Examining strategies for improving healthcare providers’ communication about adolescent HPV vaccination: evaluation of secondary outcomes in a randomized controlled trial (original) (raw)
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Vaccine, 2019
Objective: To assess secondary, parent-reported outcomes from a randomized controlled trial (RCT) of a provider communication intervention aimed at improving adolescent HPV vaccination. Methods: A paper survey was provided to a random sample of 777 parents of adolescents from 8 control and 8 intervention clinics participating in the larger trial. Chi-square or Fisher's exact tests assessed associations between study arm and providers' HPV vaccine communication strategies, parents' vaccination attitudes and parent's HPV vaccine acceptance. Exploratory analyses assessed the association between receipt of 'very strong' or presumptive HPV vaccine recommendation (regardless of study arm) and parent's perceptions about their providers' vaccine communication, and parents' attitudes and acceptance of the HPV vaccine. Results: The response rate was 47%. There were no differences between study arms in parents' report of how their provider communicated about the HPV vaccine, parent vaccination attitudes, or uptake of the HPV vaccine. Receipt of a 'very strong' recommendation was associated with greater perceived urgency for getting vaccinated, greater trust in the information received from the provider, decreased vaccine hesitancy, and increased vaccine receipt. Receipt of a presumptive recommendation was associated with a lower likelihood of having concerns about the vaccine's safety, lower vaccine hesitancy, and an increased likelihood of vaccination. Neither recommendation strategy appeared to negatively impact parents' visit experience or trust in the information being provided. Similar results were found in subanalyses of vaccine hesitant parents. Conclusions: Providing very strong, presumptive HPV vaccine recommendations is associated with improved parent vaccination attitudes and acceptance, and does not seem to have significant negative impacts, even among parents who are vaccine hesitant. Response bias in our sample could explain why there were no reported differences between study arms in parents' reports of how their adolescent's providers communicated about the HPV vaccine.
Effect of a multi-component intervention on providers’ HPV vaccine communication
Human Vaccines & Immunotherapeutics, 2020
Objective: To evaluate the effect of a multi-component intervention including communication training on provider beliefs and recommendation practices around the human papillomavirus (HPV) vaccine using both self-reports and audio-recordings of clinical interactions. Methods: We conducted a mixed method study at five family medicine and pediatric practices. Providers self-reported beliefs and practices about HPV vaccination via surveys and qualitative interviews conducted pre-and post-intervention. We also assessed provider recommendation style using audio-recordings of clinical interactions pre-and post-intervention. Content analysis was used to identify themes in qualitative interviews. Matched pre-and post-intervention surveys were analyzed for changes in provider beliefs and attitudes. Pre-and post-intervention audio recordings of clinical interactions were analyzed for observed differences in recommendation styles. Bivariate analyses of quantitative data used Chi-square and Fisher's exact tests; t-tests were used for continuous variables. Results: Providers reported in interviews that the intervention led to communication changes by increasing their knowledge, reframing the HPV vaccine as a routine vaccination, and providing tools for engaging with parents. Surveys indicated that the proportion of providers reporting that the HPV vaccine is one of the most important adolescent vaccines increased from 71% pre-intervention to 100% post-intervention (p = .03). Audio-recording analysis demonstrated that use of an indicated (presumptive) recommendation style increased from 62.5% pre-intervention to 79.6% post-intervention (p = .047). Conclusions: Educating providers about HPV vaccination and giving them tools to facilitate communication with parents can reframe HPV as a routine adolescent vaccination and motivate providers to routinely use effective recommendation styles in practice.
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.
Toward Optimal Communication About HPV Vaccination for Preteens and Their Parents
Journal of Public Health Management and Practice, 2019
Objective: Healthcare provider recommendation is a key determinant of HPV vaccination. We developed an online training program for providers that addressed vaccine guidelines, hesitancy to strongly recommend the vaccine and reluctance to discuss HPV as a sexually transmitted infection. Design: Single group evaluation with three waves. Providers completed a 29-item electronic survey with closed and open-ended response options after course completion.
JAMA Pediatrics
IMPORTANCE The incidence of human papillomavirus (HPV)-related cancers is more than 35 000 cases in the United States each year. Effective HPV vaccines have been available in the United States for several years but are underused among adolescents, the target population for vaccination. Interventions to increase uptake are needed. OBJECTIVE To evaluate the effect of a 5-component health care professional HPV vaccine communication intervention on adolescent HPV vaccination.
Providers’ time spent and tools used when discussing the HPV vaccine with parents of adolescents
Vaccine, 2016
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 11-12 year 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.
Vaccine, 2016
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. 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. 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 messa...
Journal of Community Health
Human papillomavirus (HPV) vaccine uptake among adolescents remains suboptimal in the US. The COVID-19 pandemic posed new challenges to increase HPV vaccination rates. To characterize parent-reported barriers to obtain HPV vaccination for their children and to identify psychosocial factors associated with parents' intention to vaccinate their children for HPV, we administered parent surveys between April 2020 and January 2022 during a randomized pragmatic trial assessing the impact of evidence-based implementation strategies on HPV vaccination rates for adolescent patients at six Mayo Clinic primary care practices in Southeast Minnesota. A total of 342 surveys were completed (response rate 34.1%). Analyses were focused on parents of unvaccinated children (n = 133). The survey assessed the main reason the child did not receive the HPV vaccine, parental beliefs about the vaccine, and the parent's intention to vaccinate the child for HPV in the next 12 months. Frequently reported awareness and access barriers to HPV vaccination included not knowing the child was due (17.8%) and COVID-19 related delay (11.6%). Frequently reported attitudinal barriers include the belief that the child was too young for the vaccine (17.8%) and that the vaccine is not proven to be safe (16.3%). Injunctive social norm (Adjusted-OR = 3.15, 95%CI: 1.94, 5.41) and perceived harm beliefs (Adjusted-OR = 0.58, 95%CI: 0.35, 0.94) about the HPV vaccine were positively and negatively associated with HPV vaccination intention, respectively. Our findings suggest that continued efforts to overcome parental awareness, access, and attitudinal barriers to HPV vaccination are needed and underscore the importance of utilizing evidence-based health system-level interventions.