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Palmer KE, Moorman KL, Nickman NA, Owen DG. Factors influencing rates of human papillomavirus vaccination. Am J Health Syst Pharm 2019; 76:2053-2059. [DOI: 10.1093/ajhp/zxz246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Purpose
Failure modes and effects analysis (FMEA) was used to identify ways in which community clinic practices related to suboptimal human papillomavirus (HPV) vaccination rates could be improved.
Method
FMEA is a standardized safety method that helps determine where processes fail, the impact of failures, and needed process changes. In a quality improvement initiative conducted at an academic health center–based community clinic, a multidisciplinary team used FMEA to map HPV vaccination processes and identify areas for improvement of vaccination practices. Risk priority numbers (RPNs) were assigned to identified failure modes based on likelihood of occurrence, likelihood of detection, and ability to correct locally. Failure modes with the highest RPNs were targeted for process improvements.
Results
High RPN failure modes were related to clinic processes for follow-up, immunization status checks during well-child visits, and vaccination discussions during sick-child visits. New procedures included scheduling follow-up vaccinations and reminders during the initial vaccination appointment. HPV immunization rates improved following implementation of these procedures, indicating that clinic processes focused on patient follow-up can impact vaccination series completion.
Conclusion
FMEA processes can help health systems identify workflow barriers and locally relevant opportunities for improvement. Team-based approaches to care process improvements can also benefit from standardized problem identification and solving.
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Affiliation(s)
| | | | - Nancy A Nickman
- University of Utah Health Pharmacy Services, Salt Lake City, UT
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2
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Dempsey AF, Maertens J, Sevick C, Jimenez-Zambrano A, Juarez-Colunga E. A randomized, controlled, pragmatic trial of an iPad-based, tailored messaging intervention to increase human papillomavirus vaccination among Latinos. Hum Vaccin Immunother 2019; 15:1577-1584. [PMID: 30689494 DOI: 10.1080/21645515.2018.1559685] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Human papillomavirus (HPV) causes a number of cancers that disproportionally affect Latinos yet there is a paucity of research on interventions to increase HPV vaccination among this population. We sought to evaluate the efficacy of a web-based, individually customizable intervention, called CHICOs (Combatting HPV Infection and Cancers, tailored intervention) for its impact on HPV vaccine utilization. We conducted a three-armed, randomized, controlled trial in the waiting rooms of five family medicine practices from June 2014-February 2016 where CHICOS was compared to an iPad-based version of the Vaccine Information Sheet from the Centers for Disease Control and Prevention (untailored intervention), and usual care. Pair-wise comparisons between study arms of 6 different measures of HPV vaccine uptake were assessed, with analyses stratified by adolescents versus young adults. Of the 1,294 participants enrolled in the study, 1,013 individuals could be assessed for vaccination. Across study arms, 265 adolescents, but only 18 young adults, received an HPV vaccine dose during the study period. In both intention-to-treat and per-protocol analyses there were essentially no differences between the CHICOS and untailored arms in any vaccination measure, or between the untailored or CHICOS arms and usual care. Our study suggests that a tailored educational intervention may not be effective for increasing HPV vaccine uptake among Latino adolescents or young adults. However, the higher than expected baseline levels of positive vaccination attitudes of study participants could have diminished the statistical power of the study. Trial Registration Number: ClinicalTrials.gov (NCT02145156).
