A Comprehensive Pre-Natal Intervention to Increase Vaccine Coverage

说明(申请人提供)：推荐的儿童疫苗接种率一直很高，19-35个月儿童系列疫苗接种率接近80%。然而，这些高免疫覆盖率并没有完全解释儿童早期(即不到一岁)接种疫苗的延迟或拒绝。总体而言，未接种所有推荐疫苗的儿童或其父母一直限制探视级疫苗接种的儿童比例正在增加。没有领到的孩子 所有推荐的疫苗都有更大的风险感染疫苗可预防的疾病，这可能导致严重的后遗症、住院和死亡。此外，尽管有证据表明，为孕妇接种疫苗在减少太小而不能完全接种疫苗的婴儿中的疾病方面有效果，但产妇免疫率仍然很低。我们开发并试行了一种新颖的、创新的、基于证据的、全面的免疫干预措施，在实践、提供者和患者(P3)层面上，以满足母亲多样化和复杂的信息需求。这项P3干预包括使用实践层面的疫苗冠军、扩大的提醒召回系统和提供实践层面的免疫率反馈(实践层面的干预)等组成部分；医生同行提供的与疫苗、疫苗可预防疾病、接种建议和接种系统后勤有关的培训，以及推荐接种时使用的标准化谈话要点(提供者层面的干预)；以及供孕妇在等待护理时查看的交互式平板电脑(IPad)教育应用程序(患者层面的干预)。我们的试点测试发现，这种P3干预得到了提供者和患者的良好接受，并指出了干预可以改进的几个领域。在拟议的项目中，我们将开发和评估P3干预的改进版本，称为P3+。对最初的P3框架的改进将基于最初评价项目的调查结果以及其他形成性研究。然后，我们将在佐治亚州(社区级实践)和科罗拉多州(科罗拉多州凯撒永久管理护理组织办公室)的一组地理和社会人口统计学上不同的产科-妇科医生办公室评估P3+干预措施。这项研究将由在理解和解决疫苗采用障碍方面拥有丰富经验的多名私人投资者领导。拟议的评估将涉及孕妇及其子女在24个月大期间接种疫苗的问题，以检验这样一种假设，即在怀孕期间提高疫苗的可接受性将导致儿童对疫苗的接受度发生积极变化。

DESCRIPTION (provided by applicant): Immunization rates for recommended childhood vaccines have consistently been high, with childhood series completion near 80% by 19-35 months. However, these high immunization coverage rates do not fully account for delays or refusals of early childhood (i.e., less than one year of age) vaccine uptake. Overall, the proportion of children not receiving all recommended vaccines or whose parents are consistently limiting visit-level vaccine administration is increasing. Children who do not receive all recommended vaccines are at greater risk of contracting vaccine-preventable diseases, which can lead to development of severe sequelae, hospitalizations, and death. Additionally, despite evidence showing the effect of vaccinating pregnant women in reducing disease among infants too young to be fully vaccinated, maternal immunization rates remain low. We developed and pilot tested a novel, innovative, evidence based, and comprehensive immunization intervention at the Practice, Provider, and Patient (P3) levels to meet the diverse and complex information needs of mothers. This P3 intervention included components such as use of practice-level vaccine champions, expanded reminder-recall systems, and provision of practice-level immunization rate feedback (practice-level interventions); physician peer-delivered training related to vaccines, vaccine-preventable diseases, vaccination recommendations, and vaccination system logistics, as well as standardized talking points for use when recommendation vaccination (provider-level interventions); and an interactive tablet computer (iPad) education application for pregnant women to view while waiting for care (patient-level intervention). Our pilot testing found this P3 intervention to be well received by providers and patients and indicated a few areas where the intervention could be improved. In the proposed project, we will develop and evaluate an improved version of the P3 intervention, to be called P3+. Improvements to the initial P3 framework will be based on findings from the original evaluation project as well as additional formative research. We will then evaluate the P3+ intervention in a geographically and socio-demographically diverse set of obstetrician- gynecologist offices in Georgia (community-level practices) and Colorado (offices of the Kaiser Permanente Colorado managed care organization). The research will be led by Multiple PIs who have extensive experienced in understanding and addressing barriers to vaccine uptake. The proposed evaluation will address vaccine uptake both for pregnant women and for their children, through 24 months of age, to test the hypothesis that increasing acceptability of vaccines during pregnancy will lead to positive changes in acceptance of vaccines for children.