1
|
Beavis AL, Krishnamoorthi MS, Adler S, Fleszar LG, Moran MB, Rositch AF. Contemporary provider perspectives on how to address HPV vaccine hesitancy in the US: A qualitative study. Vaccine X 2024; 20:100533. [PMID: 39170855 PMCID: PMC11334775 DOI: 10.1016/j.jvacx.2024.100533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 08/23/2024] Open
Abstract
Introduction Despite over 15 years of real-world data that supports the safety and efficacy of the human papillomavirus (HPV) vaccine, in the United States vaccine hesitancy persists. Many studies have focused on vaccine-hesitant parents, but fewer have examined provider perspectives on how to address HPV vaccine hesitancy. Methods Between July 2021-April 2022, we recruited providers in Maryland and the broader Mid-Atlantic region who practiced pediatrics, primary care, family medicine, or adolescent medicine and who provided outpatient care for children ages 10-17. Semi-structured virtual interviews focused on provider-reported strategies to address HPV vaccine-hesitant parents, as well as perceived barriers to successful vaccination and provider perspectives on specific interventions to address parental hesitancy. Audio recordings were transcribed and analyzed via a combination of deductive and inductive coding. Higher-level themes within the domains of strategies, barriers, and perspectives on specific proposed interventions were identified. Results and discussion A total of sixteen providers completed an interview. Within the domain of provider-reported strategies, the following themes emerged: 1) leveraging continuity of care and established parental trust, 2) supporting parental autonomy, 3) tailoring the approach to specific concerns of vaccine-hesitant parents, 4) normalizing the HPV vaccine, and 5) focusing on health prevention and cancer prevention. Barriers providers identified were: 1) limited time, 2) lack of common ground with parents, 3) parent-child decision discordance, 4) availability of misinformation, and 5) parental concerns such as safety and necessity. In the domain for proposed interventions, providers favored interventions that saved time or were not resource-intense, that did not single out the HPV vaccine as different, were patient friendly, and leveraged efficiency through the electronic medical record. The insights from this study can help inform the development of provider-acceptable and feasible tools and interventions to address parental HPV vaccine hesitancy.
Collapse
Affiliation(s)
- Anna L. Beavis
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Sarah Adler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura G. Fleszar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Meghan B. Moran
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anne F. Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
2
|
Chandeying N, Thongseiratch T. Clinician Communication Training to Increase Human Papillomavirus Vaccination Uptake: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2024; 12:611. [PMID: 38932340 PMCID: PMC11209355 DOI: 10.3390/vaccines12060611] [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: 04/21/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
The battle against Human Papillomavirus (HPV)-related cancers is hindered by suboptimal vaccination rates, despite the proven efficacy and availability of vaccines. This systematic review and meta-analysis addressed this issue by evaluating the impact of clinician communication training on increasing HPV vaccination uptake among adolescents. From an initial pool of 3213 records, six randomized controlled trials involving 245,195 participants across the United States were rigorously selected and analyzed. Our findings indicated that clinician communication training could enhance vaccination uptake rates by an average of 5.2%. Specifically, presumptive communication strategies, which proactively assume a patient's acceptance of vaccination, achieved a significant 9.1% increase in uptake, markedly outperforming the 2.3% increase observed with more passive conversational techniques. Moreover, interventions that incorporated audit and feedback processes were particularly impactful, boosting vaccination rates by 9.4%. The most striking results emerged from combining presumptive communication with audit and feedback, which propelled the effectiveness to an 11.4% increase in vaccination rates. These outcomes highlight the pivotal role of deliberate, targeted clinician-patient communication in improving health interventions. This study offers actionable insights for healthcare providers and policymakers to refine communication strategies, thus potentially maximizing HPV vaccination rates and mitigating the spread of HPV-related conditions.
Collapse
Affiliation(s)
- Nutthaporn Chandeying
- Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand;
| | - Therdpong Thongseiratch
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| |
Collapse
|
3
|
Sykes M, Rosenberg-Yunger ZRS, Quigley M, Gupta L, Thomas O, Robinson L, Caulfield K, Ivers N, Alderson S. Exploring the content and delivery of feedback facilitation co-interventions: a systematic review. Implement Sci 2024; 19:37. [PMID: 38807219 PMCID: PMC11134935 DOI: 10.1186/s13012-024-01365-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 05/13/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Policymakers and researchers recommend supporting the capabilities of feedback recipients to increase the quality of care. There are different ways to support capabilities. We aimed to describe the content and delivery of feedback facilitation interventions delivered alongside audit and feedback within randomised controlled trials. METHODS We included papers describing feedback facilitation identified by the latest Cochrane review of audit and feedback. The piloted extraction proforma was based upon a framework to describe intervention content, with additional prompts relating to the identification of influences, selection of improvement actions and consideration of priorities and implications. We describe the content and delivery graphically, statistically and narratively. RESULTS We reviewed 146 papers describing 104 feedback facilitation interventions. Across included studies, feedback facilitation contained 26 different implementation strategies. There was a median of three implementation strategies per intervention and evidence that the number of strategies per intervention is increasing. Theory was used in 35 trials, although the precise role of theory was poorly described. Ten studies provided a logic model and six of these described their mechanisms of action. Both the exploration of influences and the selection of improvement actions were described in 46 of the feedback facilitation interventions; we describe who undertook this tailoring work. Exploring dose, there was large variation in duration (15-1800 min), frequency (1 to 42 times) and number of recipients per site (1 to 135). There were important gaps in reporting, but some evidence that reporting is improving over time. CONCLUSIONS Heterogeneity in the design of feedback facilitation needs to be considered when assessing the intervention's effectiveness. We describe explicit feedback facilitation choices for future intervention developers based upon choices made to date. We found the Expert Recommendations for Implementing Change to be valuable when describing intervention components, with the potential for some minor clarifications in terms and for greater specificity by intervention providers. Reporting demonstrated extensive gaps which hinder both replication and learning. Feedback facilitation providers are recommended to close reporting gaps that hinder replication. Future work should seek to address the 'opportunity' for improvement activity, defined as factors that lie outside the individual that make care or improvement behaviour possible. REVIEW REGISTRATION The study protocol was published at: https://www.protocols.io/private/4DA5DE33B68E11ED9EF70A58A9FEAC02 .
Collapse
Affiliation(s)
| | | | | | | | | | - Lisa Robinson
- Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Karen Caulfield
- Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | | |
Collapse
|
4
|
Meadows RJ, Gehr AW, Lu Y, Maynard G, Akpan IN, Taskin T, Fulda KG, Patel D, Matches S, Ojha RP, Thompson EL. Effectiveness of provider communication training for increasing human papillomavirus vaccine initiation at a safety-net health system. Prev Med Rep 2024; 39:102660. [PMID: 38426039 PMCID: PMC10901897 DOI: 10.1016/j.pmedr.2024.102660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 03/02/2024] Open
Abstract
Background Strong provider recommendation can increase uptake of human papillomavirus (HPV) vaccination. Therefore, we developed and implemented a provider education intervention on communication strategies for recommending HPV vaccination with clinic-level audit and feedback (HPV: Communicating about HPV to Adults and Teens [HPV CHAT]). We aimed to evaluate the effect of HPV CHAT on HPV vaccine uptake in seven family medicine and pediatric clinics in a large urban health system (USA). Methods We used a quasi-experimental design, where the eligible population included people aged 9-26 years with at least one encounter in June 2020-February 2023 at one of the participating community health clinics. We used interrupted time-series analysis to assess changes in the prevalence of HPV vaccine uptake. We used segmented Poisson regression with a log link function to estimate prevalence ratios (PR) and 95% confidence limits (CL) for level (immediate) and slope (over time) changes with adjustment for seasonality using Fourier transformation. Results Our study population comprised 60,328 observations in which the median age was 17 years (interquartile range: 13-21). A majority (58%) were female and 87% were racial/ethnic minorities. Overall, we observed no sizeable effect of the intervention on HPV vaccination uptake. Nonetheless, heterogeneity was observed by age group with modest increases in individuals aged 9-12 and 13-17 years. Conclusion Our provider feedback intervention had minimal effect on increasing prevalence of HPV vaccination in seven family medicine and pediatric clinics. Novel strategies are needed to address provider barriers related to HPV vaccination.
