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Ou L, Chen ACC, Amresh A. The Effectiveness of mHealth Interventions Targeting Parents and Youth in Human Papillomavirus Vaccination: Systematic Review. JMIR Pediatr Parent 2023; 6:e47334. [PMID: 37988155 PMCID: PMC10698656 DOI: 10.2196/47334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 09/18/2023] [Accepted: 10/12/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The prevalence of human papillomavirus (HPV) and its related cancers is a major global concern. In the United States, routine HPV vaccination is recommended for youth aged 11 or 12 years. Despite HPV being the most common sexually transmitted infection and the vaccine's proven efficacy, the vaccination rate among US youth remains below the recommended 80% completion rate. Mobile health (mHealth) interventions have demonstrated promise in improving health. Examining and synthesizing the current evidence about the impact of mHealth interventions on vaccination coverage in youth and intervention characteristics could guide future mHealth interventions aimed at mitigating the vaccination gap and disease burden. OBJECTIVE This study aims to conduct a systematic review to assess the effectiveness of mHealth interventions on parental intent to vaccinate youth against HPV and youth's vaccine uptake. METHODS We searched empirical papers through databases including Google Scholar, PubMed, CINAHL, PsycINFO, and Cochrane Library. The inclusion criteria were the following: (1) published between January 2011 and December 2022; (2) using mHealth aimed to improve HPV vaccination rate; (3) targeted unvaccinated youth or their parents; and (4) measured HPV-related knowledge, vaccination intention, or vaccine uptake. Overall, 3 researchers screened and appraised the quality of the eligible papers using the Melnyk Levels of Evidence and the Cochrane Grading of Recommendations Assessment, Development, and Evaluation methodology. Disagreements in search results and result interpretation were resolved through consensus. RESULTS Overall, 17 studies that met the inclusion criteria were included in the final review. Most studies were conducted in the United States (14/17, 82%), used a randomized controlled trial design (12/17, 71%), and adopted behavior change theories or a culture-centric approach (10/17, 59%). mHealth interventions included SMS text message reminders, motivational SMS text messages, computer-tailored or tablet-tailored interventions, smartphone apps, web-based tailored interventions, social media (Facebook) campaigns, digital videos, and digital storytelling interventions. Approximately 88% (15/17) of the mHealth interventions demonstrated positive effects on knowledge, intention, or behaviors related to HPV vaccination. Overall, 12% (2/17) reported limited or no intervention impact on vaccine uptake or vaccine series completion. Effective vaccine uptake was commonly seen in interventions based on behavior change theories and those that provided culturally relevant information. CONCLUSIONS This systematic review identified the impact of mHealth interventions among unvaccinated youth and their parents, which showed improvement in HPV-related knowledge, vaccination intention, or vaccine initiation. The interventions that incorporated theories and culture-centric approaches revealed the most promising results. Although these outcomes are encouraging, future studies are needed to investigate factors associated with the success of interventions using SMS text messaging or social media. More studies are also needed for a better understanding of the intervention elements that boost the responses of age-specific and ethnicity-specific populations.
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Affiliation(s)
- Lihong Ou
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | | | - Ashish Amresh
- College of Engineering, Informatics, and Applied Sciences, Northern Arizona University, Flagstaff, AZ, United States
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Chandeying N, Thongseiratch T. Systematic review and meta-analysis comparing educational and reminder digital interventions for promoting HPV vaccination uptake. NPJ Digit Med 2023; 6:162. [PMID: 37644090 PMCID: PMC10465590 DOI: 10.1038/s41746-023-00912-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
Global Human papillomavirus (HPV) vaccination rates remain low despite available WHO-approved vaccines. Digital interventions for promoting vaccination uptake offer a scalable and accessible solution to this issue. Here we report a systematic review and meta-analysis examining the efficacy of digital interventions, comparing educational and reminder approaches, for promoting HPV vaccination uptake (HVU). This study also identifies factors influencing the effectiveness of these interventions. We searched PubMed, PsycInfo, Web of Science, and the Cochrane Library from each database's inception to January 2023. Three raters independently evaluate the studies using a systematic and blinded method for resolving disagreements. From 1929 references, 34 unique studies (281,280 unique participants) have sufficient data. Client reminder (OR, 1.41; 95% CI, 1.23-1.63; P < 0.001), provider reminder (OR, 1.39; 95% CI, 1.11-1.75; P = 0.005), provider education (OR, 1.18; 95% CI, 1.05-1.34; P = 0.007), and client education plus reminder interventions (OR, 1.29; 95% CI, 1.04-1.59; P = 0.007) increase HVU, whereas client education interventions do not (OR, 1.08; 95% CI, 0.92-1.28; P = 0.35). Digital intervention effectiveness varies based on participants' gender and the digital platform used. Interventions targeting male or mixed-gender participants demonstrate greater benefit, and reminder platforms (SMS, preference reminders, or electronic health record alerts) are more effective in increasing HVU. Digital interventions, particularly client and provider reminders, along with provider education, prove significantly more effective than client education alone. Incorporating digital interventions into healthcare systems can effectively promote HPV vaccination uptake. Reminder interventions should be prioritized for promoting HVU.
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Affiliation(s)
- Nutthaporn Chandeying
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Therdpong Thongseiratch
- Child Development Unit, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
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Wynn CS, Fiks AG, Localio R, Shults J, Nekrasova E, Shone LP, Torres A, Griffith M, Unger R, Ware LA, Kelly MK, Stockwell MS. Examination of Text Message Plans and Baseline Usage of Families Enrolled in a Text Message Influenza Vaccine Reminder Trial: Survey Study. JMIR Form Res 2023; 7:e39576. [PMID: 37389945 PMCID: PMC10365607 DOI: 10.2196/39576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) is quickly expanding as a method of health promotion, but some interventions may not be familiar or comfortable for potential users. SMS text messaging has been investigated as a low-cost, accessible way to provide vaccine reminders. Most (97%) US adults own a cellphone and of those adults most use SMS text messaging. However, understanding patterns of SMS text message plan type and use in diverse primary care populations needs more investigation. OBJECTIVE We sought to use a survey to examine baseline SMS text messaging and data plan patterns among families willing to accept SMS text message vaccine reminders. METHODS As part of a National Institutes of Health (NIH)-funded national study (Flu2Text) conducted during the 2017-2018 and 2018-2019 influenza seasons, families of children needing a second seasonal influenza vaccine dose were recruited in pediatric primary care offices at the time of their first dose. Practices were from the American Academy of Pediatrics' (AAP) Pediatric Research in Office Settings (PROS) research network, the Children's Hospital of Philadelphia, and Columbia University. A survey was administered via telephone (Season 1) or electronically (Season 2) at enrollment. Standardized (adjusted) proportions for SMS text message plan type and texting frequency were calculated using logistic regression that was adjusted for child and caregiver demographics. RESULTS Responses were collected from 1439 participants (69% of enrolled). The mean caregiver age was 32 (SD 6) years, and most children (n=1355, 94.2%) were aged 6-23 months. Most (n=1357, 94.3%) families were English-speaking. Most (n=1331, 92.8%) but not all participants had an unlimited SMS text messaging plan and sent or received texts at least once daily (n=1313, 91.5%). SMS text messaging plan type and use at baseline was uniform across most but not all subgroups. However, there were some differences in the study population's SMS text messaging plan type and usage. Caregivers who wanted Spanish SMS text messages were less likely than those who chose English to have an unlimited SMS text messaging plan (n=61, 86.7% vs n=1270, 94%; risk difference -7.2%, 95% CI -27.1 to -1.8). There were no significant differences in having an unlimited plan associated with child's race, ethnicity, age, health status, insurance type, or caregiver education level. SMS text messaging use at baseline was not uniform across all subgroups. Nearly three-quarters (n=1030, 71.9%) of participants had received some form of SMS text message from their doctor's office; most common were appointment reminders (n=1014, 98.4%), prescription (n=300, 29.1%), and laboratory notifications (n=117, 11.4%). Even the majority (n=64, 61.5%) of those who did not have unlimited plans and who texted less than daily (n=72, 59%) reported receipt of these SMS text messages. CONCLUSIONS In this study, most participants had access to unlimited SMS text messaging plans and texted at least once daily. However, infrequent texting and lack of access to an unlimited SMS text messaging plan did not preclude enrolling to receive SMS text message reminders in pediatric primary care settings.
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Affiliation(s)
- Chelsea S Wynn
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Alexander G Fiks
- Department of Pediatrics, Clinical Futures & PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Russell Localio
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Justine Shults
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Ekaterina Nekrasova
- Department of Pediatrics, Clinical Futures & PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Laura P Shone
- Primary Care Research, American Academy of Pediatrics, Itasca, IL, United States
| | - Alessandra Torres
- Primary Care Research, American Academy of Pediatrics, Itasca, IL, United States
| | - Miranda Griffith
- Primary Care Research, American Academy of Pediatrics, Itasca, IL, United States
| | - Rebecca Unger
- Northwestern Children's Practice, Chicago, IL, United States
| | - Leigh Ann Ware
- Building Blocks Pediatrics, Pleasanton, TX, United States
| | - Mary Kate Kelly
- Department of Pediatrics, Clinical Futures & PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, United States
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Hanley K, Chung TH, Nguyen LK, Amadi T, Stansberry S, Yetman RJ, Foxhall LE, Bello R, Diallo T, Le YCL. Using Electronic Reminders to Improve Human Papillomavirus (HPV) Vaccinations among Primary Care Patients. Vaccines (Basel) 2023; 11:vaccines11040872. [PMID: 37112784 PMCID: PMC10145812 DOI: 10.3390/vaccines11040872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
The COVID-19 pandemic led to delays in routine preventative primary care and declines in HPV immunization rates. Providers and healthcare organizations needed to explore new ways to engage individuals to resume preventive care behaviors. Thus, we evaluated the effectiveness of using customized electronic reminders with provider recommendations for HPV vaccination to increase HPV vaccinations among adolescents and young adults, ages 9-25. Using stratified randomization, participants were divided into two groups: usual care (control) (N = 3703) and intervention (N = 3705). The control group received usual care including in-person provider recommendations, visual reminders in exam waiting rooms, bundling of vaccinations, and phone call reminders. The intervention group received usual care and an electronic reminder (SMS, email or patient portal message) at least once, and up to three times (spaced at an interval of 1 reminder per month). The intervention group had a 17% statistically significantly higher odds of uptake of additional HPV vaccinations than the usual care group (Adjusted Odds Ratio: 1.17, 95% CI: 1.01-1.36). This work supports previous findings that electronic reminders are effective at increasing immunizations and potentially decreasing healthcare costs for the treatment of HPV-related cancers.
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Affiliation(s)
- Kathleen Hanley
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Tong Han Chung
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Linh K Nguyen
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Tochi Amadi
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Sandra Stansberry
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Robert J Yetman
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Lewis E Foxhall
- Office of Health Policy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Rosalind Bello
- Office of Health Policy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The HPV Vaccination Initiative, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Talhatou Diallo
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Yen-Chi L Le
- Department of Healthcare Transformation Initiatives, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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Glenn BA, Crespi CM, Herrmann AK, Nonzee NJ, Rosen DL, Park CL, Johnson G, Chang LC, Singhal R, Taylor VM, Bastani R. Effectiveness and feasibility of three types of parent reminders to increase adolescent human papillomavirus (HPV) vaccination. Prev Med 2023; 169:107448. [PMID: 36773962 DOI: 10.1016/j.ypmed.2023.107448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/17/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023]
Abstract
Parent reminders have produced modest improvements in human papillomavirus (HPV) vaccination among adolescents. However, little prior research has compared the effectiveness and feasibility of different HPV reminder types in resource-limited settings. We conducted a quasi-experimental study (2016-2017) to evaluate the effectiveness of three parent reminder types (mailed letters, robocalls, text messages) on next-dose HPV vaccine receipt among 12-year-olds in a large Federally Qualified Health Center in Los Angeles County. Six clinics were matched into three pairs: randomly assigning one clinic within each pair to intervention and control. Intervention clinics were randomly assigned to deliver one of the three parent reminder types. We calculated rates of next-dose vaccine receipt and assessed intervention effects using logistic regression models. We calculated the proportion of each type of reminder successfully delivered as a feasibility measure. The study sample comprised 877 12-year-olds due for an HPV vaccine dose (47% female, >85% Latino). At 4-month follow-up, 23% of intervention patients received an HPV vaccine dose compared to only 12% of control patients. Overall, receipt of any reminder increased rates of the next-needed HPV vaccine compared to usual care (p = 0.046). Significant improvements were observed for text reminders (p = 0.036) and boys (p = 0.006). Robocalls were the least feasible reminder type. Text message reminders are feasible and effective for promoting HPV vaccination. Future research is needed to assess the effectiveness and feasibility of reminders compared to other vaccine promotion strategies.
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Affiliation(s)
- Beth A Glenn
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, 650 Charles E Young Dr. S, Los Angeles, CA 90095-6900, USA.
| | - Catherine M Crespi
- UCLA Center for Cancer Prevention and Control Research, Department of Biostatistics, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Dr. South, Los Angeles, CA 90095-6900, USA.
| | - Alison K Herrmann
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, 650 Charles E Young Dr. S, Los Angeles, CA 90095-6900, USA.
| | - Narissa J Nonzee
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, 650 Charles E Young Dr. S, Los Angeles, CA 90095-6900, USA.
| | - Debra L Rosen
- Northeast Valley Health Corporation, San Fernando Health Center, 1600 San Fernando Rd, San Fernando, CA 91340, USA.
| | - Christine L Park
- Northeast Valley Health Corporation, San Fernando Health Center, 1600 San Fernando Rd, San Fernando, CA 91340, USA.
| | - Gina Johnson
- Northeast Valley Health Corporation, San Fernando Health Center, 1600 San Fernando Rd, San Fernando, CA 91340, USA.
| | - L Cindy Chang
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, 650 Charles E Young Dr. S, Los Angeles, CA 90095-6900, USA.
| | - Rita Singhal
- Disease Control Bureau, Los Angeles County Department of Public Health, 2615 S Grand Ave #500, Los Angeles, CA 90007, USA.
| | - Victoria M Taylor
- Department of Health Services, University of Washington School of Public Health and Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA..
| | - Roshan Bastani
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, 650 Charles E Young Dr. S, Los Angeles, CA 90095-6900, USA.
