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McGlone MS, Stephens KK, Jia M, Montagnolo C, Xu Y. Multiple Messaging Strategies for Increasing HPV Vaccination Intentions among English- and Spanish-Speaking Parents in the United States and Mexico. Vaccines (Basel) 2024; 12:650. [PMID: 38932379 PMCID: PMC11209435 DOI: 10.3390/vaccines12060650] [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: 05/16/2024] [Revised: 06/02/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024] Open
Abstract
The reported study compared the impact of four influence strategies (agency assignment, enhanced active choice, deviance regulation marking, and temporal framing) on English- and Spanish-speaking parents' reported intention to vaccinate their children for HPV. An online experiment was conducted to examine the impact of the strategies. In a fractional factorial design, participating parents (N = 1663) were exposed to combinations of influence strategies in text messages presented as reminders they might receive from a healthcare provider about their child's eligibility for the vaccine series. The results indicated small but significant impacts of agency assignment, enhanced active choice, and deviance regulation marking on parents' reported vaccination intentions. The study adds to the research literature on HPV vaccination communication in two important respects. First, it demonstrated how incorporating evidence-based influence strategies into reminder messages can increase parents' vaccination intentions, an important precursor and predictor of actual vaccine uptake. Second, it sets an important precedent by examining the effects of influence strategies on vaccination intentions across different languages.
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Affiliation(s)
- Matthew S. McGlone
- Technology and Information Policy Institute, Moody College of Communication, The University of Texas at Austin, Austin, TX 78712, USA; (K.K.S.); (C.M.); (Y.X.)
| | - Keri K. Stephens
- Technology and Information Policy Institute, Moody College of Communication, The University of Texas at Austin, Austin, TX 78712, USA; (K.K.S.); (C.M.); (Y.X.)
| | - Mian Jia
- Department of English, City University of Hong Kong, Hong Kong SAR 999077, China;
| | - Carolyn Montagnolo
- Technology and Information Policy Institute, Moody College of Communication, The University of Texas at Austin, Austin, TX 78712, USA; (K.K.S.); (C.M.); (Y.X.)
| | - Yifan Xu
- Technology and Information Policy Institute, Moody College of Communication, The University of Texas at Austin, Austin, TX 78712, USA; (K.K.S.); (C.M.); (Y.X.)
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Hakim H, Driedger SM, Gagnon D, Chevrier J, Roch G, Dubé E, Witteman HO. Digital Gamification Tools to Enhance Vaccine Uptake: Scoping Review. JMIR Serious Games 2024; 12:e47257. [PMID: 38421688 PMCID: PMC10906656 DOI: 10.2196/47257] [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: 03/14/2023] [Revised: 09/22/2023] [Accepted: 01/02/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Gamification has been used successfully to promote various desired health behaviors. Previous studies have used gamification to achieve desired health behaviors or facilitate their learning about health. OBJECTIVE In this scoping review, we aimed to describe digital gamified tools that have been implemented or evaluated across various populations to encourage vaccination, as well as any reported effects of identified tools. METHODS We searched Medline, Embase, CINAHL, the Web of Science Core Collection, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Academic Search Premier, PsycInfo, Global Health, and ERIC for peer-reviewed papers describing digital gamified tools with or without evaluations. We also conducted web searches with Google to identify digital gamified tools lacking associated publications. We consulted 12 experts in the field of gamification and health behavior to identify any papers or tools we might have missed. We extracted data about the target population of the tools, the interventions themselves (eg, type of digital gamified tool platform, type of disease/vaccine, type and design of study), and any effects of evaluated tools, and we synthesized data narratively. RESULTS Of 1402 records, we included 28 (2%) peer-reviewed papers and 10 digital gamified tools lacking associated publications. The experts added 1 digital gamified tool that met the inclusion criteria. Our final data set therefore included 28 peer-reviewed papers and 11 digital gamified tools. Of the 28 peer-reviewed papers, 7 (25%) explained the development of the tool, 16 (57%) described evaluation, and 2 (7%) reported both development and evaluation of the tool. The 28 peer-reviewed papers reported on 25 different tools. Of these 25 digital gamified tools, 11 (44%) were web-based tools, 8 (32%) mobile (native mobile or mobile-enabled web) apps, and 6 (24%) virtual reality tools. Overall, tools that were evaluated showed increases in knowledge and intentions to receive vaccines, mixed effects on attitudes, and positive effects on beliefs. We did not observe discernible advantages of one type of digital gamified tool (web based, mobile, virtual reality) over the others. However, a few studies were randomized controlled trials, and publication bias may have led to such positive effects having a higher likelihood of appearing in the peer-reviewed literature. CONCLUSIONS Digital gamified tools appear to have potential for improving vaccine uptake by fostering positive beliefs and increasing vaccine-related knowledge and intentions. Encouraging comparative studies of different features or different types of digital gamified tools could advance the field by identifying features or types of tools that yield more positive effects across populations and contexts. Further work in this area should seek to inform the implementation of gamification for vaccine acceptance and promote effective health communication, thus yielding meaningful health and social impacts.
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Affiliation(s)
- Hina Hakim
- Department of Family and Emergency Medicine, Université Laval, Québec City, QC, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Dominique Gagnon
- Direction des risques biologiques, Institut national de santé publique du Québec, Quebec City, QC, Canada
| | - Julien Chevrier
- Bibliothèque Louise-Lalonde-Lamarre, Polytechnique Montréal, Montréal, QC, Canada
| | - Geneviève Roch
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- Centre hospitalier universitaire (CHU) de Québec-Université Laval, Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Université Laval, Quebec City, QC, Canada
| | - Eve Dubé
- Direction des risques biologiques, Institut national de santé publique du Québec, Quebec City, QC, Canada
- Département d'anthropologie, Université Laval, Quebec City, QC, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec City, QC, Canada
- Centre hospitalier universitaire (CHU) de Québec-Université Laval, Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Université Laval, Quebec City, QC, Canada
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Finney Rutten LJ, Griffin JM, St Sauver JL, MacLaughlin K, Austin JD, Jenkins G, Herrin J, Jacobson RM. Multilevel Implementation Strategies for Adolescent Human Papillomavirus Vaccine Uptake: A Cluster Randomized Clinical Trial. JAMA Pediatr 2024; 178:29-36. [PMID: 37983062 PMCID: PMC10957109 DOI: 10.1001/jamapediatrics.2023.4932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Importance Despite availability of a safe and effective vaccine, an estimated 36 500 new cancers in the US result from human papillomavirus (HPV) annually. HPV vaccine uptake falls short of national public health goals and lags other adolescent vaccines. Objective To evaluate the individual and combined impact of 2 evidence-based interventions on HPV vaccination rates among 11- and 12-year-old children. Design, Setting, and Participants The study team conducted a cluster randomized clinical trial with a stepped-wedge factorial design at 6 primary care practices affiliated with Mayo Clinic in southeastern Minnesota. Using block randomization to ensure balance of patient volumes across interventions, each practice was allocated to a sequence of four 12-month steps with the initial baseline step followed by 2 intermediate steps (none, 1, or both interventions) and a final step wherein all practices implemented both interventions. Each month, all eligible children who turned 11 or 12 years in the 2 months prior were identified and followed until the end of the step. Data were analyzed from April 2018 through March 2019. Participants included children who turned 11 or 12 years old and were due for a dose of the HPV vaccine. Interventions Parents of eligible patients were mailed reminder/recalls following their child's birthdays. Health care professionals received confidential audit/feedback on their personal in-office success with HPV vaccine uptake via intra-campus mail. These 2 interventions were assessed separately and in combination. Main Outcomes and Measures Eligible patients' receipt of any valid dose of HPV vaccine during the study step. Results The cohort was comprised of 9242 11-year-olds (5165 [55.9%]) and 12-year-olds (4077 [44.1%]), and slightly more males (4848 [52.5%]). Parent reminder/recall resulted in 34.6% receiving a dose of HPV vaccine, health care professional audit/feedback, 30.4%, both interventions together resulted in 39.7%-all contrasted to usual care, 21.9%. Compared with usual care, the odds of HPV vaccination were higher for parent reminder/recall (odds ratio [OR], 1.56; 95% CI, 1.23-1.97) and for the combination of parent reminder/recall and health care professional audit/feedback (OR, 2.03; 95% CI, 1.44-2.85). Health care professional audit/feedback alone did not differ significantly from usual care (OR, 1.19; 95% CI, 0.94-1.51). Conclusions and Relevance In this cluster randomized trial, the combination of parent reminder/recall and health care professional audit/feedback increased the odds of HPV vaccination compared with usual care. These findings underscore the value of simultaneous implementation of evidence-based strategies to improve HPV vaccination.
