Using Intervention Mapping to Develop an Efficacious Multicomponent Systems-Based Intervention to Increase Human Papillomavirus (HPV) Vaccination in a Large Urban Pediatric Clinic Network

Crawford, Claire; Shegog, Ross; Savas, Lara S.; Frost, Erica L.; Healy, C. Mary; Coan, Sharon P.; Gabay, Efrat K.; Spinner, Stanley W; Vernon, Sally W.

doi:10.58464/2155-5834.1405

Cited by 4 publications

(8 citation statements)

References 40 publications

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“…Action Plan Printout : The Action Plan comprises sections that describe each of the six intervention strategies. These are listed in order of the recommended implementation sequence: establish an AVP Champion, link provider to CME, institute quarterly assessment and feedback reports, develop a patient reminder system, develop a provider EMR prompt to cue to the presence of vaccine eligible youth, and promote a patient education app ( HPVcancerFree ) [ 23 , 25 ]. Each of the six strategy sections provides information describing the strategy and its importance: ‘How To’ steps to follow to implement the strategy, ‘Tools’ that link to resources needed in the implementation process, ‘Tips for Success’ that list bulleted practical recommendations for success informed by previous studies, and ‘Quotes from the Field’ that provides tips from HPCs who have implemented the strategies.…”

Section: Resultsmentioning

confidence: 99%

“…Content analysis of the original AVP design document (describing its aims, target population, objectives, behavioral matrices, content, and tools) provided the foundation for AVP-IT design. The Intervention Mapping (IM) framework had guided the original AVP development [ 23 ]. Core content, scope, and best practice characteristics were represented in behavioral change matrices, a product of the IM process.…”

Section: Methodsmentioning

confidence: 99%

“…These cross-referenced targeted behavioral outcomes, performance objectives, behavioral mediators, and learning objectives [ 36 ]. Targeted behavioral outcomes for the original AVP program are described elsewhere [ 23 ]. These included: (1) collaboration with AVP champions in each clinic regarding implementation of strategies and immunization rates; (2) HCP review of assessment and feedback reports on their HPV vaccination rates; (3) coordination with clinical staff to provide consistent messaging to patient/parents regarding HPV vaccination; (4) checking for vaccine eligibility at every clinic encounter; (5) delivering strong presumptive recommendations to eligible patients at time of visit; (6) bundling HPV vaccine recommendations with other vaccines; (7) determining patient/parent concerns if they are vaccine hesitant; (8) communicating tailored messages to address specific patient/parent concerns; and (9) reminding patients to schedule follow-up HPV vaccine dose(s) before leaving the clinic.…”

Section: Methodsmentioning

confidence: 99%

“…Healthcare-system-based implementation strategies are effective because they can operate simultaneously at the organizational, provider, and patient levels. Despite this, there is inconsistency in the strategies that are adopted and the degree of implementation across clinics, even within clinical networks [ 22 , 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

“…The Adolescent Vaccination Program (AVP) is a multi-component program to increase HPV vaccination rates in pediatric clinics. The AVP targets HCPs and parents of pediatric patients 11–17 years of age [ 23 ]. The AVP contains a suite of evidence-based strategies that include: (1) immunization champions, (2) provider assessment and feedback, (3) provider continuing education, (4) provider prompts, (5) parent (patient) reminders, and (6) parent (patient) education.…”

Section: Introductionmentioning

confidence: 99%

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Adaptation and Formative Evaluation of Online Decision Support to Implement Evidence-Based Strategies to Increase HPV Vaccination Rates in Pediatric Clinics

Shegog,

Savas,

Frost

et al. 2023

Vaccines

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Human papilloma virus (HPV) vaccination rates remain below national goals in the United States despite the availability of evidence-based strategies to increase rates. The Adolescent Vaccination Program (AVP) is a multi-component intervention demonstrated to increase HPV vaccination rates in pediatric clinics through the implementation of six evidence-based strategies. The purpose of this study, conducted in Houston, Texas, from 2019–2021, was to adapt the AVP into an online decision support implementation tool for standalone use and to evaluate its feasibility for use in community clinics. Phase 1 (Adaptation) comprised clinic interviews (n = 23), literature review, Adolescent Vaccination Program Implementation Tool (AVP-IT) design documentation, and AVP-IT development. Phase 2 (Evaluation) comprised usability testing with healthcare providers (HCPs) (n = 5) and feasibility testing in community-based clinics (n = 2). AVP-IT decision support provides an Action Plan with tailored guidance on implementing six evidence-based strategies (immunization champions, assessment and feedback, continuing education, provider prompts, parent reminders, and parent education). HCPs rated the AVP-IT as acceptable, credible, easy, helpful, impactful, and appealing (≥80% agreement). They rated AVP-IT supported implementation as easier and more effective compared to usual practice (p ≤ 0.05). The clinic-based AVP-IT uses facilitated strategy implementation by 3-month follow-up. The AVP-IT promises accessible, utilitarian, and scalable decision support on strategies to increase HPV vaccination rates in pediatric clinic settings. Further feasibility and efficacy testing is indicated.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Adaptation and Formative Evaluation of Online Decision Support to Implement Evidence-Based Strategies to Increase HPV Vaccination Rates in Pediatric Clinics

