Evaluation of the Presumptively Initiating Vaccines and Optimizing Talk with Motivational Interviewing (PIVOT with MI) Intervention

项目总结 这项提案解决了一个重大的公共卫生问题-父母对疫苗的犹豫不决和拒绝 目前，很少有精心设计和严格评估的干预措施。国家估计的 19-35个月大的儿童中，及时接种推荐疫苗的比例仍低于健康水平 人民2020年的目标。免疫不足的一个关键因素是父母拒绝或推迟接种疫苗，原因是 疫苗方面的担忧。对疫苗犹豫不决的父母(VHP)，一大群拒绝和/或拖延的父母 至少为他们的孩子推荐一种疫苗，是旨在进行干预的重要人群 提高疫苗接种率。虽然VHP最值得信赖的信息来源是他们孩子的供应商， 供应商在与VHP沟通方面缺乏信心，并经常认为他们的讨论对 让父母改变主意。因此，改善提供商与VHP的沟通至关重要 提高儿童疫苗接种率，预防疫苗可预防疾病的暴发。 然而，对于供应商的具体沟通策略，缺乏实验证据。在……里面 前期工作，欧宝等人。发现提供者使用推定(例如“好吧，我们得拍几张照片。” 而不是参与式(例如“你对今天的疫苗有什么看法？”要启动的通信格式 疫苗推荐与父母对疫苗接受度的提高有关。这一推定 然而，形式可能会导致家长满意度下降，这引发了人们的担忧，即推定的入门将 导致疫苗接种量随着时间的推移而下降。在单独的工作中，O‘Leary等人。探索了励志语言的用法 访谈(MI)，以增加青少年推荐的HPV疫苗接种量。激励性访谈 是以患者为中心的行为改变框架，它包含的元素与已知的 VHP在疫苗方面的沟通偏好。O‘Leary等人的研究。发现提供程序在 与抵制HPV疫苗推荐的父母讨论后，父母接种的疫苗增加了 接受和改善了提供者对其影响父母疫苗决策的能力的看法。 在这份提案中，奥利里和欧宝的目标是将这两种技术结合起来--假定 通过激励性访谈启动疫苗接种和优化谈话(与MI的Pivot) 干预措施--提高疫苗接种率，提高家长探视满意度，改善 供应商对疫苗对话充满信心。我们的具体目标将是(1)开发一种多方面的、 可行的，文化上适当的支点与心肌梗死干预提供者培训计划；(2)评估 采用MI干预的Pivot通过随机抽取24个月龄儿童对19个月龄儿童免疫状况的影响 两个州(华盛顿州和科罗拉多州)的初级保健做法，以使用集群控制或干预武器 随机设计；以及(3)评估支点与MI干预对父母和提供者的影响 经验。

PROJECT SUMMARY This proposal addresses a significant public health problem—parental vaccine hesitancy and refusal—for which there are currently few well-designed and rigorously evaluated interventions. National estimates of the percentage of 19 – 35 month old children who are up-to-date on recommended vaccines remain below Healthy People 2020 goals. A key contributor to under-immunization is parental refusal or delay of vaccines due to vaccine concerns. Vaccine-hesitant parents (VHPs), a large, diverse group of parents who refuse and/or delay at least one recommended vaccine for their child, are an important population for interventions aimed at improving vaccine acceptance. While VHPs’ most trusted source of information is their child’s provider, providers lack confidence in communicating with VHPs and often perceive their discussions will do little to change a parent’s mind. Improved provider communication with VHPs is therefore critical to improving childhood vaccine uptake and preventing outbreaks of vaccine-preventable disease. However, there is a lack of experimental evidence for specific communication strategies for providers. In preliminary work, Opel et al. found that provider use of a presumptive (e.g. “Well we have to do some shots.”) rather than a participatory (e.g. “How do you feel about vaccines today?”) communication format to initiate the vaccine recommendation was associated with increased parental vaccine acceptance. This presumptive format, though, may lead to decreased parent satisfaction, raising concerns that a presumptive initiation will result in decreased vaccine uptake over time. In separate work, O’Leary et al. explored the use of Motivational Interviewing (MI) to increase uptake of HPV vaccine recommended for adolescents. Motivational Interviewing is a patient-centered framework for behavior change that contains elements that are consistent with known communication preferences of VHPs regarding vaccines. O’Leary et al. found that provider use of MI in discussions with parents who resisted the HPV vaccine recommendation resulted in increased parental vaccine acceptance and improved provider perceptions of their ability to influence parental vaccine decision-making. In this proposal, O’Leary and Opel aim to combine these two techniques—the Presumptively Initiating Vaccines and Optimizing Talk with Motivational Interviewing (PIVOT with MI) intervention—to achieve increased vaccine uptake, high parent visit satisfaction, and improved provider confidence in the vaccine conversation. Our specific aims will be to (1) develop a multifaceted, feasible, and culturally appropriate PIVOT with MI intervention provider training program; (2) evaluate the impact of the PIVOT with MI intervention on child immunization status at 19 months of age by randomizing 24 primary care practices in 2 states (Washington and Colorado) to control or intervention arms using a cluster randomized design; and (3) evaluate the impact of the PIVOT with MI intervention on parent and provider experience.