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Affiliation(s)
| | - Joan M Griffin
- Division of Health Care Delivery Research and Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Gregory Jenkins
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
- Flying Buttress Associates, Charlottesville, Virginia
| | - Robert M Jacobson
- Division of Epidemiology, Mayo Clinic, Rochester, Minnesota
- Division of Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
- Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, Minnesota
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Alonge OD, Hanson KE, Eggebrecht M, Funk P, Christianson B, Williams CL, Belongia EA, McLean HQ. COVID-19 Booster Dose Reminder/Recall for Adolescents: Findings From a Health-Care System in Wisconsin. J Adolesc Health 2023; 73:953-956. [PMID: 37610391 DOI: 10.1016/j.jadohealth.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/22/2023] [Accepted: 06/26/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE This study assessed efficacy of one-time COVID-19 booster reminder/recall for booster eligible adolescents in a health-care system in Wisconsin. METHODS COVID-19 booster eligible patients aged 12-17 years were randomized 1:1 to receive one reminder/recall message from the health-care system using the parent's preferred communication method (intervention) or no reminder/recall (usual care) in May 2022. RESULTS Reminder/recall was sent to 2,146/4,296 (50%) adolescent patients. During the 90-day evaluation period following randomization, booster dose receipt was 2.0 percentage points (CI: 0.3%-3.7%) higher in the intervention (10.0%) versus usual care groups (8.0%). Among patients with ≥1 preventive visit during the evaluation period, uptake was 7.5 percentage points higher in the intervention (16.4%) versus usual care groups (8.9%). DISCUSSION A single COVID-19 booster dose reminder/recall resulted in a small but statistically significant increase in booster dose receipt, though uptake overall was low. Additional strategies are needed to increase uptake.
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Affiliation(s)
- Oluwakemi D Alonge
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin.
| | - Kayla E Hanson
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Meranda Eggebrecht
- Institute for Quality Innovation & Patient Safety, Marshfield Clinic Health System, Marshfield, Wisconsin
| | - Penny Funk
- Institute for Quality Innovation & Patient Safety, Marshfield Clinic Health System, Marshfield, Wisconsin
| | | | - Charnetta L Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Edward A Belongia
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Huong Q McLean
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin
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Xu MA, Choi J, Capasso A, DiClemente R. Patient-Provider Health Communication Strategies: Enhancing HPV Vaccine Uptake among Adolescents of Color. Healthcare (Basel) 2023; 11:1702. [PMID: 37372820 DOI: 10.3390/healthcare11121702] [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: 04/24/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Cervical cancer remains a public health issue in the United States, particularly among stigmatized racial and ethnic populations. The human papillomavirus (HPV) vaccine has been clinically proven to prevent cervical cancers, and other HPV-associated cancers, among men and women. However, HPV vaccine uptake is suboptimal; only 55% of adolescents complete the two-dose series by age 15. Past research has shown that provider HPV vaccine communication for people of marginalized races/ethnicities is subpar. This article focuses on provider communication strategies to promote HPV vaccine uptake effectively and equitably. The authors reviewed the literature on evidence-based patient-provider HPV vaccine communication techniques to create a set of communication language providers could use and avoid using to enhance HPV vaccine acceptance and uptake among adolescents of marginalized racial and ethnic groups. Evidence has shown that information and the manner of dissemination are critical for influencing HPV vaccine uptake. These communication strategies must be suited to the context of the targeted population, and the message content can be broadly categorized into source, content, and modality. Strategies to improve patient-provider communication among adolescents of color using source, modality, and content include the following: (1) Source: increase provider self-efficacy to provide the recommendation, building rapport between providers and parents; (2) Content: persistent, forceful language with minimal acquiescence should be employed, reframing the conversation focus from sex to cancer; and (3) Modality: use multiple vaccine reminder modalities, and work with the community to culturally adapt the vaccination language. Utilizing effective behavior-change communication adapted for adolescents of color can reduce missed opportunities for HPV prevention, potentially decreasing racial and ethnic disparities in HPV-related morbidity and mortality.
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Affiliation(s)
- Mia Ann Xu
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | - Jasmin Choi
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | | | - Ralph DiClemente
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
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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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MacDonald SE, Marfo E, Sell H, Assi A, Frank-Wilson A, Atkinson K, Kellner JD, McNeil D, Klein K, Svenson LW. Text Message Reminders to Improve Immunization Appointment Attendance in Alberta, Canada: The Childhood Immunization Reminder Project Pilot Study. JMIR Mhealth Uhealth 2022; 10:e37579. [PMID: 36346666 PMCID: PMC9682453 DOI: 10.2196/37579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 09/15/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Vaccine coverage for 18-month-old children in Canada is often below the recommended level, which may be partially because of parental forgetfulness. SMS text message reminders have been shown to potentially improve childhood immunization uptake but have not been widely used in Alberta, Canada. In addition, it has been noted that language barriers may impede immunization service delivery but continue to remain unaddressed in many existing reminder and recall systems. OBJECTIVE This study aimed to assess the effectiveness and acceptability of using SMS text messages containing a link to web-based immunization information in different languages to remind parents of their child's 18-month immunization appointment. METHODS The Childhood Immunization Reminder Project was a pilot intervention at 2 public health centers, one each in Lethbridge and Edmonton, Alberta, Canada. Two SMS text message reminders were sent to parents: a booking reminder 3 months before their child turned 18 months old and an appointment reminder 3 days before their scheduled appointment. Booking reminders included a link to the study website hosting immunization information in 9 languages. To evaluate intervention effectiveness, we compared the absolute attendance no-show rates before the intervention and after the intervention. The acceptability of the intervention was evaluated through web-based surveys completed by parents and public health center staff. Google Analytics was used to determine how often web-based immunization information was accessed, from where, and in which languages. RESULTS Following the intervention, the health center in Edmonton had a reduction of 6.4% (95% CI 3%-9.8%) in appointment no-shows, with no change at the Lethbridge Health Center (0.8%, 95% CI -1.4% to 3%). The acceptability surveys were completed by 222 parents (response rate: 23.9%) and 22 staff members. Almost all (>95%) respondents indicated that the reminders were helpful and provided useful suggestions for improvement. All surveyed parents (222/222, 100%) found it helpful to read web-based immunization information in their language of choice. Google Analytics data showed that immunization information was most often read in English (118/207, 57%), Punjabi (52/207, 25.1%), Arabic (13/207, 6.3%), Spanish (12/207, 5.8%), Italian (4/207, 1.9%), Chinese (4/207, 1.9%), French (2/207, 0.9%), Tagalog (1/207, 0.5%), and Vietnamese (1/207, 0.5%). CONCLUSIONS The study's findings support the use of SMS text message reminders as a convenient and acceptable method to minimize parental forgetfulness and potentially reduce appointment no-shows. The diverse languages accessed in web-based immunization information suggest the need to provide appropriate translated immunization information. Further research is needed to evaluate the impact of SMS text message reminders on childhood immunization coverage in different settings.
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Affiliation(s)
- Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Emmanuel Marfo
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Hannah Sell
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Ali Assi
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Andrew Frank-Wilson
- South Zone Data & Analytics, Alberta Health Services, Lethbridge, AB, Canada
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
| | - Katherine Atkinson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - James D Kellner
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Deborah McNeil
- Strategic Clinical Networks, Alberta Health Services, Calgary, AB, Canada
| | - Kristin Klein
- Communicable Disease Control, Provincial Population & Public Health, Alberta Health Services, Edmonton, AB, Canada
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lawrence W Svenson
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Analytics and Performance Reporting, Alberta Health, Edmonton, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
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9
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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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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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11
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SPN white paper: Recommendations for pediatric reminder and recall interventions to improve immunization rates. J Pediatr Nurs 2022; 63:151-153. [PMID: 35287878 DOI: 10.1016/j.pedn.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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12
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Margolis MA, Brewer NT, Boynton MH, Lafata JE, Southwell BG, Gilkey MB. Provider response and follow-up to parental declination of HPV vaccination. Vaccine 2022; 40:344-350. [PMID: 34887133 PMCID: PMC8755625 DOI: 10.1016/j.vaccine.2021.11.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Parents often decline HPV vaccination, but little is known about how healthcare providers should promote vaccination at a later visit for secondary acceptance. We examined the associations of two factors, providers' response to declination during the visit and follow-up after the visit, with secondary acceptance. METHODS We conducted a cross-sectional survey of US parents whose 9- to 17-year-old child had not yet completed the HPV vaccination series. Parents who declined HPV vaccination during an initial discussion with a provider (n = 447) reported whether their provider engaged in any active response during the visit (e.g., giving information, trying to change their mind) or any follow-up after the visit (e.g., scheduling another visit). We conducted multivariable logistic regression to determine whether an active response or follow-up was associated with secondary acceptance of HPV vaccination. RESULTS Only about one-third of parents reported an active response during the visit (35%) or follow-up after the visit (39%) following HPV vaccination declination. Parents had higher odds of secondary acceptance of HPV vaccine if they received any provider follow-up after the visit (43% vs. 20%, aOR:3.19; 95% CI:2.00:5.07). Receipt of an active provider response was not associated with secondary acceptance. More parents thought a provider should actively respond and follow-up (61% and 68% respectively), compared with those who received such a response (both p < .01). CONCLUSIONS Providers' follow-up after the visit may be important for promoting secondary acceptance of HPV vaccination. Parents who decline HPV vaccination often prefer to receive an active response or follow-up from a provider.