Collapse
Affiliation(s)
- Rachel J. Meadows
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, Fort Worth, TX, USA
| | - Aaron W. Gehr
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, Fort Worth, TX, USA
| | - Yan Lu
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, Fort Worth, TX, USA
| | - Grace Maynard
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Idara N. Akpan
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Tanjila Taskin
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Kimberly G. Fulda
- North Texas Primary Care Practice-Based Research Network (NorTex), Department of Family Medicine and Osteopathic Manipulative Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Divya Patel
- Department of Epidemiology, Human Genetics and Environmental Science, UTHealth Houston School of Public Health in Austin, Austin, TX, USA
| | - Sarah Matches
- Department of Pediatrics & Women’s Health, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Rohit P. Ojha
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, Fort Worth, TX, USA
| | - Erika L. Thompson
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| |
Collapse
|
5
|
Brandt HM, Footman A, Adsul P, Ramanadhan S, Kepka D. Implementing interventions to start HPV vaccination at age 9: Using the evidence we have. Hum Vaccin Immunother 2023; 19:2180250. [PMID: 36803261 PMCID: PMC10026886 DOI: 10.1080/21645515.2023.2180250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Human papillomavirus (HPV) vaccination is routinely recommended for adolescents aged 11 or 12 years but can begin at age 9. On-time HPV vaccination by the thirteenth birthday has proven to be effective in preventing HPV cancer and pre-cancer. However, HPV coverage rates continue to lag behind other routinely recommended vaccinations for adolescents. A promising approach to improving coverage is to start HPV vaccination at age 9. This approach has been endorsed by the American Academy of Pediatrics and the American Cancer Society. Benefits of this approach include increased time to complete vaccination series by the thirteenth birthday, additional spacing of recommended vaccines, and a more concentrated focus on cancer prevention messaging. While promising, little is known about how and if existing evidence-based interventions and approaches can be used to promote starting HPV vaccination at age 9. Implementation science frameworks offer scientific direction in how to adapt current and develop new interventions to promote starting HPV vaccination at age 9 and accelerate dissemination and prevent HPV cancers.
Collapse
Affiliation(s)
- Heather M Brandt
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Alison Footman
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Deanna Kepka
- Huntsman Cancer Institute and College of Nursing, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
6
|
Crawshaw J, Meyer C, Antonopoulou V, Antony J, Grimshaw JM, Ivers N, Konnyu K, Lacroix M, Presseau J, Simeoni M, Yogasingam S, Lorencatto F. Identifying behaviour change techniques in 287 randomized controlled trials of audit and feedback interventions targeting practice change among healthcare professionals. Implement Sci 2023; 18:63. [PMID: 37990269 PMCID: PMC10664600 DOI: 10.1186/s13012-023-01318-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/19/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Audit and feedback (A&F) is among the most widely used implementation strategies, providing healthcare professionals with summaries of their practice performance to prompt behaviour change and optimize care. Wide variability in effectiveness of A&F has spurred efforts to explore why some A&F interventions are more effective than others. Unpacking the variability of the content of A&F interventions in terms of their component behaviours change techniques (BCTs) may help advance our understanding of how A&F works best. This study aimed to systematically specify BCTs in A&F interventions targeting healthcare professional practice change. METHODS We conducted a directed content analysis of intervention descriptions in 287 randomized trials included in an ongoing Cochrane systematic review update of A&F interventions (searched up to June 2020). Three trained researchers identified and categorized BCTs in all trial arms (treatment & control/comparator) using the 93-item BCT Taxonomy version 1. The original BCT definitions and examples in the taxonomy were adapted to include A&F-specific decision rules and examples. Two additional BCTs ('Education (unspecified)' and 'Feedback (unspecified)') were added, such that 95 BCTs were considered for coding. RESULTS In total, 47/95 BCTs (49%) were identified across 360 treatment arms at least once (median = 5.0, IQR = 2.3, range = 129 per arm). The most common BCTs were 'Feedback on behaviour' (present 89% of the time; e.g. feedback on drug prescribing), 'Instruction on how to perform the behaviour' (71%; e.g. issuing a clinical guideline), 'Social comparison' (52%; e.g. feedback on performance of peers), 'Credible source' (41%; e.g. endorsements from respected professional body), and 'Education (unspecified)' (31%; e.g. giving a lecture to staff). A total of 130/287 (45%) control/comparator arms contained at least one BCT (median = 2.0, IQR = 3.0, range = 0-15 per arm), of which the most common were identical to those identified in treatment arms. CONCLUSIONS A&F interventions to improve healthcare professional practice include a moderate range of BCTs, focusing predominantly on providing behavioural feedback, sharing guidelines, peer comparison data, education, and leveraging credible sources. We encourage the use of our A&F-specific list of BCTs to improve knowledge of what is being delivered in A&F interventions. Our study provides a basis for exploring which BCTs are associated with intervention effectiveness. TRIAL REGISTRATIONS N/A.
Collapse
Affiliation(s)
- Jacob Crawshaw
- Centre for Evidence-Based Implementation, Hamilton Health Sciences, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Carly Meyer
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, WC1E 7HB, UK
| | - Vivi Antonopoulou
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, WC1E 7HB, UK
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Jesmin Antony
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Jeremy M Grimshaw
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Noah Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Kristin Konnyu
- Department of Health Services, Policy and Practice, Center for Evidence Synthesis in Health, Brown University School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Meagan Lacroix
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Justin Presseau
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Michelle Simeoni
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Sharlini Yogasingam
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Fabiana Lorencatto
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, WC1E 7HB, UK.
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
| |
Collapse
|
7
|
Fu LY, Smith A, Ciotoli C, Dannenbaum M, Jacobs M. An immunization quality improvement learning collaborative in the college health setting. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:2612-2621. [PMID: 34670105 DOI: 10.1080/07448481.2021.1979560] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 08/25/2021] [Accepted: 09/05/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To increase administration of influenza (flu), human papillomavirus (HPV) and meningococcal serogroup B (MenB) vaccinations to students at college student health centers (SHCs). PARTICIPANTS Improvement teams from 45 US-based SHCs. METHODS Teams participated in a 7-month virtual learning collaborative to implement immunization delivery best practices at their SHCs. A pre-post-intervention design was used to compare vaccination coverage in May 2017 to May 2018 among students who were unvaccinated at the start of the academic year. RESULTS Data were compared from 29 SHCs and 152,648 students (2017) and from 18 SHCs and 122,315 students (2018). Percent of newly vaccinated students increased for ≥1 dose of flu vaccine by 14.3 percentage points to 32.3% (p < .01), ≥1 dose of HPV vaccine by 3.9 points to 7.8% (p < .05) and ≥3 doses of HPV vaccine by 0.7 points to 1.5% (p < .05). CONCLUSIONS Participating in a learning collaborative may help SHCs improve vaccination delivery.