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Affiliation(s)
- Amanda F Dempsey
- a Adult and Child Consortium for Outcomes Research and Dissemination Science, University of Colorado , Aurora, CO , USA
| | - Julie Maertens
- a Adult and Child Consortium for Outcomes Research and Dissemination Science, University of Colorado , Aurora, CO , USA
| | - Carter Sevick
- a Adult and Child Consortium for Outcomes Research and Dissemination Science, University of Colorado , Aurora, CO , USA
| | - Andrea Jimenez-Zambrano
- a Adult and Child Consortium for Outcomes Research and Dissemination Science, University of Colorado , Aurora, CO , USA
| | - Elizabeth Juarez-Colunga
- a Adult and Child Consortium for Outcomes Research and Dissemination Science, University of Colorado , Aurora, CO , USA.,b Department of Biostatistics and Informatics, University of Colorado , Aurora , CO , USA
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3
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Reno JE, Thomas J, Pyrzanowski J, Lockhart S, O'Leary ST, Campagna EJ, Dempsey AF. Examining strategies for improving healthcare providers' communication about adolescent HPV vaccination: evaluation of secondary outcomes in a randomized controlled trial. Hum Vaccin Immunother 2019; 15:1592-1598. [PMID: 30433845 DOI: 10.1080/21645515.2018.1547607] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
There is a critical need for campaigns and interventions to increase rates of human papillomavirus (HPV) vaccination among U.S. adolescents. Healthcare providers are key stakeholders in parents' HPV vaccine decision-making. The current study presents the evaluation of secondary outcomes in a multi-component communication-based intervention to improve healthcare providers' communication about HPV vaccination. Evaluation was conducted via surveys of providers participating in a 12-month randomized controlled trial. Findings suggest use of communication components (combined use of the presumptive approach [PA] with all patients, and motivational interviewing and a fact sheet with vaccine hesitant parents) contributed to providers in the intervention group reporting higher perceived levels of parental HPV vaccine acceptance than control providers, as well as increased vaccination rates in the intervention arm in the main RCT.
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Affiliation(s)
- Jenna E Reno
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver , Aurora , CO , USA
| | - Jacob Thomas
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver , Aurora , CO , USA
| | - Jennifer Pyrzanowski
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver , Aurora , CO , USA
| | - Steven Lockhart
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver , Aurora , CO , USA
| | - Sean T O'Leary
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver , Aurora , CO , USA
| | - Elizabeth J Campagna
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver , Aurora , CO , USA
| | - Amanda F Dempsey
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver , Aurora , CO , USA
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4
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Troha M, Šterbenc A, Mlaker M, Poljak M. Human papillomavirus (HPV) infection and vaccination: knowledge and attitudes among healthcare professionals and the general public in Slovenia. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2018. [DOI: 10.15570/actaapa.2018.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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5
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Reno JE, O'Leary S, Garrett K, Pyrzanowski J, Lockhart S, Campagna E, Barnard J, Dempsey AF. Improving Provider Communication about HPV Vaccines for Vaccine-Hesitant Parents Through the Use of Motivational Interviewing. JOURNAL OF HEALTH COMMUNICATION 2018; 23:313-320. [PMID: 29474117 DOI: 10.1080/10810730.2018.1442530] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Human papillomavirus (HPV) vaccine uptake is below that of other routine adolescent vaccines. This is due in part to the fact that the HPV vaccine is often not routinely recommended by providers to all eligible adolescents. While providers' recommendations are crucial, even a strongly stated recommendation can be insufficient among HPV vaccine-hesitant parents. Providers must be prepared to respond to parental concerns following giving the recommendation for the HPV vaccine. This paper presents the analysis of implementation of an intervention aimed at improving provider communication with HPV vaccine-hesitant parents. Healthcare providers and staff at eight pediatric and family medicine clinics received communication training that included motivational interviewing (MI) techniques. Process evaluation in the form of serial surveys, as well as program evaluation in the form of focus groups with participating providers and staff, assessed the perceived efficacy of the intervention. Outcomes included time spent discussing the HPV vaccine during clinical visits, providers' self-efficacy for addressing parental HPV vaccine hesitancy, and their general perceptions of the effectiveness of MI techniques. Overall, findings indicate the intervention improved providers' communication with HPV vaccine-hesitant parents and providers reported the use of MI played a central role in improved HPV vaccine acceptance. Lessons learned and recommendations for future interventions are also discussed.