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Affiliation(s)
- Marjorie A Margolis
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599 USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599 USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Marcella H Boynton
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599 USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; Department of Medicine, Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer Elston Lafata
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; Division of Pharmaceutical Outcomes and Policy, University of North Carolina, Chapel Hill, NC, USA
| | - Brian G Southwell
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599 USA; Science in the Public Sphere, RTI International, Research Triangle Park, NC, USA; Duke Forge, School of Medicine, Duke University, Durham, NC, USA
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599 USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
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13
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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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14
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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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15
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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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16
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Increasing Human Papillomavirus Vaccination in a Federally Qualified Health Center Organization Using a Systems-Based Intervention Integrating EHR and Statewide Immunization Information System. J Community Health 2021; 47:53-62. [PMID: 34333719 PMCID: PMC8825389 DOI: 10.1007/s10900-021-00965-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 11/12/2022]
Abstract
Public acceptance of the HPV vaccine has not matched that of other common adolescent vaccines, and HPV vaccination rates remain below the Healthy People 2020 target of 80% compliance. The purpose of this study was to evaluate the capacity of nine pediatric clinics in a Federally Qualified Health Center organization to implement a systems-based intervention targeting office staff and providers using EHRs and a statewide immunization information system to increase HPV vaccination rates in girls and boys, ages 11 to 16 over a 16-month period. System changes included automated HPV prompts to staff, postcard reminders to parents when youths turned 11 or 12 years old, and monthly assessment of provider vaccination rates. During the intervention, 8960 patients (11–16 yo) were followed, with 48.8% girls (n = 4370) and 51.2% boys (n = 4590). For this study period, 80.5% of total patients received the first dose of the HPV vaccine and 47% received the second dose. For the first dose, 55.5% of 11 year old girls and 54.3% of 11 year old boys were vaccinated. For ages 12 to 16, first dose vaccination rates ranged from the lowest rate of 84.5% for 14 yo girls up to the highest rate of 90.5% for 13 yo boys. Logistic regression showed age was highly significantly associated with first dose completion (OR 1.565, 95% CI 1.501, 1.631) while males did not have a significant association with first dose completion compared to females. The intervention increased overall counts of first and second HPV vaccination rates.
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17
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Oh NL, Biddell CB, Rhodes BE, Brewer NT. Provider communication and HPV vaccine uptake: A meta-analysis and systematic review. Prev Med 2021; 148:106554. [PMID: 33857561 DOI: 10.1016/j.ypmed.2021.106554] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/06/2021] [Accepted: 04/11/2021] [Indexed: 12/13/2022]
Abstract
Provider communication can be critically important to families as they consider HPV vaccination. We sought to characterize the association of provider communication and HPV vaccine uptake, and when communication better motivates vaccination. We searched four databases for studies published between 2006 and 2019. Eligible studies examined health care provider communication (defined as recommendation or discussion) and HPV vaccine uptake (defined as initiation, completion, or follow-through) in the US. Two coders independently identified eligible studies and coded effect sizes and study characteristics. We pooled effect sizes using random-effects meta-analysis. We identified 59 eligible studies of 265,083 patients. Receiving a provider recommendation was associated with higher HPV vaccine initiation (pooled OR = 10.1, 95% CI: 7.6-13.4). HPV vaccine initiation was 24% for patients without and 60% for patients with a provider recommendation. The pooled effect size for provider recommendation and initiation was smaller for probability samples, clinical records, and NIS-Teen (all p < 0.002). Recommendations were equally effective for males and females, for different patient ages, and over time. Provider recommendation was also associated with higher HPV vaccine series completion and follow-through. Provider discussion was similarly associated with higher HPV vaccine initiation (OR = 12.4, 95% CI: 6.3-24.3). In summary, provider communication was robustly associated with HPV vaccination initiation, completion, and follow-through. These findings suggest that US public health efforts to increase HPV vaccine coverage should continue to emphasize provider communication.
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Affiliation(s)
- N Loren Oh
- University of North Carolina School of Medicine, United States of America; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States of America
| | - Caitlin B Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States of America
| | - Blythe E Rhodes
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, United States of America
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina, United States of America.
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18
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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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19
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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:e20200395. [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] [MESH Headings] [Grants] [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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20
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Berenson AB, Hirth JM, Kuo YF, Starkey JM, Rupp RE. Use of patient navigators to increase HPV vaccination rates in a pediatric clinical population. Prev Med Rep 2020; 20:101194. [PMID: 32963935 PMCID: PMC7490555 DOI: 10.1016/j.pmedr.2020.101194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/19/2020] [Accepted: 08/23/2020] [Indexed: 11/01/2022] Open
Abstract
A patient navigator (PN) program was implemented in pediatric clinics to increase uptake of the human papillomavirus (HPV) vaccine. The purpose of this study is to examine the impact of this program. All visits between April 1, 2013 and December 31, 2017 for 9-17 year old patients at 3 program and 5 non-program clinics were examined using electronic medical records. These dates included patient visits before and after program initiation (February 1, 2015). Visits including 1 dose of the HPV vaccine were assessed as a proportion of total visits for each month. Multivariable binary logistic regression was used to examine the odds of HPV vaccination across time, between program and non-program clinics, and age group. A total of 128,051 visits by 21,395 patients were examined. HPV vaccines were administered during 12,742 visits (10.0%). Odds of HPV vaccination during visits by 13-17 year olds was greater than during visits by 9-12 year olds in the pre-intervention period (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.04-1.19). However, this association changed during the intervention period, with odds of HPV vaccination among visits by 13-17 year olds lower compared to visits by 9-12 year olds (OR: 0.78, 95% CI: 0.75-0.82). The odds of HPV vaccination were elevated among 9-12 year olds in program clinics as compared to 2014, the year before the program was implemented. Having on-site PNs can increase the frequency of HPV vaccination in pediatric clinics, particularly among patients 9-12 years of age.
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Affiliation(s)
- Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Jacqueline M Hirth
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Yong-Fang Kuo
- Preventive Medicine & Population Health, Office of Biostatistics and Epidemiology, University of Texas Medical Branch, USA
| | - Jonathan M Starkey
- Preventive Medicine & Population Health, Institute for Translational Sciences, Center for Interdisciplinary Research on Women's Health, University of Texas Medical Branch, USA
| | - Richard E Rupp
- Department of Pediatrics, University of Texas Medical Branch, USA
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21
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Allison WE, Rubin A, Melhado TV, Choi A, Levine DA. Knowledge and Acceptability of Human Papillomavirus Vaccination and Text Message Reminders for Adolescents in Urban Emergency Departments: A Pilot Study. Open Access Emerg Med 2020; 12:145-153. [PMID: 32581603 PMCID: PMC7277577 DOI: 10.2147/oaem.s245221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose Cervical, oropharyngeal and anogenital cancers are vaccine-preventable diseases, but human papillomavirus (HPV) vaccination coverage in the US remains poor overall with regional variations in vaccination rates. We explore the acceptability by adolescents and their parents of HPV vaccination and text message reminders in the non-traditional setting of the emergency department (ED). Patients and Methods The modified validated Carolina HPV Attitudes and Beliefs Scale (CHIAS) survey was administered at two urban EDs to adolescents aged 13–18 years and their parents. Demographic information was collected for each participating adolescent. Recruitment occurred with consecutive eligible participants on the ED census list approached within 4-hour blocks from 8am to 8pm. Results Ninety-six adolescents completed the survey. The mean adolescent and parental knowledge scores were 63% (SD=29.7) and 60% (SD=22.1), respectively. The higher the HPV knowledge score among both adolescents and parents, the more likely they were to accept HPV vaccine in ED. Among the 10 cases where the parents disagreed to the HPV vaccine and the adolescents agreed to the HPV vaccine, the mean knowledge score among parents disagreeing was 47 compared to 62 among the remaining parents (p=0.04). Sixty-seven percent of adolescents and 68% of parents were agreeable to the adolescent receiving vaccination in the ED (kappa = 0.24). Seventy-five percent of adolescents and 71% of parents reported being agreeable to receiving text reminders for HPV vaccines (kappa = 0.20). Adolescent agreement with receiving a text message reminder corresponded with an increased willingness to be vaccinated (OR=3.21, 95% CI=1.07–9.57, p-value=0.0368). Sexually active adolescents were older (mean age, 17 years) than those who reported no sexual activity (mean age, 15 years) (p<0.0001). Conclusion Increased knowledge about HPV influences vaccine acceptance. Parents and adolescents may disagree in accepting HPV vaccination. A majority of adolescents and their parents were agreeable to receiving HPV vaccination in the ED and subsequent text message reminders. The ED should be explored further as a non-traditional healthcare setting for HPV vaccination of adolescents.
