Physicians' Intentions to Administer HPV Vaccine

描述(由申请人提供)：宫颈癌、生殖器疣和其他与人乳头瘤病毒(HPV)相关的健康状况确切的发病率、死亡率和费用。2006年，美国食品和药物管理局(FDA)批准为9-26岁的女性接种四价HPV疫苗，免疫实践咨询委员会(ACIP)建议11-12岁的女孩接种常规疫苗。然而，到目前为止，疫苗接种率不高，表明在扩大疫苗覆盖率和遵守推荐的疫苗时间表方面存在问题，并可能预示着实现疫苗的公共卫生承诺的困难。与疫苗实施有关的以提供者为导向的问题和挑战可能被低估了，研究仍然不足，特别是关于初级保健医生(PCP)，他们非常适合为大多数年轻女性提供疫苗。这项研究的广泛目标是确定与临床医生声明的按建议接种HPV疫苗的意图不同的适当因素星座。我们的中心假设是，临床医生的态度、主观规范和将问题视为障碍的看法显著影响他们接种疫苗的意图，并最终影响他们的行为，正如计划行为理论(TPB)所预测的那样。我们提出了四个具体目标：1)开发一个理论上知情的调查问卷，用于评估基于TPB的PCP和其他措施的PCP接种HPV疫苗的意图；2)在阿拉巴马州和密西西比州的PCP中实施调查问卷；3)检查PCP的特征和基于TPB的措施，了解不同条件下接种HPV疫苗的意愿；以及4)确定在TPB因素和意向性之间的功能关系模式方面可以区分的PCP群体。通过名义上的小组技术会议和其他步骤，将与初级保健医生、家庭实习医生和教职员工一起开发、预试和试行调查工具。将从初级保健医生那里收集至少300份完整的调查回复，以检验我们的假设以及不同患者条件下相关变量与意向性之间的关系。意向性将通过一系列以行为为基础的案例小插曲来运作。还将评估PCP对ACIP建议的认识和态度。这项研究将在HPV相关疾病负担高、PCP严重短缺和HPV免疫率低的两个州进行。拟议的研究将产生重要的信息，以增进对HPV疫苗接种的理论预测因素和实际操作中基于提供者的障碍的理解。这也应该为制定以提供者为基础的战略提供有用的方向，以增加疫苗接种的可能性，可以在未来的研究中进行研究。 公共卫生相关性：只要更好地了解和克服困扰当前适度接种率的问题，HPV疫苗接种就提供了一种有效的预防策略，可以降低持续HPV感染造成的大量发病率和医疗成本。这项拟议的研究将使用新的意向性衡量标准和临床医生对专业建议的评估看法，检查与临床医生声明的接种HPV疫苗的意图存在差异的因素。我们的工作将有助于为未来的研究和战略设计提供信息，以提高医生采用HPV疫苗接种建议的可能性。

DESCRIPTION (provided by applicant): Cervical cancer, genital warts, and other health conditions associated with human papillomavirus (HPV) exact substantial morbidity, mortality, and expenses. In 2006, the Food and Drug Administration (FDA) approved a quadrivalent HPV vaccine for females ages 9-26, and the Advisory Committee on Immunization Practices (ACIP) recommended routine vaccination for girls ages 11-12. Modest vaccination rates to date, however, indicate problems with increasing coverage and adherence to the recommended vaccine schedule, and may presage difficulties in realizing the vaccine's public health promise. Provider-oriented issues and challenges related to vaccine implementation may have been underestimated and remain insufficiently studied, especially with regard to primary care physicians (PCPs), who are well suited to provide vaccine to most young females. The broad objective of this study is to identify the appropriate constellation of factors that differentially relate to clinicians' stated intentions to administer HPV vaccine as recommended. Our central hypothesis is that clinicians' attitudes, subjective norms, and perceptions of issues as barriers significantly influence their intentions to administer the vaccine and, ultimately, their behavior, as predicted by the theory of planned behavior (TPB). We propose four specific aims: 1) to develop a theoretically-informed survey questionnaire for the assessment of TPB-based and other measures of PCPs' intentions to administer the HPV vaccine; 2) to implement the survey questionnaire among PCPs in Alabama and Mississippi; 3) to examine PCP characteristics and TPB-based measures regarding intention to administer HPV vaccine under different conditions; and 4) to identify groups of PCPs who can be differentiated with respect to the patterns of functional relations between the TPB-factors and intentionality. Using nominal group technique meetings and other steps, the survey instrument will be developed, pre-tested and piloted with PCPs and family practice residents and faculty. At least 300 complete survey responses will be collected from PCPs to allow examination of our hypotheses and relationships between relevant variables and intentionality under different patient conditions. Intentionality will be operationalized through a series of behaviorally anchored case vignettes. PCPs' awareness and attitudes regarding ACIP recommendations will also be evaluated. The study will be administered in two states with high HPV-associated disease burdens, acute PCP shortages, and low HPV immunization rates. The proposed research will yield important information to improve understanding of theoretical predictors and provider-based barriers to HPV vaccination in actual practice. This should also suggest useful direction for developing provider-based strategies to increase the likelihood of vaccine administration that could be studied in future research. PUBLIC HEALTH RELEVANCE: HPV vaccination offers an effective prevention strategy for reducing the substantial morbidity and healthcare costs caused by persistent HPV infection, so long as problems besetting current modest vaccination rates are better understood and overcome. The proposed study will examine factors that differentially relate to clinicians' stated intentions to administer HPV vaccine, using new measures of intentionality and clinicians' evaluative perceptions of professional recommendations. Our work will help inform future research and the design of strategies to improve the likelihood that physicians would adopt recommendations for administering HPV vaccine.