Effect of a Health Care Professional Communication Training Intervention on Adolescent Human Papillomavirus Vaccination

Abstract

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. DESIGN, SETTING, AND PARTICIPANTS A cluster randomized clinical trial using covariate-constrained randomization to assign study arms and an intent-to-treat protocol was conducted in 16 primary care practices in the Denver, Colorado, metropolitan area. Participants included 188 medical professionals and 43 132 adolescents. INTERVENTIONS The 5 components of the intervention were an HPV fact sheet library to create customized information sheets relevant to each practice's patient population, a tailored parent education website, a set of HPV-related disease images, an HPV vaccine decision aid, and 2½ hours of communication training on using a presumptive vaccine recommendation, followed by motivational interviewing if parents were resistant to vaccination. Each practice participated in a series of 2 intervention development meetings over a 6-month period (August 1, 2014, to January 31, 2015) before the intervention. MAIN OUTCOMES AND MEASURES Differences between control and intervention changes over time (ie, difference in differences between the baseline and intervention period cohorts of patients) in HPV vaccine series initiation (Ն1 dose) and completion (Ն3 doses) among patients aged 11 to 17 years seen at the practices between February 1, 2015, and January 31, 2016. Vaccination data were obtained from the practices' records and augmented with state immunization information system data. RESULTS Sixteen practices and 43 132 patients (50.3% female; median age, 12.6 years [interquartile range, 10.8-14.7 years] at the beginning of the study period) participated in this trial. Adolescents in the intervention practices had significantly higher odds of HPV vaccine series initiation (adjusted odds ratio [aOR], 1.46; 95% CI, 1.31-1.62) and completion (aOR, 1.56; 95% CI, 1.27-1.92) than those in the control practices (a 9.5-absolute percentage point increase in HPV vaccine series initiation and a 4.4-absolute percentage point increase in HPV vaccine series completion in intervention practices). The intervention had a greater effect in pediatric practices compared with family medicine practices and in private practices compared with public ones. Health care professionals reported that communication training and the fact sheets were the most used and useful intervention components. CONCLUSIONS AND RELEVANCE A health care professional communication intervention significantly improved HPV vaccine series initiation and completion among adolescent patients. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02456077

Questions and Concerns About HPV Vaccine: A Communication Experiment

“…Interventions used to increase parents' confidence in and motivation to get HPV vaccine alone may not increase vaccine uptake; however, they could be used to increase uptake in combination with clear, strong provider recommendations to get the vaccine, as other studies have shown. 4,5,25 The validity of our findings must also be interpreted in light of the fact that parents were exposed to a separate experiment of prerecorded videos of vaccine recommendation strategies before they viewed the messages to which they were randomly assigned in our current study. Although randomization in both experiments revealed no observable selection bias in our 7 topic conditions, parents were likely primed to pay closer attention to our messages, which could have influenced the processing of these messages.…”

“…3 To date, randomized control trials have identified communication techniques providers can use to bring up HPV vaccination and make effective recommendations to parents. 4,5 However, little research has been focused on how providers can effectively address questions and ease concerns parents may have after the initial recommendation. Two recent environmental scans of continuing medical education and educational resources about HPV vaccination identified messages developed by the Centers for Disease Control and Prevention (CDC), American Cancer Society, American Academy of Pediatrics, and vaccination experts to help aid providers to communicate information about HPV vaccine.…”

Acceptance of and preference for COVID-19 vaccination in healthcare workers: a comparative analysis and discrete choice experiment

“…Besides under a higher risk of getting infected by various pathogens such as influenza viruses and SARS-CoV-2 than the general population (8,9), health-care workers (HCWs) are also vital in helping the vaccinees or guardians understand and accept the vaccination. The importance of HCWs' vaccination recommendation to the public in the decision-making process has been well documented and HCWs are one of the strongest influencers in vaccination decisions (10)(11)(12).…”

The potential population‐based impact of an HPV vaccination intervention in Colorado

“…The intervention included HPV fact sheets, a parent education website, pictures of diseases caused by HPV, a decision aid for the HPV vaccination, and HPV vaccine communication training for health care professionals. Adolescents in the intervention practices had significantly higher odds of HPV vaccine series initiation (adjusted odds ratio [aOR], 1.46; 95% CI, 1.31‐1.62) and completion (aOR, 1.56; 95% CI, 1.27‐1.92) than those in the control practices (a 9.5—absolute percentage point increase in HPV vaccine series initiation and a 4.4—absolute percentage point increase in HPV vaccine series completion in intervention practices) …”