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Affiliation(s)
- Waridibo E Allison
- University of Texas Health Science Center San Antonio, Department of Medicine, Division of Infectious Disease, San Antonio, TX, USA
| | - Ada Rubin
- New York University, Ronald O. Perelman Department of Emergency Services, New York, NY, USA
| | - Trisha V Melhado
- University of Texas Health Science Center San Antonio, Department of Medicine, Division of Infectious Disease, San Antonio, TX, USA
| | - Aro Choi
- University of Texas Health Science Center San Antonio, Department of Medicine, Division of Infectious Disease, San Antonio, TX, USA
| | - Deborah A Levine
- New York University, Ronald O. Perelman Department of Emergency Services, New York, NY, USA
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22
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Montagni I, Mabchour I, Tzourio C. Digital Gamification to Enhance Vaccine Knowledge and Uptake: Scoping Review. JMIR Serious Games 2020; 8:e16983. [PMID: 32348271 PMCID: PMC7265110 DOI: 10.2196/16983] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/13/2020] [Accepted: 03/20/2020] [Indexed: 01/18/2023] Open
Abstract
Background Vaccine hesitancy is a growing threat to population health, and effective interventions are needed to reduce its frequency. Digital gamification is a promising new approach to tackle this public health issue. Objective The purpose of this scoping review was to assess the amount and quality of outcomes in studies evaluating gamified digital tools created to increase vaccine knowledge and uptake. Methods We searched for peer-reviewed articles published between July 2009 and August 2019 in PubMed, Google Scholar, Journal of Medical Internet Research, PsycINFO, PsycARTICLES, Psychology and Behavioral Sciences Collection, and SocINDEX. Studies were coded by author, year of publication, country, journal, research design, sample size and characteristics, type of vaccine, theory used, game content, game modality, gamification element(s), data analysis, type of outcomes, and mean quality score. Outcomes were synthesized through the textual narrative synthesis method. Results A total of 7 articles met the inclusion criteria and were critically reviewed. Game modalities and gamification elements were diverse, but role play and a reward system were present in all studies. These articles included a mixture of randomized controlled trials, quasi-experimental studies, and studies comprising quantitative and qualitative measures. The majority of the studies were theory-driven. All the identified gamified digital tools were highly appreciated for their usability and were effective in increasing awareness of vaccine benefits and motivation for vaccine uptake. Conclusions Despite the relative paucity of studies on this topic, this scoping review suggests that digital gamification has strong potential for increasing vaccination knowledge and, eventually, vaccination coverage.
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Affiliation(s)
- Ilaria Montagni
- Bordeaux Population Health U1219, Inserm-University of Bordeaux, Bordeaux, France.,Institute of Public Health, Epidemiology and Development (ISPED), University of Bordeaux, Bordeaux, France
| | - Inass Mabchour
- Faculty of Medicine Hyacinthe Bastaraud, University of Antilles-Guyane, Pointe-à-Pitre, Guadeloupe
| | - Christophe Tzourio
- Bordeaux Population Health U1219, Inserm-University of Bordeaux, Bordeaux, France
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23
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Menzies R, Heron L, Lampard J, McMillan M, Joseph T, Chan J, Storken A, Marshall H. A randomised controlled trial of SMS messaging and calendar reminders to improve vaccination timeliness in infants. Vaccine 2020; 38:3137-3142. [PMID: 32147296 DOI: 10.1016/j.vaccine.2020.02.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effectiveness of SMS reminders in improving vaccination coverage has been assessed previously, with effectiveness varying between settings. However, there are very few studies on their effect on the timeliness of vaccination. DESIGN Unblinded, randomised controlled trial with blocked sampling. METHODS 1594 Australian infants and young children were recruited to assess the impact of (1) SMS reminders only, (2) a personalised calendar, (3) SMS reminder and personalised calendar and (4) no intervention, on receipt of vaccine within 30 days of the due date. Outcomes were measured for receipt of vaccines due at 2, 4, 6, 12 and 18 months of age. A post-hoc assessment was also conducted of the impact of a new national "No jab No Pay" policy introduced during the trial, which removed philosophical objections as an exemption for financial penalties for non-vaccination. RESULTS There was a statistically significant improvement in on-time vaccination only at the 12 month schedule point amongst infants who received SMS reminders alone (RR 1.09, 95% CI 1.01-1.18) or in combination with a personalised calendar (1.11, CI 1.03-1.20) compared to controls. This impact was limited to participants who had received one or more previous doses late. No statistically significant impacts of calendar interventions alone were seen. There was a high rate of on-time compliance amongst control participants - 95%, 86%, 80%, 74% at the 4, 6, 12 and 18 month schedule points respectively, which increased more than 10 percentage points after implementation of the "No Jab, No Pay" policy. CONCLUSIONS SMS reminders are more effective in improving timeliness where pre-existing compliance is lower, but the 18 month schedule point appeared to be less amenable to intervention. Australia and New Zealand Clinical Trial Registration No. ACTRN12614000970640.
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Affiliation(s)
- R Menzies
- Kirby Institute, University of New South Wales, Kensington, NSW, Australia.
| | - L Heron
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, NSW, Australia; Kids Research Institute, The Children's Hospital Westmead, Westmead, NSW, Australia
| | - J Lampard
- Kids Research Institute, The Children's Hospital Westmead, Westmead, NSW, Australia
| | - M McMillan
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - T Joseph
- Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - J Chan
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, NSW, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - A Storken
- Department of Health, South Australia, Adelaide, SA, Australia
| | - H Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
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24
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Abstract
PURPOSE OF REVIEW To summarize evidence-based strategies for improving pediatric immunization rates including physician behaviors, clinic and public health processes, community-based and parent-focused interventions, and legal and policy approaches RECENT FINDINGS: Studies continue to show the effectiveness of audit and feedback, provider reminders, standing orders, and reminder/recall to increase immunization rates. Provider communication strategies may improve immunization rates including use of a presumptive approach and motivational interviewing. Centralized reminder/recall (using a state Immunization Information System) is more effective and cost-effective compared to a practice-based approach. Recent work shows the success of text messages for reminder/recall for vaccination. Web-based interventions, including informational vaccine websites with interactive social media components, have shown effectiveness at increasing uptake of pediatric and maternal immunizations. Vaccination requirements for school attendance continue to be effective policy interventions for increasing pediatric and adolescent vaccination rates. Allowance for and ease of obtaining exemptions to vaccine requirements are associated with increased exemption rates. SUMMARY Strategies to increase vaccination rates include interventions that directly impact physician behavior, clinic and public health processes, patient behaviors, and policy. Combining multiple strategies to work across different settings and addressing different barriers may offer the best approach to optimize immunization coverage.
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25
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DeCamp LR, Godage SK, Valenzuela Araujo D, Dominguez Cortez J, Wu L, Psoter KJ, Quintanilla K, Rivera Rodríguez T, Polk S. A Texting Intervention in Latino Families to Reduce ED Use: A Randomized Trial. Pediatrics 2020; 145:peds.2019-1405. [PMID: 31879276 DOI: 10.1542/peds.2019-1405] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Latino children in immigrant families experience health care disparities. Text messaging interventions for this population may address disparities. The objective of this study was to evaluate the impact of a Spanish-language text messaging intervention on infant emergency department use and well care and vaccine adherence. METHODS The Salud al Día intervention, an educational video and interactive text messages throughout the child's first year of life, was evaluated via randomized controlled trial conducted in an urban, academic pediatric primary care practice from February 2016 to December 2017. Inclusion criteria were publicly insured singleton infant <2 months of age; parent age >18, with Spanish as the preferred health care language; and at least 1 household cellular phone. Primary outcomes were abstracted from the electronic medical record at age 15 months. Intention-to-treat analyses were used. RESULTS A total of 157 parent-child dyads were randomly assigned to Salud al Día (n = 79) or control groups (n = 78). Among all participants, mean parent age was 29.3 years (SD: 6.2 years), mean years in the United States was 7.3 (SD: 5.3 years), and 87% of parents had limited or marginal health literacy. The incidence rate ratio for emergency department use for the control versus intervention group was 1.48 (95% confidence interval: 1.04-2.12). A greater proportion of intervention infants received 2 flu vaccine doses compared with controls (81% vs 67%; P = .04). CONCLUSIONS This Spanish-language text messaging intervention reduced emergency department use and increased flu vaccine receipt among a population at high risk for health care disparities. Tailored text message interventions are a promising method for addressing disparities.