Collapse
Affiliation(s)
- Linda Y Fu
- Center for Translational Science, Children's National Hospital, Washington, District of Columbia, USA
| | - Allison Smith
- NYU Student Health, New York University, New York, New York, USA
| | - Carlo Ciotoli
- NYU Student Health, New York University, New York, New York, USA
| | - Martha Dannenbaum
- Student Health Services, Texas A&M University, College Station, Texas, USA
| | - Marni Jacobs
- Center for Translational Science, Children's National Hospital, Washington, District of Columbia, USA
| |
Collapse
|
8
|
Laur C, Ladak Z, Hall A, Solbak NM, Nathan N, Buzuayne S, Curran JA, Shelton RC, Ivers N. Sustainability, spread, and scale in trials using audit and feedback: a theory-informed, secondary analysis of a systematic review. Implement Sci 2023; 18:54. [PMID: 37885018 PMCID: PMC10604689 DOI: 10.1186/s13012-023-01312-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Audit and feedback (A&F) is a widely used implementation strategy to influence health professionals' behavior that is often tested in implementation trials. This study examines how A&F trials describe sustainability, spread, and scale. METHODS This is a theory-informed, descriptive, secondary analysis of an update of the Cochrane systematic review of A&F trials, including all trials published since 2011. Keyword searches related to sustainability, spread, and scale were conducted. Trials with at least one keyword, and those identified from a forward citation search, were extracted to examine how they described sustainability, spread, and scale. Results were qualitatively analyzed using the Integrated Sustainability Framework (ISF) and the Framework for Going to Full Scale (FGFS). RESULTS From the larger review, n = 161 studies met eligibility criteria. Seventy-eight percent (n = 126) of trials included at least one keyword on sustainability, and 49% (n = 62) of those studies (39% overall) frequently mentioned sustainability based on inclusion of relevant text in multiple sections of the paper. For spread/scale, 62% (n = 100) of trials included at least one relevant keyword and 51% (n = 51) of those studies (31% overall) frequently mentioned spread/scale. A total of n = 38 studies from the forward citation search were included in the qualitative analysis. Although many studies mentioned the need to consider sustainability, there was limited detail on how this was planned, implemented, or assessed. The most frequent sustainability period duration was 12 months. Qualitative results mapped to the ISF, but not all determinants were represented. Strong alignment was found with the FGFS for phases of scale-up and support systems (infrastructure), but not for adoption mechanisms. New spread/scale themes included (1) aligning affordability and scalability; (2) balancing fidelity and scalability; and (3) balancing effect size and scalability. CONCLUSION A&F trials should plan for sustainability, spread, and scale so that if the trial is effective, the benefits can continue. A deeper empirical understanding of the factors impacting A&F sustainability is needed. Scalability planning should go beyond cost and infrastructure to consider other adoption mechanisms, such as leadership, policy, and communication, that may support further scalability. TRIAL REGISTRATION Registered with Prospero in May 2022. CRD42022332606.
Collapse
Affiliation(s)
- Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
- Institute of Health Policy, Management and Evaluation, Health Sciences Building, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.
| | - Zeenat Ladak
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
- Ontario Institute for Studies in Education, University of Toronto, 252 Bloor Street West, Toronto, ON, M5S 1V6, Canada
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Nathan M Solbak
- Physician Learning Program, Continuing Medical Education and Professional Development, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
- Health Quality Programs, Queen's University, 92 Barrie Street, Kingston, ON, K7L 3N6, Canada
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Shewit Buzuayne
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Janet A Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Noah Ivers
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
- Institute of Health Policy, Management and Evaluation, Health Sciences Building, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, M5G 1V7, Canada
| |
Collapse
|
9
|
Hittson H, McAleer L, Saucedo L, Mahler L, Andino G, Zorba A, Walden S, Pickett BE, Poole BD, Abel EL. Association between Religious Beliefs and HPV Vaccination Attitudes among College Students. Vaccines (Basel) 2023; 11:1623. [PMID: 37897025 PMCID: PMC10611068 DOI: 10.3390/vaccines11101623] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE AND PARTICIPANTS The authors sought an updated examination of attitudes toward Human Papillomavirus (HPV) catch-up vaccination among college students at a private religious university. METHODS A total of 1557 college students completed a 62-question survey of religious and HPV vaccination attitudes during the fall of 2021. Students' willingness to receive catch-up HPV vaccination and willingness to vaccinate a future child against HPV were recorded. RESULTS Of the 46.8% of students who reported being unvaccinated or unaware of vaccination status, ~26% reported being uninterested in receiving catch-up HPV vaccination; ~22% of all students surveyed reported being unwilling to vaccinate a future child against HPV. The strongest predictors of vaccine hesitancy included religious concerns about sexual abstinence and safety concerns. CONCLUSIONS College health professionals can increase the rate of HPV vaccination among college students and subsequent future generations by addressing the safety and utility of the vaccine regardless of intentions for sexual abstinence prior to marriage. Additionally, rather than a uniform approach to all students who self-identify as Christian, an effort to identify and discuss the unique religiously influenced beliefs of individual students is recommended when discussing HPV vaccination.
Collapse
Affiliation(s)
- Hannah Hittson
- Honors Program, Honors College, Baylor University, Waco, TX 76798, USA; (H.H.); (L.M.); (L.S.); (L.M.); (G.A.); (A.Z.)
| | - Leah McAleer
- Honors Program, Honors College, Baylor University, Waco, TX 76798, USA; (H.H.); (L.M.); (L.S.); (L.M.); (G.A.); (A.Z.)
| | - Lydia Saucedo
- Honors Program, Honors College, Baylor University, Waco, TX 76798, USA; (H.H.); (L.M.); (L.S.); (L.M.); (G.A.); (A.Z.)
| | - Lindsay Mahler
- Honors Program, Honors College, Baylor University, Waco, TX 76798, USA; (H.H.); (L.M.); (L.S.); (L.M.); (G.A.); (A.Z.)
| | - Gabriel Andino
- Honors Program, Honors College, Baylor University, Waco, TX 76798, USA; (H.H.); (L.M.); (L.S.); (L.M.); (G.A.); (A.Z.)
| | - Andie Zorba
- Honors Program, Honors College, Baylor University, Waco, TX 76798, USA; (H.H.); (L.M.); (L.S.); (L.M.); (G.A.); (A.Z.)
| | - Sarah Walden
- Baylor Interdisciplinary Core, Honors College, Baylor University, Waco, TX 76798, USA;
| | - Brett E. Pickett
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, UT 84602, USA; (B.E.P.); (B.D.P.)
| | - Brian D. Poole
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, UT 84602, USA; (B.E.P.); (B.D.P.)
| | - Erika L. Abel
- Honors Program, Honors College, Baylor University, Waco, TX 76798, USA; (H.H.); (L.M.); (L.S.); (L.M.); (G.A.); (A.Z.)
| |
Collapse
|
10
|
Ryan GW, Charlton ME, Scherer AM, Ashida S, Gilbert PA, Daly E, Askelson NM. Understanding Implementation of Evidence-Based Interventions to Address Human Papillomavirus Vaccination: Qualitative Perspectives of Middle Managers. Clin Pediatr (Phila) 2023; 62:1193-1200. [PMID: 36762821 DOI: 10.1177/00099228231154661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Engaging individuals in middle management positions (eg, nurse or clinic managers) could facilitate implementation of evidence-based interventions (EBIs) to improve uptake of human papillomavirus (HPV) vaccination. Our goal was to understand middle managers' role in and perspectives on implementation of EBIs for HPV vaccination. We conducted qualitative interviews with middle managers in pediatric and family practice clinics. We used constructs from the Consolidated Framework for Implementation Research (CFIR) to design the interview guide and as a coding framework. Participants (n = 19) reported overseeing implementation related to HPV vaccination. Across interviews, CFIR inner setting constructs (eg, structural characteristics and implementation climate) were identified as being both barriers and facilitators. As evidenced in this study, middle managers have a deep understanding of organizational factors, and they have the ability to facilitate implementation efforts related to HPV vaccination. Future efforts could focus on engaging middle managers and leveraging their expertise and understanding of barriers and facilitators.