Shegog,

Savas,

Frost

et al. 2023

Vaccines

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AVPCancerFree : Impact of a digital behavior change intervention on parental HPV vaccine –related perceptions and behaviors

Shegog

Savas

Healy

et al. 2022

Human Vaccines & Immunotherapeutics

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Parent hesitancy contributes to reduced HPV vaccination rates. The HPVcancerfree app (HPVCF) was designed to assist parents in making evidence-based decisions regarding HPV vaccination. This study examined if parents of vaccine-eligible youth (11–12 yrs.) who use HPVCF in addition to usual care demonstrate significantly more positive intentions and attitudes toward HPV vaccination and greater HPV vaccination rates compared to those not using HPVCF. Clinics (n = 51) within a large urban pediatric network were randomly assigned to treatment (HPVCF + usual care) or comparison (usual care only) conditions in a RCT conducted between September 2017 and February 2019. Parents completed baseline and 5-month follow-up surveys. Participant-level analysis determined 1) change in HPV vaccination initiation behavior and related psychosocial determinants and 2) predictors of HPV vaccine initiation. Parents (n = 375) who completed baseline and 5-month follow-up surveys were female (95.2%), 40.8 (±5.8) yrs. married (83.7%), employed (68.3%), college educated (61.9%), and privately insured (76.5%). Between-group analysis of HPVCF efficacy demonstrated that parents assigned to receive HPVCF significantly increased knowledge about HPV and HPV vaccination ( p < .05). Parents who accessed content within HPVCF significantly increased knowledge about HPV & HPV vaccine ( p < .01) and perceived effectiveness of HPV vaccine ( p < .05). Change in HPV vaccine initiation was not significant. A multivariate model to describe predictors of HPV vaccine initiation demonstrated an association with Tdap and MCV vaccination adoption, positive change in perceived effectiveness of the HPV vaccine, and reduction in perceived barriers against HPV vaccination. HPVCF appears to be a feasible adjunct to the education received in usual care visits and reinforces the value of apps to support the important persuasive voice of the health-care provider in overcoming parent HPV vaccine hesitancy.

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Effect of an HPV Vaccination Multi-Level, Multi-Component Program on HPV Vaccination Initiation and Completion in a Pediatric Clinic Network

Savas,

Shegog,

Frost

et al. 2024

Vaccines

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Despite clear evidence of the public health benefits of the human papillomavirus (HPV) vaccine in preventing HPV-related cancers and genital warts, underutilization of HPV vaccination in the United States persists. Interventions targeting multi-level determinants of vaccination behavior are crucial for improving HPV vaccination rates. The study’s purpose was to implement and evaluate the adapted Adolescent Vaccination Program (AVP), a clinic-based, multi-level, multi-component intervention aimed at increasing HPV vaccine initiation and completion rates in a five-clinic pediatric network in Bexar County, Texas. The adaptation process was guided by established frameworks and involved formative work with clinic stakeholders. The study utilized a quasi-experimental single group pre- and post- study design, with an external comparison data using the National Immunization Survey-Teen (NIS-Teen) datasets for the same time period to examine the AVP’s effect on HPV vaccination initiation and completion. A series of interrupted time series analyses (ITSA) compared the clinic system patient outcomes (HPV vaccination initiation and completion rates) in the post-intervention to the general adolescent population (NIS-Teen). Of the 6438 patients (11–17 years) with clinic visits during the 3-year study period, HPV vaccination initiation rates increased from 64.7% to 80.2% (p < 0.05) and completion rates increased from 43.2% to 60.2% (p < 0.05). The AVP was effective across various demographic and economic subgroups, demonstrating its generalizability. ITSA findings indicated the AVP improved HPV vaccination initiation and completion rates in clinic settings and that AVP strategies facilitated resilience during the pandemic. The minimal adaptation required for implementation in a new clinic system underscores its feasibility and potential for widespread adoption.

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Using Intervention Mapping to Develop an Efficacious Multicomponent Systems-Based Intervention to Increase Human Papillomavirus (HPV) Vaccination in a Large Urban Pediatric Clinic Network

Cited by 4 publications

References 40 publications

Adaptation and Formative Evaluation of Online Decision Support to Implement Evidence-Based Strategies to Increase HPV Vaccination Rates in Pediatric Clinics

Adaptation and Formative Evaluation of Online Decision Support to Implement Evidence-Based Strategies to Increase HPV Vaccination Rates in Pediatric Clinics

AVPCancerFree : Impact of a digital behavior change intervention on parental HPV vaccine –related perceptions and behaviors

Effect of an HPV Vaccination Multi-Level, Multi-Component Program on HPV Vaccination Initiation and Completion in a Pediatric Clinic Network

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