Evaluating the Feasibility of a Mobile Coaching Intervention to Improve HPV Vaccine Delivery

项目摘要 广泛的人乳头瘤病毒（HPV）疫苗接种可以预防大多数HPV相关的癌症， 每年影响美国（US）超过40，000人。尽管有这种潜在的好处，HPV疫苗 青少年的覆盖率仍然很低。到2017年，只有不到一半（39%）的13岁儿童完成了 2-剂量系列。针对低覆盖率的研究表明，针对提供者的多层次干预措施， 父母沟通和临床环境可能特别有效。干预策略 包括沟通培训，以改善医疗保健提供者的HPV疫苗建议，以及 评估和反馈诊所的HPV疫苗覆盖率。然而，在真实的中实施这些策略- 世界临床环境仍然具有挑战性，部分原因是现有的干预措施受到其 依赖繁琐的小组会议。需要采取新的办法， 提供者需要的培训和持续数据，以采用和维持与疫苗相关的实践改进。 为了满足这一需求，拟议的研究将加强和评估Up 2Date，一个现有的，理论- 知情的移动的指导干预，以改善HPV疫苗的接种。Up 2Date由一个简短的- 为医疗团队提供诊所培训，然后通过移动的为提供者提供为期12周的个性化辅导 应用程序（app）。具体而言，该应用程序支持持续评估和量身定制的反馈，旨在改善 提供者如何推荐HPV疫苗并解决父母的担忧，使用研究测试的图书馆 充分和传播在目标1中，我们将增强Up 2Date，以包括诊所HPV疫苗覆盖率的仪表板， 可用于设定和跟踪共同的改进目标。这样做，我们将创建一个多层次的移动的 平台，以支持提供者层面和诊所层面的评估和反馈，以改善HPV疫苗接种。 在目标2中，我们将通过向20个儿科提供者提供我们的干预来评估Up 2Date的可行性 在初级保健诊所，HPV疫苗覆盖率低于全国平均水平。我们将评估前/后 与临床水平环境以及提供者水平认知相关的中间结果的变化 和行为。我们假设提供者的整体推荐质量将在基线之间增加， 和12周的随访。我们还将对我们的长期、家庭水平的结果进行有限的疗效测试： 青少年的HPV疫苗覆盖率和父母对护理的满意度。最后，我们将评估过程 措施，包括我们干预的可接受性和要求。这些分析将使用定性 以及来自调查、访谈、应用分析和电子健康记录的定量数据。 拟议的研究是建立在一个成熟的小组的工作，以评估一个 创新的、多层次的移动的辅导干预。本可行性研究的结果将产生效应量 为将来的随机对照试验提供信息，以测试移动的指导的有效性。如果成功，我们 干预将提高HPV疫苗的覆盖率，并保护青少年免受未来HPV相关癌症的侵害。

PROJECT SUMMARY Widespread human papillomavirus (HPV) vaccination could prevent most HPV-related cancers, which affect over 40,000 people in the United States (US) each year. Despite this potential benefit, HPV vaccine coverage among adolescents remains low. By 2017, fewer than half (39%) of 13-year-olds had completed the 2-dose series. Research to address low coverage suggests that multi-level interventions targeting provider- parent communication and clinical environments may be especially effective. Proven intervention strategies include communication training to improve healthcare providers’ HPV vaccine recommendations, as well as assessment and feedback on clinics’ HPV vaccine coverage. However, implementing these strategies in real- world clinical settings remains challenging, in part because existing interventions are constrained by their reliance on burdensome group-based meetings. New approaches are needed to deliver the comprehensive training and ongoing data that providers require to adopt and sustain vaccine-related practice improvements. To address this need, the proposed study will enhance and evaluate Up2Date, an existing, theory- informed mobile coaching intervention to improve the delivery of HPV vaccine. Up2Date consists of a brief in- clinic training for healthcare teams, followed by 12 weeks of individualized coaching for providers via a mobile application (app). Specifically, the app supports ongoing assessment and tailored feedback aimed at improving how providers recommend HPV vaccine and address parents’ concerns, using a library of research-tested messages. In Aim 1, we will enhance Up2Date to include a dashboard of clinics’ HPV vaccine coverage that can be used to set and track shared goals for improvement. In doing so, we will create a multi-level mobile platform to support both provider-level and clinic-level assessment and feedback to improve HPV vaccination. In Aim 2, we will evaluate the feasibility of Up2Date by delivering our intervention to 20 pediatric providers in primary care clinics with HPV vaccine coverage below the national average. We will assess pre/post changes in intermediate outcomes related to clinic-level environments as well as provider-level cognitions and behaviors. We hypothesize that providers’ overall recommendation quality will increase between baseline and 12-week follow up. We will also conduct limited efficacy testing of our long-term, family-level outcomes: adolescents’ HPV vaccine coverage and parents’ satisfaction with care. Finally, we will assess process measures, including the acceptability of and demand for our intervention. These analyses will use qualitative and quantitative data from surveys, interviews, app analytics, and electronic health records. The proposed study builds on the work of a well-established team to evaluate the feasibility of an innovative, multi-level mobile coaching intervention. Results from this feasibility study will generate effect sizes to inform a future randomized controlled trial to test the effectiveness of mobile coaching. If successful, our intervention will improve HPV vaccine coverage and protect adolescents from future HPV-related cancers.