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Affiliation(s)
- Lisa Ross DeCamp
- Center for Salud/Health and Opportunity for Latinos and .,Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sashini K Godage
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | | | - Linxuan Wu
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Kevin J Psoter
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Sarah Polk
- Center for Salud/Health and Opportunity for Latinos and.,Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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26
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Domek GJ, Contreras-Roldan IL, Bull S, O'Leary ST, Bolaños Ventura GA, Bronsert M, Kempe A, Asturias EJ. Text message reminders to improve infant immunization in Guatemala: A randomized clinical trial. Vaccine 2019; 37:6192-6200. [PMID: 31492475 DOI: 10.1016/j.vaccine.2019.08.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/15/2019] [Accepted: 08/21/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Millions of infants worldwide remain under-immunized and at risk for unnecessary morbidity and mortality. Text messaging may offer a low-cost solution. We aimed to evaluate text message reminders to improve infant immunization in Guatemala. METHODS A randomized clinical trial was conducted at four public health clinics in rural and urban Guatemala. Infants ages six weeks to six months presenting for the first visit of the primary immunization series were randomly and equally allocated to an intervention or usual care group. Intervention participants were sent three text reminders before the second and third vaccine visits. The main outcome was timeliness of the second and third visits of the primary immunization series. RESULTS Of 1088 families approached for enrollment between March to November 2016, 871 were eligible and 720 (82.7%) participated; only 54 families did not own a cell phone. Due to country-wide vaccine shortages, visit completion was used as a proxy for overall immunization coverage. In intention to treat analysis, both intervention and usual care groups had high rates of visit completion, but intervention participants presented on the scheduled date more often (151 [42.2%] of 358 intervention vs. 111 [30.7%] of 362 usual care participants for visit 2, p = 0.001, and 112 [34.0%] of 329 intervention vs. 90 [27.0%] of 333 usual care participants for visit 3, p = 0.05). Intervention caregivers were significantly more likely to want to receive future text message reminders for vaccines and other appointments and were more willing to pay for these reminders. CONCLUSION Caregivers who were sent text message reminders in urban and rural Guatemala were less delayed for their child's immunization visits and reported high user satisfaction. Text message reminders may be an effective tool to increase infant vaccination coverage in low-income settings by reminding parents to vaccinate. TRIAL REGISTRATION NCT02567006 at clinicaltrials.gov.
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Affiliation(s)
- Gretchen J Domek
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, B065, 13123 E. 16th Ave., Aurora, CO 80045, USA; Center for Global Health, Colorado School of Public Health, A090, 13199 E. Montview Blvd., Suite 310, Aurora, CO 80045, USA.
| | - Ingrid L Contreras-Roldan
- Center for Health Studies, Universidad del Valle de Guatemala, 18 Av. 11-95, Zona 15, Vista Hermosa III, Guatemala City, Guatemala
| | - Sheana Bull
- Center for Global Health, Colorado School of Public Health, A090, 13199 E. Montview Blvd., Suite 310, Aurora, CO 80045, USA; Department of Community and Behavioral Health, Colorado School of Public Health, B119, 13001 E. 17th Place, Aurora, CO 80045, USA
| | - Sean T O'Leary
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, B065, 13123 E. 16th Ave., Aurora, CO 80045, USA; Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, F443, 13199 E. Montview Blvd., Suite 300, Aurora, CO 80045, USA
| | | | - Michael Bronsert
- Center for Global Health, Colorado School of Public Health, A090, 13199 E. Montview Blvd., Suite 310, Aurora, CO 80045, USA; Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, F443, 13199 E. Montview Blvd., Suite 300, Aurora, CO 80045, USA
| | - Allison Kempe
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, B065, 13123 E. 16th Ave., Aurora, CO 80045, USA; Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, F443, 13199 E. Montview Blvd., Suite 300, Aurora, CO 80045, USA
| | - Edwin J Asturias
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, B065, 13123 E. 16th Ave., Aurora, CO 80045, USA; Center for Global Health, Colorado School of Public Health, A090, 13199 E. Montview Blvd., Suite 310, Aurora, CO 80045, USA; Department of Epidemiology, Colorado School of Public Health, B119, 13001 E. 17th Place, Aurora, CO 80045, USA
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27
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Chantler T, Letley L, Paterson P, Yarwood J, Saliba V, Mounier-Jack S. Optimising informed consent in school-based adolescent vaccination programmes in England: A multiple methods analysis. Vaccine 2019; 37:5218-5224. [PMID: 31351797 DOI: 10.1016/j.vaccine.2019.07.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/29/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Abstract
The process of obtaining informed consent for school-based adolescent immunisation provides an opportunity to engage families. However, the fact that parental consent needs to be obtained remotely adds complexity to the process and can have a detrimental effect on vaccine uptake. We conducted a multiple methods analysis to examine the practice of obtaining informed consent in adolescent immunisation programmes. This involved a thematic analysis of consent related data from 39 interviews with immunisation managers and providers collected as part of a 2017 service evaluation of the English adolescent girls' HPV vaccine programme and a descriptive statistical analysis of data from questions related to consent included in a 2017 survey of parents' and adolescents' attitudes to adolescent vaccination. The findings indicated that the non-return of consent forms was a significant logistical challenge for immunisation teams, and some were piloting opt-out consent mechanisms, increasing the proportion of adolescents consenting for their own immunisations, and introducing electronic consent. Communicating vaccine related information to parents and schools and managing uncertainties about obtaining adolescent self-consent for vaccination were the main practical challenges encountered. Survey data showed that parents and adolescents generally agreed on vaccine decisions although only 32% of parents discussed vaccination with their teenager. Parental awareness about the option for adolescents to self-consent for vaccination was limited and adolescents favoured leaving the decision-making to parents. From the interviews and variability of consent forms it was evident that health professionals were not always clear about the best way to manage the consent process. Some were also unfamiliar with self-consent processes and lacked confidence in assessing for 'Gillick competency'. Developing pathways and related interventions to improve the logistics and practice of consent in school-based adolescent immunisation programmes could help improve uptake.
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Affiliation(s)
- Tracey Chantler
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, UK.
| | - Louise Letley
- Department of Immunisation, Hepatitis and Blood Safety, Public Health England, UK
| | - Pauline Paterson
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, UK
| | - Joanne Yarwood
- Department of Immunisation, Hepatitis and Blood Safety, Public Health England, UK
| | - Vanessa Saliba
- Department of Immunisation, Hepatitis and Blood Safety, Public Health England, UK
| | - Sandra Mounier-Jack
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, UK
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28
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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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29
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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 PMCID: PMC6746491 DOI: 10.1080/21645515.2019.1611158] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 04/01/2019] [Accepted: 04/21/2019] [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
- Department of Pediatrics, Columbia University, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Chelsea S Wynn
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Melissa S Stockwell
- Department of Pediatrics, Columbia University, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
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30
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Wilkinson TA, Dixon BE, Xiao S, Tu W, Lindsay B, Sheley M, Dugan T, Church A, Downs SM, Zimet G. Physician clinical decision support system prompts and administration of subsequent doses of HPV vaccine: A randomized clinical trial. Vaccine 2019; 37:4414-4418. [PMID: 31201057 DOI: 10.1016/j.vaccine.2019.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND HPV vaccine is effective in preventing several cancers and anogenital warts, yet rates of HPV vaccination series completion in the United States are low. A primary reason identified by parents for vaccinating children against HPV is a health care provider's recommendation. Although most clinicians embrace vaccine recommendations, they are not always carried out evenly and subsequent HPV vaccines are missed. METHODS Using an electronic health records-based decision support system (CHICA) clinicians were randomized to either usual practice or to receive an automated reminder to recommend the 2nd or 3rd dose of HPV vaccine. The reminder was delivered to clinicians of all intervention group eligible adolescents who had already initiated the vaccine series. Logistic regression models with generalized estimating equations were used for data analysis. RESULTS A total of 1285 clinical encounters were observed across 29 randomized pediatric providers over a 13-month time frame (50.7% control group, 49.3% intervention group). Overall, patients were 44.9% female, 59.4% Black, 22.1% Hispanic, and 48.8% were ages 11-12 yrs. Within the control group, 421 (64.7%) received a subsequent HPV vaccine, compared to 481 (75.9%) (OR: 1.72, (95% CI 1.35-2.19)). Adjusted analysis showed no difference between the groups (aOR 1.52 (95% CI 0.88-2.62)) or when examined by age (11-12yrs aOR 1.66, (95% CI 0.79-3.48)) and 13-17yrs (aOR 1.19, (95% CI 0.76-1.85)) or gender female (aOR 1.39 (95% CI 0.71-2.72)) and males (aOR 1.67 (95% CI 0.95-2.92)). When results were stratified by both age and gender, there was similarly no statistically significant effect between the two groups. CONCLUSIONS Automated physician reminders for subsequent 2nd and 3rd doses of HPV vaccination were used. Despite increased rates of vaccination in the intervention group, the differences did not reach the level of statistical significance. Future studies with multifaceted approaches may be needed to examine the efficacy of computer-based reminders. CLINICAL TRIAL REGISTRATION NCT02558803, "HPV Vaccination: Evaluation of Reminder Prompts for Doses 2 & 3".
