Increasing Child Immunization Rates via Improved Provider-Parent Communication

描述（由申请人提供）：父母对疫苗的接受程度已经下降，越来越多的父母要求从入学免疫法中获得非医疗豁免。由此造成的儿童免疫接种不足，导致可通过接种疫苗预防的疾病持续存在，每年有300名儿童死于这些疾病。儿科卫生保健提供者对父母的免疫决策有着至关重要的影响，并在提高和维持儿童免疫接种率方面发挥着重要作用。候选人Doug Opel，MD，MPH的长期目标是通过更好的提供者-父母沟通来提高儿童疫苗接种率。这一目标与医学研究所维持和提高免疫接种覆盖率的目标以及美国卫生与公众服务部2020年健康人的拟议目标一致，即增加报告其医疗保健提供者具有令人满意的沟通技能的人的比例。为了实现这一目标，欧宝博士将追求正式的课程，指导学习和体验式培训，以提高知识和技能，在三个具体领域：（1）设计，数据收集和分析的研究提供者-家长沟通;（2）科学，社会，政治，经济和监管方面的疫苗开发和管理;和（3） 行为改变理论和方法的干预设计，以改善供应商与父母的沟通。欧宝博士确定了一位具有免疫研究专业知识的主要导师（詹姆斯·泰勒博士）和3位在医患沟通、卫生服务和生物伦理学研究方面具有经验和熟练程度的共同导师（托马斯·加拉格尔博士、丽塔·曼吉奥内-史密斯博士和黛安·马丁博士）。他们都在华盛顿大学的西雅图工作。欧宝将与泰勒博士每周一次，以确保充分的接触，并与所有4个我的导师一起每月，使他们能够评估和支持我的进步。额外的指导将由8名顾问提供，这些顾问具有与拟议研究计划相关的方法学或专题专业知识，包括儿科传染病，生物统计学，生物伦理学，行为科学，以及使用对话分析的定性技术来研究提供者与父母的沟通。欧宝博士提出了三个创新和连续的项目，在这个应用程序，建立在他的培训目标。每个项目都将有助于更好地理解特定的和可修改的提供者免疫接种沟通行为，这些行为既能有效地提高父母对儿童免疫接种的接受程度，又能作为提供者未来基于沟通的干预措施的一部分。本提案的具体目标是：（1）在儿科健康监督访视期间，对疫苗犹豫不决的父母描述关键提供者的免疫沟通行为;（2）开发和评估父母自我报告工具在识别提供者免疫沟通行为方面的有效性;和（3）进行疫苗的纵向前瞻性队列研究-犹豫不决的父母，以确定是否确定供应商的沟通行为预测随着时间的推移，父母的免疫接受。这项建议是新颖的，因为它涉及到录像带的方法应用到一个新的领域的健康传播研究，探索供应商的沟通行为随着时间的推移，而不仅仅是在一个单一的遭遇，并使用临床相关的结果，一个孩子的免疫状态，以确定什么是有效的沟通。由西雅图儿童研究所和华盛顿大学提供的优秀的研究环境，以及欧宝博士与两个招募和数据收集地点的牢固的现有关系--团体健康合作社和基于实践的研究网络，普吉特海湾儿科研究网络--将加强他的培训，促进他的项目目标。 博士欧宝是一名普通儿科医生，接受过卫生服务研究和生物伦理学方面的培训。在过去的2年里，他发表了7篇关于儿童免疫接种、沟通和生物伦理学的论文，并获得了几项赠款和合同，开始制定一项研究计划，旨在通过改善提供者与父母的沟通来降低父母儿童免疫接种拒绝率。该奖项将使欧宝博士几乎完全专注于他的培训和研究有关改善供应商与父母的沟通，并承诺至少75%的全职专业努力，他的职业发展计划和活动。此外，它将为他提供资金，作为R 01奖项的一部分，为提供者进行一项基于沟通的干预的随机对照试验，以增加他们与疫苗犹豫父母的有效沟通行为的使用。 公共卫生相关性：父母拒绝儿童免疫接种是一个重大的公共卫生问题。免疫不足的儿童感染和传播疫苗可预防疾病的风险增加。该项目的总体目标是通过识别有效提高父母对儿童免疫接种接受度的具体和可修改的提供者免疫接种沟通行为，改善提供者与父母的沟通。

DESCRIPTION (provided by applicant): Parental acceptance of vaccines has eroded and more parents are claiming nonmedical exemptions from school-entry immunization laws. The resultant under-immunization of children has contributed to the persistence of vaccine-preventable diseases that kill 300 children annually. Pediatric health care providers have a critical influence on parental immunization decision-making and play an important role in improving and sustaining childhood immunization rates. The long-term objective of the candidate, Doug Opel, MD, MPH, is to improve childhood vaccination rates through better provider-parent communication. This goal is consistent with the Institute of Medicine objective to sustain and improve immunization coverage rates as well as the US Department of Health and Human Services Healthy People 2020 proposed objective to increase the proportion of persons who report that their health care provider has satisfactory communication skills. To achieve this objective, Dr. Opel will pursue formal coursework, directed learning, and experiential training to improve knowledge and skills in three specific areas: (1) the design, data collection, and analysis of research on provider-parent communication; (2) the scientific, social, political, economic and regulatory aspects of vaccine development and administration; and (3) behavior change theory and approaches to the design of an intervention to improve provider-parent communication. Dr. Opel has identified a primary mentor with expertise in immunization research (Dr. James Taylor) and 3 co-mentors with experience and proficiency in research in provider-patient communication, health services, and bioethics (Drs. Thomas Gallagher, Rita Mangione-Smith, and Diane Martin). All are based in Seattle at the University of Washington. Dr. Opel will meet with Dr. Taylor weekly to ensure adequate contact and