The Implementation Guide is a resource for implementing this program. It provides important information about the staffing and functions necessary for administering this program in the user's setting. Additionally, the steps needed to carry out the research-tested program, relevant program materials, and information for evaluating the program are included. The Implementation Guide can be viewed and downloaded in the Products page.
Making Effective HPV Vaccine Recommendations
|Program Title||Making Effective HPV Vaccine Recommendations|
|Purpose||Designed to promote HPV vaccination. (2016)|
|Program Focus||Awareness Building for Healthcare Providers and Behavioral Modification for Healthcare Providers|
|Age||This information has not been reported.|
|Gender||This information has not been reported.|
|Race/Ethnicity||This information has not been reported.|
|Setting||This information has not been reported.|
|Funded by||NCI (Grant number(s): R25CA57726, K22CA186979)|
|User Reviews||(Be the first to write a review for this program)|
A physician educator delivers the training to HPV vaccine providers (e.g., physicians, physician assistants, nurse practitioners) as well as other clinic staff in positions to influence parents' agreement to vaccinate. The 1-hour training, which uses a standardized script and slides, has four parts:
-- Review Evidence: The educator summarizes the latest research on HPV vaccination practices, HPV vaccine effectiveness and safety, and the rationale for targeting younger adolescents for vaccination.
-- Build Skills: The educator describes how to vaccine providers can make effective HPV vaccine recommendations using the announcement strategy. First, the provider announces that the child is due for three vaccines to be given today. (For example, "I see here that Michael just turned 11. Because he's 11, Michael is due for meningitis, HPV, and Tdap vaccines. We'll give those at the end of today's visit.") This announcement mentions the child's age, explains that the child is due for three vaccines recommended for children this age, places the HPV vaccine in the middle of the list of three vaccinations, and states that the vaccination will occur today. Second, only if parents ask questions, the provider asks what the main concern is and eases this concern using a structured approach. Third, for parents who asked questions, the provider clearly and strongly recommends HPV vaccination by giving a motivational statement and ending with "I recommend....," which encourages parents to proceed with vaccination that day. If parents do not agree to vaccinate during the clinic visit, the provider asks them to return in 2 months to discuss it further.
-- Practice: The educator demonstrates the communication approach for the participants, gives them a note card that outlines the steps, and asks them to identify three situations in which they already use announcements with patients. Providers then draft an announcement and complete a short role-play exercise with partners to practice the announcement strategy.
-- Application to Your Practice: The educator engages participants in a discussion on applying the training in their clinic.
The physician educator encourages providers to use announcements with at least five vaccine-eligible patients within 2 weeks of the training. After completing the training, physicians are eligible to receive up to 1 continuing medical education (CME) credit.
-- Approximately 60 minutes to deliver the training to providers
Required resources to implement the program include the following:
-- Making Effective HPV Vaccine Recommendations website
For costs associated with this program, please contact the developer, Noel Brewer. (See products page on the RTIPs website for developer contact information.)
To be eligible for the study, clinics were required to have 100 or more patients aged 11 or 12 in the North Carolina Immunization Registry (NCIR), be located within a 2-hour drive of Chapel Hill, North Carolina, and have at least one pediatric or family medicine physician who provided HPV vaccination to adolescents aged 11 or 12. Clinics that had participated in other HPV vaccination interventions within the past 6 months or planned to do so in the next 6 months were ineligible to participate.
All clinic patients who were aged 11 or 12 years (target population) and 13 through 17 years were included in the analysis. Data were obtained from the NCIR and included 17,173 adolescents aged 11 or 12 and 37,796 adolescents aged 13 through 17. The 9 clinics in the announcement training group had an average of 476 11- and 12-year-olds and a mean age breakdown of 49% male, 46% female, and 5% not specified. Clinics in the conversation training group (n=10) had an average of 690 11- and 12-year-olds and a mean gender breakdown of 47% male, 48% female, and 5% not specified. The ten control group clinics had an average of 600 11- and 12-year-olds and a mean gender breakdown of 50% male, 47% female, and 3% not specified. Although clinics did not significantly differ in these characteristics at baseline, significant differences were observed in baseline vaccination coverage: Patients in control clinics had a significantly higher vaccination rate among 11- and 12-year-olds in the first or subsequent HPV dose, all three HPV doses, and Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis). Patients aged 13 through 17 also had higher vaccination rates in the first or subsequent HPV doses, all three HPV doses, Tdap, and meningococcal conjugate.
The study's primary outcome, measured by review of NCIR data, was HPV vaccine at 6 months for 11- and 12-year-olds. The NCIR, a secure, web-based registry, is used by more than 90% of vaccine providers in North Carolina and contains immunization data for almost all adolescents in the state. Mean change in vaccine initiation was calculated from baseline to 3 and 6 months after the training. Intervention groups were matched on timing of trainings and assessments to control for seasonal variation in vaccination.
- At 6-month follow-up, clinics in the announcement training group had a greater increase in HPV vaccine initiation among 11- and 12-year-olds in comparison with clinics in the control group (5.4% difference, p=.02).
- At 3-month follow-up, clinics in the announcement training group had a greater increase in HPV vaccine initiation among 11- and 12-year-olds compared with clinics in the control group (5.1% difference, p=.003).
- At 3- and 6-month follow-up, clinics in the announcement training group had a greater increase in HPV vaccine initiation compared with clinics in the control group among 11- and 12-year-old girls (4.8% difference, p=.004; 4.6% difference, p=.045) and 11- and 12-year-old boys (5.6% difference, p=.003; 6.2% difference, p=.01).
- At 3- and 6-month follow-up, clinics in the conversation training group did not differ from clinics in the control group in HPV vaccine initiation among 11- and 12-year-olds.
The architecture of provider-parent vaccine discussions at health supervision visits. (2013). The architecture of provider-parent vaccine discussions at health supervision visits. Pediatrics, 132 (6), 1037-1046.
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