A Comprehensive Pre-Natal Intervention to Increase Vaccine Coverage

推荐的儿童疫苗的免疫接种率一直很高，到19-35个月，儿童系列疫苗的完成率接近80%。然而，这些高免疫覆盖率并不能完全解释幼儿期的延迟或拒绝（即，不到一岁）疫苗接种。总体而言，未接受所有推荐疫苗或父母一直限制接种疫苗的儿童比例正在增加。得不到教育的儿童 所有推荐的疫苗都有更大的风险感染疫苗可预防的疾病，这可能导致严重后遗症、住院和死亡。此外，尽管有证据表明，孕妇接种疫苗对减少因年龄太小而无法完全接种疫苗的婴儿的疾病有效果，但孕产妇免疫接种率仍然很低。我们在实践、提供者和患者（P3）层面开发并试点测试了一种新颖、创新、循证和全面的免疫干预措施，以满足母亲多样化和复杂的信息需求。这一P3干预措施包括使用实践层面的疫苗冠军、扩大疫苗召回系统以及提供实践层面的免疫接种率反馈等组成部分（实践层面的干预措施）;医生同行提供的与疫苗、疫苗可预防疾病、疫苗接种建议和疫苗接种系统后勤有关的培训，以及建议疫苗接种时使用的标准化谈话要点（提供者一级的干预措施）;以及一个交互式平板电脑（iPad）教育应用程序，供孕妇在等待护理时查看（患者一级的干预措施）。我们的试点测试发现，这种P3干预措施受到了提供者和患者的欢迎，并指出了干预措施可以改进的一些领域。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+。将根据最初评价项目的调查结果以及其他形成性研究，改进项目、项目和项目3的初步框架。然后，我们将在格鲁吉亚（社区级实践）和科罗拉多（Kaiser Permanente科罗拉多管理式护理组织的办公室）的一组地理和社会人口统计学上多样化的妇产科医生办公室中评估P3+干预。该研究将由多名PI领导，他们在理解和解决疫苗接种障碍方面拥有丰富的经验。拟议的评价将涉及孕妇及其24个月大的孩子的疫苗接种情况，以检验以下假设：怀孕期间疫苗可接受性的提高将导致儿童疫苗接受性的积极变化。

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.