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Currie GE, Totterdell J, Bowland G, Leeb A, Peters I, Blyth CC, Waddington C, Marsh JA, Snelling TL. The AuTOMATIC trial: a study protocol for a multi-arm Bayesian adaptive randomised controlled trial of text messaging to improve childhood immunisation coverage. Trials 2023; 24:97. [PMID: 36750833 PMCID: PMC9904255 DOI: 10.1186/s13063-023-07097-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/17/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND While most Australian children are vaccinated, delays in vaccination can put them at risk from preventable infections. Widespread mobile phone ownership in Australia could allow automated short message service (SMS) reminders to be used as a low-cost strategy to effectively 'nudge' parents towards vaccinating their children on time. METHODS AuTOMATIC is an adaptive randomised trial which aims to both evaluate and optimise the use of SMS reminders for improving the timely vaccination of children at primary care clinics across Australia. The trial will utilise high levels of digital automation to effect, including eligibility assessment, randomisation, delivery of intervention, data extraction and analysis, thereby allowing healthcare-embedded trial delivery. Up to 10,000 parents attending participating primary care clinics will be randomised to one of 12 different active SMS vaccine reminder content and timing arms or usual practice only (no SMS reminder). The primary outcome is vaccine receipt within 28 days of the scheduled date for the index vaccine (the first scheduled vaccine after randomisation). Secondary analyses will assess receipt and timeliness for all vaccine occasions in all children. Regular scheduled analyses will be performed using Bayesian inference and pre-specified trial decision rules, enabling response adaptive randomisation, suspension of any poorly performing arms and early stopping if a single best message is identified. DISCUSSION This study will aim to optimise SMS reminders for childhood vaccination in primary care clinics, directly comparing alternative message framing and message timing. We anticipate that the trial will be an exemplar in using Bayesian adaptive methodology to assess a readily implementable strategy in a wide population, capable of delivery due to the levels of digital automation. Methods and findings from this study will help to inform strategies for implementing reminders and embedding analytics in primary health care settings. TRIAL REGISTRATION ANZCTR: ACTRN12618000789268 .
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Affiliation(s)
- Grace E. Currie
- grid.414659.b0000 0000 8828 1230Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA Australia ,grid.1013.30000 0004 1936 834XSchool of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006 Australia
| | - James Totterdell
- grid.414659.b0000 0000 8828 1230Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA Australia ,grid.1013.30000 0004 1936 834XSchool of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006 Australia
| | - Grahame Bowland
- grid.414659.b0000 0000 8828 1230Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA Australia
| | - Alan Leeb
- SmartVax, c/o Illawarra Medical Centre, Perth, WA Australia
| | - Ian Peters
- SmartVax, c/o Illawarra Medical Centre, Perth, WA Australia
| | - Chris C. Blyth
- grid.414659.b0000 0000 8828 1230Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA Australia ,grid.410667.20000 0004 0625 8600Department of Infectious Diseases, Perth Children’s Hospital, Perth, WA Australia ,grid.1012.20000 0004 1936 7910School of Medicine, University of Western Australia, Perth, WA Australia
| | - Claire Waddington
- grid.5335.00000000121885934Department of Medicine, University of Cambridge, Cambridge, UK
| | - Julie A. Marsh
- grid.414659.b0000 0000 8828 1230Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA Australia
| | - Thomas L. Snelling
- grid.414659.b0000 0000 8828 1230Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA Australia ,grid.1013.30000 0004 1936 834XSchool of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006 Australia ,grid.410667.20000 0004 0625 8600Department of Infectious Diseases, Perth Children’s Hospital, Perth, WA Australia ,grid.1032.00000 0004 0375 4078School of Public Health, Curtin University, Perth, WA Australia ,Menzies School of Public Health, Darwin, NT Australia
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Gatwood J, Brookhart A, Kinney O, Hagemann T, Chiu CY, Ramachandran S, Gravlee E, Hohmeier K. Impact of patient and provider nudges on addressing herpes zoster vaccine series completion. Vaccine 2023; 41:778-786. [PMID: 36526504 DOI: 10.1016/j.vaccine.2022.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To determine the combined impact of provider-facing and text message-based, patient nudges on herpes zoster vaccine series completion. METHODS Following a period during which Kroger Health implemented provider facing nudges, select US patients that initiated herpes zoster vaccination were randomized to receive timed text messages when the second dose was due and available as part of a quality improvement exercise. Main comparisons were between patients intervened by provider nudge only and those intervened by both provider and patient nudges. Data were assessed by GEE-basedlogistic and linear regression, controlling for available patient- and store-level characteristics, and geospatial analyses. RESULTS During the baseline period, 100,627 adults received at least one HZ vaccine dose and 83.9% completed the series within 6 months over 88.6 days (SD: 26.53) on average. In the intervention period, 120,339 adults were vaccinated at least once and series completion was 88.3% (both provider nudges and text messaging) and 85.3% (not texted) during this observation window (both p < 0.0001). Time between doses was shorter for those who received text messages compared to both the baseline period and those in the intervention period that were not texted (both p < 0.001). Controlling for multiple characteristics, the odds of completion improved in the intervention period compared to baseline (OR: 1.07; 95% CI: 1.033-1.111), but a noticeably higher completion odds was observed amongst patients who received a text message in the intervention period (OR: 1.35; 95% CI: 1.286-1.414). Adjusting for patient and pharmacy factors, those who were texted received their second herpes zoster vaccine dose 8.6 days sooner (95% CI: -9.08 - -8.17, p < 0.0001) compared to those intervened by the provider nudge only. CONCLUSION The combined use of clinical and patient-focused nudges is a simple mechanism by which pharmacies and other health care access points can address the multi-dose vaccine needs of diverse patient populations.
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Affiliation(s)
- Justin Gatwood
- University of Tennessee Health Science Center, College of Pharmacy, 301 S. Perimeter Park Drive, Nashville, TN 37211, USA.
| | | | - Olivia Kinney
- Kroger Health, 555 Race Street, Cincinnati, OH 45202, USA
| | - Tracy Hagemann
- University of Tennessee Health Science Center, College of Pharmacy, 301 S. Perimeter Park Drive, Nashville, TN 37211, USA
| | - Chi-Yang Chiu
- University of Tennessee Health Science Center, College of Medicine, Doctor's Office Building, Memphis, TN 38163, USA
| | - Sujith Ramachandran
- University of Mississippi, School of Pharmacy, P.O. Box 1848, Oxford, MS 38677, USA
| | - Emily Gravlee
- University of Mississippi, School of Pharmacy, P.O. Box 1848, Oxford, MS 38677, USA
| | - Kenneth Hohmeier
- University of Tennessee Health Science Center, College of Pharmacy, 301 S. Perimeter Park Drive, Nashville, TN 37211, USA
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Düzgün MV, İşler Dalgıç A. The Effect of Interventions on the Prevention of Parental Vaccine Refusal and Hesitancy: A Systematic Review and Meta-analysis of Randomized Controlled Trials. GÜNCEL PEDIATRI 2022. [DOI: 10.4274/jcp.2022.13334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Rosa SDSRF, da Silva AKA, dos Santos CR, Silva MDS, Perillo ALP, Mendonça AF, Rosa MFF, Sampaio TL, Carneiro MLB, Rocha JCT, Piratelli-Filho A, de Oliveira AL. Effects of vaccine registration on disease prophylaxis: a systematic review. Biomed Eng Online 2022; 21:84. [PMID: 36463207 PMCID: PMC9719654 DOI: 10.1186/s12938-022-01053-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/27/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND The impact of the pandemic caused by the coronavirus (SARS-CoV-2), causing the disease COVID-19, has brought losses to the world in terms of deaths, economic and health problems. The expected return of the public to activities adapted to the new health situation led to discussions about the use of vaccination and its effects. However, the demand for proof of vaccination showed how inconsistent, unregistered, and uncontrolled this health process is with current technologies. Despite the proven effectiveness of vaccines in reducing infection rates, mortality, and morbidity, there are still doubts about their use in preventing certain infections and injuries, as well as the use of digital medical records for identification at public events and disease prevention. Therefore, this review aims to analyze the use of digital immunization cards in disease prevention in general. METHODS A systematic review of Science, PubMed/MEDLINE, LILACS /BSV, CINALH, and IEEE and Xplore was performed using PRISMA guidelines. The authors summarized the studies conducted over the last decade on the impacts of prophylaxis by control through immunization cards. Studies were selected using the following terms: Vaccination; Mobile Applications; Health Smarts Cards; Immunization Programs; Vaccination Coverage. For data analysis, we used Mendeley, Excel, RStudio, and Bibliometrix software among others. RESULTS A total of 1828 publications were found. After applying eligibility criteria (Articles published in Portuguese, Spanish or English in the last 10 years). Studies that only dealt with paper or physical records were excluded, as well as studies that were not linked to their country's health Department, as a possibility of bias exists with these types of information). After removing duplicates and applying filters 1 and 2, we included 18 studies in this review. This resulted in 18 papers that met our priori inclusion criteria; it was found that the most relevant sources were from the databases of the Institute of Electrical and Electronics Engineers (IEEE). CONCLUSIONS Considering the selected studies, we found that scientific evidence and epidemiological surveillance are essential tools to characterize the efficiency and effectiveness of immunization passport protection intervention and to ethically justify them. Technological development of digital vaccine passports can assist in vaccination programs and positively impact disease prophylaxis.
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Affiliation(s)
- Suelia de Siqueira Rodrigues Fleury Rosa
- grid.7632.00000 0001 2238 5157Biomedical Engineering Program at Faculty of Gama, University of Brasília, Brasília, DF Brazil ,grid.7632.00000 0001 2238 5157Mechatronic Systems Program, at Mechanical Engineering Department, University of Brasília, Brasília, DF Brazil
| | - Ana Karoline Almeida da Silva
- grid.7632.00000 0001 2238 5157Graduate Program in Medical Sciences, Faculty of Medicine, University of Brasília, Brasília, DF Brazil
| | - Carolina Ramos dos Santos
- grid.7632.00000 0001 2238 5157Biomedical Engineering Program at Faculty of Gama, University of Brasília, Brasília, DF Brazil
| | - Mayla dos Santos Silva
- grid.7632.00000 0001 2238 5157Mechatronic Systems Program, at Mechanical Engineering Department, University of Brasília, Brasília, DF Brazil
| | | | | | - Mario Fabrício Fleury Rosa
- grid.7632.00000 0001 2238 5157Biomedical Engineering Program at Faculty of Gama, University of Brasília, Brasília, DF Brazil
| | | | - Marcella Lemos Brettas Carneiro
- grid.7632.00000 0001 2238 5157Biomedical Engineering Program at Faculty of Gama, University of Brasília, Brasília, DF Brazil
| | - José Carlos Tatmatsu Rocha
- grid.7632.00000 0001 2238 5157Biomedical Engineering Program at Faculty of Gama, University of Brasília, Brasília, DF Brazil ,Center for Research and Technological Innovations in Human Rehabilitation – INOVAFISIO, University Federal of Ceará, Fortaleza, Ceará Brazil
| | - Antônio Piratelli-Filho
- grid.7632.00000 0001 2238 5157Mechatronic Systems Program, at Mechanical Engineering Department, University of Brasília, Brasília, DF Brazil
| | - Allisson Lopes de Oliveira
- grid.7632.00000 0001 2238 5157Mechatronic Systems Program, at Mechanical Engineering Department, University of Brasília, Brasília, DF Brazil ,Federal Institute of Education, Science and Technology, Brasília, DF Brazil
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10
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Khuwaja SS, Peck JL. Increasing HPV Vaccination Rates Using Text Reminders: An Integrative Review of the Literature. J Pediatr Health Care 2022; 36:310-320. [PMID: 35288016 DOI: 10.1016/j.pedhc.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Human papillomavirus (HPV) is the most common sexually transmitted infection among youth in the United States. Although HPV vaccinations are readily available, HPV immunizations remain lower than target rates. The purpose of this review is to consider text message reminder system efficacy to improve HPV vaccination rates in eligible children. METHOD A literature review was conducted using Cumulative Index to Nursing and Allied Health Literature and PubMed databases to search articles illustrating the effect of text message reminder systems. RESULTS Research is primarily conclusive of improved HPV vaccination rates through text message reminder systems, indicating the need for practice guidelines directed at text message delivery and text message content. DISCUSSION This integrative review synthesizes and highlights available literature on implementing text message reminder systems to improve HPV vaccination rates. Once the text message reminder system is in place, automatic arrangement of preventive care service is hassle-free for practices.
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11
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Chow EPF, Phillips TR, Bowesman H, Ong JJ, Tran J, Aung ET, Chen MY, Fairley CK. Human papillomavirus vaccine coverage in male-male partnerships attending a sexual health clinic in Melbourne, Australia. Hum Vaccin Immunother 2022; 18:2068929. [PMID: 35714275 PMCID: PMC9302508 DOI: 10.1080/21645515.2022.2068929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We aimed to investigate the sexual mixing by human papillomavirus (HPV) vaccination status in male-male partnerships and estimate the proportion of male-male partnerships protected against HPV. We analyzed male-male partnerships attending the Melbourne Sexual Health Center between 2018 and 2019. Data on self-reported HPV vaccination status were collected. Newman’s assortativity coefficient was used to examine the sexual mixing by HPV vaccination status. Assortativity refers to the tendency of individuals to have partners with similar characteristics (i.e. same vaccination status). Of 321 male-male partnerships where both men reported their HPV vaccination status, 52.6% (95% CI: 47.0–58.2%) partnerships had both men vaccinated, 32.1% (95% CI: 27.0–37.5%) partnerships had only one man vaccinated, and 15.3% (95% CI: 11.5–19.7%) had both men unvaccinated. The assortativity on HPV vaccination status was moderate (assortativity coefficient = 0.265, 95% CI: 0.196–0.335). There were about 15% of male-male partnerships where both men were not protected against HPV. Interventions targeting vaccinated individuals to encourage their unvaccinated partners to be vaccinated might increase the HPV vaccine coverage.
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Affiliation(s)
- Eric P F Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tiffany R Phillips
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Henry Bowesman
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Jason J Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Julien Tran
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Ei T Aung
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Marcus Y Chen
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
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12
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Siddiqui FA, Padhani ZA, Salam RA, Aliani R, Lassi ZS, Das JK, Bhutta ZA. Interventions to Improve Immunization Coverage Among Children and Adolescents: A Meta-analysis. Pediatrics 2022; 149:186948. [PMID: 35503337 DOI: 10.1542/peds.2021-053852d] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Vaccinations are recognized as a feasible, cost-effective public health intervention for reducing the burden and associated mortality of many infectious diseases. The purpose of this study was to evaluate the effectiveness of potential interventions to improve the uptake of vaccines among children and adolescents. METHODS We performed a literature search until December 2020. Eligible studies were identified using Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, and other sources. We included studies conducted on children and adolescents aged 5 to 19 years. Studies comprised of hospitalized children and those with comorbid conditions were excluded. Two authors independently performed the meta-analysis. RESULTS Findings from 120 studies (123 articles), of which 95 were meta-analyzed, reveal that vaccination education may increase overall vaccination coverage by 19% (risk ratio [RR], 1.19; 95% confidence interval [CI], 1.12-1.26), reminders by 15% (RR, 1.15; 95% CI, 1.11-1.18), interventions for providers by 13% (RR, 1.13; 95% CI, 1.07-1.19), financial incentives by 67% (RR, 1.67; 95% CI, 1.40-1.99), and multilevel interventions by 25% (RR, 1.25; 95% CI, 1.10-1.41). The impact of school-based clinics and policy and legislation on overall vaccination coverage is still uncertain, and no impact of a multicomponent intervention on overall vaccination coverage was found. CONCLUSIONS Educational interventions, reminders, provider-directed interventions, financial incentives, and multilevel interventions may improve vaccination coverage among school-aged children and adolescents.