Collapse
Affiliation(s)
- Grace W Ryan
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Mary E Charlton
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Aaron M Scherer
- Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Sato Ashida
- Department of Community and Behavioral Health, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Paul A Gilbert
- Department of Community and Behavioral Health, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Eliza Daly
- Department of Community and Behavioral Health, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Natoshia M Askelson
- Department of Community and Behavioral Health, College of Public Health, The University of Iowa, Iowa City, IA, USA
- Public Policy Center, The University of Iowa, Iowa City, IA, USA
| |
Collapse
|
11
|
Khalid K, Lee KY, Mukhtar NF, Warijo O. Recommended Interventions to Improve Human Papillomavirus Vaccination Uptake among Adolescents: A Review of Quality Improvement Methodologies. Vaccines (Basel) 2023; 11:1390. [PMID: 37631958 PMCID: PMC10459466 DOI: 10.3390/vaccines11081390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/27/2023] [Accepted: 07/17/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Routine human papillomavirus (HPV) vaccine uptake continues to be suboptimal since its recommendation in 2006 for girls and in 2011 for boys. This paper aims to review published quality improvement (QI) methodologies on interventions to improve HPV vaccine uptake among adolescents. METHODS Science Direct and Scopus databases were searched for QI initiatives evaluating the effect of multimodal interventions to improve HPV vaccination rates (initiation and/or completion of series) among adolescents. Studies that included an outcome of interest among adolescents aged 10 to 18 years old were included. Two investigators worked independently to screen for potential articles and a designated investigator extracted data on study characteristics and evaluated the outcomes. RESULTS A preliminary search yielded a total of 523 articles and 13 were included in the final analysis. Common strategies were provider-specific (i.e., webinar, telementoring, train-the-trainer approach) and patient- and/or parent-specific interventions (i.e., reminder emails, phone calls and text messages, social events), with an emphasis on education and knowledge empowerment. System-level interventions such as policy changes and revised protocols were less commonly prescribed despite being associated with a more significant weight on the overall outcome. CONCLUSIONS Creative, sustainable, and economical multilevel interventions that focus not only on provider training and public education but also incorporate local policies and system enhancements can substantially improve HPV vaccination coverage among adolescents.
Collapse
Affiliation(s)
- Karniza Khalid
- Specialized Diagnostic Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Kuala Lumpur 50588, Malaysia
| | - Kun Yun Lee
- Institute for Health Management, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia;
| | - Nur Farihan Mukhtar
- Department of Obstetrics and Gynecology, Hospital Tuanku Fauziah, Ministry of Health Malaysia, Kangar 01000, Malaysia;
| | - Othman Warijo
- Kedah State Health Department, Ministry of Health Malaysia, Alor Setar 05400, Malaysia;
| |
Collapse
|
12
|
Grabert BK, McRee AL, Henrikson NB, Heisler-MacKinnon J, Blasi PR, Norris CM, Nguyen MB, Dunn J, McKeithen MC, Gilkey MB. Feasibility of using an app-based coaching intervention to improve provider communication about HPV vaccination. Transl Behav Med 2023; 13:581-588. [PMID: 36999806 PMCID: PMC10415729 DOI: 10.1093/tbm/ibad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Provider communication training is effective for increasing HPV vaccination rates among U.S. adolescents. However, such trainings often rely on in-person meetings, which can be burdensome for providers and costly to implement. To evaluate the feasibility of Checkup Coach, an app-based coaching intervention, to improve provider communication about HPV vaccination. In 2021, we offered Checkup Coach to providers in 7 primary care clinics in a large integrated delivery system. Participating providers (n = 19) attended a 1-h interactive virtual workshop that taught 5 high-quality practices for recommending HPV vaccination. Providers then had 3 months of access to our mobile app, which offered ongoing communication assessments, tailored tips for addressing parents' concerns, and a dashboard of their clinic's HPV vaccination coverage. Online surveys assessed pre-/post-intervention changes in providers' perceptions and communication behaviors. Compared to baseline, more providers reported high-quality HPV vaccine recommendation practices at 3-month follow-up (47% vs. 74%, p < .05). Providers' knowledge, self-efficacy, and shared commitment to improving HPV vaccination also improved (all p < .05). Although we found improvements in several other cognitions after the workshop, these changes did not retain statistical significance at 3 months. About three-quarters (78%) of providers used the mobile app, logging 2.3 sessions on average. Most providers agreed the app was easy to use (mean = 4.7/5.0), a convenient way to get vaccination data (mean = 4.6/5.0), and a tool they would recommend (mean = 4.3/5.0). Our app-based coaching intervention demonstrated feasibility and warrants additional evaluation as a novel mode for training providers to improve their HPV vaccine communication.
Collapse
Affiliation(s)
- Brigid K Grabert
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NCUSA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NCUSA
| | - Annie-Laurie McRee
- University of Minnesota Medical School, Minneapolis, MNUSA
- Center for Scientific Review, National Institutes of Health, Bethesda, MDUSA
| | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jennifer Heisler-MacKinnon
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NCUSA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NCUSA
| | - Paula R Blasi
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Consuelo M Norris
- Office of Performance, Strategy and Budget, King County, Seattle, WA, USA
| | - Matthew B Nguyen
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - John Dunn
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Kaiser Permanente Washington, Seattle, WA, USA
| | - Mary Catharine McKeithen
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NCUSA
| | - Melissa B Gilkey
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NCUSA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NCUSA
| |
Collapse
|
13
|
Desjardins C, Denis-LeBlanc M, Cannalonga CP, Rahmani M, Gawargy TA, Dion PM, Harasym JL, Fotsing S, Cherba M, Langlois N, Boet S. Communicating effectively with patients about vaccination: A systematic review of randomized controlled trials. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2023; 49:331-341. [PMID: 38455879 PMCID: PMC10917362 DOI: 10.14745/ccdr.v49i78a05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Background Good communication between healthcare professionals and their patients is essential to enlighten the benefits and risks of vaccination. Despite the availability of effective vaccines, reluctance prevails, sometimes fuelled by sub-optimal communication leading to a lack of trust. An evaluation of the effectiveness of a communication strategy for which healthcare professionals are trained has yet to be carried out. Objective Systematic review of studies with a randomized controlled trial (RCT) to define and evaluate the impact of healthcare professionals' communication on patients' vaccine adherence. Methods We performed a structured search on Medline, Embase, CENTRAL, PsycINFO and CINAHL. The studies selected include those involving healthcare professionals authorized to administer vaccines according to Canadian guidelines. Primary outcomes include vaccination rate or vaccine hesitancy rate. Results Nine articles were included. Five studies (n=5) reported intervention effectiveness according to vaccine adherence. The results are largely represented by parental vaccine hesitancy for human papillomavirus (HPV) or childhood vaccination, while three studies (n=3) target the general population. The risk of bias relative to the studies is either low (n=7) or of some concern (n=2). Conclusion The effectiveness of communication varies according to the studies and knowledge acquired through training. Future studies will need to examine communication with healthcare professionals in order to establish a consensus on optimal and appropriate training.