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Affiliation(s)
- Tracey A Wilkinson
- Indiana University School of Medicine, Department of Pediatrics-Children's Health Services Research, 410 W. 10th Street, Suite 2000, Indianapolis, IN 46202, United States.
| | - Brian E Dixon
- Indiana Univ, Fairbanks School of Public Health, Department of Epidemiology, 1050 Wishard Blvd, RG5, INpolis, IN 46202, United States; Regenstreif Institute, Center for Biomedical Informatics, 1101 W. 10th St., Indianapolis, IN 46202, United States.
| | - Shan Xiao
- Indiana University School of Medicine, Department of Biostatistics, 410 W. 10th St., Suite 3000, Indianapolis, IN 46202, United States
| | - Wanzhu Tu
- Regenstreif Institute, Center for Biomedical Informatics, 1101 W. 10th St., Indianapolis, IN 46202, United States; Indiana University School of Medicine, Department of Biostatistics, 410 W. 10th St., Suite 3000, Indianapolis, IN 46202, United States.
| | - Brianna Lindsay
- Center for Observational and Real-World Evidence, Merck & Co., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, United States.
| | - Meena Sheley
- Indiana University School of Medicine, Department of Pediatrics-Children's Health Services Research, 410 W. 10th Street, Suite 2000, Indianapolis, IN 46202, United States.
| | - Tamara Dugan
- Indiana University School of Medicine, Department of Pediatrics-Children's Health Services Research, 410 W. 10th Street, Suite 2000, Indianapolis, IN 46202, United States.
| | - Abby Church
- Regenstreif Institute, Center for Biomedical Informatics, 1101 W. 10th St., Indianapolis, IN 46202, United States.
| | - Stephen M Downs
- Indiana University School of Medicine, Department of Pediatrics-Children's Health Services Research, 410 W. 10th Street, Suite 2000, Indianapolis, IN 46202, United States.
| | - Gregory Zimet
- Indiana Univ. School of Medicine, Dept. of Pediatrics-Adolescent Medicine, 410 W. 10th St., Suite 1001, Indianapolis, IN 46202, United States.
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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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Ortiz RR, Smith A, Coyne-Beasley T. A systematic literature review to examine the potential for social media to impact HPV vaccine uptake and awareness, knowledge, and attitudes about HPV and HPV vaccination. Hum Vaccin Immunother 2019; 15:1465-1475. [PMID: 30779682 DOI: 10.1080/21645515.2019.1581543] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
This article summarizes the findings from a systematic literature review to examine how social media may impact HPV vaccine uptake and HPV and HPV vaccine related awareness, knowledge, and attitudes. Study inclusion criteria was original data collection of at least one data point about social media and HPV and/or HPV vaccination, such that the study provided insight into how social media content may influence HPV and HPV vaccine related knowledge, attitudes, and/or behaviors. A total of 44 relevant articles were identified using the following databases: PubMed, PsycINFO, Communication Source, Sociological Abstracts, Business Source Elite, and the Educational Resources Information Center (ERIC). Most studies analyzed the valence, type, and frequency of social media content about HPV vaccination, and some found associations between potential exposure to negative, anti-vacc`11qine content and lower vaccination rates. Some studies that included primary human subject data collection found that engagement with HPV related social media content was associated with improved awareness and knowledge but not with increased vaccine uptake. The literature overall is lacking in systematic and rigorous research examining the effects of social media on HPV related knowledge, attitudes, and behaviors and needs further examination as social media increasingly becomes a source of health information.
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Affiliation(s)
- Rebecca R Ortiz
- a S.I. Newhouse School of Public Communications, Syracuse University , Syracuse , NY , USA
| | - Andrea Smith
- a S.I. Newhouse School of Public Communications, Syracuse University , Syracuse , NY , USA
| | - Tamera Coyne-Beasley
- b School of Medicine, University of Alabama at Birmingham , Birmingham , AL , USA
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Rodriguez AM, Do TQN, Goodman M, Schmeler KM, Kaul S, Kuo YF. Human Papillomavirus Vaccine Interventions in the U.S.: A Systematic Review and Meta-analysis. Am J Prev Med 2019; 56:591-602. [PMID: 30773231 DOI: 10.1016/j.amepre.2018.10.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 12/13/2022]
Abstract
CONTEXT Despite current recommendations, human papillomavirus vaccine uptake remains low. A systematic review and meta-analysis assessed the effectiveness of interventions targeting human papillomavirus vaccine initiation and completion among children, adolescents, and young adults aged 9-26 years. EVIDENCE ACQUISITION Three electronic databases (CINAHL, OVID, and Web of Science) were searched for articles published in English peer-reviewed journals between January 2006 and January 2017 of U.S. studies that evaluated intervention strategies and reported post-intervention human papillomavirus vaccine initiation or completion rates among individuals aged 9-26 years. Study characteristics and outcomes were extracted. Data were collected in 2016 and analyzed in 2017. EVIDENCE SYNTHESIS Reviewers screened 983 unique titles and abstracts, read 241 full-text articles, and extracted data from 30 articles meeting the inclusion criteria (12 behavioral, ten environmental, four informational, and four combination strategies). Published EQUATOR (Enhancing the Quality and Transparency of Health Research) guidelines were used to assess study quality. Random effects meta-analyses were conducted. The meta-analyses included 17 RCTs and quasi-experiments involving 68,623 children, adolescents, and young adults. The pooled relative incidence estimates were 1.84 (95% CI=1.36, 2.48) for human papillomavirus vaccine initiation and 1.50 (95% CI=1.23, 1.83) for completion. Behavioral and informational interventions doubled human papillomavirus vaccine initiation (relative incidence estimate=2.04, 95% CI=1.36, 3.06 and relative incidence estimate=1.92, 95% CI=1.27, 2.91, respectively). Behavioral interventions increased completion by 68% (relative incidence estimate=1.68, 95% CI=1.25, 2.27). CONCLUSIONS Evidence supports behavioral interventions for increasing human papillomavirus vaccine initiation and completion. Future studies are needed to assess the effectiveness of interventions in reaching diverse populations and reducing missed opportunities for human papillomavirus vaccination.
