Use of a Novel Parent-Report Measure to Improve Childhood Vaccine Uptake

 描述（由申请人提供）：国家估计的19 - 35个月大的儿童谁是最新的推荐疫苗的百分比仍然低于健康的人2020年的目标。造成免疫不足的一个重要因素是父母因严重的疫苗问题而拒绝或推迟接种儿童疫苗。有证据表明，儿科提供者对父母的疫苗决策有重要影响，他们与父母的疫苗讨论可以增加疫苗的接受度。然而，改善疫苗讨论存在一些父母和提供者层面的障碍，例如在卫生监督访问期间没有足够的时间讨论父母的疫苗问题，父母难以披露疫苗问题，以及提供者在确定哪些父母有疫苗问题时不准确。因此，父母对疫苗的关注往往被忽视，错过了改善疫苗摄取的机会。 该项目的主要目标是评估旨在解决这些障碍的创新干预措施的有效性-犹豫筛选优化对话（SHOT）干预措施-在改善提供者-父母疫苗讨论和提高疫苗接受度方面。SHOT干预措施包括对父母进行有效的父母报告措施，即父母对儿童疫苗的态度（PACV）调查，并在孩子2个月和6个月的健康监督访问之前向孩子的提供者传达他们的分数和特定项目的反应。PACV包含15个关于健康信念模型概念的问题，这些问题影响父母的疫苗接种行为，并已被证明可以预测免疫接种不足。我们假设，在接种疫苗的卫生监督访视之前，使用PACV征求父母的疫苗问题和犹豫状态，将提高提供者充分解决父母疫苗问题的能力，并提高父母对疫苗的接受程度。 我们的具体目标将是（1）使用配对、分组随机对照试验设计评价SHOT干预对儿童免疫状态的影响，在该试验中，我们将位于华盛顿州西雅图的Group Health医疗保健提供系统内的16家初级保健诊所分配到对照组或SHOT组，并招募160名对疫苗犹豫不决的父母，他们的新生儿在研究诊所接受健康监督;（2）评估父母对他们与孩子的提供者的疫苗讨论的评分如何作为SHOT干预的函数而变化;和（3）比较研究前和研究后SHOT和对照组中提供者与父母讨论高质量疫苗的障碍的看法。这项R21申请解决了一个重要的公共卫生问题-父母疫苗犹豫和拒绝-在这方面，目前很少有精心设计和严格评价的干预措施。它将为在初级保健环境中给予PACV的可行性和有效性提供证据，并将为未来R 01资助的多中心随机对照试验的设计和评价提供信息。

 DESCRIPTION (provided by applicant): National estimates for the percentage of 19 - 35 month old children who are up-to-date on recommended vaccines remain below the Healthy People 2020 goal. An important contributor to under-immunization is parental refusal or delay of childhood vaccines due to significant vaccine concerns. Evidence suggests pediatric providers are an important influence on parental vaccine decision-making and that their vaccine discussions with parents can increase vaccine acceptance. However, several parent- and provider-level barriers to improving the vaccine discussion exist, such as insufficient time to discuss parental vaccine concerns during health supervision visits, parental difficulty in disclosing vaccine concerns, and provider inaccuracy in identifying which parents have vaccine concerns. Consequently, parental vaccine concerns are often neglected and opportunities to improve vaccine uptake are missed. The primary goals of this project are to evaluate the effectiveness of an innovative intervention designed to address these barriers-the Screening for Hesitancy to Optimize Talk (SHOT) intervention-in improving provider-parent vaccine discussions and increasing vaccine acceptance. The SHOT intervention involves administering a validated parent-report measure, the Parent Attitudes about Childhood Vaccines (PACV) survey, to parents and communicating their score and item-specific responses to their child's provider before their child's 2 and 6 month health supervision visits. The PACV contains 15 questions regarding Health Belief Model concepts that influence parent vaccination behavior and has been shown to predict under-immunization. We hypothesize that using the PACV to solicit parental vaccine concerns and hesitancy status prior to health supervision visits in which vaccines are administered will improve providers' ability to adequately address parental vaccine concerns and increase parental vaccine acceptance. Our specific aims will be to (1) evaluate the impact of the SHOT intervention on a child's immunization status using a matched-pair, cluster randomized controlled trial design in which we assign 16 primary care clinics within the Group Health healthcare delivery system based in Seattle, WA to a control arm or the SHOT arm and enroll 160 vaccine-hesitant parents whose newborns receive health supervision at study clinics; (2) assess how parents' ratings of their vaccine discussions with their child's provider change as a function of the SHOT intervention; and (3) compare pre- and post-study perceptions of barriers to quality vaccine discussions with parents between providers in the SHOT and control arm. This R21 application addresses a significant public health problem-parental vaccine hesitancy and refusal-for which there are currently few well-designed and rigorously evaluated interventions. It will provide evidence for the feasibility and efficacy of administering the PACV in a primary care setting and will inform the design and evaluation of a future R01-funded multi-site randomized controlled trial.