Collapse
Affiliation(s)
- Chloé Desjardins
- Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, ON
| | - Manon Denis-LeBlanc
- Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, ON
- Department of Family Medicine, University of Ottawa, Ottawa, ON
- Institut du Savoir Montfort, Ottawa, ON
| | | | - Malek Rahmani
- Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, ON
| | - Teresa A Gawargy
- Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, ON
| | - Pierre-Marc Dion
- Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, ON
| | | | - Salomon Fotsing
- Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, ON
- Department of Family Medicine, University of Ottawa, Ottawa, ON
- Institut du Savoir Montfort, Ottawa, ON
| | - Maria Cherba
- Department of Communication, Faculty of Arts, University of Ottawa, Ottawa, ON
| | | | - Sylvain Boet
- Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, ON
- Institut du Savoir Montfort, Ottawa, ON
- Faculty of Education, University of Ottawa, Ottawa, ON
- Departments of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
- Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, ON
| |
Collapse
|
14
|
Landier W, Bhatia S, Richman JS, Campos Gonzalez PD, Cherven B, Chollette V, Aye J, Castellino SM, Gramatges MM, Lindemulder S, Russell TB, Turcotte LM, Colditz GA, Gilkey MB, Klosky JL. Implementation of a provider-focused intervention for maximizing human papillomavirus (HPV) vaccine uptake in young cancer survivors receiving follow-up care in pediatric oncology practices: protocol for a cluster-randomized trial of the HPV PROTECT intervention. BMC Pediatr 2022; 22:541. [PMID: 36096775 PMCID: PMC9466329 DOI: 10.1186/s12887-022-03562-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/21/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Childhood cancer survivors are at high risk for developing new cancers (such as cervical and anal cancer) caused by persistent infection with the human papillomavirus (HPV). HPV vaccination is effective in preventing the infections that lead to these cancers, but HPV vaccine uptake is low among young cancer survivors. Lack of a healthcare provider recommendation is the most common reason that cancer survivors fail to initiate the HPV vaccine. Strategies that are most successful in increasing HPV vaccine uptake in the general population focus on enhancing healthcare provider skills to effectively recommend the vaccine, and reducing barriers faced by the young people and their parents in receiving the vaccine. This study will evaluate the effectiveness and implementation of an evidence-based healthcare provider-focused intervention (HPV PROTECT) adapted for use in pediatric oncology clinics, to increase HPV vaccine uptake among cancer survivors 9 to 17 years of age. METHODS This study uses a hybrid type 1 effectiveness-implementation approach. We will test the effectiveness of the HPV PROTECT intervention using a stepped-wedge cluster-randomized trial across a multi-state sample of pediatric oncology clinics. We will evaluate implementation (provider perspectives regarding intervention feasibility, acceptability and appropriateness in the pediatric oncology setting, provider fidelity to intervention components and change in provider HPV vaccine-related knowledge and practices [e.g., providing vaccine recommendations, identifying and reducing barriers to vaccination]) using a mixed methods approach. DISCUSSION This multisite trial will address important gaps in knowledge relevant to the prevention of HPV-related malignancies in young cancer survivors by testing the effectiveness of an evidence-based provider-directed intervention, adapted for the pediatric oncology setting, to increase HPV vaccine initiation in young cancer survivors receiving care in pediatric oncology clinics, and by procuring information regarding intervention delivery to inform future implementation efforts. If proven effective, HPV PROTECT will be readily disseminable for testing in the larger pediatric oncology community to increase HPV vaccine uptake in cancer survivors, facilitating protection against HPV-related morbidities for this vulnerable population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04469569, prospectively registered on July 14, 2020.
Collapse
Affiliation(s)
- Wendy Landier
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7th Ave. South, Lowder 500, Birmingham, Alabama, 35233, USA.
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Alabama at Birmingham, 1600 7th Ave. South, Lowder 512, Birmingham, Alabama, 35233, USA.
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7th Ave. South, Lowder 500, Birmingham, Alabama, 35233, USA
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Alabama at Birmingham, 1600 7th Ave. South, Lowder 512, Birmingham, Alabama, 35233, USA
| | - Joshua S Richman
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7th Ave. South, Lowder 500, Birmingham, Alabama, 35233, USA
| | - Paula D Campos Gonzalez
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7th Ave. South, Lowder 500, Birmingham, Alabama, 35233, USA
| | - Brooke Cherven
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, 2015 Uppergate Drive, ECC#412, Atlanta, GA, 30322, USA
| | - Veronica Chollette
- Healthcare Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr., Room 3E344, MSC 9762, Rockville, MD, 20850, USA
| | - Jamie Aye
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Alabama at Birmingham, 1600 7th Ave. South, Lowder 512, Birmingham, Alabama, 35233, USA
| | - Sharon M Castellino
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, 2015 Uppergate Drive, ECC#412, Atlanta, GA, 30322, USA
| | - Maria M Gramatges
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Baylor College of Medicine, 1102 Bates St., Suite 1200, Houston, TX, 77030, USA
| | - Susan Lindemulder
- Department of Pediatrics, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon, 97239, USA
| | - Thomas B Russell
- Department of Pediatrics, Wake Forest University, Medical Center Boulevard, Winston-Salem, North Carolina, 27157, USA
| | - Lucie M Turcotte
- Department of Pediatrics, University of Minnesota, D-557 Mayo Building, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Graham A Colditz
- Department of Surgery, Washington University at St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 317 Rosenau Hall, CB #7440, 135 Dauer Drive, Chapel Hill, North Carolina, 27599, USA
| | - James L Klosky
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, 2015 Uppergate Drive, ECC#412, Atlanta, GA, 30322, USA
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Curran JA, Gallant AJ, Wong H, Shin HD, Urquhart R, Kontak J, Wozney L, Boulos L, Bhutta Z, Langlois EV. Knowledge translation strategies for policy and action focused on sexual, reproductive, maternal, newborn, child and adolescent health and well-being: a rapid scoping review. BMJ Open 2022; 12:e053919. [PMID: 35039297 PMCID: PMC8765012 DOI: 10.1136/bmjopen-2021-053919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify knowledge translation (KT) strategies aimed at improving sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) and well-being. DESIGN Rapid scoping review. SEARCH STRATEGY A comprehensive and peer-reviewed search strategy was developed and applied to four electronic databases: MEDLINE ALL, Embase, CINAHL and Web of Science. Additional searches of grey literature were conducted to identify KT strategies aimed at supporting SRMNCAH. KT strategies and policies published in English from January 2000 to May 2020 onwards were eligible for inclusion. RESULTS Only 4% of included 90 studies were conducted in low-income countries with the majority (52%) conducted in high-income countries. Studies primarily focused on maternal newborn or child health and well-being. Education (81%), including staff workshops and education modules, was the most commonly identified intervention component from the KT interventions. Low-income and middle-income countries were more likely to include civil society organisations, government and policymakers as stakeholders compared with high-income countries. Reported barriers to KT strategies included limited resources and time constraints, while enablers included stakeholder involvement throughout the KT process. CONCLUSION We identified a number of gaps among KT strategies for SRMNCAH policy and action, including limited focus on adolescent, sexual and reproductive health and rights and SRMNCAH financing strategies. There is a need to support stakeholder engagement in KT interventions across the continuum of SRMNCAH services. Researchers and policymakers should consider enhancing efforts to work with multisectoral stakeholders to implement future KT strategies and policies to address SRMNCAH priorities. REGISTRATION The rapid scoping review protocol was registered on Open Science Framework on 16 June 2020 (https://osf.io/xpf2k).
