Investigating Behavioral Mechanisms and Efficacy of a Provider-Directed Intervention for HPV Vaccine Promotion in Real-World Dental Settings

项目摘要 人乳头瘤病毒（HPV）是美国口咽癌的主要原因。尽管安全和 HPV疫苗（HPV-V）的有效性，覆盖率远远低于其他常规青少年疫苗 2030年的健康人口目标是80%。在牙科就诊时推广HPV-V被视为一个主要机会， 预防口咽和其他癌症，但许多牙科提供者不舒服这样做，由于缺乏 知识和自我效能感，以及害怕损害医患关系。使用NIH Stage 以行为干预发展模式为指导，我们提出发展一个基于理论的 干预以解决牙科提供者对HPV-V促进的障碍，阐明干预的行为 机制，并测试干预在催化提供者HPV-V促进中的真实世界功效。的 干预措施将包括：1）提供者关于HPV/HPV-V的培训; 2）定制脚本，以帮助提供者 在UG 3阶段，我们将随机选择21名患者/父母/监护人， HealthPartners牙科集团诊所干预与常规护理（UC; n=~131提供者）。UG 3的目标是： 制定调查措施和试点测试提供者HPV-V宣传培训（目标1）和定制脚本（目标2）; 制定措施和方法，监测提供者对培训和干预活动的忠诚度（Aim 起草合规/研究文件并获得IRB/NIDCR批准（目标4）。在UH 3阶段， 我们将进行一项群集（诊所）随机临床试验（干预与UC），以测试 增加HPV-V促进活性的干预（目标5）。我们将评估干预是否 影响了三个预期的行为机制目标：增加HPV/HPV-V的知识;增加 HPV-V促进的自我效能;以及减少对HPV-V促进的负面影响患者的恐惧- 供应商关系（目标6）。对于每个目标，我们还将评估干预措施的效果是否随之而来 终点行为的完整机制途径，HPV-V促进（目的7）。超越我们的目标，我们将 开展探索性工作，检查另外两个候选行为机制：材料的充足性 支持牙科提供者促进HPV-V的资源，以及提供者认为HPV-V促进 符合他们的职业身份。我们还将对干预措施进行探索性分析， 增加HPV-V摄取的有效性（访视后30天患者疫苗接种率）。我们的长期目标是 通过牙科服务提供者的HPV-V宣传，降低HPV和口咽癌的患病率。显著 该项目的影响包括：1）开发了第一个基于HPV-V促进的行为干预理论 针对牙科提供者; 2）提供此类干预的真实世界疗效的第一个证据; 3） 阐明了据称是供应商行为改变的基础的行为机制; 4）产生基本的 知识，以指导未来的HPV-V促进干预发展;和5）推进科学， 通过揭示供应商行为变化背后的行为原则来改变行为。

Project Summary Human papillomavirus (HPV) is the leading cause of oropharyngeal cancers in the US. Despite the safety and effectiveness of the HPV vaccine (HPV-V), coverage is far below that for other routine adolescent vaccines and the Healthy People 2030 goal of 80%. HPV-V promotion at dental visits is seen as a prime opportunity to prevent oropharyngeal and other cancers, yet many dental providers are not comfortable doing so due to lack of knowledge and self-efficacy, and fear of harming the patient-provider relationship. Using the NIH Stage Model of Behavioral Intervention Development as our guide, we propose to develop a theory-based intervention to address dental provider barriers to HPV-V promotion, elucidate the intervention's behavioral mechanisms, and test the real-world efficacy of the intervention in catalyzing provider HPV-V promotion. The intervention will consist of 1) provider training about HPV/HPV-V; 2) tailored scripts to aid providers in responding to patient/parent/guardian concerns about HPV-V. During the UG3 phase, we will randomize 21 HealthPartners Dental Group clinics to intervention vs. usual care (UC; n=~131 providers). UG3 aims are to: develop survey measures and pilot-test provider HPV-V promotion training (Aim 1) and tailored scripts (Aim 2); develop measures and methods for monitoring provider fidelity to the training and intervention activities (Aim 3); and draft compliance/study documents and obtain IRB/NIDCR approvals (Aim 4). During the UH3 phase, we will conduct a cluster (clinic)-randomized clinical trial (intervention vs. UC) to test the real-world efficacy of the intervention to increase HPV-V promotion activity (Aim 5). We will assess whether the intervention impacted the three intended behavioral mechanism targets: increased knowledge of HPV/HPV-V; increased self-efficacy for HPV-V promotion; and reduced fear of HPV-V promotion negatively affecting the patient- provider relationship (Aim 6). For each target, we will also assess whether the intervention's effects followed the full mechanistic pathway to the endpoint behavior, HPV-V promotion (Aim 7). Beyond our aims, we will conduct exploratory work examining two additional candidate behavioral mechanisms: adequacy of material resources to support dental providers in promoting HPV-V, and providers' perception that HPV-V promotion comports with their professional identity. We will also conduct an exploratory analysis of the intervention's efficacy in increasing HPV-V uptake (30-day post-visit patient vaccination rates). Our long-term goal is to reduce HPV and oropharyngeal cancer prevalence through HPV-V promotion by dental providers. Significant impact of the project includes: 1) developing the first theory-based behavioral intervention for HPV-V promotion aimed at dental providers; 2) delivering the first evidence of real-world efficacy of such an intervention; 3) illuminating behavioral mechanisms purported to underlie provider behavior change; 4) producing fundamental knowledge to guide future HPV-V promotion intervention development; and 5) advancing the science of behavior change by revealing behavioral principles underlying provider behavior change.