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Heisler-MacKinnon JA, Queen T, Yi Kong W, Kennedy KL, Thomas T, Calo WA, Gilkey MB. Identifying effective vaccine champions: Findings from a national survey of primary care professionals. Vaccine 2024; 42:3148-3152. [PMID: 38575435 PMCID: PMC11056286 DOI: 10.1016/j.vaccine.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Vaccine champions are common in primary care, but little is known about which champions are effective. METHODS In 2022, we surveyed 2,144 US primary care professionals (PCPs) who reported working with vaccine champions. Respondents rated the champion with whom they worked most closely on their effectiveness at improving vaccination rates. RESULTS About half (49 %) of PCPs perceived their closest champion as highly effective. PCPs perceived advanced practice providers and nursing staff as highly effective somewhat more often than physicians (52 % and 58 % vs 43 %, p <.001). Other correlates of perceived effectiveness included being a formally appointed versus informal champion, working extremely versus less closely with PCPs, and using a high (4-5) versus low (0-1) number of implementation strategies to improve vaccination rates (all p <.001). CONCLUSIONS Results suggest vaccine champions may benefit from having formal roles and opportunities to work closely with colleagues to improve vaccination rates using multiple strategies.
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Affiliation(s)
- Jennifer A Heisler-MacKinnon
- Lineberger Comprehensive Cancer Center, University of North Carolina, UNC Lineberger Building, 450 West Drive, Chapel Hill, NC 27514, USA; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, CB #7440, Chapel Hill, NC 27599-7440, USA.
| | - Tara Queen
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, CB #7440, Chapel Hill, NC 27599-7440, USA.
| | - Wei Yi Kong
- Mayo Clinic, Division of Epidemiology, 200 1st St. SW, Rochester, MN 55905, USA.
| | - Kathryn L Kennedy
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, CB #7440, Chapel Hill, NC 27599-7440, USA.
| | - Tami Thomas
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Modesto A. Maidique Campus, 11200 SW 8 Street - AHC 3, Miami, FL 33199, USA.
| | - William A Calo
- Penn State College of Medicine, The Pennsylvania State University, 90 Hope Drive, Hershey, PA 17033, USA.
| | - Melissa B Gilkey
- Lineberger Comprehensive Cancer Center, University of North Carolina, UNC Lineberger Building, 450 West Drive, Chapel Hill, NC 27514, USA; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, CB #7440, Chapel Hill, NC 27599-7440, USA
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Fernandes A, Wang D, Domachowske JB, Suryadevara M. Vaccine knowledge, attitudes, and recommendation practices among health care providers in New York State. Hum Vaccin Immunother 2023; 19:2173914. [PMID: 36749617 PMCID: PMC10026857 DOI: 10.1080/21645515.2023.2173914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Community-wide vaccine uptake remains sub-optimal. Healthcare provider (HCP) vaccine recommendations influence patient vaccination; however, provider vaccine recommendation behavior is highly influenced by one's own vaccine attitudes and/or knowledge. We aim to describe vaccine knowledge, attitudes, and recommendation practices (KAP) among New York State HCPs. A survey to assess HCP KAP was developed and electronically distributed to NYS members of national medical organizations via their local chapter administrators. Descriptive statistical methods were used to define provider KAP. A total of 864 surveys were included, 500 (60%) and 336 (40%) primary and specialty care providers, respectively. Eighty-one percent (402/499) of primary care providers (PCPs) report encountering vaccine hesitant patients daily or weekly. Of the 500 PCPs who responded, only 204 (41%) stated strong agreement with confidence in their communications with vaccine hesitant patients. HCPs who correctly answered all four knowledge questions were more likely to self-report routine recommendations of standard vaccines to all patients when compared to those who correctly answered fewer questions (489/588 (83%) vs 135/241 (56%), p < .05). HCPs were more likely to routinely recommend standard vaccines to all patients if they also report initiating vaccine discussion (476/485 (98%) vs 148/344 (43%), p < .05) and reviewing and recommending vaccinations at each encounter (315/320 (98%) vs 308/508 (61%), p < .05). Vaccine hesitancy exists across healthcare specialties and provider roles. Focused interventions should include reaching all HCPs to promote vaccinations for disease prevention, tailoring messages to reduce HCP vaccine misperceptions, and increasing awareness of evidence-based office strategies known to facilitate immunizations.