with all 4 of my mentors together monthly so they can assess and support my progress. Additional mentoring will be provided by 8 consultants with methodological or topical expertise relevant to the proposed research plan, including pediatric infectious disease, biostatistics, bioethics, behavioral science, and the use of the qualitative technique of conversation analysis to study provider-parent communication. Dr. Opel proposes three innovative and sequential projects in this application that build upon his training goals. Each project will contribute to an improved understanding of specific and modifiable provider immunization communication behaviors that are both effective in increasing parental acceptance of childhood immunizations and can be targeted as part of a future communication-based intervention for providers. The specific aims of this proposal are to: (1) characterize key provider immunization communication behaviors during pediatric health supervision visits with vaccine-hesitant parents; (2) develop and evaluate the validity of a parent self-report instrument in identifying provider immunization communication behaviors; and (3) conduct a longitudinal prospective cohort study of vaccine-hesitant parents to determine whether identified provider communication behaviors predict parental immunization acceptance over time. This proposal is novel because it involves the application of videotape methodology to a new area of health communication research, the exploration of provider communication behaviors over time and not just during a single encounter, and the use of a clinically relevant outcome-a child's immunization status-to determine what constitutes effective communication. The excellent research environments provided by Seattle Children's Research Institute and the University of Washington, as well as Dr. Opel's strong, existing relationships with 2 sites at which recruitment and data collection will occur-Group Health Cooperative and the practice-based research network, Puget Sound Pediatric Research Network-will enhance his training and facilitate his project goals. Dr. Opel is a general pediatrician with training in health services research and bioethics. He has published 7 papers in the last 2 years on the topics of childhood immunization, communication, and bioethics and has secured several grants and contracts to begin the development of a research program aimed at decreasing parental childhood immunization refusal rates by improving provider-parent communication. This award would allow Dr. Opel to focus almost exclusively on his training and research related to improving provider-parent communication and to commit at least 75% of full-time professional effort to his career development program and activities. In addition, it would prepare him to pursue funding as part of an R01 award to conduct a randomized controlled trial of a communication-based intervention for providers to increase their use of effective communication behaviors with vaccine-hesitant parents. PUBLIC HEALTH RELEVANCE: Parental refusal of childhood immunizations represents a significant public health problem. Underimmunized children are at increased risk for contracting and transmitting vaccine-preventable disease. The overall goal of this project is to improve provider communication with parents by identifying specific and modifiable provider immunization communication behaviors that are effective in increasing parental acceptance of childhood immunizations.