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Affiliation(s)
- Faareha A Siddiqui
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Zahra A Padhani
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Razia Aliani
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Zohra S Lassi
- Robinson Research Institute, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan.,Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada
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13
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Mohamed R, Kelly KM, Nili M, Kelley GA. A systematic review with meta-analysis of parental interventions for human papillomavirus vaccine uptake. J Am Pharm Assoc (2003) 2022; 62:1142-1153. [DOI: 10.1016/j.japh.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/26/2022]
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14
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Hirth JM, Eboreime KA, Cofie LE, Rupp RE, Berenson AB. Human papillomavirus dose reminder preferences among parents from a diverse clinical sample: a qualitative study. Hum Vaccin Immunother 2022; 18:2031697. [PMID: 35180370 PMCID: PMC8993081 DOI: 10.1080/21645515.2022.2031697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Reminders are an important method for encouraging patients to return for follow-up visits, such as for successive doses of the human papillomavirus (HPV) vaccine. However, patients may have preferences for different types of reminders. This study examined which reminder methods parents of pediatric patients found most useful and their thoughts on how the reminders helped them to complete their children’s HPV vaccine series. This qualitative study was conducted on a purposively sampled group of parents who participated in a multi-level intervention intended to improve uptake and completion of the HPV vaccine series. Parents who agreed to participate were interviewed by phone using semi-structured interviews about their satisfaction with different program components, including reminders they received. Interviews were conducted between May 26, 2016 and October 18, 2017. Thematic analyses of data were conducted using NVivo software. Among 269 program participants invited to participate in the interviews, 157 agreed (58.4%) and 89 were successfully interviewed (33.1%). Participants thought that reminders were effective at helping them return for follow-up visits to ensure their children received all recommended HPV vaccine doses. Although most parents preferred texts, many also favored other reminder methods by themselves or in combination with texts. Parents suggested that the reminders indicate the purpose of the appointment and for which child. Reminders are an important part of a multi-component intervention that aims to increase completion of the HPV vaccine series. Program enrollees prefer different types of reminders, so offering several options may improve returns for follow-up doses.
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Affiliation(s)
- Jacqueline M Hirth
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Kayla A Eboreime
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Leslie E Cofie
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| | - Richard E Rupp
- Department of Pediatrics, The University of Texas Medical Branch, Galveston, TX, USA
| | - Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX, USA
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15
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Jenssen BP, Fiks AG. COVID-19 and Routine Childhood Vaccinations-Identifying Gaps and Informing Solutions. JAMA Pediatr 2022; 176:21-23. [PMID: 34617971 DOI: 10.1001/jamapediatrics.2021.4248] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Brian P Jenssen
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Center for Pediatric Clinical Effectiveness, The Possibilities Project, and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alexander G Fiks
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Center for Pediatric Clinical Effectiveness, The Possibilities Project, and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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16
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Wynn CS, Catallozzi M, Kolff CA, Holleran S, Meyer D, Ramakrishnan R, Stockwell MS. Personalized Reminders for Immunization Using Short Messaging Systems to Improve Human Papillomavirus Vaccination Series Completion: Parallel-Group Randomized Trial. JMIR Mhealth Uhealth 2021; 9:e26356. [PMID: 34958306 PMCID: PMC8749571 DOI: 10.2196/26356] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/09/2021] [Accepted: 10/13/2021] [Indexed: 11/15/2022] Open
Abstract
Background Completion rates among adolescents who initiate the human papillomavirus (HPV) vaccine 3-dose series are low. SMS text message vaccine reminders are effective, but less is known about the best types for HPV series completion or the ability to assess and target vaccine decision-making stage. Objective The aim of this study is to compare the effectiveness of HPV vaccine series completion in minority adolescents who received precision and educational versus conventional SMS text message reminders. Methods Enrolled parents of adolescents aged 9-17 years who received the first HPV vaccine dose at 1 of the 4 academic-affiliated community health clinics in New York City were randomized 1:1 to 1 of the 2 parallel, unblinded arms: precision SMS text messages (which included stage-targeted educational information, next dose due date, and site-specific walk-in hours) or conventional SMS text messages without educational information. Randomization was stratified according to gender, age, and language. The primary outcome was series completion within 12 months. In post hoc analysis, enrollees were compared with concurrent nonenrollees and historical controls. Results Overall, 956 parents were enrolled in the study. The precision (475 families) and conventional (481 families) SMS text message arms had similarly high series completion rates (344/475, 72.4% vs 364/481, 75.7%). A total of 42 days after the first dose, two-thirds of families, not initially in the preparation stage, moved to preparation or vaccinated stage. Those in either SMS text message arm had significantly higher completion rates than nonenrollees (708/1503, 47.1% vs 679/1503, 45.17%; P<.001). Even after removing those needing only 2 HPV doses, adolescents receiving any SMS text messages had higher completion rates than historical controls (337/2823, 11.93% vs 981/2823, 34.75%; P<.001). A population-wide effect was seen from 2014 to 2016, above historical trends. Conclusions SMS text message reminders led to timely HPV vaccine series completion in a low-income, urban, minority study population and also led to population-wide effects. Educational information did not provide an added benefit to this population. Trial Registration ClinicalTrials.gov NCT02236273; https://clinicaltrials.gov/ct2/show/NCT02236273
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Affiliation(s)
- Chelsea S Wynn
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States
| | - Marina Catallozzi
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States.,Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States.,NewYork-Presbyterian Hospital, New York, NY, United States
| | - Chelsea A Kolff
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States.,Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Stephen Holleran
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States
| | - Dodi Meyer
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States.,NewYork-Presbyterian Hospital, New York, NY, United States
| | - Rajasekhar Ramakrishnan
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States.,Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States.,NewYork-Presbyterian Hospital, New York, NY, United States
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17
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The impact of publicly funded immunization programs on human papillomavirus vaccination in boys and girls: An observational study. LANCET REGIONAL HEALTH. AMERICAS 2021; 8:100128. [PMID: 36778727 PMCID: PMC9904075 DOI: 10.1016/j.lana.2021.100128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Reaching and maintaining high global human papillomavirus (HPV) vaccine uptake has been challenging. The impact of publicly funded HPV immunization programs and the interplay of sociodemographic, psychosocial and policy factors in maximizing vaccination is poorly understood. This observational study examined the impact of introducing publicly funded school-based HPV vaccination programs for boys directly on uptake in boys and indirectly on uptake in girls, while concurrently examining other important sociodemographic and psychosocial factors. Methods Data were collected from a national, longitudinal sample of Canadian parents of children aged 9-16 years during August-September 2016 (T1) and June-July 2017 (T2). Participants completed an online questionnaire measuring sociodemographic characteristics, vaccine knowledge and attitudes, health care provider recommendation, and HPV vaccine uptake. Analyses were conducted separately for parents of boys and girls using logistic regression analyses at T1 and T2. Jurisdictions with HPV vaccine funding for boys at both time-points were compared to those with funding at neither time-points and those that introduced funding between time-points. Findings The sample included parents of boys (n = 716) and girls (n = 843). In multivariable analyses, jurisdictions with funding for boys at both time-points had higher odds of vaccination (adjusted odds ratio, T1 = 10.18, T2 = 11.42; 95% confidence interval, T1 = 3.08-33.58, T2 = 5.61-23.23) than jurisdictions without funding at both time-points; however, funded jurisdictions did not have higher odds of vaccination compared to jurisdictions that newly introduced funding for boys. Vaccination was associated with consistent determinants in boys and girls including child's age, health care provider recommendation, perceived vaccine harms, and perceived vaccine affordability. Interpretation This gender-sensitive analysis highlights the interplay of sociodemographic, psychosocial, and policy factors that can improve HPV vaccination. Publicly funded school-based programs are an impactful strategy to increase vaccine uptake. Funding This work was supported by the Canadian Cancer Society Research Institute (#704,036). GKS was supported by the Vanier Canada Graduate Scholarship and Queen Elizabeth II Diamond Jubilee Scholarship programs. The funders of this work had no role in the data collection, analysis, or interpretation, or any aspect pertinent to the study.
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18
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Pharmacists' Perceived Barriers to Human Papillomavirus (HPV) Vaccination: A Systematic Literature Review. Vaccines (Basel) 2021; 9:vaccines9111360. [PMID: 34835291 PMCID: PMC8617618 DOI: 10.3390/vaccines9111360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 12/03/2022] Open
Abstract
About 45:000 cancers are linked to HPV each year in the United States alone. The HPV vaccine prevents cancer and is highly effective, yet vaccination coverage remains low. Pharmacies can play a meaningful role in increasing HPV vaccination access due to their availability and convenience. However, little is known about pharmacists’ perceived barriers to HPV vaccination. The objective of this systematic review was to summarize existing literature on perceived barriers to administering HPV vaccination reported by pharmacists. Barriers identified from selected studies were synthesized and further grouped into patient, parental, (pharmacist’s) personal, and system/organization barrier groups. Six studies were included in this review. The cost of the HPV vaccine, insurance coverage and reimbursement were commonly reported perceived barriers. Adolescent HPV vaccination barriers related to parental concerns, beliefs, and inadequate knowledge about the HPV vaccine. Perceived (pharmacist’s) personal barriers were related to lack of information and knowledge about HPV vaccine and recommendations. At the system/organization level, barriers reported included lack of time/staff/space; difficulty in series completion; tracking and recall of patient; perceived competition with providers; and other responsibilities/vaccines taking precedence. Future strategies involving pharmacy settings in HPV-related cancer prevention efforts should consider research on multilevel pharmacy-driven interventions addressing barriers.
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19
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Gurfinkel D, Kempe A, Albertin C, Breck A, Zhou X, Vangala S, Beaty B, Rice J, Tseng CH, Campbell JD, Valderrama R, Rand C, Humiston SG, Roth H, Arora S, Szilagyi P. Centralized Reminder/Recall for Human Papillomavirus Vaccination: Findings From Two States-A Randomized Clinical Trial. J Adolesc Health 2021; 69:579-587. [PMID: 33846054 PMCID: PMC9639215 DOI: 10.1016/j.jadohealth.2021.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Centralized reminder/recall (C-R/R) using Immunization Information Systems has been effective in increasing childhood immunization rates. Previously, C-R/R using autodialer for human papillomavirus (HPV) vaccine did not raise rates. We assessed C-R/R for HPV vaccine using other modalities and focused on younger adolescents. METHODS We conducted a three-arm pragmatic RCT in randomly sampled primary care practices in Colorado (n = 88) and New York (n = 136), proportionate to where adolescents received care. We randomized, within practices, adolescents aged 11-14 years who had not completed the HPV vaccination series to receive C-R/R using different modalities (Colorado: autodialer, mail, or control; New York: autodialer, text, or control). Up to two reminders were sent in intervention arms for each dose needed between 2/2017 and 12/2018. RESULTS In Colorado, no significant differences were found for series initiation (31.3% control, 31.1% autodial, 31.8% mail), with slight improvement for series completion in the autodialer arm (29.7% control, 31.1% autodialer, p = .04) but not the mail arm (30.9%, p = .06). No significant differences were found in New York for series initiation (24.1% for all arms) or completion (17.1% control, 16.9% autodial, 17.9% text). Adjusted analyses showed higher completion rates for the autodialer arm in Colorado but not for other arms. In Colorado, C-R/R reduced time to series completion by around 2 months. Cost per adolescent was $1.81 for mail; under $.40 for all other modalities. CONCLUSIONS C-R/R has less benefit for raising HPV vaccination rates than other studies have noted for childhood immunizations, although it may quicken series completion at little cost.
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Affiliation(s)
- Dennis Gurfinkel
- Adult and Child Consortium For Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado.
| | - Allison Kempe
- Adult and Child Consortium For Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Christina Albertin
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California at Los Angeles, Los Angeles, California
| | - Abigail Breck
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California at Los Angeles, Los Angeles, California
| | - Xinkai Zhou
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Sitaram Vangala
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Brenda Beaty
- Adult and Child Consortium For Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - John Rice
- Adult and Child Consortium For Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Chi-Hong Tseng
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Jonathan D. Campbell
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Rebecca Valderrama
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California at Los Angeles, Los Angeles, California
| | - Cynthia Rand
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - Heather Roth
- Colorado Immunization Information System, Colorado Department of Public Health and Environment, Denver, Colorado
| | - Shivani Arora
- New York State Immunization Information System, New York State Department of Health, Albany, New York
| | - Peter Szilagyi
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California at Los Angeles, Los Angeles, California
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20
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Eze P, Lawani LO, Acharya Y. Short message service (SMS) reminders for childhood immunisation in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Glob Health 2021; 6:bmjgh-2021-005035. [PMID: 34290051 PMCID: PMC8296799 DOI: 10.1136/bmjgh-2021-005035] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/29/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction Childhood vaccine delivery services in the low- and middle-income countries (LMIC) are struggling to reach every child with lifesaving vaccines. Short message service (SMS) reminders have demonstrated positive impact on a number of attrition-prone healthcare delivery services. We aimed to evaluate the effectiveness of SMS reminders in improving immunisation coverage and timeliness in LMICs. Methods PubMed, Embase, Scopus, Cochrane CENTRAL, CINAHL, CNKI, PsycINFO and Web of Science including grey literatures and Google Scholar were systematically searched for randomised controlled trials (RCTs) and non-RCTs that evaluated the effect of SMS reminders on childhood immunisation and timeliness in LMICs. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 assessment tool for RCTs and Cochrane Risk of Bias in Non-randomised Studies of Interventions tool for non-RCTs. Meta-analysis was conducted using random-effects models to generate pooled estimates of risk ratio (RR). Results 18 studies, 13 RCTs and 5 non-RCTs involving 32 712 infants (17 135 in intervention groups and 15 577 in control groups) from 11 LMICs met inclusion criteria. Pooled estimates showed that SMS reminders significantly improved childhood immunisation coverage (RR=1.16; 95% CI: 1.10 to 1.21; I2=90.4%). Meta-analysis of 12 included studies involving 25 257 infants showed that SMS reminders significantly improved timely receipt of childhood vaccines (RR=1.21; 95% CI: 1.12 to 1.30; I2=87.3%). Subgroup analysis showed that SMS reminders are significantly more effective in raising childhood immunisation coverage in lower middle-income and low-income countries than in upper middle-income countries (p<0.001) and sending more than two SMS reminders significantly improves timely receipt of childhood vaccines than one or two SMS reminders (p=0.040). Conclusion Current evidence from LMICs, although with significant heterogeneity, suggests that SMS reminders can contribute to achieving high and timely childhood immunisation coverage. PROSPERO registration number CRD42021225843.