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Affiliation(s)
- Jenna E Reno
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Aurora , USA
| | - Sean O'Leary
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Aurora , USA
| | - Kathleen Garrett
- b Department of Behavioral & Behavioral Health , University of Colorado Denver , USA
| | - Jennifer Pyrzanowski
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Aurora , USA
| | - Steven Lockhart
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Aurora , USA
| | - Elizabeth Campagna
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Aurora , USA
| | - Juliana Barnard
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Aurora , USA
| | - Amanda F Dempsey
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Aurora , USA
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6
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Rosen BL, Shew ML, Zimet GD, Ding L, Mullins TLK, Kahn JA. Human Papillomavirus Vaccine Sources of Information and Adolescents' Knowledge and Perceptions. Glob Pediatr Health 2017; 4:2333794X17743405. [PMID: 29204462 PMCID: PMC5703096 DOI: 10.1177/2333794x17743405] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/15/2017] [Indexed: 11/17/2022] Open
Abstract
Understanding where adolescents obtain information about human papillomavirus (HPV) vaccines may be helpful in designing public health interventions promoting HPV vaccination. This study assessed the following: (1) exposure to specific sources of information about HPV vaccines, (2) self-reported helpfulness of these sources of information, and (3) whether the specific source of information was associated with knowledge and perceptions about HPV vaccines among adolescent girls. There were 339 adolescent girls (mean age = 16.8 years) recruited into the study. Television advertisements, the Internet, doctors/nurses, and mothers were the most frequently reported sources of vaccine information; more than 90% of participants who received information from these sources reported they were helpful. Adolescents who received information about HPV vaccines from television advertisements, the Internet, clinicians, and mothers had higher knowledge about HPV vaccines and more positive perceptions. Assuring the accuracy of messages from these sources will be essential, given their importance in influencing adolescents' knowledge and perceptions about HPV vaccines.
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Affiliation(s)
| | | | | | - Lili Ding
- University of Cincinnati, Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Tanya L K Mullins
- University of Cincinnati, Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jessica A Kahn
- University of Cincinnati, Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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7
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Acceptability of multipurpose human papillomavirus vaccines among providers and mothers of adolescent girls: A mixed-methods study in five countries. PAPILLOMAVIRUS RESEARCH 2017; 3:126-133. [PMID: 28720446 PMCID: PMC5608022 DOI: 10.1016/j.pvr.2017.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 03/26/2017] [Accepted: 04/01/2017] [Indexed: 11/23/2022]
Abstract
Introduction Multipurpose vaccines (MPVs) could be formulated to prevent multiple sexually transmitted infections simultaneously. Little is known about acceptability of MPVs among vaccine health care providers (HCPs) or mothers of adolescent girls. Methods 151 adolescent vaccine providers and 118 mothers of adolescent girls aged 9–14 were recruited from five geographically-diverse countries: Argentina, Malaysia, South Africa, South Korea, and Spain. We assessed providers’ preferences for single-purpose human papillomavirus (HPV) vaccine versus MPVs (including HPV+herpes simplex virus (HSV)−2, HPV+HIV, or HPV+HSV-2+HIV) via quantitative surveys. Maternal MPV attitudes were assessed in four focus group discussions (FGDs) in each country. Results Most providers preferred MPVs over single-purpose HPV vaccination, with preference ranging from 61% in Malaysia to 96% in South Africa. HPV+HSV-2+HIV was the most preferred MPV formulation (56–82%). Overall, 53% of the mothers preferred MPVs over single-purpose HPV vaccines, with strongest support in South Africa (90%) and lowest support in South Korea (29%). Convenience and trust in the health care system were commonly-cited reasons for MPV acceptability. Safety and efficacy concerns were common barriers to accepting MPVs, though specific concerns differed by country. Across FGDs, additional safety and efficacy information on MPVs were requested, particularly from trusted sources like HCPs. Conclusions Though maternal acceptability of MPVs varied by country, MPV acceptability would be enhanced by having HCPs provide parents with additional MPV vaccine safety and efficacy information. While most providers preferred MPVs, future health behavior research should identify acceptability barriers, and targeted provider interventions should equip providers to improve vaccination discussions with parents. We gauged acceptance of a multipurpose vaccine (MPV) concept to prevent HPV and STIs. Most vaccine providers were willing to administer an MPV for HPV, HSV-2, and HIV. Mothers of teen girls desired safety and efficacy evidence before accepting MPVs. In mothers, MPV acceptability differed by region and daughter's vaccination history.