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Affiliation(s)
| | - Dongliang Wang
- Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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Molokwu J, Mendez M, Bracamontes C. The Effect of Clinical Decision Prompts in Improving Human Papillomavirus Vaccination Rates in a Multispecialty Practice in a Predominantly Hispanic Population: Quasi-Experimental Study. JMIR Cancer 2023; 9:e42890. [PMID: 36920453 PMCID: PMC10131873 DOI: 10.2196/42890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/05/2023] [Accepted: 01/26/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The human papillomavirus (HPV) is implicated in the causal pathway of cancers of the vulva, vagina, penis, cervix, anus, and oropharyngeal region. It is the most common sexually transmitted infection in the United States. Despite the documented safety and effectiveness of the HPV vaccine, rates lag behind those of other vaccines given at the same age. OBJECTIVE Provider recommendation is identified as a robust predictor of HPV vaccine uptake, and physician-prompting is shown to increase the provision of preventive care services in general. Theoretically, providing reminders to providers should increase opportunities for providing HPV vaccine recommendations and therefore affect vaccination rates. The objective of our study was to assess the effectiveness of an electronic medical record (EMR) prompt in improving HPV vaccination rates in an academic clinic setting caring for a predominantly Hispanic border population. METHODS We used a quasi-experimental design with a retrospective chart audit to evaluate the effect of a clinical decision prompt (CDP) on improving HPV immunization rates in different specialty settings. We introduced an EMR prompt to remind providers to recommend the HPV vaccine when seeing appropriate patients in an obstetrics and gynecology (OBGYN), pediatrics (PD), and family medicine (FM) clinic in a large multispecialty academic group located along the Texas-Mexico border. We assessed HPV vaccination rates in all the departments involved before and after introducing the prompts. Participants included male and female patients between the ages of 9 and 26 years, presenting at the clinics between January 2014 and December 2015. RESULTS We reviewed over 2800 charts in all 3 clinics. After adjusting for age, ethnicity, race, type of insurance, preferred language, and clinic, the odds of immunization were 92% (P<.001) higher in patients after the prompt implementation of the EMR. In addition, there was an overall statistically significant increase in the overall HPV vaccination completion rates after implementing the CDP (31.96% vs 21.22%; P<.001). Again, OBGYN saw the most significant improvement in vaccination completion rates, with rates at follow-up 66.02% higher than baseline rates (P=.04). PD and FM had somewhat similar but no less impressive improvements (57.7% and 58.36%; P<.001). CONCLUSIONS Implementing an EMR CDP improved our overall odds of HPV vaccination completion by 92%. We theorize that the decision prompts remind health care providers to discuss or recommend the HPV vaccination during clinical service delivery. CDPs in the EMR help increase HPV vaccination rates in multiple specialties and are a low-cost intervention for improving vaccination rates.