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Affiliation(s)
- Paul Eze
- Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Lucky Osaheni Lawani
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Yubraj Acharya
- Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania, USA
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21
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Mavundza EJ, Iwu-Jaja CJ, Wiyeh AB, Gausi B, Abdullahi LH, Halle-Ekane G, Wiysonge CS. A Systematic Review of Interventions to Improve HPV Vaccination Coverage. Vaccines (Basel) 2021; 9:vaccines9070687. [PMID: 34201421 PMCID: PMC8310215 DOI: 10.3390/vaccines9070687] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022] Open
Abstract
Human papillomavirus (HPV) infection is the most common sexually transmitted infection worldwide. Although most HPV infections are transient and asymptomatic, persistent infection with high-risk HPV types may results in diseases. Although there are currently three effective and safe prophylactic HPV vaccines that are used across the world, HPV vaccination coverage remains low. This review evaluates the effects of the interventions to improve HPV vaccination coverage. We searched the Cochrane Central Register of Controlled Trials, PubMed, Web of Science, Scopus, and the World Health Organization International Clinical Trials Registry Platform and checked the reference lists of relevant articles for eligible studies. Thirty-five studies met inclusion criteria. Our review found that various evaluated interventions have improved HPV vaccination coverage, including narrative education, outreach plus reminders, reminders, financial incentives plus reminders, brief motivational behavioral interventions, provider prompts, training, training plus assessment and feedback, consultation, funding, and multicomponent interventions. However, the evaluation of these intervention was conducted in high-income countries, mainly the United States of America. There is, therefore, a need for studies to evaluate the effect of these interventions in low-and middle-income countries, where there is a high burden of HPV and limited HPV vaccination programs.
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Affiliation(s)
- Edison J. Mavundza
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town 7501, South Africa;
- Correspondence:
| | - Chinwe J. Iwu-Jaja
- Department of Nursing and Midwifery, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa;
| | - Alison B. Wiyeh
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA;
| | - Blessings Gausi
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa;
| | - Leila H. Abdullahi
- African Institute for Development Policy, Nairobi P.O. Box 14688-00800, Kenya;
| | | | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town 7501, South Africa;
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa;
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
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Kempe A, Stockwell MS, Szilagyi P. The Contribution of Reminder-Recall to Vaccine Delivery Efforts: A Narrative Review. Acad Pediatr 2021; 21:S17-S23. [PMID: 33958086 DOI: 10.1016/j.acap.2021.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 12/27/2022]
Abstract
Reminders, alerting patients to the need for vaccines that will be due in the future, and recall messages, informing patients about vaccines that are overdue, have been shown to improve immunization rates for children and adolescents in numerous systematic reviews. Therefore, reminder and recall interventions (R/R) are recommended by the Task Force on Community Preventive Services for increasing immunization rates on the basis of strong evidence. R/R messages can be delivered by mail (letter or postcard), via personal or auto-dialer phone calls, by text or e-mail or via patient-portals and can simply be alerts to action or can include educational material with the aim of motivating patients to seek vaccination. R/R has also been shown to be a relatively low-cost intervention with high cost-effectiveness compared with other recommended strategies. However, although R/R as a strategy is consistently effective and cost-effective overall, there is wide variation in the impact of R/R by 1) modality of how it is delivered, 2) the targeted vaccine, 3) the age group, and 4) whether the R/R is conducted centrally by a health system or Immunization Information System or by individual practices. This narrative review summarizes the literature about effectiveness of R/R within each of these categories. We also discuss limitations of R/R, with a focus on the potential impact of parental vaccine hesitancy in blunting its effectiveness and problems with data integrity, on which R/R relies. We also discuss challenges to sustaining R/R efforts, including potential methods of funding for R/R efforts.
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Affiliation(s)
- Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe), Aurora, Colo; Department of Pediatrics, University of Colorado School of Medicine (A Kempe), Aurora, Colo.
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center (MS Stockwell), New York, NY; Department of Population and Family Health, Columbia University Irving Medical Center (MS Stockwell), New York, NY
| | - Peter Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles (P Szilagyi)
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Fiks AG, Nekrasova E, Hambidge SJ. Health Systems as a Catalyst for Immunization Delivery. Acad Pediatr 2021; 21:S40-S47. [PMID: 33958091 DOI: 10.1016/j.acap.2021.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Alexander G Fiks
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania School and Children's Hospital of Philadelphia (AG Fiks), Philadelphia, Pa; Center for Pediatric Clinical Effectiveness (CPCE) and the Possibilities Project, Children's Hospital of Philadelphia (AG Fiks and E Nekrasova), Philadelphia, Pa.
| | - Ekaterina Nekrasova
- Center for Pediatric Clinical Effectiveness (CPCE) and the Possibilities Project, Children's Hospital of Philadelphia (AG Fiks and E Nekrasova), Philadelphia, Pa
| | - Simon J Hambidge
- Community Health Services, Denver Health (SJ Hambidge), Denver, Colo; Department of Pediatrics, University of Colorado School of Medicine (SJ Hambidge), Denver, Colo
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Leidner AJ, Tang Z, Tsai Y. Primary Care Use Among Commercially Insured Adolescents: Evidence From the 2018 Healthcare Effectiveness Data and Information Set. Am J Prev Med 2021; 60:411-414. [PMID: 33223362 PMCID: PMC8952601 DOI: 10.1016/j.amepre.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Improving the utilization of preventive care among adolescents is important for achieving individual-level and population-level health goals. The Healthcare Effectiveness Data and Information Set reports data submitted by managed care health plans, capturing a large number of individuals in the U.S. METHODS Using Healthcare Effectiveness Data and Information Set from 2018, mean performance levels were calculated for 5 preventive care measures among adolescents. Differences in performance between states that use Healthcare Effectiveness Data and Information Set or Health Plan Accreditation and those that use neither were estimated. Analysis was conducted in January-July 2020. RESULTS The sample included data from 39 states, with 32 that use Healthcare Effectiveness Data and Information Set or Health Plan Accreditation and 7 that do not. Adolescent vaccination coverage was 28% for the complete human papillomavirus series, 81% for meningococcal, and 88% for tetanus, diphtheria, and acellular pertussis. Access to a primary care practitioner (a 2-year measure) was 91%, and well-care visits (a 1-year measure) were 50%. When compared with states that do not use Healthcare Effectiveness Data and Information Set or Health Plan Accreditation, the mean performance of states that used either Healthcare Effectiveness Data and Information Set or Health Plan Accreditation was statistically significantly higher for 4 of the 5 assessed measures. CONCLUSIONS Healthcare Effectiveness Data and Information Set measures can help public health officials to monitor progress toward health goals, such as Healthy People 2020, and identify poorly performing health plans and types of preventive services in greatest need of improvement. States using Healthcare Effectiveness Data and Information Set or Health Plan Accreditation were associated with better performance in some adolescent measures, which suggests that health plan accountability may have a role in achieving health outcomes and could be an important area for future research.
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Affiliation(s)
- Andrew J Leidner
- National Center for Immunization Services and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Zhaoli Tang
- Berry Technology Solutions, Peachtree City, Georgia
| | - Yuping Tsai
- National Center for Immunization Services and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Ilozumba O, Schmidt P, Ket JC, Jaspers M. Can mHealth interventions contribute to increased HPV vaccination uptake? A systematic review. Prev Med Rep 2021; 21:101289. [PMID: 33425667 PMCID: PMC7777527 DOI: 10.1016/j.pmedr.2020.101289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/19/2020] [Accepted: 12/15/2020] [Indexed: 12/15/2022] Open
Abstract
The objective of this review was to synthesize existing evidence on mobile health (mHealth) interventions geared at improving HPV related knowledge, HPV vaccination intent and HPV vaccination uptake. Between November and December 2019, systematic searches were performed in the databases PubMed, Ebsco/CINAHL, Ebsco/PsycINFO, and Clarivate Analytics/Web of Science Social Science Citation Index (SSCI). We identified 805 articles of which 92 were eligible for inclusion after abstract screening. 19 articles met the inclusion criteria of the review based on full article review and all but one of the included interventions were conducted in the United States. mHealth interventions ranged from text messages, phone calls to interactive voice recordings and software on tablets. All four interventions which attempted to improve HPV knowledge and vaccination intent, reported positive findings, however, only two interventions reported statistically significant improvements between intervention and control groups. 14 interventions reported an increase in HPV vaccination uptake and vaccination series completion among the intervention groups; including when mHealth interventions were compared to control groups or non-mHealth interventions. Some factors noted in the successful interventions included frequency of messages, combinations of multiple interventions including in-person education session, written educational materials, texts alongside call or emails; tailored messages as well as participant's intent to vaccinate at baseline. mHealth interventions potentially show promise as tools in improving short-term vaccination knowledge, intent, and uptake of HPV vaccination. There is however a need to refine components which can promote mHealth interventions' success as well as for the evaluation of such interventions in different contexts and over time.
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Affiliation(s)
- Onaedo Ilozumba
- Vrije Universiteit Amsterdam, Faculty of Sciences, The Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
| | - Paula Schmidt
- Vrije Universiteit Amsterdam, Faculty of Sciences, The Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
| | - Johannes C.F. Ket
- Medical Library, Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Monique Jaspers
- Centre for Human Factors Engineering of Interactive Health Information Technology (HIT-lab), Department of Medical Informatics, J1B-116, Amsterdam Public Health Research Institute – AmsterdamUMC, Location Academic Medical Center, PO Box 22700, Amsterdam, The Netherlands
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Internal and External Validity of Social Media and Mobile Technology-Driven HPV Vaccination Interventions: Systematic Review Using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework. Vaccines (Basel) 2021; 9:vaccines9030197. [PMID: 33652809 PMCID: PMC7996801 DOI: 10.3390/vaccines9030197] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/12/2021] [Accepted: 02/23/2021] [Indexed: 12/26/2022] Open
Abstract
Social media human papillomavirus (HPV) vaccination interventions show promise for increasing HPV vaccination rates. An important consideration for the implementation of effective interventions into real-world practice is the translation potential, or external validity, of the intervention. To this end, we conducted a systematic literature review to describe the current body of evidence regarding the external validity of social media HPV vaccination-related interventions. Constructs related to external validity were based on the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework. Seventeen articles published between 2006 and 2020 met the inclusion criteria. Three researchers independently coded each article using a validated RE-AIM framework. Discrepant codes were discussed with a fourth reviewer to gain consensus. Of these 17 studies, 3 were pilot efficacy studies, 10 were randomized controlled trials (RCTs) to evaluate effectiveness, 1 was a population-based study, and 3 did not explicitly state which type of study was conducted. Reflecting this distribution of study types, across all studies the mean level of reporting RE-AIM dimensions varied with reach recording 90.8%, effectiveness (72.1%), adoption (40.3%), implementation (45.6%), and maintenance (26.5%). This review suggests that while the current HPV vaccination social media-driven interventions provide sufficient information on internal validity (reach and effectiveness), few have aimed to gather data on external validity needed to translate the interventions into real world implementation. Our data suggest that implementation research is needed to move HPV vaccination-related interventions into practice. Included in this review are recommendations for enhancing the design and reporting of these HPV vaccination social media-related interventions.
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Randomized controlled study using text messages to help connect new medicaid beneficiaries to primary care. NPJ Digit Med 2021; 4:26. [PMID: 33589706 PMCID: PMC7884833 DOI: 10.1038/s41746-021-00389-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 01/05/2021] [Indexed: 11/08/2022] Open
Abstract
Accessing primary care is often difficult for newly insured Medicaid beneficiaries. Tailored text messages may help patients navigate the health system and initiate care with a primary care physician. We conducted a randomized controlled trial of tailored text messages with newly enrolled Medicaid managed care beneficiaries. Text messages included education about the importance of primary care, reminders to obtain an appointment, and resources to help schedule an appointment. Within 120 days of enrollment, we examined completion of at least one primary care visit and use of the emergency department. Within 1 year of enrollment, we examined diagnosis of a chronic disease, receipt of preventive care, and use of the emergency department. 8432 beneficiaries (4201 texting group; 4231 control group) were randomized; mean age was 37 years and 24% were White. In the texting group, 31% engaged with text messages. In the texting vs control group after 120 days, there were no differences in having one or more primary care visits (44.9% vs. 45.2%; difference, −0.27%; p = 0.802) or emergency department use (16.2% vs. 16.0%; difference, 0.23%; p = 0.771). After 1 year, there were no differences in diagnosis of a chronic disease (29.0% vs. 27.8%; difference, 1.2%; p = 0.213) or appropriate preventive care (for example, diabetes screening: 14.1% vs. 13.4%; difference, 0.69%; p = 0.357), but emergency department use (32.7% vs. 30.2%; difference, 2.5%; p = 0.014) was greater in the texting group. Tailored text messages were ineffective in helping new Medicaid beneficiaries visit primary care within 120 days.
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28
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Spencer JC, Brewer NT, Trogdon JG, Weinberger M, Coyne-Beasley T, Wheeler SB. Cost-effectiveness of Interventions to Increase HPV Vaccine Uptake. Pediatrics 2020; 146:peds.2020-0395. [PMID: 33199466 PMCID: PMC7786823 DOI: 10.1542/peds.2020-0395] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We sought to prioritize interventions for increasing human papillomavirus (HPV) vaccination coverage based on cost-effectiveness from a US state perspective to inform decisions by policy makers. METHODS We developed a dynamic simulation model of HPV transmission and progression scaled to a medium-sized US state (5 million individuals). We modeled outcomes over 50 years comparing no intervention to a one-year implementation of centralized reminder and recall for HPV vaccination, school-located HPV vaccination, or quality improvement (QI) visits to primary care clinics. We used probabilistic sensitivity analysis to assess a range of plausible outcomes associated with each intervention. Cost-effectiveness was evaluated relative to a conservative willingness-to-pay threshold; $50 000 per quality-adjusted life-year (QALY) . RESULTS All interventions were cost-effective, relative to no intervention. QI visits had the lowest cost and cost per QALY gained ($1538 versus no intervention). Statewide implementation of centralized reminder and recall cost $28 289 per QALY gained versus QI visits. School-located vaccination had the highest cost but was cost-effective at $18 337 per QALY gained versus QI visits. Scaling to the US population, interventions could avert 3000 to 14 000 future HPV cancers. When varying intervention cost and impact over feasible ranges, interventions were typically preferred to no intervention, but cost-effectiveness varied between intervention strategies. CONCLUSIONS Three interventions for increasing HPV vaccine coverage were cost-effective and offered substantial health benefits. Policy makers seeking to increase HPV vaccination should, at minimum, dedicate additional funding for QI visits, which are consistently effective at low cost and may additionally consider more resource-intensive interventions (reminder and recall or school-located vaccination).