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8
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Underwood NL, Gargano LM, Jacobs S, Seib K, Morfaw C, Murray D, Hughes JM, Sales JM. Influence of Sources of Information and Parental Attitudes on Human Papillomavirus Vaccine Uptake among Adolescents. J Pediatr Adolesc Gynecol 2016; 29:617-622. [PMID: 27216710 DOI: 10.1016/j.jpag.2016.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 04/26/2016] [Accepted: 05/07/2016] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE The purpose of this study was to: 1) describe parental sources of information about human papillomavirus (HPV) vaccination for adolescents, 2) understand how parental sources of information about HPV vaccine are associated with adolescent HPV vaccine uptake, and 3) understand if the relationship between a greater number of HPV-related information sources and HPV vaccine uptake among adolescents is mediated by parental attitudes. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS We conducted a 3-arm randomized controlled trial in middle and high schools in eastern Georgia from 2011 to 2013. As part of the trial, we surveyed parents during the final year to understand their sources of information about HPV vaccine for their adolescent. Data were collected from 360 parents via phone and online surveys. MAIN OUTCOME MEASURES Parents responded to a survey that asked them to identify demographic information, parental HPV attitudes, sources of information about HPV vaccination, and HPV vaccine uptake. RESULTS Most of the sample was African American (74%; n = 267) and 53% of parents (n = 192) reported that their adolescent received at least 1 HPV vaccine dose. The top sources of information about HPV vaccine reported by parents were a doctor or medical professional (80%; n = 287) and television (64%; n = 232). A mediation analysis showed sources of information about HPV vaccine are associated with parental attitudes, and parental attitudes about HPV vaccine are associated with vaccine uptake among adolescents. CONCLUSION These findings highlight the importance of HPV sources of information on parental attitudes.
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Affiliation(s)
| | | | - Samantha Jacobs
- Emory University, Rollins School of Public Health, Atlanta, Georgia
| | | | - Christopher Morfaw
- East Central Health District, Georgia Department of Public Health, Atlanta, Georgia
| | - Dennis Murray
- Georgia Regents University, School of Medicine, Atlanta, Georgia
| | - James M Hughes
- Emory University, School of Medicine, Atlanta, Georgia; Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Jessica M Sales
- Emory University, Rollins School of Public Health, Atlanta, Georgia
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Dempsey AF, Lockhart S, Campagna EJ, Pyrzanowski J, Barnard J, O' Leary ST. Providers' time spent and tools used when discussing the HPV vaccine with parents of adolescents. Vaccine 2016; 34:6217-6222. [PMID: 27840015 DOI: 10.1016/j.vaccine.2016.10.083] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/21/2016] [Accepted: 10/28/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Little is known about HPV vaccine communication tools currently used by primary care providers of adolescents, or how such tools impact the quality of HPV vaccine recommendations, which some have defined as using a "presumptive" communication style, continuing to offer vaccines despite resistance, and strongly recommending vaccines at the appropriate ages. We surveyed primary care providers to assess their current use of HPV vaccine communication tools, and how these related to their HPV vaccine recommendation quality. STUDY DESIGN Cross sectional survey of 183 pediatrics and family medicine primary care providers in the Denver metro area. RESULTS Response rate was 82% (n=150). Most (59%) providers used a presumptive vaccine recommendation >75% of the time, and 76% reported continuing to offer the HPV vaccine even after parent refusal. However, less than two-thirds of providers "strongly" recommended the vaccine to 11-12year olds (60% for females, 55% for males, p=0.02). The HPV vaccine information sheet from the Centers from Disease Control and Prevention was the most frequently used communication tool during clinical visits (64% used at least 75% of the time) and directing parents to preferred websites was the most frequently used between-visit communication tool (21% used >50% of visits). Use of tools was not associated with any measure of HPV vaccine recommendation quality but was associated with longer HPV vaccine discussion times. CONCLUSIONS Providers use only limited types of adolescent HPV vaccine communication tools, and frequently do not use preferred vaccine communication strategies. Better engagement with existing HPV vaccine communication tools, and/or the creation of new tools may be needed to enhance providers' ability to provide high quality HPV vaccine recommendations.