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Affiliation(s)
- Jennifer Molokwu
- Department of Family And Community Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States
| | - Melissa Mendez
- Department of Obstetrics and Gynecology, Hospital Corporation of America Las Palmas Del Sol Healthcare, El Paso, TX, United States
| | - Christina Bracamontes
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States
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Dang JHT, McClure S, Gori ACT, Martens T, Mojadedi A, Smith U, Austin CJ, Chen MS. Implementation and evaluation of a multilevel intervention to increase uptake of the human papillomavirus vaccine among rural adolescents. J Rural Health 2023; 39:136-141. [PMID: 35798683 PMCID: PMC9771865 DOI: 10.1111/jrh.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Geographic disparities exist in uptake of the human papillomavirus vaccine (HPV). In 2020, the National Immunization Survey-Teen reported that adolescents living in nonmetropolitan statistical areas (MSAs) had lower HPV vaccination coverage (≥ 1 dose) compared to adolescents living in MSA principal cities. This paper describes the implementation and evaluation of a multilevel pilot intervention study to increase uptake of the HPV vaccine among adolescent patients ages 11-17 of a rural health clinic. METHODS This parent, primary care team, and clinic multilevel pilot intervention was guided by evidence-based approaches to increase HPV vaccinations, formative research, and input from the community. HPV vaccination initiation and completion rates were analyzed at baseline and 23 months follow-up. FINDINGS The proportion of adolescent patients ages 11-17 who had initiated the HPV vaccine series was significantly greater at follow-up compared to baseline, (82.7% compared to 52.4%), χ2 (1, n = 498) = 49.2, P < .0001. The proportion of adolescent patients ages 11-17 who had completed the HPV vaccine series was also significantly greater at follow-up compared to baseline, (58.0% compared to 27.0%), χ2 (1, n = 498) = 50.8, P < .0001. CONCLUSIONS The multilevel intervention significantly increased HPV initiation and completion rates among adolescent patients ages 11-17 at this rural health clinic. This study demonstrates the feasibility of utilizing a multilevel intervention to address low HPV vaccination rates among rural adolescents and the potential of employing this strategy for a large-scale randomizing-controlled trial.
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Affiliation(s)
- Julie H. T. Dang
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, School of Medicine, Sacramento, California, USA
- University of California, Davis Comprehensive Cancer Center, Sacramento, California, USA
| | | | - Alexandra C. T. Gori
- University of California, Davis Comprehensive Cancer Center, Sacramento, California, USA
| | | | | | - Ulissa Smith
- Neighborhood Wellness Foundation, Sacramento, California, USA
| | | | - Moon S. Chen
- University of California, Davis Comprehensive Cancer Center, Sacramento, California, USA
- Division of Hematology and Oncology, Department of Internal Medicine, University of California, Davis, School of Medicine, Sacramento, California, USA
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Constable C, Ferguson K, Nicholson J, Quinn GP. Clinician communication strategies associated with increased uptake of the human papillomavirus (HPV) vaccine: A systematic review. CA Cancer J Clin 2022; 72:561-569. [PMID: 35969145 DOI: 10.3322/caac.21753] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022] Open
Abstract
Human papillomavirus (HPV) is currently linked to almost 35,000 new cases of cancer in women and men each year in the United States. Gardasil-9 (Merck & Company), the only HPV vaccine now available in the United States, is nearly 100% effective at preventing precancers caused by oncogenic HPV types. In the United States, however, only about one half of adolescents are up to date with HPV vaccination. It is well known that health care clinicians' recommendations play a significant role in parents' decisions regarding HPV vaccination. A growing body of literature examines specific communication strategies for promoting uptake of the HPV vaccine. A comprehensive review of the evidence for each of these strategies is needed. The authors searched the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Web of Science Complete databases for original articles with a defined clinician communication strategy and an outcome of HPV vaccine uptake or intention to vaccinate (PROSPERO registry no. CRD42020107602). In total, 46 studies were included. The authors identified two main strategies with strong evidence supporting their positive impact on vaccine uptake: strong recommendation and presumptive recommendation. Determinations about a causal relationship were limited by the small numbers of randomized controlled trials. There is also opportunity for more research to determine the effects of motivational interviewing and cancer-prevention messaging.