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Affiliation(s)
- Jennifer C. Spencer
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts;,Departments of Health Policy and Management and
| | - Noel T. Brewer
- Health Behavior, Gillings School of Global Public Health and,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina; and
| | - Justin G. Trogdon
- Departments of Health Policy and Management and,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina; and
| | | | - Tamera Coyne-Beasley
- Division of Adolescent Medicine, Departments of Pediatrics and Internal Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Stephanie B. Wheeler
- Departments of Health Policy and Management and,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina; and
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Acampora A, Grossi A, Barbara A, Colamesta V, Causio FA, Calabrò GE, Boccia S, de Waure C. Increasing HPV Vaccination Uptake among Adolescents: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7997. [PMID: 33143171 PMCID: PMC7663345 DOI: 10.3390/ijerph17217997] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/02/2020] [Accepted: 10/27/2020] [Indexed: 12/28/2022]
Abstract
Human Papillomavirus (HPV) vaccination is a well-known fundamental strategy in the prevention of cervical cancer, as it is always caused by HPV infection. In fact, primary prevention of the infection corresponds to primary prevention of HPV-related cancers and other diseases. Since an effective prevention at the population level is the final goal, it is mandatory for healthcare systems to achieve a high HPV vaccination coverage among the adolescents to reduce the circulation of the virus and the burden of HPV-related diseases. This research identified, through a systematic literature review, 38 papers on strategies adopted to increase HPV vaccination coverage among adolescents. The evaluated strategies targeted adolescents/parents and/or healthcare providers and could be grouped in three main types: (1) reminder-based, (2) education, information, and communication activities, and (3) multicomponent strategies. Several types of strategy, such as those relied only on reminders and integrating different interventions, showed a positive impact on vaccination coverage. Nonetheless, the heterogeneity of the interventions suggests the importance to adapt such strategies to the specific national/local contexts to maximize vaccination coverage.
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Affiliation(s)
- Anna Acampora
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.A.); (A.G.); (A.B.); (V.C.); (F.A.C.); (S.B.)
| | - Adriano Grossi
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.A.); (A.G.); (A.B.); (V.C.); (F.A.C.); (S.B.)
| | - Andrea Barbara
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.A.); (A.G.); (A.B.); (V.C.); (F.A.C.); (S.B.)
| | - Vittoria Colamesta
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.A.); (A.G.); (A.B.); (V.C.); (F.A.C.); (S.B.)
- Unità Operativa Complessa Direzione Sanitaria S. Spirito e Nuovo Regina Margherita, Local Health Unit ASL RM1, 00193 Rome, Italy
| | - Francesco Andrea Causio
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.A.); (A.G.); (A.B.); (V.C.); (F.A.C.); (S.B.)
| | - Giovanna Elisa Calabrò
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.A.); (A.G.); (A.B.); (V.C.); (F.A.C.); (S.B.)
- VIHTALI (Value in Health Technology and Academy for Leadership & Innovation), Spin-Off of Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.A.); (A.G.); (A.B.); (V.C.); (F.A.C.); (S.B.)
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Chiara de Waure
- Department of Experimental Medicine, University of Perugia, 06132 Perugia, Italy;
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Palmer MJ, Henschke N, Bergman H, Villanueva G, Maayan N, Tamrat T, Mehl GL, Glenton C, Lewin S, Fønhus MS, Free C. Targeted client communication via mobile devices for improving maternal, neonatal, and child health. Cochrane Database Syst Rev 2020; 8:CD013679. [PMID: 32813276 PMCID: PMC8477611 DOI: 10.1002/14651858.cd013679] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The global burden of poor maternal, neonatal, and child health (MNCH) accounts for more than a quarter of healthy years of life lost worldwide. Targeted client communication (TCC) via mobile devices (MD) (TCCMD) may be a useful strategy to improve MNCH. OBJECTIVES To assess the effects of TCC via MD on health behaviour, service use, health, and well-being for MNCH. SEARCH METHODS In July/August 2017, we searched five databases including The Cochrane Central Register of Controlled Trials, MEDLINE and Embase. We also searched two trial registries. A search update was carried out in July 2019 and potentially relevant studies are awaiting classification. SELECTION CRITERIA We included randomised controlled trials that assessed TCC via MD to improve MNCH behaviour, service use, health, and well-being. Eligible comparators were usual care/no intervention, non-digital TCC, and digital non-targeted client communication. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane, although data extraction and risk of bias assessments were carried out by one person only and cross-checked by a second. MAIN RESULTS We included 27 trials (17,463 participants). Trial populations were: pregnant and postpartum women (11 trials conducted in low-, middle- or high-income countries (LMHIC); pregnant and postpartum women living with HIV (three trials carried out in one lower middle-income country); and parents of children under the age of five years (13 trials conducted in LMHIC). Most interventions (18) were delivered via text messages alone, one was delivered through voice calls only, and the rest were delivered through combinations of different communication channels, such as multimedia messages and voice calls. Pregnant and postpartum women TCCMD versus standard care For behaviours, TCCMD may increase exclusive breastfeeding in settings where rates of exclusive breastfeeding are less common (risk ratio (RR) 1.30, 95% confidence intervals (CI) 1.06 to 1.59; low-certainty evidence), but have little or no effect in settings where almost all women breastfeed (low-certainty evidence). For use of health services, TCCMD may increase antenatal appointment attendance (odds ratio (OR) 1.54, 95% CI 0.80 to 2.96; low-certainty evidence); however, the CI encompasses both benefit and harm. The intervention may increase skilled attendants at birth in settings where a lack of skilled attendants at birth is common (though this differed by urban/rural residence), but may make no difference in settings where almost all women already have a skilled attendant at birth (OR 1.00, 95% CI 0.34 to 2.94; low-certainty evidence). There were uncertain effects on maternal and neonatal mortality and morbidity because the certainty of the evidence was assessed as very low. TCCMD versus non-digital TCC (e.g. pamphlets) TCCMD may have little or no effect on exclusive breastfeeding (RR 0.92, 95% CI 0.79 to 1.07; low-certainty evidence). TCCMD may reduce 'any maternal health problem' (RR 0.19, 95% CI 0.04 to 0.79) and 'any newborn health problem' (RR 0.52, 95% CI 0.25 to 1.06) reported up to 10 days postpartum (low-certainty evidence), though the CI for the latter includes benefit and harm. The effect on health service use is unknown due to a lack of studies. TCCMD versus digital non-targeted communication No studies reported behavioural, health, or well-being outcomes for this comparison. For use of health services, there are uncertain effects for the presence of a skilled attendant at birth due to very low-certainty evidence, and the intervention may make little or no difference to attendance for antenatal influenza vaccination (RR 1.05, 95% CI 0.71 to 1.58), though the CI encompasses both benefit and harm (low-certainty evidence). Pregnant and postpartum women living with HIV TCCMD versus standard care For behaviours, TCCMD may make little or no difference to maternal and infant adherence to antiretroviral (ARV) therapy (low-certainty evidence). For health service use, TCC mobile telephone reminders may increase use of antenatal care slightly (mean difference (MD) 1.5, 95% CI -0.36 to 3.36; low-certainty evidence). The effect on the proportion of births occurring in a health facility is uncertain due to very low-certainty evidence. For health and well-being outcomes, there was an uncertain intervention effect on neonatal death or stillbirth, and infant HIV due to very low-certainty evidence. No studies reported on maternal mortality or morbidity. TCCMD versus non-digital TCC The effect is unknown due to lack of studies reporting this comparison. TCCMD versus digital non-targeted communication TCCMD may increase infant ARV/prevention of mother-to-child transmission treatment adherence (RR 1.26, 95% CI 1.07 to 1.48; low-certainty evidence). The effect on other outcomes is unknown due to lack of studies. Parents of children aged less than five years No studies reported on correct treatment, nutritional, or health outcomes. TCCMD versus standard care Based on 10 trials, TCCMD may modestly increase health service use (vaccinations and HIV care) (RR 1.21, 95% CI 1.08 to 1.34; low-certainty evidence); however, the effect estimates varied widely between studies. TCCMD versus non-digital TCC TCCMD may increase attendance for vaccinations (RR 1.13, 95% CI 1.00 to 1.28; low-certainty evidence), and may make little or no difference to oral hygiene practices (low-certainty evidence). TCCMD versus digital non-targeted communication TCCMD may reduce attendance for vaccinations, but the CI encompasses both benefit and harm (RR 0.63, 95% CI 0.33 to 1.20; low-certainty evidence). No trials in any population reported data on unintended consequences. AUTHORS' CONCLUSIONS The effect of TCCMD for most outcomes is uncertain. There may be improvements for some outcomes using targeted communication but these findings were of low certainty. High-quality, adequately powered trials and cost-effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCCMD. Future studies should measure potential unintended consequences, such as partner violence or breaches of confidentiality.
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Affiliation(s)
- Melissa J Palmer
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Tigest Tamrat
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Garrett L Mehl
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | | | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Caroline Free
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Palmer MJ, Henschke N, Villanueva G, Maayan N, Bergman H, Glenton C, Lewin S, Fønhus MS, Tamrat T, Mehl GL, Free C. Targeted client communication via mobile devices for improving sexual and reproductive health. Cochrane Database Syst Rev 2020; 8:CD013680. [PMID: 32779730 PMCID: PMC8409381 DOI: 10.1002/14651858.cd013680] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The burden of poor sexual and reproductive health (SRH) worldwide is substantial, disproportionately affecting those living in low- and middle-income countries. Targeted client communication (TCC) delivered via mobile devices (MD) (TCCMD) may improve the health behaviours and service use important for sexual and reproductive health. OBJECTIVES To assess the effects of TCC via MD on adolescents' knowledge, and on adolescents' and adults' sexual and reproductive health behaviour, health service use, and health and well-being. SEARCH METHODS In July/August 2017, we searched five databases including The Cochrane Central Register of Controlled Trials, MEDLINE and Embase. We also searched two trial registries. A search update was carried out in July 2019 and potentially relevant studies are awaiting classification. SELECTION CRITERIA We included randomised controlled trials of TCC via MD to improve sexual and reproductive health behaviour, health service use, and health and well-being. Eligible comparators were standard care or no intervention, non-digital TCC, and digital non-targeted communication. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane, although data extraction and risk of bias assessments were carried out by one person only and cross-checked by a second. We have presented results separately for adult and adolescent populations, and for each comparison. MAIN RESULTS We included 40 trials (27 among adult populations and 13 among adolescent populations) with a total of 26,854 participants. All but one of the trials among adolescent populations were conducted in high-income countries. Trials among adult populations were conducted in a range of high- to low-income countries. Among adolescents, nine interventions were delivered solely through text messages; four interventions tested text messages in combination with another communication channel, such as emails, multimedia messaging, or voice calls; and one intervention used voice calls alone. Among adults, 20 interventions were delivered through text messages; two through a combination of text messages and voice calls; and the rest were delivered through other channels such as voice calls, multimedia messaging, interactive voice response, and instant messaging services. Adolescent populations TCCMD versus standard care TCCMD may increase sexual health knowledge (risk ratio (RR) 1.45, 95% confidence interval (CI) 1.23 to 1.71; low-certainty evidence). TCCMD may modestly increase contraception use (RR 1.19, 95% CI 1.05 to 1.35; low-certainty evidence). The effects on condom use, antiretroviral therapy (ART) adherence, and health service use are uncertain due to very low-certainty evidence. The effects on abortion and STI rates are unknown due to lack of studies. TCCMD versus non-digital TCC (e.g. pamphlets) The effects of TCCMD on behaviour (contraception use, condom use, ART adherence), service use, health and wellbeing (abortion and STI rates) are unknown due to lack of studies for this comparison. TCCMD versus digital non-targeted communication The effects on sexual health knowledge, condom and contraceptive use are uncertain due to very low-certainty evidence. Interventions may increase health service use (attendance for STI/HIV testing, RR 1.61, 95% CI 1.08 to 2.40; low-certainty evidence). The intervention may be beneficial for reducing STI rates (RR 0.61, 95% CI 0.28 to 1.33; low-certainty evidence), but the confidence interval encompasses both benefit and harm. The effects on abortion rates and on ART adherence are unknown due to lack of studies. We are uncertain whether TCCMD results in unintended consequences due to lack of evidence. Adult populations TCCMD versus standard care For health behaviours, TCCMD may modestly increase contraception use at 12 months (RR 1.17, 95% CI 0.92 to 1.48) and may reduce repeat abortion (RR 0.68 95% CI 0.28 to 1.66), though the confidence interval encompasses benefit and harm (low-certainty evidence). The effect on condom use is uncertain. No study measured the impact of this intervention on STI rates. TCCMD may modestly increase ART adherence (RR 1.13, 95% CI 0.97 to 1.32, low-certainty evidence, and standardised mean difference 0.44, 95% CI -0.14 to 1.02, low-certainty evidence). TCCMD may modestly increase health service utilisation (RR 1.17, 95% CI 1.04 to 1.31; low-certainty evidence), but there was substantial heterogeneity (I2 = 85%), with mixed results according to type of service utilisation (i.e. attendance for STI testing; HIV treatment; voluntary male medical circumcision (VMMC); VMMC post-operative visit; post-abortion care). For health and well-being outcomes, there may be little or no effect on CD4 count (mean difference 13.99, 95% CI -8.65 to 36.63; low-certainty evidence) and a slight reduction in virological failure (RR 0.86, 95% CI 0.73 to 1.01; low-certainty evidence). TCCMD versus non-digital TCC No studies reported STI rates, condom use, ART adherence, abortion rates, or contraceptive use as outcomes for this comparison. TCCMD may modestly increase in service attendance overall (RR: 1.12, 95% CI 0.92-1.35, low certainty evidence), however the confidence interval encompasses benefit and harm. TCCMD versus digital non-targeted communication No studies reported STI rates, condom use, ART adherence, abortion rates, or contraceptive use as outcomes for this comparison. TCCMD may increase service utilisation overall (RR: 1.71, 95% CI 0.67-4.38, low certainty evidence), however the confidence interval encompasses benefit and harm and there was considerable heterogeneity (I2 = 72%), with mixed results according to type of service utilisation (STI/HIV testing, and VMMC). Few studies reported on unintended consequences. One study reported that a participant withdrew from the intervention as they felt it compromised their undisclosed HIV status. AUTHORS' CONCLUSIONS TCCMD may improve some outcomes but the evidence is of low certainty. The effect on most outcomes is uncertain/unknown due to very low certainty evidence or lack of evidence. High quality, adequately powered trials and cost effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCC delivered by mobile devices. Given the sensitivity and stigma associated with sexual and reproductive health future studies should measure unintended consequences, such as partner violence or breaches of confidentiality.