Collapse
Affiliation(s)
- Janet A Curran
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Allyson J Gallant
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Helen Wong
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julia Kontak
- Maritime SPOR SUPPORT Unit, Halifax, Nova Scotia, Canada
| | - Lori Wozney
- Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Leah Boulos
- Maritime SPOR SUPPORT Unit, Halifax, Nova Scotia, Canada
| | - Zulfiqar Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Etienne V Langlois
- The Partnership for Maternal, Newborn & Child Health, World Health Organization, Geneva, Switzerland
| |
Collapse
|
17
|
Vasudevan L, Ostermann J, Wang Y, Harrison SE, Yelverton V, McDonald JA, Fish LJ, Williams C, Walter EB. Predictors of HPV vaccination in the southern US: A survey of caregivers from 13 states. Vaccine 2021; 39:7485-7493. [PMID: 34742592 PMCID: PMC8685535 DOI: 10.1016/j.vaccine.2021.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/01/2021] [Accepted: 10/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite a high burden of human papillomavirus (HPV)-attributable cancers, the southern US lags other regions in HPV vaccination coverage. This study sought to characterize and contextualize predictors of HPV vaccination in the southern US. METHODS From December 2019 - January 2020, parents of adolescents (ages 9-17 years) living in thirteen southern US states were recruited from a nationally-representative online survey panel and completed a cross-sectional survey. The primary study outcome was initiation of HPV vaccination. RESULTS Of 1105 parents who responded to the survey, most were ≥35 years of age and of female gender. HPV vaccination initiation was reported only among 37.3% of adolescents and was highest at age 12. Cumulative HPV vaccination coverage was highest at age 15 (60%) but lower than coverage for tetanus-diphtheria-acellular pertussis (Tdap, 79.3%) and Meningococcal vaccines (MenACWY, 67.3%). Provider recommendation was strongly associated with higher odds of HPV vaccination (aOR: 49.9, 95 %CI: 23.1-107.5). In alternative predictive models, home/online (vs. public) schooling and parents' working status were associated with lower odds of vaccination; health care visits in the past 12 months and shorter travel times to adolescents' usual health care provider were associated with greater odds of vaccination. CONCLUSIONS Our findings suggest missed opportunities for HPV vaccination in the southern US and support strengthening provider recommendation for on-time initiation of HPV vaccination among adolescents. Other strategies to increase HPV vaccinations may include encouraging co-administration with other adolescent vaccines, increasing vaccine access, and promoting vaccinations for home/online-school students.
Collapse
Affiliation(s)
- Lavanya Vasudevan
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 W. Main Street, Suite 600, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA.
| | - Jan Ostermann
- Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Department of Health Services Policy & Management, 915 Greene Street, University of South Carolina, Columbia, SC 29208, USA; South Carolina Smart State Center for Healthcare Quality, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Yunfei Wang
- Duke Vaccine and Trials Unit, Duke Human Vaccine Institute, 2608 Erwin Road, Suite 210, Durham, NC 27705, USA
| | - Sayward E Harrison
- South Carolina Smart State Center for Healthcare Quality, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; Department of Psychology, University of South Carolina, 1512 Pendleton Street, Barnwell College, Suite #220, Columbia, SC 29208, USA
| | - Valerie Yelverton
- Department of Health Services Policy & Management, 915 Greene Street, University of South Carolina, Columbia, SC 29208, USA
| | - Jodi-Ann McDonald
- Duke Vaccine and Trials Unit, Duke Human Vaccine Institute, 2608 Erwin Road, Suite 210, Durham, NC 27705, USA
| | - Laura J Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 W. Main Street, Suite 600, Durham, NC 27705, USA; Duke Cancer Institute, 2424 Erwin Rd, Suite 602, Durham, NC 27710, USA
| | - Charnetta Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA 30329, USA
| | - Emmanuel B Walter
- Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke Vaccine and Trials Unit, Duke Human Vaccine Institute, 2608 Erwin Road, Suite 210, Durham, NC 27705, USA; Department of Pediatrics, Duke University School of Medicine, Box 3675, DUMC, Durham, NC 27710, USA
| |
Collapse
|
18
|
Francis JK, Rodriguez SA, Dorsey O, Blackwell JM, Balasubramanian BA, Kale N, Day P, Preston SM, Thompson EL, Pruitt SL, Tiro JA. Provider perspectives on communication and dismissal policies with HPV vaccine hesitant parents. Prev Med Rep 2021; 24:101562. [PMID: 34976628 PMCID: PMC8683895 DOI: 10.1016/j.pmedr.2021.101562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 11/16/2022] Open
Abstract
Parental vaccine hesitancy is a growing concern. Less is known about provider or practice characteristics that encounter HPV-specific vaccine-hesitant parents, the providers' confidence in responding to HPV vaccine concerns, and the attitudes and use of vaccine dismissal policies (i.e., removing patients from the practice). North Texas providers completed an online survey. Dependent variables assessed: (1) percentage of HPV vaccine-hesitant parents encountered in practice defined as substantive, or high (≥11%, or among more than one out of ten adolescent patient encounters) versus low (≤10%) levels; (2) confidence in responding to 11 HPV vaccine concerns; (3) attitudes and use of vaccine dismissal policies. Chi-square and Fisher's exact tests were conducted. Among 156 providers, 29% reported high HPV vaccine hesitancy (≥11% of patient population). Overall, providers reported being "very confident" in addressing vaccine concerns (mean: 3.37 out of 4, SD: 0.57). Mean confidence scores were significantly higher for white (vs. non-white) providers and for pediatricians (vs. family practitioners). Providers were least confident in responding to parents' religious/personal beliefs (69%). Some providers (25%) agreed with policies that dismissed vaccine-hesitant parents after repeated counseling attempts. More providers used dismissal policies for childhood (19%) than adolescent (10%) immunizations. Provider communication training should include parental religious/personal beliefs to effectively address HPV vaccine hesitancy. Other regions should examine their HPV-specific vaccine hesitancy levels to understand how the use of dismissal policies might vary between adolescent and childhood immunizations.
