Improving Healthcare Providers' Communication about HPV Vaccine

描述（由申请人提供）：尽管国家指导方针规定了人乳头瘤病毒（HPV）疫苗的常规接种，但目前美国只有33%的青春期女孩和7%的青春期男孩接受了所有三种推荐剂量。医疗保健提供者对父母决定是否为青少年儿童接种HPV疫苗具有很大影响力，但提供者往往未能推荐疫苗。此外，提供者提供的建议往往很薄弱。本研究的总体目标是开发和评估一个简短的培训计划，以改善供应商对HPV疫苗的沟通。这项研究将特别关注联邦合格卫生中心的提供者，因为这些诊所服务的低收入和少数民族青少年更有可能在以后的生活中患上HPV相关癌症。HPV疫苗是， 因此在这种情况下尤为重要。 在方法方面，我们将首先确定与HPV疫苗接种相关的提供者沟通特征（目标1）。利用现有的数据，我们将进行混合方法分析204音频记录的医疗服务提供者，青少年患者和他们的父母之间的遭遇。我们将利用这项分析的结果，为在低资源环境中执业的提供者制定一个简短的教育干预措施（目标2）。根据社会认知理论，培训的目的是提高提供者就HPV疫苗进行沟通的知识、技能和信心。最后，我们将向4个联邦合格卫生中心的16名提供者提供培训，以调查干预措施的可行性（目标3）。使用录音的医疗遭遇和供应商，患者和家长的调查，我们将评估干预措施的能力，以改善供应商的看法和建议的做法，以及其可接受的供应商和家庭。 这项拟议的研究建立在Melissa Gilkey博士先前在调查研究和项目评估方面的工作基础上，旨在确定和克服HPV疫苗接种的障碍。候选人的长期职业目标是将研究转化为青少年循证癌症预防计划。她的近期职业目标是获得患者与提供者沟通的内容知识，开发行为干预措施的技能，以及进行随机临床试验以测试这些干预措施的专业知识。拟议的职业发展奖将使Gilkey博士能够通过提供有针对性的培训以及受保护的研究时间来成长为一名独立的研究人员。建议的研究计划将为Gilkey博士的第一个R01级研究奠定基础，以建立沟通培训的有效性， 提高HPV疫苗的覆盖率。

DESCRIPTION (provided by applicant): Despite national guidelines for routine administration of human papillomavirus (HPV) vaccine, only 33% of adolescent girls and 7% of adolescent boys in the U.S. currently receive all three recommended doses. Healthcare providers are highly influential in parents' decisions to get their adolescent children HPV vaccine, and yet providers often fail to recommend it. Further, recommendations providers do deliver are often weak. The overall goal of this study is to develop and evaluate a brief training program to improve providers' communication about HPV vaccine. This study will focus specifically on providers in Federally Qualified Health Centers because the low-income and minority adolescents served by these clinics are more likely to suffer from HPV-related cancers later in life. HPV vaccination is, thus, especially important in this setting. In terms of methods, we will first identify provider communication characteristics associated with HPV vaccine delivery (Aim 1). Using existing data, we will conduct a mixed-methods analysis of 204 audio-recorded medical encounters between providers, adolescent patients, and their parents. We will use findings from this analysis to develop a brief educational intervention for providers practicing in low-resource settings (Aim 2). Informed by social cognitive theory, the training's purpose will be to improve providers' knowledge, skills, and confidence for communicating about HPV vaccine. Finally, we will deliver the training to 16 providers in 4 Federally Qualified Health Centers to investigate the intervention's feasibility (Aim 3). Using audio-recordings of medical encounters and surveys of providers, patients, and parents, we will assess the intervention's ability to improve provider perceptions and recommendation practices as well as its acceptability to providers and families. The proposed study builds on Dr. Melissa Gilkey's prior work in survey research and program evaluation aimed at identifying and overcoming barriers to HPV vaccination. The candidate's long-term career goal is to translate research into evidence-based cancer prevention programs for adolescents. Her immediate career goals are to gain content knowledge in patient-provider communication, skills in developing behavioral interventions, and expertise in conducting randomized clinical trials to test those interventions. The proposed career development award will enable Dr. Gilkey to grow as an independent investigator by providing focused training as well as protected time for research. The proposed program of research will lay the groundwork for Dr. Gilkey's first R01-level study to establish the effectiveness of communication training for raising coverage of HPV vaccine.