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Affiliation(s)
- Melissa J Palmer
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Tigest Tamrat
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Garrett L Mehl
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Caroline Free
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Askelson N, Ryan G, Seegmiller L, Preiss A, Comstock S. Intersectoral cooperation to increase HPV vaccine coverage: an innovative collaboration between Managed Care Organizations and state-level stakeholders. Hum Vaccin Immunother 2020; 16:1385-1391. [PMID: 31810424 DOI: 10.1080/21645515.2019.1694814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
In order to reduce disparities in human papillomavirus (HPV) vaccine coverage, intersectoral approaches are needed to reach vulnerable populations, including Medicaid enrollees. This manuscript describes a collaboration between Medicaid Managed Care Organizations (MCOs), the American Cancer Society, and a state health department in a Midwestern state to address HPV vaccination. Qualitative interviews (n = 11) were conducted via telephone with key stakeholders from the three participating organizations using an interview guide designed to capture the process of developing the partnership and implementing the HPV-focused project. Interviews were transcribed and coded using thematic analysis. Interviewees described motivation to participate, including shared goals, and facilitators, like pooled resources. They cited barriers, such as time and legal challenges. Overall, interviewees reported that they believed this project is replicable. Conducting this project revealed the importance of shared vision, effective communication, and the complementary resources and experiences contributed by each organization. Valuable lessons were learned about reaching the Medicaid population and groundwork was laid for future efforts to serve vulnerable populations and reduce health disparities. This work has significant implications for other organizations seeking to partner with large nonprofits, state health departments, MCOs, or others, and the lessons learned from this project could be translated to other groups working to improve vaccination rates in their communities.
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Affiliation(s)
- Natoshia Askelson
- Department of Community and Behavioral Health, College of Public Health, University of Iowa , Iowa City, IA, USA.,Public Policy Center, University of Iowa , Iowa City, IA, USA
| | - Grace Ryan
- Department of Community and Behavioral Health, College of Public Health, University of Iowa , Iowa City, IA, USA.,Public Policy Center, University of Iowa , Iowa City, IA, USA
| | - Laura Seegmiller
- Department of Community and Behavioral Health, College of Public Health, University of Iowa , Iowa City, IA, USA
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Szilagyi P, Albertin C, Saville AW, Valderrama R, Breck A, Helmkamp L, Zhou X, Vangala S, Dickinson LM, Tseng CH, Campbell JD, Whittington M, Roth H, Rand C, Humiston SG, Hoefer D, Kempe A. Effect of State Immunization Information System Based Reminder/Recall for Influenza Vaccinations: A Randomized Trial of Autodialer, Text, and Mailed Messages. J Pediatr 2020; 221:123-131.e4. [PMID: 32446470 PMCID: PMC7518461 DOI: 10.1016/j.jpeds.2020.02.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/21/2020] [Accepted: 02/11/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the effect of different modalities of centralized reminder/recall (autodialer, text, mailed reminders) on increasing childhood influenza vaccination. STUDY DESIGN Two simultaneous randomized clinical trials conducted from October 2017 to April 1, 2018, in New York State and Colorado. There were 61 931 children in New York (136 practices) and 23 845 children in Colorado (42 practices) who were randomized to different centralized reminder/recall modalities-4 arms in New York (autodialer, text, mailed, and no reminder control) and 3 arms in Colorado (autodialer, mailed, and no reminder control). The message content was similar across modalities. Up to 3 reminders were sent for intervention arms. The main outcome measure was receipt of ≥1 influenza vaccine. RESULTS In New York, compared with the control arm (26.6%), postintervention influenza vaccination rates in the autodialer arm (28.0%) were 1.4 percentage points higher (adjusted risk ratio, 1.06; 95% CI, 1.02-1.10), but the rates for text (27.6%) and mail (26.8%) arms were not different from controls. In Colorado, compared with the control arm (29.9%), postintervention influenza vaccination rates for the autodialer (32.9%) and mail (31.5%) arms were 3.0 percentage points (adjusted risk ratio, 1.08; 95% CI, 1.03-1.12) and 1.6 percentage points (adjusted risk ratio, 1.06; 95% CI, 1.02-1.10) higher, respectively. Compared with the control arm, the incremental cost per additional vaccine delivered was $20 (New York) and $16 (Colorado) for autodialer messages. CONCLUSIONS Centralized reminder/recall for childhood influenza vaccine was most effective via autodialer, less effective via mail, and not effective via text messages. The impact of each modality was modest. Compared with no reminders, the incremental cost per additional vaccine delivered was also modest for autodialer messages. TRIAL REGISTRATION ClinicalTrials.gov: NCT03294473 and NCT03246100.
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Affiliation(s)
- Peter Szilagyi
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California at Los Angeles, Los Angeles, California
| | - Christina Albertin
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California at Los Angeles, Los Angeles, California
| | - Alison W. Saville
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Rebecca Valderrama
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California at Los Angeles, Los Angeles, California
| | - Abigail Breck
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California at Los Angeles, Los Angeles, California
| | - Laura Helmkamp
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Xinkai Zhou
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Sitaram Vangala
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, California
| | - L. Miriam Dickinson
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Chi-Hong Tseng
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Jonathan D. Campbell
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Melanie Whittington
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Heather Roth
- Colorado Immunization Information System, Colorado Department of Public Health and Environment
| | - Cynthia Rand
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | | | - Dina Hoefer
- New York State Immunization Information System, New York State Department of Health
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
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Szilagyi P, Albertin C, Gurfinkel D, Beaty B, Zhou X, Vangala S, Rice J, Campbell JD, Whittington MD, Valderrama R, Breck A, Roth H, Meldrum M, Tseng CH, Rand C, Humiston SG, Schaffer S, Kempe A. Effect of State Immunization Information System Centralized Reminder and Recall on HPV Vaccination Rates. Pediatrics 2020; 145:peds.2019-2689. [PMID: 32253263 PMCID: PMC7193977 DOI: 10.1542/peds.2019-2689] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although autodialer centralized reminder and recall (C-R/R) from state immunization information systems (IISs) has been shown to raise childhood vaccination rates, its impact on human papillomavirus (HPV) vaccination rates is unclear. METHODS In a 4-arm pragmatic randomized controlled trial across 2 states, we randomly selected practices representative of the specialty (pediatrics, family medicine, and health center) where children received care. Within each practice, patients 11 to 17.9 years old who had not completed their HPV vaccine series (NY: N = 30 616 in 123 practices; CO: N = 31 502 in 80 practices) were randomly assigned to receive 0, 1, 2, or 3 IIS C-R/R autodialer messages per vaccine dose. We assessed HPV vaccine receipt via the IIS, calculated intervention costs, and compared HPV vaccine series initiation and completion rates across study arms. RESULTS In New York, HPV vaccine initiation rates ranged from 37.0% to 37.4%, and completion rates were between 29.1% and 30.1%, with no significant differences across study arms. In Colorado, HPV vaccine initiation rates ranged from 31.2% to 33.5% and were slightly higher for 1 reminder compared with none, but vaccine completion rates, ranging from 27.0% to 27.8%, were similar. On adjusted analyses in Colorado, vaccine initiation rates were slightly higher for 1 and 3 C-R/R messages (adjusted risk ratios 1.07 and 1.04, respectively); completion rates were slightly higher for 1 and 3 C-R/R messages (adjusted risk ratios 1.02 and 1.03, respectively). CONCLUSIONS IIS-based C-R/R for HPV vaccination did not improve HPV vaccination rates in New York and increased vaccination rates slightly in Colorado.
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Affiliation(s)
- Peter Szilagyi
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California;
| | - Christina Albertin
- Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Dennis Gurfinkel
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine and
| | - Brenda Beaty
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine and
| | | | | | - John Rice
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine and,Department of Biostatistics Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Rebecca Valderrama
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Abigail Breck
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Heather Roth
- Colorado Immunization Information System, Colorado Department of Public Health and Environment, Denver, Colorado
| | - Megan Meldrum
- New York State Immunization Information System, New York State Department of Health, Albany, New York; and
| | | | - Cynthia Rand
- Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Sharon G. Humiston
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri
| | - Stanley Schaffer
- Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Allison Kempe
- Departments of Pediatrics and,Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine and
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Teeter BS, Mosley C, Thomas JL, Martin B, Jones D, Romero JR, Curran GM. Improving HPV vaccination using implementation strategies in community pharmacies: Pilot study protocol. Res Social Adm Pharm 2020; 16:336-341. [DOI: 10.1016/j.sapharm.2019.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 12/30/2022]
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Teitelman AM, Gregory EF, Jayasinghe J, Wermers Z, Koo JH, Morone JF, Leri DC, Davis A, Feemster KA. Vaccipack, A Mobile App to Promote Human Papillomavirus Vaccine Uptake Among Adolescents Aged 11 to 14 Years: Development and Usability Study. JMIR Nurs 2020; 3:e19503. [PMID: 34345789 PMCID: PMC8279454 DOI: 10.2196/19503] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/31/2020] [Accepted: 09/28/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND More than 90% of human papillomavirus (HPV)-related cancers could be prevented by widespread uptake of the HPV vaccine, yet vaccine use in the United States falls short of public health goals. OBJECTIVE The purpose of this study was to describe the development, acceptability, and intention to use the mobile app Vaccipack, which was designed to promote uptake and completion of the adolescent HPV vaccine series. METHODS Development of the mobile health (mHealth) content was based on the integrated behavioral model (IBM). The technology acceptance model (TAM) was used to guide the app usability evaluation. App design utilized an iterative process involving providers and potential users who were parents and adolescents. App features include a vaccine-tracking function, a discussion forum, and stories with embedded messages to promote intention to vaccinate. Parents and adolescents completed surveys before and after introducing the app in a pediatric primary care setting with low HPV vaccination rates. RESULTS Surveys were completed by 54 participants (20 adolescents aged 11 to 14 years and 34 parents). Notably, 75% (15/20) of adolescents and 88% (30/34) of parents intended to use the app in the next 2 weeks. Acceptability of the app was high among both groups: 88% (30/34) of parents and 75% (15/20) of adolescents indicated that Vaccipack was easy to use, and 82% (28/34) of parents and 85% (17/20) of adolescents perceived the app to be beneficial. Higher levels of app acceptability were found among parents with strong intentions to use the app (P=.09; 95% CI -2.15 to 0.15). CONCLUSIONS mHealth technology, such as Vaccipack, may be an acceptable and nimble platform for providing information to parents and adolescents and advancing the uptake of important vaccines.
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Affiliation(s)
- Anne M Teitelman
- University of Pennsylvania School of Nursing Philadelphia, PA United States
| | - Emily F Gregory
- Children's Hospital of Philadelphia Philadelphia, PA United States
- Perelman School of Medicine University of Pennsylvania Philadelphia, PA United States
| | - Joshua Jayasinghe
- University of Pennsylvania School of Nursing Philadelphia, PA United States
| | | | - Ja H Koo
- University of Pennsylvania School of Nursing Philadelphia, PA United States
| | - Jennifer F Morone
- Yale University New Haven, CT United States
- Veterans Affairs West Haven, CT United States
| | - Damien C Leri
- Big Yellow Star, Inc. Philadelphia, PA United States
| | - Annet Davis
- University of Pennsylvania School of Nursing Philadelphia, PA United States
| | - Kristen A Feemster
- Children's Hospital of Philadelphia Philadelphia, PA United States
- Perelman School of Medicine University of Pennsylvania Philadelphia, PA United States
- Division of Disease Control Department of Public Health Philadelphia, PA United States
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Tull F, Borg K, Knott C, Beasley M, Halliday J, Faulkner N, Sutton K, Bragge P. Short Message Service Reminders to Parents for Increasing Adolescent Human Papillomavirus Vaccination Rates in a Secondary School Vaccine Program: A Randomized Control Trial. J Adolesc Health 2019; 65:116-123. [PMID: 30879881 DOI: 10.1016/j.jadohealth.2018.12.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/28/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE In Victoria (Australia), the human papillomavirus (HPV) vaccine is delivered within a state-wide secondary school vaccine program, administered by local government. This study aimed to test the hypothesis that sending a short message service (SMS) reminder to parents who had consented to their child's receiving the HPV vaccine would lead to greater uptake of the vaccine within the program. The secondary aim was to assess the effect of self-regulatory versus motivational message content in the SMS. METHODS A randomized control trial design was used across 31 schools within seven local government areas. Parents of 4,386 consented adolescents were randomized into three study conditions: motivational SMS versus self-regulatory SMS versus no SMS. Follow-up extended beyond the final school visit to the end of the calendar year to capture those who may have attended a catch-up vaccination session. RESULTS On the day of the final school visit, 85.71% of consented students in the control condition received the HPV vaccine, compared with 88.35% (2.64% point increase) in the motivational message condition, and 89.00% (3.29% point increase) in the self-regulatory message condition, χ2 (2, N = 4,386) = 8.31, p = .016. Both intervention messages were similarly effective at increasing vaccination rates. This effect was maintained in the extended follow-up period. CONCLUSIONS The trial findings supported the hypothesis that SMS reminders to parents/guardians would lead to greater uptake of the HPV vaccine in adolescents participating in school-based vaccination. Also, this effect was observed whether we used a motivational or self-regulatory message framework. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12617001307392). Registration Date: September 12, 2017. Retrospectively registered.