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Affiliation(s)
- Amanda F Dempsey
- Adult and Child Consortium for Outcomes Research and Dissemination Science Program, Children's Hospital Colorado and University of Colorado, 13199 East Montview Blvd, Suite 300, Aurora, CO 80045, United States.
| | - Steven Lockhart
- Adult and Child Consortium for Outcomes Research and Dissemination Science Program, Children's Hospital Colorado and University of Colorado, 13199 East Montview Blvd, Suite 300, Aurora, CO 80045, United States.
| | - Elizabeth J Campagna
- Adult and Child Consortium for Outcomes Research and Dissemination Science Program, Children's Hospital Colorado and University of Colorado, 13199 East Montview Blvd, Suite 300, Aurora, CO 80045, United States.
| | - Jennifer Pyrzanowski
- Adult and Child Consortium for Outcomes Research and Dissemination Science Program, Children's Hospital Colorado and University of Colorado, 13199 East Montview Blvd, Suite 300, Aurora, CO 80045, United States.
| | - Juliana Barnard
- Adult and Child Consortium for Outcomes Research and Dissemination Science Program, Children's Hospital Colorado and University of Colorado, 13199 East Montview Blvd, Suite 300, Aurora, CO 80045, United States.
| | - Sean T O' Leary
- Adult and Child Consortium for Outcomes Research and Dissemination Science Program, Children's Hospital Colorado and University of Colorado, 13199 East Montview Blvd, Suite 300, Aurora, CO 80045, United States. Sean.O'
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Scherr CL, Augusto B, Ali K, Malo TL, Vadaparampil ST. Provider-reported acceptance and use of the Centers for Disease Control and Prevention messages and materials to support HPV vaccine recommendation for adolescent males. Vaccine 2016; 34:4229-4234. [PMID: 27340095 DOI: 10.1016/j.vaccine.2016.06.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE We evaluated Florida-based physicians' awareness and use of the Centers for Disease Control and Prevention's (CDC) "You are the Key" campaign website, including messages to support physicians' human papillomavirus (HPV) vaccine recommendations. METHODS Using closed-ended and free-text survey items, physicians' (n=355) practices related to HPV vaccination recommendations for males and use of the CDC's materials were assessed. Descriptive statistics were calculated for closed-ended questions, and thematic analysis was conducted on free-text responses. RESULTS Over half of physicians were aware of the CDC's website (n=186; 57.9%); of those aware, fewer than half reported using the website (n=86; 46.2%). Slightly more than half reported awareness of the CDC's messages (n=178; 55.3%); however, less than one-third of those aware reported using them (n=56; 31.5%). Physicians' comments on the CDC's messages were favorable; 78.6-93.2% said they would use a message in clinic. CONCLUSION Additional research is needed to identify the best mechanisms for resource dissemination and to understand why physicians do not use these messages, despite favorable attitudes.
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Affiliation(s)
- C L Scherr
- Northwestern University, School of Communication, Department of Communication Studies, Center for Communication and Health, 710 North Lake Shore Drive 15th Floor, Chicago, IL 60611, USA
| | - B Augusto
- Moffitt Cancer Center, Health Outcomes and Behavior, 120902 Magnolia Drive, MRCCANCONT, Tampa, FL 33612, USA
| | - K Ali
- Moffitt Cancer Center, Health Outcomes and Behavior, 120902 Magnolia Drive, MRCCANCONT, Tampa, FL 33612, USA
| | - T L Malo
- University of North Carolina, Lineberger Comprehensive Cancer Center and Department of Health Behavior, 324 Rosenau Hall CB# 7440, Chapel Hill, NC 27599, USA
| | - S T Vadaparampil
- Moffitt Cancer Center, Health Outcomes and Behavior, 120902 Magnolia Drive, MRCCANCONT, Tampa, FL 33612, USA.