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Affiliation(s)
- Ana M Rodriguez
- Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, Texas; Sealy Institute for Vaccine Sciences, University of Texas Medical Branch at Galveston, Galveston, Texas.
| | - Thuy Quynh N Do
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Michael Goodman
- Department of Epidemiology, Emory University, Atlanta, Georgia
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sapna Kaul
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch at Galveston, Galveston, Texas
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Wilkinson TA, Dixon BE, Xiao S, Tu W, Lindsay B, Sheley M, Dugan T, Church A, Downs SM, Zimet G. WITHDRAWN: Physician Clinical Decision Support System Prompts and Administration of Subsequent Doses of HPV Vaccine: A Randomized Clinical Trial. Vaccine X 2019. [DOI: 10.1016/j.jvacx.2019.100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Abstract
OBJECTIVES The objectives of this study were to estimate the prevalence of cell phone and computer use among urban families bringing their children to an emergency department and to determine which technologies parents prefer to use to receive health information. METHODS We visited 2 pediatric emergency departments in Baltimore, Md, and Little Rock, Ark. A convenience sample of parents of children 8 years old or younger completed a self-administered survey in the waiting area. RESULTS Two hundred thirty-eight surveys were completed. Respondents were primarily female (83%), less than 35 years old (74%), and had at least a high school diploma or General Educational Development (94%). Forty-three percent were employed full time. A majority (95%) of respondents reported owning a cell phone, with most (88%) owning a smartphone and 96% reported having some internet access. Of cell phone owners, 91% reported daily text messaging activity. Over half (63%) of respondents reported having computer internet access at home; 31% reported having internet access at work. Patterns of behavior and preferences emerged for both cell phone and computer use. Respondents were more likely to check their email (75% vs 50%, P < 0.0001) and access the internet (78% vs 67%, P = 0.002) with a smartphone rather than their computer. CONCLUSIONS Both cell phones and computers are prevalent and used among urban families seen in pediatric emergency departments, offering new ways to deliver health information to these often underserved populations. Providers aiming to deliver health information should consider smartphone applications, text message-based programs, and email to communicate with their patients.
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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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Gopalani SV, Janitz AE, Campbell JE. Trends in cervical cancer incidence and mortality in Oklahoma and the United States, 1999-2013. Cancer Epidemiol 2018; 56:140-145. [PMID: 30176544 DOI: 10.1016/j.canep.2018.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 08/11/2018] [Accepted: 08/22/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The twin prevention strategies of HPV vaccination and cervical cancer screening reduce new cases and averts deaths, yet women still develop or die from cervical cancer. To assess and better understand the burden of cervical cancer in Oklahoma, we analyzed incidence and mortality trends in Oklahoma from 1999 to 2013. METHODS We obtained age-adjusted cervical cancer incidence and mortality rates and calculated standardized rate ratios (RR) for women in Oklahoma compared to the US. To evaluate temporal changes in annual age-adjusted incidence and mortality, we calculated the annual percent change (APC) using the Joinpoint Regression Program. RESULTS We observed higher age-adjusted incidence (RR: 1.2; 95% CI: 1.1, 1.3) and mortality (RR: 1.2; 95% CI: 1.1, 1.2) rates among women in Oklahoma compared to the US. The overall incidence and mortality rates in Oklahoma were 9.7 and 2.9 per 100,000 women, respectively. In Oklahoma, the highest age-adjusted incidence rates were in American Indian/Alaska Native (AI/AN) (14.8 per 100,000 females) and Asian or Pacific Islander (API) (11.7 per 100,000 females) women and the highest mortality rates were in AI/AN (4.5 per 100,000 females) and African American (AA) (3.9 per 100,000 females) women. Incidence rates decreased for AA women (APC: -4.0; 95% CI: -7.7, -0.2), but were stable for all other races and ethnicities in Oklahoma (APC: -0.8; 95% CI: -2.2, 0.7). A stable trend for mortality was observed in Oklahoma (APC: 0.1; 95% CI: -2.2, 2.5) each year. CONCLUSION Women in Oklahoma had a higher cervical cancer incidence and mortality rate than the US. A disproportionately higher incidence of cervical cancer among AI/AN and API women and deaths among AI/AN and AA women were observed signaling continuing racial disparities.
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Affiliation(s)
- Sameer Vali Gopalani
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States.
| | - Amanda E Janitz
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States
| | - Janis E Campbell
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States
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Westrick SC, Patterson BJ, Kader MS, Rashid S, Buck PO, Rothholz MC. National survey of pharmacy-based immunization services. Vaccine 2018; 36:5657-5664. [PMID: 30049631 DOI: 10.1016/j.vaccine.2018.07.027] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Pharmacists in the United States (U.S.) are authorized to administer vaccines. This study described: how and to what extent immunization services are offered, promoted, and documented in community pharmacies; reasons for referral to other locations for vaccination; and perceived barriers to immunization services. METHODS A mixed-mode (mail/electronic) survey of a stratified random sample of 1999 nationally-representative community pharmacies in the U.S. was conducted in April-July 2017. Survey instrument development was informed by validated scales and 10 in-depth interviews with community pharmacists; content and face validity were ensured via pre- (n = 5) and pilot-tests (n = 26) among community pharmacists. Potential non-response bias was investigated and descriptive statistics were used to analyze survey responses. RESULTS Of the 1999 community pharmacies, 119 pharmacies were deemed ineligible. Of those eligible pharmacies, complete responses were provided by 292 respondents, each representing a unique pharmacy (15.5% response rate). Respondents were evenly split male/female (52.5/47.5%) and about half were pharmacy managers (51.3%). The majority (79.5%) reported offering at least one type of vaccine in 2016, with the most commonly administered vaccine types (average doses in 2016) being: Influenza (484), Pneumococcal 13-valent conjugate (55), Herpes Zoster (41), and Pneumococcal polysaccharide (39). Two-thirds (66.7%) of immunizing pharmacies provided adolescent vaccinations. Most frequently reported referral reasons were patients' insurance not covering vaccine administration at the pharmacy and patients' age not within approved protocol, policy or state law. The majority of respondents did not perceive organizational and environmental factors as barriers; however, they reported patient-related factors, especially cost and insurance coverage, as important barriers. CONCLUSIONS The majority of U.S. community pharmacies reported offering at least one type of vaccine. The scope of pharmacy engagement in immunization services varied in terms of how and to what extent they were offered and documented. Addressing patient-related barriers is needed to further enhance pharmacy-based immunization services.
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Affiliation(s)
| | | | - Mohammad S Kader
- Auburn University, 020 James E. Foy Hall, Auburn, AL 36849, USA.
| | - Sanuwar Rashid
- Auburn University, 020 James E. Foy Hall, Auburn, AL 36849, USA.
| | | | - Mitchel C Rothholz
- American Pharmacists Association, 2215 Constitution Ave, NW, Washington, DC 20037, USA.
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Finney Rutten LJ, Radecki Breitkopf C, St Sauver JL, Croghan IT, Jacobson DJ, Wilson PM, Herrin J, Jacobson RM. Evaluating the impact of multilevel evidence-based implementation strategies to enhance provider recommendation on human papillomavirus vaccination rates among an empaneled primary care patient population: a study protocol for a stepped-wedge cluster randomized trial. Implement Sci 2018; 13:96. [PMID: 30001723 PMCID: PMC6043954 DOI: 10.1186/s13012-018-0778-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 06/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Each year, human papillomavirus (HPV) causes 30,000 cancers in the USA despite the availability of effective and safe vaccines. Uptake of HPV vaccine has been low and lags behind other adolescent vaccines. This protocol describes a multilevel intervention to improve HPV vaccination rates. Methods Using a cluster randomized trial, we will evaluate the independent and combined impact of two evidence-based implementation strategies with innovative enhancements on HPV vaccination rates for female and male patients. The clusters are six primary care sites providing care to pediatric populations. We will use a stepped-wedge cluster randomized design, including process evaluation, to test the hypothesis that compared with the current course of care and a practice-level intervention using reminder-recall interventions coupled with provider-level audit and feedback with education increases HPV vaccination rates in exposed clusters. The factorial design allows us to use a single trial to test these two interventions and to assess each individually and in combination. Our design has four 12-month steps. The first step will be a baseline period; data collected during it will provide a within-practice control group for each cluster. Second, two clusters will be randomly assigned to receive intervention 1 (reminder and recall), and two clusters will be randomly selected to receive intervention 2 (audit and feedback with education). Third, the other two clusters will be randomly allocated to intervention 1 or 2. Clusters initially with intervention 1 will be randomly allocated to 1 + 2 or 1; clusters initially with intervention 2 will be randomly allocated to 1 + 2 or 2. Fourth, all clusters will receive both interventions. To ensure balance of patient numbers across interventions, we will use block randomization at the first step, with the six clusters grouped into three pairs according to volume. Our primary outcome will be vaccination rates. Discussion Results of our clinical trial and process evaluation will provide evidence showing whether practice- and provider-level interventions improve HPV vaccination rates and will offer insight into contextual factors associated with direction and magnitude of trial outcomes. Trial registration ClinicalTrials.gov, NCT03501992, registered April 18, 2018. Electronic supplementary material The online version of this article (10.1186/s13012-018-0778-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lila J Finney Rutten
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA. .,Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | | | - Jennifer L St Sauver
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - Ivana T Croghan
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Epidemiology, Mayo Clinic, Rochester, MN, USA.,Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA
| | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Patrick M Wilson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - Robert M Jacobson
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, 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: 23] [Impact Index Per Article: 3.8] [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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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: 16] [Impact Index Per Article: 2.7] [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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Using an Implementation Research Framework to Identify Potential Facilitators and Barriers of an Intervention to Increase HPV Vaccine Uptake. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 23:e1-e9. [PMID: 27902559 DOI: 10.1097/phh.0000000000000367] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although the incidence of cervical cancer has been decreasing in the United States over the last decade, Hispanic and African American women have substantially higher rates than Caucasian women. The human papillomavirus (HPV) is a necessary, although insufficient, cause of cervical cancer. In the United States in 2013, only 37.6% of girls 13 to 17 years of age received the recommended 3 doses of a vaccine that is almost 100% efficacious for preventing infection with viruses that are responsible for 70% of cervical cancers. Implementation research has been underutilized in interventions for increasing vaccine uptake. The Consolidated Framework for Implementation Research (CFIR), an approach for designing effective implementation strategies, integrates 5 domains that may include barriers and facilitators of HPV vaccination. These include the innovative practice (Intervention), communities where youth and parents live (Outer Setting), agencies offering vaccination (Inner Setting), health care staff (Providers), and planned execution and evaluation of intervention delivery (Implementation Process). METHODS Secondary qualitative analysis of transcripts of interviews with 30 community health care providers was conducted using the CFIR to code potential barriers and facilitators of HPV vaccination implementation. RESULTS All CFIR domains except Implementation Process were well represented in providers' statements about challenges and supports for HPV vaccination. CONCLUSION A comprehensive implementation framework for promoting HPV vaccination may increase vaccination rates in ethnically diverse communities. This study suggests that the CFIR can be used to guide clinicians in planning implementation of new approaches to increasing HPV vaccine uptake in their settings. Further research is needed to determine whether identifying implementation barriers and facilitators in all 5 CFIR domains as part of developing an intervention contributes to improved HPV vaccination rates.
