both rural providers and parents.

摘要 尽管人类乳头瘤病毒(HPV)疫苗可以预防34,800多例与HPV相关的病毒 癌症在美国每年，到2018年只有51%的女孩和男孩是最新的。农村人口是 受HPV相关癌症的影响最大。最佳实践，如公告方法、培训和系统 传播已被证明在增加HPV疫苗接种方面有效，但农村提供者难以获得和 实施此类最佳实践。这些数据引发了一个问题：“学术中心如何支持HPV？ 在农村初级保健实践中接种疫苗？“虽然从未对HPV疫苗进行过测试，但ECHO(扩展 对于社区医疗保健结果)模式是一种很有前途的实施战略(实践促进)， 允许学术中心的“专家”与初级保健提供者联系，讨论保健方面的最佳实践 以及在当地业务范围内管理的复杂案件。此R01目标是测试两个回声传输 农村基层医疗机构人乳头瘤病毒疫苗接种沟通干预研究第一个将提供公告 方法培训(HPV ECHO)；第二个将提供这种方法以及沟通的系统策略 父母最初拒绝接种疫苗(HPV ECHO+)。该项目的基本原理是Echo是一种 强大、高度可访问的平台，为农村提供商提供最佳实践并解决特定背景 家长的沟通需求。我们的长期目标是提高农村诊所和农村地区的HPV疫苗接种率 减少农村人口在癌症结果方面经历的健康不平等。目标1是评估以下项目的影响 HPV ECHO和HPV ECHO+对青少年HPV疫苗接种的影响我们将实施三臂集群 宾夕法尼亚州农村36家初级保健诊所的随机试验。诊所将随机分配到：HPV ECHO， HPV ECHO+，或对照。我们的主要结果将是HPV疫苗启动(≥1剂量)的变化 11-14岁的青少年，在12个月的随访中。目标2是评估HPV ECHO和HPV的影响 关于执行结果的回应+。在实施科学框架的指导下，我们将开展 混合方法评估，比较干预措施的可接受性、采用率、成本、渗透率和 可持续发展。目标3是评估干预措施的疫苗信息对二次接受疫苗的影响 在临床层面接种HPV疫苗。我们还将跟踪200名拒绝接种疫苗的父母的子集，最多12人 几个月来评估来自研究机构的疫苗信息与自然发生的疫苗信息的接触和影响 二次接受的来源(例如，社交媒体)。我们的预期结果是展示 高效和可扩展的实施战略ECHO在支持HPV疫苗接种方面的有效性 乡村诊所。这项研究在利用学术中心的现有基础设施方面具有创新性，可提供最佳 在最需要的地方接种HPV疫苗的做法，以及更好地了解 拒绝接种疫苗的父母对决策的影响。我们预计该项目将有一个重要的 在我们解决农村提供者和父母的沟通需求时，对HPV疫苗接种的影响。