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Dempsey AF, Pyrzanowski J, Lockhart S, Campagna E, Barnard J, O'Leary ST. Parents' perceptions of provider communication regarding adolescent vaccines. Hum Vaccin Immunother 2016; 12:1469-75. [PMID: 27078515 DOI: 10.1080/21645515.2016.1147636] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Strong provider recommendations for adolescent vaccines are critical for achieving high vaccination levels. However, little is known about parents' preferred provider communication strategies for adolescent vaccines in general, and for human papillomavirus (HPV) vaccines specifically. We performed a cross-sectional survey of 800 parents of 9-14 year olds in April 2014 to assess current adolescent vaccine communication practices by providers, parents' preferred HPV vaccine-specific communication strategies, and the association of these two outcomes with experiential, attitudinal and demographic characteristics. Among the 356 parents in the study (response rate 48%), HPV vaccines were reported as less likely to have been "very strongly" recommended by their adolescent's provider (39%) than other adolescent-targeted vaccines (45%-59%, <0.05 for all comparisons). Receiving a very strong recommendation for HPV vaccines was associated with a higher likelihood of vaccine receipt (71% versus 39%, p<0.001), or among those not yet vaccinated, increased likelihood of positive vaccination intentions (82% vs. 60%, p = 0.015). Nearly all parents (87%) reported that, if available, they would use a website providing personalized HPV vaccine-related materials before their adolescent's next check-up, and other technology-based communications were also endorsed by the majority of parents. From these data we conclude that parents received weaker recommendations for HPV vaccines than other adolescent vaccines, and that most parents want additional HPV vaccine-related materials, preferably delivered using a variety of technology-based modalities which is not their providers' current practice.
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Affiliation(s)
- Amanda F Dempsey
- a ACCORDs Program; University of Colorado Denver , Denver , CO , USA
| | | | - Steven Lockhart
- a ACCORDs Program; University of Colorado Denver , Denver , CO , USA
| | | | - Juliana Barnard
- a ACCORDs Program; University of Colorado Denver , Denver , CO , USA
| | - Sean T O'Leary
- a ACCORDs Program; University of Colorado Denver , Denver , CO , USA
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12
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Berenson AB, Rahman M, Hirth JM, Rupp RE, Sarpong KO. A brief educational intervention increases providers' human papillomavirus vaccine knowledge. Hum Vaccin Immunother 2016; 11:1331-6. [PMID: 25945895 DOI: 10.1080/21645515.2015.1022691] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Recommendation by a healthcare provider is critical to increase human papillomavirus (HPV) vaccine uptake in the US. However, current deficits in providers' knowledge of HPV and its vaccine are not fully understood and interventions to amend knowledge gaps are untested. To determine whether attending a structured presentation could increase provider knowledge of the HPV vaccine, we assessed knowledge levels of physicians, non-physician healthcare workers, and medical students before and after attending a 30-minute lecture held between October 2012 and June 2014. Paired t-test and McNemar's test were used to compare knowledge scores and the proportion of correct responses for each question, respectively. Multiple linear regression analyses were performed to examine correlates of baseline knowledge and change in knowledge scores post-intervention. A total of 427 participants, including 75 physicians, 208 medical students, and 144 nurses or other healthcare workers, attended one of 16 presentations and responded to both pre-test and post-test surveys. Baseline knowledge was low among all groups, with scores higher among older participants and physicians/medical students. On average, knowledge scores significantly improved from 8 to 15 after the presentation (maximum possible score 16) (P < .001), irrespective of specialty, race/ethnicity, gender, and age. Although lower at baseline, knowledge scores of younger participants and non-physician healthcare workers (e.g., nurses, physician assistants (PAs), nursing students) improved the most of all groups. We conclude that a brief, structured presentation increased HPV knowledge among a variety of healthcare workers, even when their baseline knowledge was low.
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Affiliation(s)
- Abbey B Berenson
- a Center for Interdisciplinary Research in Women's Health; The University of Texas Medical Branch ; Galveston , TX , USA
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13
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Cates JR, Coyne-Beasley T. Social marketing to promote HPV vaccination in pre-teenage children: talk about a sexually transmitted infection. Hum Vaccin Immunother 2015; 11:347-9. [PMID: 25692313 PMCID: PMC4514322 DOI: 10.4161/21645515.2014.994458] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A significant barrier to the delivery of HPV vaccine is reluctance by both healthcare providers and parents to vaccinate at age 11 or 12, which may be considered a young age. This barrier has been called “vaccine hesitancy” in recent research. In this commentary, we suggest using social marketing strategies to promote HPV vaccination at the recommended preteen ages. We emphasize a critical public health message of a sexually transmitted infection (STI) as preventable and vaccination against HPV as a way to protect against its consequences. The message tackles the issue of vaccine hesitancy head on, by saying that most people are at risk for HPV and there is a way to prevent HPV's serious consequences of cancer. Our approach to this conversation in the clinical setting is also to engage the preteen in a dialog with the parent and provider. We expect our emphasis on the risk of STI infection will not only lead to increased HPV vaccination at preteen ages but also lay important groundwork for clinical adoption of other STI vaccines in development (HIV, HSV, Chlamydia, and Gonorrhea) as well as begin conversations to promote sexual health.
