Improving Vaccination Coverage Among Adolescents

描述（由申请人提供）：认识到青少年是几种疫苗可预防疾病的储存库，导致了一些专门针对这一人群的新疫苗建议。然而，“青少年疫苗纲要”的实施，包括破伤风-白喉-无细胞百日咳疫苗、脑膜炎球菌结合疫苗、人乳头瘤病毒4型疫苗（女性），迄今为止大大低于国家疫苗覆盖率目标。关于采取有效干预措施提高青少年人口疫苗接种覆盖率的数据很少。因此，我们广泛的长期研究目标是开发和评估干预措施，以提高这一人群的疫苗接种率。青少年疫苗接种的患者、父母和提供者的障碍和促进因素还没有得到很好的理解。这项建议的目的是进行形成性研究，以便更好地了解这些因素，然后利用这些信息来制定、实施和评估一项多组成部分的干预措施，以提高青少年的疫苗接种率。至少，干预措施将包括1）提醒/召回系统，提醒父母和提供者何时需要疫苗剂量，以及2）量身定制的教育网络工具，以改变父母对青少年疫苗的负面态度。这两个问题被认为是提高青少年疫苗利用率的主要障碍。本提案的四个目的是：1）确定密歇根州特定人群中青少年疫苗平台疫苗使用的基线使用水平以及与之相关的临床和个人特征; 2）评估目前阻碍该人群青少年疫苗使用的患者、父母和提供者障碍; 3）制定、实施和评估一项多要素干预措施，以提高这一人群中的青少年疫苗接种率; 4）根据我们干预措施的“经验教训”，开发一个青少年疫苗接种“工具包”。影响：我们的建议的预期成果是开发一种多成分干预措施，有效地提高青少年疫苗的利用率，并开发一种可用于在其他地方实施这些干预措施的供应商“工具包”。因为我们打算制定可以在各种环境中切实实施的干预措施，我们的干预措施可能会产生重大影响，因为它很容易扩展到更广泛和更大的人群，以提高青少年疫苗接种率。 公共卫生相关性：青少年疫苗利用不足是一个主要的公共卫生问题，因为它导致获得和传播疫苗可预防疾病的风险增加。我们提出的创新干预方法将能够改善已被证明的增加免疫接种的策略（即提醒/召回系统），并探索改善青少年疫苗接种的新方法（例如定制信息），这些方法已成功应用于其他预防性卫生保健行为，但尚未在青少年疫苗接种领域进行评估。我们的努力将转化为免疫接种提供者工具包，使我们的方法能够在更广泛的人群中实施，可能对青少年疫苗接种率产生重大影响。

DESCRIPTION (provided by applicant): Recognition that adolescents are a reservoir for several vaccine preventable diseases has led to a number of new vaccine recommendations specifically targeted to this population. However, implementation of the "adolescent platform" of vaccines, which includes the tetanus-diphtheria-acellular pertussis (Tdap), meningococcal conjugate (MCV4), human papillomavirus (HPV4) vaccines (for females) has thus far been substantially below national vaccine coverage goals. There is a paucity of data regarding effective interventions for improving vaccination coverage within the adolescent population. Our broad, long term research objective therefore is to develop and evaluate interventions to improve uptake of vaccines by this population. Patient, parent and provider barriers to, and facilitators of, adolescent vaccination are not well understood. The objectives of this proposal are to conduct formative research so as to better understand these factors, and then use this information to develop, implement and assess a multi-component intervention to improve adolescent vaccine uptake. At a minimum, the intervention will include 1) reminder/recall systems to alert parents and providers about when vaccine doses are needed, and 2) a tailored educational web-based tool to modify negative parental attitudes about adolescent vaccines. These two issues are believed to be major barriers to improving adolescent vaccine utilization. The four Aims of this proposal are: 1) To determine the baseline utilization levels of, and the clinical and personal characteristics associated with, vaccine utilization for the adolescent platform of vaccines among a defined population in Michigan; 2) To assess the patient, parent and provider barriers that currently hinder adolescent vaccine utilization in this population; 3) To develop, implement, and assess a multi-component intervention to improve adolescent vaccination rates within this population; and 4) To develop an adolescent vaccination "toolkit" that is based on "lessons learned" from our intervention. Impact: The expected outcome of our proposal is the development of a multi-component intervention that is effective at increasing adolescent vaccine utilization, and a provider "toolkit" that can be used to implement these interventions elsewhere. Because we intend to develop interventions that could be feasibly implemented in a variety of settings, our intervention could have a significant impact because it would be easily scaleable to broader and larger populations to improve adolescent vaccination rates. PUBLIC HEALTH RELEVANCE: Under-utilization of adolescent vaccines is a major public health concern because it leads to an increased risk of acquiring and transmitting vaccine preventable diseases. The innovative intervention approaches we propose will be able to improve upon proven strategies for increasing immunization (i.e. reminder/recall systems) and also explore novel methods for improving adolescent vaccine delivery (e.g. tailored messaging) that have been successfully applied to other preventive health care behaviors, but have not been evaluated in the realm of adolescent vaccination. Our efforts will be translated into an immunization provider toolkit which would enable our methods to be implemented in a much broader population, potentially having a substantial impact adolescent vaccination rates.