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Affiliation(s)
- Fraser Tull
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Victoria, Australia.
| | - Kim Borg
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Victoria, Australia
| | - Cameron Knott
- Behavioural Insights Unit, Department of Premier and Cabinet, Victorian State Government, Melbourne, Australia
| | - Megan Beasley
- Immunisation Section, Health Protection Branch, Department of Health and Human Services, Victorian State Government, Melbourne, Australia
| | - Justin Halliday
- Public Sector Innovation, Department of Premier and Cabinet, Victorian State Government, Melbourne, Australia
| | - Nicholas Faulkner
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Victoria, Australia
| | - Kim Sutton
- Immunisation Section, Health Protection Branch, Department of Health and Human Services, Victorian State Government, Melbourne, Australia
| | - Peter Bragge
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Victoria, Australia
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Stephens AB, Wynn CS, Stockwell MS. Understanding the use of digital technology to promote human papillomavirus vaccination - A RE-AIM framework approach. Hum Vaccin Immunother 2019; 15:1549-1561. [PMID: 31158064 DOI: 10.1080/21645515.2019.1611158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The human papillomavirus virus (HPV) vaccine is effective at preventing various cancers, but coverage falls short of targets that are needed for community protection. Here, we use the RE-AIM implementation framework (Reach, Effectiveness, Adoption, Implementation, Maintenance) to understand how text, email, and electronic health record (EHR) reminders and social media campaigns can be used as part of policy and practice interventions to increase HPV vaccination. These technology-based interventions could be used together and mainstreamed into clinical and system-based practice to have the greatest impact. Of the interventions explored, text-based, email-based, and EHR reminders have the most evidence behind them to support their effectiveness. While there are several studies of promotion of the HPV vaccine on social media, more studies are needed to demonstrate their effects and better methods are needed to be able to attribute results to these interventions.
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Affiliation(s)
- Ashley B Stephens
- a Department of Pediatrics, Columbia University , New York , NY , USA.,b NewYork-Presbyterian Hospital , New York , NY , USA
| | - Chelsea S Wynn
- a Department of Pediatrics, Columbia University , New York , NY , USA
| | - Melissa S Stockwell
- a Department of Pediatrics, Columbia University , New York , NY , USA.,b NewYork-Presbyterian Hospital , New York , NY , USA.,c Department of Population and Family Health, Mailman School of Public Health, Columbia University , New York , NY , USA
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Btoush R, Brown DR, Tsui J, Toler L, Bucalo J. Knowledge and Attitudes Toward Human Papillomavirus Vaccination Among Latina Mothers of South American and Caribbean Descent in the Eastern US. Health Equity 2019; 3:219-230. [PMID: 31289782 PMCID: PMC6608702 DOI: 10.1089/heq.2018.0058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose: The purpose of this study was to examine knowledge, attitudes, barriers, and facilitators for human papillomavirus (HPV) vaccination among Latina mothers of HPV vaccine-eligible children in low-income urban areas, as well as useful strategies to improve HPV vaccination. Methods: The study included 132 Latina mothers of HPV vaccine-eligible children, interviewed in 14 focus groups. Using semi-structured discussions, mothers were asked about their knowledge about HPV infection and vaccine, views toward HPV vaccination, barriers for HPV vaccine initiation as well as completion, and opinions on strategies to improve HPV vaccination. Results: Only 55% of mothers reported having ever heard of the HPV vaccine, 27% of mothers indicated initiating the HPV vaccine, and 14% indicated completing the multi-dose series. Mothers generally lacked knowledge about HPV infection and vaccination, with varying degrees by Latino descent. Health care provider (HCP) recommendation was the strongest barrier/facilitator for HPV vaccination. Useful strategies to improve HPV vaccine initiation and completion that the mothers suggested included strong recommendation from HCPs and addressing side effects and safety concerns. Other useful strategies included community and school-based approaches and the use of text messaging and smartphone technology to educate mothers and send vaccine reminders. Conclusion: The findings provide insight for the development of interventions targeting low-income Latina mothers and the need to improve HCP communication on HPV vaccination.
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Affiliation(s)
- Rula Btoush
- School of Nursing, Rutgers University, Newark, New Jersey
| | - Diane R Brown
- School of Public Health, Rutgers University, Newark, New Jersey
| | - Jennifer Tsui
- Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Lindsey Toler
- School of Public Health, Rutgers University, Piscataway, New Jersey
| | - Jennifer Bucalo
- School of Graduate Studies, Rutgers University, Newark, New Jersey
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Hirth JM, Berenson AB, Cofie LE, Matsushita L, Kuo YF, Rupp RE. Caregiver acceptance of a patient navigation program to increase human papillomavirus vaccination in pediatric clinics: a qualitative program evaluation. Hum Vaccin Immunother 2019; 15:1585-1591. [PMID: 30829116 DOI: 10.1080/21645515.2019.1587276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective: The purpose of this evaluation was to examine the acceptability of a multi-component patient navigator (PN) intervention program designed to decrease barriers to human papillomavirus (HPV) vaccination among caregivers of adolescents. We sought to understand the most important components of the program from the caregivers' perspective and to evaluate remaining barriers to vaccination. Method: Caregivers of children 9-17 years old (N = 102) participated in qualitative semi-structured interviews with questions informed by the Theory of Planned Behavior. These interviews assessed experiences with a PN program which offered HPV vaccination, scheduling, and reminders in pediatric clinics. We included randomly selected 46 program participant transcripts and 11 decliner transcripts. A thematic approach was used to analyze transcripts for themes related to acceptability of HPV vaccination, important program components, and any problems encountered. Results: Major themes included: reasons for making HPV vaccination decision, helpful program components and suggestions for improvement, and remaining barriers to vaccination. Those who declined vaccination stated that their child was too young or not ready to think about sex, or they did not have enough information to make a decision. However, they felt that PNs were respectful of their decision. Program participants felt that vaccination was an important way to prevent cancer. Program participants had often not been aware of the vaccine and felt that having it explained was very helpful. Conclusion: This program evaluation found that caregivers of pediatric patients, even those who declined the HPV vaccine, appreciated the program and felt it provided important information about the vaccine.
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Affiliation(s)
- Jacqueline M Hirth
- a Department of Obstetrics & Gynecology, University of Texas Medical Branch , Galveston , TX , USA
| | - Abbey B Berenson
- a Department of Obstetrics & Gynecology, University of Texas Medical Branch , Galveston , TX , USA
| | - Leslie E Cofie
- a Department of Obstetrics & Gynecology, University of Texas Medical Branch , Galveston , TX , USA.,b Department of Health Education and Promotion, East Carolina University , Greenville, NC , USA
| | - Lena Matsushita
- c School of Medicine, University of Texas Medical Branch , Galveston,TX , USA
| | - Yong-Fang Kuo
- d Department of Biostatistics, University of Texas Medical Branch , Galveston, TX , USA
| | - Richard E Rupp
- e Department of Pediatrics, University of Texas Medical Branch , Galveston, TX , USA
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Taylor D, Lunny C, Lolić P, Warje O, Geldman J, Wong T, Gilbert M, Lester R, Ogilvie G. Effectiveness of text messaging interventions on prevention, detection, treatment, and knowledge outcomes for sexually transmitted infections (STIs)/HIV: a systematic review and meta-analysis. Syst Rev 2019; 8:12. [PMID: 30621784 PMCID: PMC6323863 DOI: 10.1186/s13643-018-0921-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 12/18/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Rates of STIs continue to rise worldwide, and novel evidence-based interventions such as text messaging aimed at improving client services are needed. We conducted a meta-analysis to evaluate text messaging to support STI/HIV prevention and treatment interventions. METHODS We included articles that reported findings from randomized controlled trials (RTCs) involving adults and youth who were at risk of acquiring (or who currently had) a STI and/or HIV, a text message and comparator intervention, and reported provided outcome data on adherence to STI/HIV treatments. Articles were excluded if they were not published in English. We only included studies that have full-text publications so certainty and risk of bias assessments could be performed. Eight databases were searched to retrieve articles published between 1996 and March 2017. The Cochrane risk of bias tool was used and certainty of the evidence was assessed using GRADE. Effect estimates were pooled using a random effects model. RESULTS A total of 35 RCTs were found, 6 of which were considered at low risk of bias. Eight studies found an increased association using text messaging in appointments attended compared to standard care (OR 1.64, 95% CI 1.28 to 2.10). Participants receiving text messages had an increase in HIV testing compared to standard care (n = 6; OR 1.73, 95% CI 1.39 to 2.15). Ten text messaging RCTs measuring adherence using micro-electro-mechanical systems (MEMS) pill counts has a non-significant association (OR 1.17, 95% CI 0.95-1.45) while five studies measuring adherence by self-report was found to be significant (OR 1.64, 95% CI 1.28-2.11). CONCLUSIONS The effectiveness of text message interventions is equivocal. While text messaging has the potential to enhance the delivery of STI/HIV interventions, program planners are encouraged to evaluate any SMS intervention to ensure it is achieving the desired result. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42013006503.
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Affiliation(s)
- Darlene Taylor
- University of British Columbia, 1147 Research Road, Rm ARTS 154, Kelowna, BC, V1V 1V7, Canada.
| | - Carole Lunny
- University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada
| | - Petra Lolić
- BC Centre for Disease Control, 655 W12th Ave, Vancouver, BC, Canada
| | - Orion Warje
- Vancouver Island Health Authority, 1952 Bay Street, Victoria, BC, V8R 1J8, Canada
| | - Jasmina Geldman
- University of British Columbia, 1147 Research Road, Rm ARTS 154, Kelowna, BC, V1V 1V7, Canada
| | - Tom Wong
- Health Canada/Santé Canada, 200 Eglantine Driveway, Room 1913A, Ottawa, ON, K1A 0K9, Canada
| | - Mark Gilbert
- BC Centre for Disease Control, 655 W12th Ave, Vancouver, BC, Canada
| | - Richard Lester
- University of British Columbia, Research Pavilion, Rm 566, 828 W 10th, Vancouver, BC, V5Z 1 M9, Canada
| | - Gina Ogilvie
- University of British Columbia, Box 42, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
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Henrikson NB, Zhu W, Baba L, Nguyen M, Berthoud H, Gundersen G, Hofstetter AM. Outreach and Reminders to Improve Human Papillomavirus Vaccination in an Integrated Primary Care System. Clin Pediatr (Phila) 2018; 57:1523-1531. [PMID: 30003794 DOI: 10.1177/0009922818787868] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study evaluated the impact of health system-based outreach and reminders on human papillomavirus (HPV) vaccine series initiation and completion. Parents of 10 to 12 year olds (n = 1805) were randomized to receive either (1) an outreach letter and brochure recommending HPV vaccination followed by automated HPV vaccine reminders or (2) usual care. We interviewed a subset of 50 parents to assess program acceptability. Outcomes were HPV vaccine initiation during the study period and on-time series completion. Rates of HPV vaccine initiation during the study period (July 2015 to August 2016) were similar between the intervention and control groups, but initiation within 120 days of randomization was higher in the intervention group (23.6% and 18.8%, P = .04) as was completion during the study period (10.3% vs 6.8%, P = .04). Reminders for doses 2 and 3 did not affect completion. The program was acceptable to parents. This study provides evidence that health system-based outreach and reminders can improve HPV vaccination.
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Affiliation(s)
- Nora B Henrikson
- 1 Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.,2 University of Washington, Seattle, WA, USA
| | - Weiwei Zhu
- 1 Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Lauren Baba
- 3 Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Matthew Nguyen
- 1 Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Heidi Berthoud
- 1 Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Annika M Hofstetter
- 2 University of Washington, Seattle, WA, USA.,4 Seattle Children's Research Institute, Seattle, WA, USA
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Coley S, Hoefer D, Rausch-Phung E. A population-based reminder intervention to improve human papillomavirus vaccination rates among adolescents at routine vaccination age. Vaccine 2018; 36:4904-4909. [PMID: 30037480 DOI: 10.1016/j.vaccine.2018.06.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/18/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Public health authorities have the resources to conduct efficient immunization reminder interventions to improve vaccine uptake. The objective of this initiative was to design and implement a cost-effective centralized HPV vaccine reminder using New York State Immunization Information System data as one of five prespecified activities to increase initiation and completion among 11- to 13-year-old adolescents. METHODS The New York State Department of Health sent reminder letters to the parents or guardians of eligible adolescents who were due for the first dose of HPV vaccine and observed HPV vaccine administration in the six months after each mailing. Subjects were randomized into an intervention group, mailed on May 14, 2015 and a control group, mailed on December 8, 2015. RESULTS The analysis consisted of 81,558 eligible letter recipients. Letter recipients were 2 percent more likely to initiate vaccination than control subjects. Significant increases in vaccine uptake were observed for all age and gender strata. The intervention cost was $30.95 for each adolescent who initiated the HPV vaccine series. New York State Department of Health received far less public feedback, including negative feedback, about this intervention that was originally anticipated. CONCLUSIONS Public health entities can effectively utilize existing resources to conduct large-scale reminder interventions targeting a jurisdiction's entire 11- to 13-year-old population.
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Affiliation(s)
- Scott Coley
- New York State Department of Health, Corning Tower, Empire State Plaza, Albany, NY 12237, United States.
| | - Dina Hoefer
- New York State Department of Health, Corning Tower, Empire State Plaza, Albany, NY 12237, United States
| | - Elizabeth Rausch-Phung
- New York State Department of Health, Corning Tower, Empire State Plaza, Albany, NY 12237, United States
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Kolff CA, Scott VP, Stockwell MS. The use of technology to promote vaccination: A social ecological model based framework. Hum Vaccin Immunother 2018; 14:1636-1646. [PMID: 29781750 PMCID: PMC6067841 DOI: 10.1080/21645515.2018.1477458] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Vaccinations are an important and effective cornerstone of preventive medical care. Growing technologic capabilities and use by both patients and providers present critical opportunities to leverage these tools to improve vaccination rates and public health. We propose the Social Ecological Model as a useful theoretical framework to identify areas in which technology has been or may be leveraged to target undervaccination across the individual, interpersonal, organizational, community, and society levels and the ways in which these levels interact.
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Affiliation(s)
- Chelsea A Kolff
- a Department of Pediatrics , Columbia University , New York , NY , USA.,b Department of Population and Family Health , Mailman School of Public Health, Columbia University , New York , NY , USA
| | - Vanessa P Scott
- a Department of Pediatrics , Columbia University , New York , NY , USA.,c NewYork-Presbyterian Hospital , New York , NY , USA
| | - Melissa S Stockwell
- a Department of Pediatrics , Columbia University , New York , NY , USA.,b Department of Population and Family Health , Mailman School of Public Health, Columbia University , New York , NY , USA.,c NewYork-Presbyterian Hospital , New York , NY , USA
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Head KJ, Biederman E, Sturm LA, Zimet GD. A retrospective and prospective look at strategies to increase adolescent HPV vaccine uptake in the United States. Hum Vaccin Immunother 2018; 14:1626-1635. [PMID: 29359986 PMCID: PMC6067847 DOI: 10.1080/21645515.2018.1430539] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 12/20/2017] [Accepted: 01/15/2018] [Indexed: 01/06/2023] Open
Abstract
The HPV vaccine debuted more than ten years ago in the United States and many strategies have been evaluated to increase HPV vaccination rates, which include not only improving current vaccination behaviors but also sustaining these behaviors. Researchers and practitioners from a variety of backgrounds have engaged in this work, which has included efforts directed at public health and government policies, health education and health promotion programs, and clinical and patient-provider approaches, as well as work aimed to respond to and combat anti-HPV vaccination movements in society. Using a previously developed conceptual model to organize and summarize each of these areas, this paper also highlights the need for future HPV vaccine promotion work to adopt a multi-level and, when possible, integrated approach in order to maximize impact on vaccination rates.