Collapse
Affiliation(s)
- Jenny K.R. Francis
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
- Children’s Health, Dallas, TX
| | - Serena A. Rodriguez
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Olivia Dorsey
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - James-Michael Blackwell
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Bijal A. Balasubramanian
- Department of Epidemiology, Human Genetics, and Environmental Science, UTHealth School of Public Health, Houston, TX
| | - Neelima Kale
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, KY
| | - Philip Day
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA
| | - Sharice M. Preston
- Department of Health Promotion and Behavioral Science, UTHealth School of Public Health, Dallas, TX
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, TX
| | - Erika L. Thompson
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX
| | - Sandi L. Pruitt
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jasmin A. Tiro
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
19
|
A Vax4HPV Mobile Application for Parents of Human Papillomavirus Vaccine–Eligible Children. Comput Inform Nurs 2021; 40:455-465. [DOI: 10.1097/cin.0000000000000832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
20
|
Szilagyi PG, Humiston SG, Stephens-Shields AJ, Localio R, Breck A, Kelly MK, Wright M, Grundmeier RW, Albertin C, Shone LP, Steffes J, Rand CM, Hannan C, Abney DE, McFarland G, Kominski GF, Seixas BV, Fiks AG. Effect of Training Pediatric Clinicians in Human Papillomavirus Communication Strategies on Human Papillomavirus Vaccination Rates: A Cluster Randomized Clinical Trial. JAMA Pediatr 2021; 175:901-910. [PMID: 34028494 PMCID: PMC8145158 DOI: 10.1001/jamapediatrics.2021.0766] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Missed opportunities for human papillomavirus (HPV) vaccination during pediatric health care visits are common. OBJECTIVES To evaluate the effect of online communication training for clinicians on missed opportunities for HPV vaccination rates overall and at well-child care (WCC) visits and visits for acute or chronic illness (hereafter referred to as acute or chronic visits) and on adolescent HPV vaccination rates. DESIGN, SETTING, AND PARTICIPANTS From December 26, 2018, to July 30, 2019, a longitudinal cluster randomized clinical trial allocated practices to communication training vs standard of care in staggered 6-month periods. A total of 48 primary care pediatric practices in 19 states were recruited from the American Academy of Pediatrics Pediatric Research in Office Settings network. Participants were clinicians in intervention practices. Outcomes were evaluated for all 11- to 17-year-old adolescents attending 24 intervention practices (188 clinicians) and 24 control practices (177 clinicians). Analyses were as randomized and performed on an intent-to-treat basis, accounting for clustering by practice. INTERVENTIONS Three sequential online educational modules were developed to help participating clinicians communicate with parents about the HPV vaccine. Weekly text messages were sent to participating clinicians to reinforce learning. Statisticians were blinded to group assignment. MAIN OUTCOMES AND MEASURES Main outcomes were missed opportunities for HPV vaccination overall and for HPV vaccine initiation and subsequent doses at WCC and acute or chronic visits (visit-level outcome). Secondary outcomes were HPV vaccination rates (person-level outcome). Outcomes were compared during the intervention vs baseline. RESULTS Altogether, 122 of 188 clinicians in intervention practices participated; of these, 120, 119, and 116 clinicians completed training modules 1, 2, and 3, respectively. During the intervention period, 29 206 adolescents (14 664 girls [50.2%]; mean [SD] age, 14.2 [2.0] years) made 15 888 WCC and 28 123 acute or chronic visits to intervention practices; 33 914 adolescents (17 069 girls [50.3%]; mean [SD] age, 14.2 [2.0] years) made 17 910 WCC and 35 281 acute or chronic visits to control practices. Intervention practices reduced missed opportunities overall by 2.4 percentage points (-2.4%; 95% CI, -3.5% to -1.2%) more than controls. Intervention practices reduced missed opportunities for vaccine initiation during WCC visits by 6.8 percentage points (-6.8%; 95% CI, -9.7% to -3.9%) more than controls. The intervention had no effect on missed opportunities for subsequent doses of the HPV vaccine or at acute or chronic visits. Adolescents in intervention practices had a 3.4-percentage point (95% CI, 0.6%-6.2%) greater improvement in HPV vaccine initiation compared with adolescents in control practices. CONCLUSIONS AND RELEVANCE This scalable, online communication training increased HPV vaccination, particularly HPV vaccine initiation at WCC visits. Results support dissemination of this intervention. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03599557.
Collapse
Affiliation(s)
- Peter G. Szilagyi
- Department of Pediatrics, University of California, Los Angeles, UCLA Mattel Children’s Hospital, Los Angeles
| | | | - Alisa J. Stephens-Shields
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Russell Localio
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Abigail Breck
- Department of Pediatrics, University of California, Los Angeles, UCLA Mattel Children’s Hospital, Los Angeles
| | - Mary Kate Kelly
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Margaret Wright
- Primary Care Research, American Academy of Pediatrics, Itasca, Illinois,Pediatric Research in Office Settings, American Academy of Pediatrics, Itasca, Illinois
| | - Robert W. Grundmeier
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christina Albertin
- Department of Pediatrics, University of California, Los Angeles, UCLA Mattel Children’s Hospital, Los Angeles
| | - Laura P. Shone
- Primary Care Research, American Academy of Pediatrics, Itasca, Illinois,Pediatric Research in Office Settings, American Academy of Pediatrics, Itasca, Illinois
| | - Jennifer Steffes
- Primary Care Research, American Academy of Pediatrics, Itasca, Illinois,Pediatric Research in Office Settings, American Academy of Pediatrics, Itasca, Illinois
| | - Cynthia M. Rand
- Department of Pediatrics, University of Rochester, Rochester, New York
| | - Chloe Hannan
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Dianna E. Abney
- Primary Care Research, American Academy of Pediatrics, Itasca, Illinois
| | - Greta McFarland
- Primary Care Research, American Academy of Pediatrics, Itasca, Illinois
| | - Gerald F. Kominski
- UCLA Center for Health Policy Research, University of California Los Angeles, Los Angeles
| | - Brayan V. Seixas
- UCLA Center for Health Policy Research, University of California Los Angeles, Los Angeles
| | - Alexander G. Fiks
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Primary Care Research, American Academy of Pediatrics, Itasca, Illinois,Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
21
|
Mavundza EJ, Iwu-Jaja CJ, Wiyeh AB, Gausi B, Abdullahi LH, Halle-Ekane G, Wiysonge CS. A Systematic Review of Interventions to Improve HPV Vaccination Coverage. Vaccines (Basel) 2021; 9:vaccines9070687. [PMID: 34201421 PMCID: PMC8310215 DOI: 10.3390/vaccines9070687] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022] Open
Abstract
Human papillomavirus (HPV) infection is the most common sexually transmitted infection worldwide. Although most HPV infections are transient and asymptomatic, persistent infection with high-risk HPV types may results in diseases. Although there are currently three effective and safe prophylactic HPV vaccines that are used across the world, HPV vaccination coverage remains low. This review evaluates the effects of the interventions to improve HPV vaccination coverage. We searched the Cochrane Central Register of Controlled Trials, PubMed, Web of Science, Scopus, and the World Health Organization International Clinical Trials Registry Platform and checked the reference lists of relevant articles for eligible studies. Thirty-five studies met inclusion criteria. Our review found that various evaluated interventions have improved HPV vaccination coverage, including narrative education, outreach plus reminders, reminders, financial incentives plus reminders, brief motivational behavioral interventions, provider prompts, training, training plus assessment and feedback, consultation, funding, and multicomponent interventions. However, the evaluation of these intervention was conducted in high-income countries, mainly the United States of America. There is, therefore, a need for studies to evaluate the effect of these interventions in low-and middle-income countries, where there is a high burden of HPV and limited HPV vaccination programs.
Collapse
Affiliation(s)
- Edison J. Mavundza
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town 7501, South Africa;
- Correspondence:
| | - Chinwe J. Iwu-Jaja
- Department of Nursing and Midwifery, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa;
| | - Alison B. Wiyeh
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA;
| | - Blessings Gausi
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa;
| | - Leila H. Abdullahi
- African Institute for Development Policy, Nairobi P.O. Box 14688-00800, Kenya;
| | | | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town 7501, South Africa;
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa;
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| |
Collapse
|
22
|
Avni-Singer L, Oliveira CR, Torres A, Shapiro ED, Niccolai LM, Sheth SS. Evaluation of an Inpatient Postpartum Human Papillomavirus Immunization Program. Obstet Gynecol 2020; 136:1006-1015. [PMID: 33030866 DOI: 10.1097/aog.0000000000004097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the result of an inpatient postpartum human papillomavirus (HPV) immunization pilot program in a diverse, low-income patient population from an urban, hospital-based obstetrics and gynecology clinic. METHODS In this cohort study, we present results from the first 2 years of the inpatient postpartum HPV immunization program, in which vaccine-eligible postpartum women were identified and immunized during their hospital stays. The program was implemented after educational outreach with prenatal and postpartum clinicians and nurses. Associations between receipt of the HPV vaccine as an inpatient and the characteristics of patients, and the likelihood of and missed opportunities for receiving a subsequent dose of the HPV vaccine as an outpatient were determined using logistic regression, time-to-event analyses, chi-squared tests and t-tests. RESULTS From April 11, 2017, to April 10, 2019, 394 (59.2%) of 666 postpartum women were eligible for the inpatient postpartum HPV immunization program. The majority (265/394, 67.3%) received the immunization pilot program HPV dose; 36 of those 265 (13.6%) completed the series with that dose. Among women due for additional doses after hospital discharge, those who received the inpatient dose were more likely to receive a subsequent outpatient dose (138/229) than were those who did not receive an inpatient dose (39/129; hazard ratio 2.51, 95% CI 1.76-3.58). On average, there were 30.7 fewer (95% CI 5.8-55.6, P<.02) missed opportunities for subsequent outpatient doses for every 100 eligible visits among women who received the inpatient dose, compared with women who did not. By the end of the study, the proportion of women who had completed the vaccine series was higher among women who received the inpatient dose (95/265, 35.8%) than in those who did not (12 out 129, 9.3%; odds ratio 5.45, 95% CI 2.86-10.38). CONCLUSION The inpatient postpartum HPV immunization program was associated with increased rates of immunization and addressed a previously missed opportunity. Inpatient immunization programs can serve as a critical way to address gaps in vaccine uptake.