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Affiliation(s)
- Joan R Cates
- a School of Journalism and Mass Communication ; University of North Carolina at Chapel Hill ; Chapel Hill , NC USA
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14
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Dempsey AF, Zimet GD. Interventions to Improve Adolescent Vaccination: What May Work and What Still Needs to Be Tested. Am J Prev Med 2015; 49:S445-54. [PMID: 26272849 DOI: 10.1016/j.amepre.2015.04.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 02/03/2023]
Abstract
Since the development of the "adolescent platform" of vaccination in 1997, hundreds of studies have been conducted, identifying barriers to and facilitators of adolescent vaccination. More recent research has focused on developing and evaluating interventions to increase uptake of adolescent vaccines. This review describes a selection of recent intervention studies for increasing adolescent vaccination, divided into three categories: those with promising results that may warrant more widespread implementation, those with mixed results requiring more research, and those with proven effectiveness in other domains that have not yet been tested with regard to adolescent vaccination.
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Affiliation(s)
- Amanda F Dempsey
- Adult and Child Center for Outcomes Research and Dissemination Science program, University of Colorado Denver, Aurora, Colorado.
| | - Gregory D Zimet
- Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Tiro JA, Sanders JM, Pruitt SL, Stevens CF, Skinner CS, Bishop WP, Fuller S, Persaud D. Promoting HPV Vaccination in Safety-Net Clinics: A Randomized Trial. Pediatrics 2015; 136:850-9. [PMID: 26482674 PMCID: PMC7313721 DOI: 10.1542/peds.2015-1563] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Evaluate effects of a multicomponent intervention (human papillomavirus [HPV] vaccine-specific brochure and recalls) on HPV vaccination and secondarily examine if race/ethnicity moderates effects. METHODS Unvaccinated girls aged 11 to 18 years attending 4 safety-net pediatric clinics and their parent/guardian (n = 814 dyads) were randomized to (1) active comparison (general adolescent vaccine brochure), or (2) intervention consisting of a HPV vaccine-specific brochure, telephone recalls to parents who declined, and recalls to patients overdue for doses 2 and 3. HPV 1-dose and 3-dose coverages were assessed via electronic health records 12 months after randomization. Multivariate logistic regressions estimated adjusted odds and marginal predicted vaccine coverage by study arm and race/ethnicity. RESULTS Intent-to-treat analyses found no main effect of the HPV vaccine-specific brochure on 1-dose coverage (42.0% vs 40.6%); however, secondary analyses found race/ethnicity was a significant moderator such that the intervention was effective only for Hispanic individuals (adjusted odds ratio [AOR] 1.43; 95% confidence interval [CI] 1.02-2.02), and not effective for black individuals (AOR 0.64; 95% CI 0.41-1.13). Recalls to parents who declined the vaccine during the index visit were not effective, but recalls to patients overdue for doses 2 and 3 were effective at increasing 3-dose coverage regardless of race/ethnicity (AOR 1.99; 95% CI 1.16-3.45). CONCLUSIONS Educational materials describing only the HPV vaccine were effective for Hispanic but not black individuals. Future research should test mechanisms that may mediate intervention effects for different racial/ethnic groups, such as different informational needs or vaccine schemas (experiences, beliefs, norms).