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Direct-to-adolescent text messaging for vaccine reminders: What will parents permit? Vaccine 2018; 36:2788-2793. [PMID: 29653849 DOI: 10.1016/j.vaccine.2018.03.088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 02/19/2018] [Accepted: 03/31/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Direct-to-adolescent text messaging may be a consideration for vaccine reminders, including human papilloma virus (HPV), but no studies have explored the minimum age at which parents would allow adolescents to receive a text message. METHODS We distributed a survey to parents of 10-17 year olds during any office visit in two practice based research networks in South Carolina and Oklahoma. We asked about parental preference for receiving vaccine reminders for their adolescent, whether they would allow the healthcare provider to directly message their adolescent, and if so, what would be the acceptable minimum age. RESULTS In 546 surveys from 11 practices, parents of females were more supportive of direct-to-teen text message reminders than were parents of males, (75% v. 60%, p < .001). The median age at which parents would allow direct text messages from physicians' offices was 14 in females compared to 15 in males, p = .049. We found a correlation between the child's age and the youngest age at which parents would allow a direct text message. Of the parents who permitted a text message directly to their adolescent, most reported an allowable age higher than their adolescent's current age until the age of 15. CONCLUSION Our study suggests that direct-to-adolescent text messaging would be allowed by parents for older adolescents. This supports an intervention aimed at older adolescents, such as for receipt of MCV4 dose #2, delayed HPV vaccine series completion and annual influenza vaccination.
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Lacombe-Duncan A, Newman PA, Baiden P. Human papillomavirus vaccine acceptability and decision-making among adolescent boys and parents: A meta-ethnography of qualitative studies. Vaccine 2018; 36:2545-2558. [PMID: 29625768 DOI: 10.1016/j.vaccine.2018.02.079] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 11/04/2017] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Genital warts and human papillomavirus (HPV)-associated cancers in men can be substantially reduced through HPV vaccination; yet, globally, HPV vaccine uptake among boys remains low. This meta-ethnography synthesizes qualitative studies to understand, in-depth, HPV vaccine acceptability and decision-making among adolescent boys and/or their parents. METHODS A systematic search identified qualitative studies examining HPV vaccines from the perspectives of boys and/or boys' parents. The Consolidated Criteria for Reporting Qualitative Research (COREQ) 32-item checklist was used to assess quality of reporting. Using meta-ethnographic techniques, we conducted a structured and iterative process of data analysis, coded original studies, and then developed descriptive and analytic themes to synthesize the findings. RESULTS Review of 15 eligible studies (n = 3362 parents, n = 39 boys) revealed multilevel factors that influence HPV vaccine acceptability and decision-making among adolescent boys and their parents: (1) individual, e.g., low HPV vaccine knowledge/awareness, (2) interpersonal, e.g., key relationships between parents, sons, and healthcare providers (HCP), (3) community/societal, e.g., parental duty to protect, and (4) systemic, e.g., HPV vaccine messaging. Parents generally accepted adolescent boys' sexuality and the need for vaccination, motivated by wanting to protect their sons from HPV and HPV-associated cancers, and valued HCP-initiated discussion and recommendation. Acceptability was mitigated by low awareness/knowledge of HPV vaccines and low perceived benefits for boys, lack of HCP-initiated discussion, out-of-pocket costs, multiple doses, stigma, and mixed messages about HPV. CONCLUSIONS Multilevel factors influence HPV vaccine acceptability and decision-making among parents and their adolescent sons. Providing clear and unambiguous messages about HPV vaccines-for whom (boys and girls), for what (genital warts and cancers in men), and when (before sexual debut)-through increased HCP-initiated discussion and targeted public health campaigns may support HPV vaccine uptake among boys. Future research should consistently disaggregate findings by sex of child and parent, and explore effective messaging tailored for boys and parents.
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Affiliation(s)
- Ashley Lacombe-Duncan
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario M5S 1V4, Canada.
| | - Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario M5S 1V4, Canada.
| | - Philip Baiden
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper Street, Box 19129, Arlington, Texas, USA.
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Meaningful Methods for Increasing Human Papillomavirus Vaccination Rates: An Integrative Literature Review. J Pediatr Health Care 2018; 32:119-132. [PMID: 28918994 DOI: 10.1016/j.pedhc.2017.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/13/2017] [Accepted: 07/21/2017] [Indexed: 11/20/2022]
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and is a well-known cause of oropharyngeal, cervical, vaginal, vulvar, penile, and anal cancers. Despite the proven efficacy of the HPV vaccine, vaccination rates remain persistently low. Much literature has focused on attitudes toward the HPV vaccine; however, researchers have also investigated strategies clinicians can use to improve vaccination attitudes and acceptance. Such strategies include provider education, vaccine reminder/recall, and chart audit and feedback. The purpose of this integrative review is to uncover the best evidence-based practice interventions, with the aim of improving HPV knowledge, patient-provider conversations, and immunization uptake. This integrative review concludes that multicomponent interventions have a synergistic effect, resulting in increased provider vaccine support, improved patient/parental attitudes toward HPV vaccination, and increased immunization uptake. Such strategies hold much promise for today's pediatric providers as they work to combat current vaccination disparities.
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Abstract
PROBLEM It has been reported that some adolescents and young women who started taking human papillomavirus (HPV) vaccination are not completing all three doses. The aim of this study was to systematically review intervention studies on HPV vaccination completion. ELIGIBILITY CRITERIA Intervention studies with a comparison group that assessed HPV vaccination completion rate as the primary outcome variable in adolescents and adults younger than 26years of age, and published in English from 2006 to 2016, were eligible for review. SAMPLE Five studies from a literature search of CINAHL, EMBASE, PsycARTICLES, PubMed, SCOPUS, and Web of Science databases were included in this review. RESULTS The overall quality of the reviewed studies was moderate, and the studies have mainly been conducted in a high-income country. Intervention strategies were DVD-based education on HPV and reminders that were delivered via either electronic or non-electronic methods. Some studies used fixed type of electronic reminders. Others chose preference-based electronic reminders, allowing participants to select one or two delivery options from e-mail, text message, automated telephone message, or Facebook message. Non-electronic reminders were letters sent by standard mail. CONCLUSIONS The rates of HPV vaccination completeness increased with the interventions. However, the completeness rate of HPV vaccination remained unsatisfactory and lower than its initiation rate. IMPLICATIONS Educational and reminder interventions for HPV vaccination could contribute to HPV vaccination completion. However, this review highlights the need for more high-quality studies to identify the best way to promote vaccination completion.
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Affiliation(s)
- Hee Sun Kang
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea.
| | | | - Ye Dong Son
- Department of Nursing, Woosuk University, Wanju-gun, Jeollabuk-do, South Korea
| | - Sun-Mi Chae
- College of Nursing, Seoul National University, Seoul, South Korea.
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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: 41] [Impact Index Per Article: 6.8] [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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