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Affiliation(s)
- Katharine J. Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | | | - Lynne A. Sturm
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gregory D. Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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Schwebel FJ, Larimer ME. Using text message reminders in health care services: A narrative literature review. Internet Interv 2018; 13:82-104. [PMID: 30206523 PMCID: PMC6112101 DOI: 10.1016/j.invent.2018.06.002] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Despite the extensive use of mHealth behavior change interventions, questions remain about the use of technology-based reminders in delivering health care services. Text messaging, or short message service (SMS), is one reminder method that has been extensively researched. Most SMS-reminder research is distributed across a range of health care outcomes. The aim of this article is to systematically review the aggregate impact of these reminders on overall health care outcomes. METHODS A systematic literature review was conducted and yielded 2316 articles. Studies were included if they used SMS reminders to support patient health care outcomes. Study methodology was aligned with the PRISMA guidelines for systematic reviews. RESULTS Following screening, 162 articles met inclusion criteria. Of these studies, 93 investigated medical compliance reminders and 56 investigated appointment reminders. The review found that nearly all the SMS-reminder studies helped improve patient medical compliance and appointment reminders. Additionally, researchers reported numerous benefits from using SMS reminders, including ease of use, relative inexpensiveness, and rapid and automated message delivery. Minimal risks were reported and most participants found the reminders to be acceptable. DISCUSSION Text messages appear to be an effective reminder mechanism to promote improved patient appointment and medical compliance. Reminders should continue to be evaluated and improved to determine the most effective timing and frequency of messages for improving outcomes.
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Affiliation(s)
- Frank J. Schwebel
- University of Washington, Department of Psychology, 119A Guthrie Hall Box 351525, Seattle, WA 98195-1525, United States of America,Corresponding author.
| | - Mary E. Larimer
- University of Washington, Department of Psychology, 119A Guthrie Hall Box 351525, Seattle, WA 98195-1525, United States of America,University of Washington, Department of Psychiatry and Behavioral Sciences, 1100 NE 45th, Suite 300, Office 312, Box 354944, Seattle, WA 98105, United States of America
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Impact of a clinical interventions bundle on uptake of HPV vaccine at an OB/GYN clinic. Vaccine 2018; 36:3599-3605. [PMID: 29759380 DOI: 10.1016/j.vaccine.2018.05.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 01/05/2023]
Abstract
INTRODUCTION HPV vaccine uptake is lowest among young adults. Little is known about the most effective way to decrease missed opportunities (MO) and increase uptake of the vaccine in this vulnerable population. OBJECTIVES To determine the impact of a clinical intervention bundle on the rate of MO and uptake of the vaccine among young adult women. METHODS From 2/2014 to 7/2015, an intervention bundle (designating physician and nurse champions, pre-screening patients' charts, empowering nurses to recommend immunization, providing no-cost vaccinations, placing prompts in clinic note templates, eliminating requirement for pre-vaccination pregnancy test) was implemented at an urban, hospital-based OB/GYN clinic. Medical records were reviewed for all vaccine-eligible (non-pregnant, 11-26 years) women seen between 2/2013 and 9/2016. Impact of the bundled interventions on the monthly rates of MO and vaccine uptake was estimated by analyzing immunization trends with an interrupted time-series model using counterfactual comparison groups in order to control for pre-existing trends. RESULTS There were 6,463 vaccine-eligible visits during our study period. The prevalence of women who had both completed and initiated the series was significantly higher, 20.3% and 29.7% respectively, in the last month, compared to their counterfactuals (p < 0.01). In the last study month, the rate of MO was significantly lower than its counterfactual (19.73 per 100 encounters lower, p < 0.01). Hispanic women had attributable reductions in their rates of MO that were twice that of White women. Statistically significant attributable reductions were also seen among Spanish speakers, publicly insured, and uninsured women. CONCLUSIONS Implementation of this intervention bundle effectively reduced the monthly rate of MO and increased the prevalence of women who had initiated and completed the HPV vaccine series. The reduction of MO was most drastic among Hispanic, publicly insured and uninsured women compared to White and privately insured.
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Rand CM, Tyrrell H, Wallace-Brodeur R, Goldstein NPN, Darden PM, Humiston SG, Albertin CS, Stratbucker W, Schaffer SJ, Davis W, Szilagyi PG. A Learning Collaborative Model to Improve Human Papillomavirus Vaccination Rates in Primary Care. Acad Pediatr 2018; 18:S46-S52. [PMID: 29502638 DOI: 10.1016/j.acap.2018.01.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/02/2018] [Accepted: 01/02/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Human papillomavirus (HPV) vaccination rates remain low, in part because of missed opportunities (MOs) for vaccination. We used a learning collaborative quality improvement (QI) model to assess the effect of a multicomponent intervention on reducing MOs. METHODS Study design: pre-post using a QI intervention in 33 community practices and 14 pediatric continuity clinics over 9 months to reduce MOs for HPV vaccination at all visit types. MEASURES outcome measures comprised baseline and postproject measures of 1) MOs (primary outcome), and 2) HPV vaccine initiation and completion. Process measures comprised monthly chart audits of MOs for HPV vaccination for performance feedback, monthly Plan-Do-Study-Act surveys and pre-post surveys about office systems. INTERVENTION providers were trained at the start of the project on offering a strong recommendation for HPV vaccination. Practices implemented provider prompts and/or standing orders and/or reminder/recall if desired, and were provided monthly feedback on MOs to assess their progress. ANALYSES chi-square tests were used to assess changes in office practices, and logistic regression used to assess changes in MOs according to visit type and overall, as well as HPV vaccine initiation and completion. RESULTS MOs overall decreased (from 73% to 53% in community practices and 62% to 55% in continuity clinics; P < .01, and P = .03, respectively). HPV vaccine initiation increased for both genders in community practices (from 66% to 74% for female, 57% to 65% for male; P < .01), and for male patients in continuity clinics (from 68% to 75%; P = .05). Series completion increased overall in community practices (39% to 43%; P = .04) and for male patients in continuity clinics (from 36% to 44%; P = .03). CONCLUSIONS Office systems changes using a QI model and multicomponent interventions decreased rates of MO for HPV vaccination and increased initiation and completion rates among some gender subgroups. A learning collaborative model provides an effective forum for practices to improve HPV vaccine delivery.
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Affiliation(s)
- Cynthia M Rand
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.
| | | | - Rachel Wallace-Brodeur
- National Improvement Partnership Network, University of Vermont Medical Center, Burlington, Vt
| | - Nicolas P N Goldstein
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Paul M Darden
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Sharon G Humiston
- Department of Pediatrics, University of Missouri Kansas City School of Medicine and Children's Mercy Kansa City, Kansas City, Mo
| | | | - William Stratbucker
- Department of Pediatrics, Michigan State University/Helen DeVos Children's Hospital, Grand Rapids, Mich
| | - Stanley J Schaffer
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Wendy Davis
- National Improvement Partnership Network, University of Vermont Medical Center, Burlington, Vt
| | - Peter G Szilagyi
- Department of Pediatrics, Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, Calif
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Jacobson Vann JC, Jacobson RM, Coyne‐Beasley T, Asafu‐Adjei JK, Szilagyi PG. Patient reminder and recall interventions to improve immunization rates. Cochrane Database Syst Rev 2018; 1:CD003941. [PMID: 29342498 PMCID: PMC6491344 DOI: 10.1002/14651858.cd003941.pub3] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Immunization rates for children and adults are rising, but coverage levels have not reached optimal goals. As a result, vaccine-preventable diseases still occur. In an era of increasing complexity of immunization schedules, rising expectations about the performance of primary care, and large demands on primary care providers, it is important to understand and promote interventions that work in primary care settings to increase immunization coverage. One common theme across immunization programs in many nations involves the challenge of implementing a population-based approach and identifying all eligible recipients, for example the children who should receive the measles vaccine. However, this issue is gradually being addressed through the availability of immunization registries and electronic health records. A second common theme is identifying the best strategies to promote high vaccination rates. Three types of strategies have been studied: (1) patient-oriented interventions, such as patient reminder or recall, (2) provider interventions, and (3) system interventions, such as school laws. One of the most prominent intervention strategies, and perhaps best studied, involves patient reminder or recall systems. This is an update of a previously published review. OBJECTIVES To evaluate and compare the effectiveness of various types of patient reminder and recall interventions to improve receipt of immunizations. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL to January 2017. We also searched grey literature and trial registers to January 2017. SELECTION CRITERIA We included randomized trials, controlled before and after studies, and interrupted time series evaluating immunization-focused patient reminder or recall interventions in children, adolescents, and adults who receive immunizations in any setting. We included no-intervention control groups, standard practice activities that did not include immunization patient reminder or recall, media-based activities aimed at promoting immunizations, or simple practice-based awareness campaigns. We included receipt of any immunizations as eligible outcome measures, excluding special travel immunizations. We excluded patients who were hospitalized for the duration of the study period. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane and the Cochrane Effective Practice and Organisation of Care (EPOC) Group. We present results for individual studies as relative rates using risk ratios, and risk differences for randomized trials, and as absolute changes in percentage points for controlled before-after studies. We present pooled results for randomized trials using the random-effects model. MAIN RESULTS The 75 included studies involved child, adolescent, and adult participants in outpatient, community-based, primary care, and other settings in 10 countries.Patient reminder or recall interventions, including telephone and autodialer calls, letters, postcards, text messages, combination of mail or telephone, or a combination of patient reminder or recall with outreach, probably improve the proportion of participants who receive immunization (risk ratio (RR) of 1.28, 95% confidence interval (CI) 1.23 to 1.35; risk difference of 8%) based on moderate certainty evidence from 55 studies with 138,625 participants.Three types of single-method reminders improve receipt of immunizations based on high certainty evidence: the use of postcards (RR 1.18, 95% CI 1.08 to 1.30; eight studies; 27,734 participants), text messages (RR 1.29, 95% CI 1.15 to 1.44; six studies; 7772 participants), and autodialer (RR 1.17, 95% CI 1.03 to 1.32; five studies; 11,947 participants). Two types of single-method reminders probably improve receipt of immunizations based on moderate certainty evidence: the use of telephone calls (RR 1.75, 95% CI 1.20 to 2.54; seven studies; 9120 participants) and letters to patients (RR 1.29, 95% CI 1.21 to 1.38; 27 studies; 81,100 participants).Based on high certainty evidence, reminders improve receipt of immunizations for childhood (RR 1.22, 95% CI 1.15 to 1.29; risk difference of 8%; 23 studies; 31,099 participants) and adolescent vaccinations (RR 1.29, 95% CI 1.17 to 1.42; risk difference of 7%; 10 studies; 30,868 participants). Reminders probably improve receipt of vaccinations for childhood influenza (RR 1.51, 95% CI 1.14 to 1.99; risk difference of 22%; five studies; 9265 participants) and adult influenza (RR 1.29, 95% CI 1.17 to 1.43; risk difference of 9%; 15 studies; 59,328 participants) based on moderate certainty evidence. They may improve receipt of vaccinations for adult pneumococcus, tetanus, hepatitis B, and other non-influenza vaccinations based on low certainty evidence although the confidence interval includes no effect of these interventions (RR 2.08, 95% CI 0.91 to 4.78; four studies; 8065 participants). AUTHORS' CONCLUSIONS Patient reminder and recall systems, in primary care settings, are likely to be effective at improving the proportion of the target population who receive immunizations.
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Affiliation(s)
- Julie C Jacobson Vann
- The University of North Carolina at Chapel HillSchool of NursingCarrington HallChapel HillNorth CarolinaUSA27599‐7460
| | - Robert M Jacobson
- Mayo ClinicPediatric and Adolescent Medicine200 First Street, SWRochesterMinnesotaUSA55905‐0001
| | - Tamera Coyne‐Beasley
- University of North CarolinaGeneral Pediatrics and Adolescent MedicineChapel HillNorth CarolinaUSA
| | - Josephine K Asafu‐Adjei
- University of North Carolina at Chapel HillDepartment of Biostatistics, School of Nursing120 North Medical Drive, 2005 Carrington HallChapel HillNorth CarolinaUSA27599
| | - Peter G Szilagyi
- University of California Los AngelesDepartment of Pediatrics90024Los AngelesCaliforniaUSA90024
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Saville AW, Szilagyi P, Helmkamp L, Albertin C, Gurfinkel D, Vangela S, Dickinson LM, Zhou X, Roth H, Kempe A. Potential Strategies to Achieve Universal Influenza Vaccination for Children: Provider Attitudes in Two States. Acad Pediatr 2018; 18:873-881. [PMID: 30031132 PMCID: PMC7477487 DOI: 10.1016/j.acap.2018.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/02/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Childhood influenza vaccination rates remain suboptimal. Provider perceptions on strategies to achieve universal vaccination are needed. We assessed the perceptions and attitudes of primary care providers across 2 states regarding 2 strategies to potentially bolster rates: centralized reminder/recall (C-R/R), such as reminder/recall (R/R) notices from state immunization registries, and influenza vaccination by complementary community vaccinators (CCVs), such as retail pharmacies, schools, and health departments. METHODS We sent a mailed survey to a representative sample of providers across Colorado and New York. Questions addressed R/R activities for influenza vaccine, preferences and attitudes about the health department sending C-R/R notices for influenza vaccine, and attitudes about CCVs. Bivariate analyses assessed provider perceptions and compared perceptions by state. RESULTS The overall response rate was 56% (n = 590/1052). Twenty-two percent of providers in Colorado and 33% in New York performed practice-based R/R for all patients during the 2015-16 influenza season. Eighty-one percent of providers in both states preferred the health department or had no preference for who sent C-R/R notices for influenza vaccine to their patients; most preferred to include their practice names on C-R/R messages. Many providers in both Colorado (75%) and New York (46%, P < .001) agreed that their patients like the option of having CCVs where children can receive influenza vaccine. Some providers expressed concerns regarding potential loss of income and/or difficulty documenting receipt of influenza vaccine at CCVs. CONCLUSIONS Most providers support C-R/R, and many support CCVs to increase influenza vaccination rates. Collaborations between traditional primary care providers and CCVs might boost coverage.
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