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Affiliation(s)
- Jasmin A. Tiro
- University of Texas Southwestern Medical Center and Simmons Cancer Center, Dallas, Texas;,Address correspondence to Jasmin A. Tiro, PhD, Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390–8557, E-mail:
| | - Joanne M Sanders
- University of Texas Southwestern Medical Center and Simmons Cancer Center, Dallas, Texas
| | - Sandi L. Pruitt
- University of Texas Southwestern Medical Center and Simmons Cancer Center, Dallas, Texas
| | | | - Celette Sugg Skinner
- University of Texas Southwestern Medical Center and Simmons Cancer Center, Dallas, Texas
| | - Wendy P. Bishop
- University of Texas Southwestern Medical Center and Simmons Cancer Center, Dallas, Texas
| | - Sobha Fuller
- Parkland Health and Hospital System, Dallas, Texas
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Dempsey AF, Maertens J, Beaty BL, O'Leary ST. Understanding how different recruitment strategies impact parent engagement with an iPad-based intervention to provide personalized information about adolescent vaccines. J Adolesc Health 2015; 56:S7-13. [PMID: 25863557 DOI: 10.1016/j.jadohealth.2014.11.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 11/06/2014] [Accepted: 11/19/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE Inadequate provider time for addressing parents' questions and concerns about adolescent vaccines is a barrier to vaccine utilization. We sought to determine how different recruitment strategies impact the degree of engagement with an intervention that provided this information via an iPad placed in a clinical setting. METHODS We provided to three pediatric practices in the Denver area the "Teen VaxScene" web site that generates individually customized information for parents about adolescent vaccines. Three recruitment strategies were assessed for their impact on parental use of the intervention as follows: passive recruitment using posters to advertise a "kiosk" version of the intervention; posters plus a $10 incentive for using the kiosk; and posters plus a $10 incentive plus decoupling the iPad from the kiosks to enable "roving." We assessed the engagement with the intervention at multiple levels including log in, consent, and completion of a baseline survey and viewing individually tailored web pages. Surveys were used to assess barriers to using the intervention. RESULTS During the 14-month study period, 693 people had contact with the iPad, 199 consented, and 48 completed the survey to enable creation of tailored content; and 42 used the tailored site. Five times as many parents (n = 40) consented to participation during the 2 months when the intervention was "roving" than during the 10-month "passive" recruitment period. Engagement with the tailored material was low, with most users viewing only the "table of contents" pages. Utilizers and nonutilizers of the intervention had similar demographic characteristics. CONCLUSIONS Enabling the iPad to "rove" in the clinic greatly increased the proportion of parents consenting to use the intervention. However, meaningful engagement with the material was low. Further research is needed to understand the most effective and time efficient ways to provide vaccine-related educational information to parents of adolescents.
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Affiliation(s)
- Amanda F Dempsey
- Adult and Child Outcomes Research and Dissemination Science (ACCORDS) Program, University of Colorado Denver, Aurora, Colorado.
| | - Julie Maertens
- Adult and Child Outcomes Research and Dissemination Science (ACCORDS) Program, University of Colorado Denver, Aurora, Colorado
| | - Brenda L Beaty
- Adult and Child Outcomes Research and Dissemination Science (ACCORDS) Program, University of Colorado Denver, Aurora, Colorado
| | - Sean T O'Leary
- Adult and Child Outcomes Research and Dissemination Science (ACCORDS) Program, University of Colorado Denver, Aurora, Colorado
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A response to Fu et al.’s “Educational interventions to increase HPV vaccination acceptance”. Vaccine 2014; 32:6342-4. [DOI: 10.1016/j.vaccine.2014.09.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 07/28/2014] [Accepted: 09/18/2014] [Indexed: 01/14/2023]
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Grotto I, Grefat R. Intervention programs to increase influenza vaccination in Israel: which is the preferred one? Isr J Health Policy Res 2014; 3:19. [PMID: 24949195 PMCID: PMC4062885 DOI: 10.1186/2045-4015-3-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 05/18/2014] [Indexed: 11/10/2022] Open
Abstract
Influenza vaccine is the most effective method of preventing influenza and its complications, but coverage rates are not satisfactory. Therefore, an effective intervention is required to increase vaccination coverage. In a recent study published in IJHPR, Yamin et al. identified the need to target risk perception in the public, as a major intervention tool. Risk perception and compliance with vaccination guidelines was found to be mostly influenced by physician recommendations. These findings are in-line with similar findings in the literature, stressing the importance of patient-physician interaction in the patients' decision to comply with vaccination guidelines produced by the public health authorities. They also underscore the need to involve primary physicians in both the decision making process as well in the vaccination campaign.
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Affiliation(s)
- Itamar Grotto
- Public Health Services, Ministry of Health, Jerusalem, Israel ; Department of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Rami Grefat
- Haifa District Health Office, Ministry of Health, Haifa, Israel
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