Collapse
Affiliation(s)
- Lital Avni-Singer
- Department of Obstetrics, Gynecology & Reproductive Sciences and the Department of Pediatrics, Yale School of Medicine, and the Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | | | | | | | | | | |
Collapse
|
23
|
Kawczak S, Mooney M, Mitchner N, Senatore V, Stoller JK. The impact of a quality improvement continuing medical education intervention on physicians' vaccination practice: a controlled study. Hum Vaccin Immunother 2020; 16:2809-2815. [PMID: 32238041 PMCID: PMC7734119 DOI: 10.1080/21645515.2020.1737457] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/28/2020] [Indexed: 12/15/2022] Open
Abstract
This study investigated the impact of a longitudinal quality improvement continuing medical education (CME) intervention on influenza and pneumococcal vaccination rates for patient populations at high-risk or aged ≥ 65. An observational cohort design with a propensity score to adjust for vaccine eligibility between the intervention and control cohorts was utilized to assess the impact of the intervention among primary care physicians. The intervention was a three-stage quality improvement initiative with CME learning activities. Stage A was an assessment of practice to establish baseline performance. Stage B was participation in learning interventions and individualized action planning for practice change, and Stage C was practice reassessment. Data were also collected for a control group of clinicians who did not participate during the same period. One hundred primary care physicians completed all 3 intervention stages10/14 - 7/15. Altogether, 361,528 patient records of vaccine receipt were compared for those physicians who completed the educational intervention and those who did not. The percentage of physicians' adult patients receiving influenza or pneumococcal vaccination increased on all measures. The difference between intervention versus control groups was 3.4% higher for influenza ≥ 65 years, 2.1% for influenza high-risk, 0.6% for pneumococcal ≥ 65 years, and 1.4% for pneumococcal high-risk. These results show that physician participation in a quality improvement CME initiative can be an effective strategy to improve vaccination administration. The findings strengthen the evidence that CME learning interventions can advance quality improvement goals and more favorably affect physicians' practice when educational strategies are utilized.
Collapse
Affiliation(s)
- Steven Kawczak
- Education Institute Professional Development, Center for Continuing Education, Cleveland Clinic, Cleveland, OH, USA
| | - Molly Mooney
- Center for Continuing Education, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - James K. Stoller
- Education Institute, Jean Wall Bennett Professor of Medicine, Samson Global Leadership Academy Endowed Chair, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
24
|
Rand CM, Concannon C, Wallace-Brodeur R, Davis W, Albertin CS, Humiston SG, Szilagyi PG. Identifying Strategies to Reduce Missed Opportunities for HPV Vaccination in Primary Care: A Qualitative Study of Positive Deviants. Clin Pediatr (Phila) 2020; 59:1058-1068. [PMID: 32597722 DOI: 10.1177/0009922820930357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objectives of this study were to assess the contextual factors, practice strategies, and sustainability of interventions implemented during a national quality improvement (QI) project to raise human papillomavirus (HPV) vaccination rates. We conducted semistructured interviews with positive deviant practices that successfully reduced missed opportunities by ≥20% for HPV vaccination in the prior year. We assessed leadership support, motivators, interventions used, and sustainability. Key themes related to QI teams included strong leadership support, multidisciplinary teams, having a practice champion, and a collaborative environment. Themes related to the interventions included using a presumptive bundled recommendation for all appropriate vaccines at age 11, previsit planning, and reminders for preventive visits, which were sustainable for most practices 1-year postintervention. Both internal practice-level factors (multidisciplinary teams, collaboration, and previsit planning) and organizational factors (institutional support and health system-level reminders for preventive visits) were key to a successful QI intervention to improve HPV vaccination.
Collapse
Affiliation(s)
- Cynthia M Rand
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | - Wendy Davis
- University of Vermont Medical Center, Burlington, VT, USA
| | | | | | - Peter G Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California, Los Angeles, CA, USA
| |
Collapse
|
25
|
Szilagyi PG, Albertin CS, Gurfinkel D, Saville AW, Vangala S, Rice JD, Helmkamp L, Zimet GD, Valderrama R, Breck A, Rand CM, Humiston SG, Kempe A. Prevalence and characteristics of HPV vaccine hesitancy among parents of adolescents across the US. Vaccine 2020; 38:6027-6037. [PMID: 32758380 PMCID: PMC9495911 DOI: 10.1016/j.vaccine.2020.06.074] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND While many clinicians encounter parents or adolescents who refuse HPV vaccine, little is known about the prevalence of hesitancy for HPV vaccine nationally or its association with vaccination. METHODS In April 2019, we surveyed families with adolescents 11-17 years using a national online panel (Knowledge Panel®) as the sampling frame. We assessed the prevalence of HPV vaccine hesitancy with the validated 9-item Vaccine Hesitancy Scale (VHS). We used multivariate analyses to assess demographic factors associated with HPV vaccine hesitancy. We also assessed practical barriers to receipt of HPV vaccine and the relationship between barriers and hesitancy. Finally, we evaluated the association between both HPV vaccine hesitancy and practical barriers on HPV vaccine receipt or refusal. RESULTS 2,177 parents out of 4,185 sampled (52%) completed the survey, 2,020 qualified (lived with adolescent). Using a VHS cut-off score > 3 out of 5 points, 23% of US parents were hesitant about HPV vaccine. Hesitancy was lower among those with Hispanic ethnicity. At least one out of five parents disagreed that the HPV vaccine is beneficial for their adolescent, that the vaccine is effective, protects against HPV-related cancers, or that they followed their adolescent's health-care provider's recommendation about the vaccine. Many were concerned about vaccine side effects and the novelty of the vaccine. Adolescents living with vaccine-hesitant parents were less than one-third as likely to have received the vaccine (RR = 0.29, 95% CI 0.24, 0.35) or completed the vaccine series (RR = 0.29, 95% CI 0.23, 0.36), and were 6-fold more likely to have refused the vaccine because of parental vaccine-related concerns (RR = 6.09, 95% CI = 5.26, 7.04). Most practical barriers were independently associated with vaccine receipt but not with vaccine refusal. CONCLUSIONS HPV vaccine hesitancy is common nationally and strongly related to both under-vaccination and vaccine refusal.
Collapse
Affiliation(s)
- Peter G Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Christina S Albertin
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, USA.
| | - 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, CO, USA.
| | - Alison W Saville
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
| | - Sitaram Vangala
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - John D 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, CO, USA; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA.
| | - Laura Helmkamp
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Rebecca Valderrama
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, USA
| | - Abigail Breck
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Cynthia M Rand
- Department of Pediatrics, University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA.
| | | | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| |
Collapse
|