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Affiliation(s)
- Catherine Constable
- Department of Medicine, New York University (NYU) Langone Medical Center, New York, New York, USA
- Division of Medical Ethics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Kyle Ferguson
- Division of Medical Ethics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Joey Nicholson
- NYU Health Sciences Library, NYU Grossman School of Medicine, New York, New York, USA
| | - Gwendolyn P Quinn
- Division of Medical Ethics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Department of Obstetrics and Gynecology, NYU Langone Medical Center, New York, New York, USA
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Davis KR, Norman SL, Olson BG, Demirel S, Taha AA. A Clinical Educational Intervention to Increase HPV Vaccination Rates Among Pediatric Patients Through Enhanced Recommendations. J Pediatr Health Care 2022; 36:589-597. [PMID: 35933285 DOI: 10.1016/j.pedhc.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/04/2022] [Accepted: 07/08/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The human papillomavirus (HPV) causes largely preventable cancers by completing a vaccination series. However, pediatric HPV vaccination rates remain low. Current evidence indicates that integrating five factors creates a high-quality recommendation associated with higher HPV vaccination rates. This quality improvement project aimed to evaluate the impact of an educational intervention to improve the quality of providers' recommendations and subsequent vaccination rates. METHOD Using the Squire 2.0 Guidelines, clinical staff were observed during well-child visits (aged 11-12 years) before and after the intervention across three Plan-Do-Study-Act cycles. RESULTS Thirty-nine encounters with mostly (n = 31; 80%) families of color. The quality of vaccine recommendations was improved after the intervention; however, vaccination rates did not increase for the 39 patients. Providers' delivery approach (presumptive vs. conversational) did increase vaccination rates. DISCUSSION Providers' delivery style appears to be important when making HPV vaccine recommendations.
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Affiliation(s)
- Kelley R Davis
- Kelley R. Davis, Instructor, Department of Pediatrics, Pediatric Nurse Practitioner Child Development and Rehabilitation Center, Oregon Health & Science University, Portland, OR
| | - Sharon L Norman
- Sharon L. Norman, Assistant Professor, School of Nursing, Oregon Health & Science University, and Pediatric Clinical Nurse Specialist, Randall Children's Pediatric Care, Legacy Health, Portland, OR
| | - Bradley G Olson
- Bradley G. Olson, Medical Director, Randall Children's Pediatric Care, Legacy Health, Portland, OR
| | - Shaban Demirel
- Shaban Demirel, Interim Vice President Research Administration, Legacy Research Institute, Legacy Health, Portland, OR
| | - Asma A Taha
- Asma A. Taha, Professor, School of Nursing, Oregon Health & Science University, Portland, OR.
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Barnard JG, Marsh R, Anderson-Mellies A, Williams JL, Fisher MP, Cockburn MG, Dempsey AF, Cataldi JR. Pre-implementation evaluation for an HPV vaccine provider communication intervention among primary care clinics. Vaccine 2022; 40:4835-4844. [PMID: 35792022 PMCID: PMC10575754 DOI: 10.1016/j.vaccine.2022.06.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 05/06/2022] [Accepted: 06/23/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Interventions to improve health care provider communication about HPV vaccination can increase vaccine acceptance. Our objectives were to (1) identify clinics in locations with high HPV-associated cancer and low HPV-vaccination rates that would potentially benefit from dissemination of a proposed HPV Provider Communication intervention and (2) use qualitative interviews and a dissemination and implementation framework to assess readiness for change and fit of the HPV Provider Communication intervention to the context of these clinics. METHODS Local HPV-associated cancer and HPV vaccination rates were assigned to Practice-Based Research Network clinics using data from the Colorado Central Cancer Registry, the Colorado Immunization Information System, and the American Community Survey. Staff from 38 clinics located in areas with high numbers of adolescents not up-to-date for HPV vaccine and high rates of HPV-associated cancers were recruited for qualitative interviews. Interview questions used the Promoting Action on Research Implementation in Health Services (PARIHS) conceptual framework and addressed the proposed intervention, current vaccination practices and prior quality improvement (QI) experience. RESULTS Twenty-seven interviews were completed with clinicians, clinic managers, and other staff across 17 clinics (9 pediatric, 5 family medicine, 3 public/school-based health). Most clinics had some prior QI experience and there were few thematic differences between sites with more or less foundation for QI/immunization work. Participants were motivated to improve the health of their patients and valued both guidelines and local experience as important evidence to consider adopting an intervention. Interviewees were more interested in implementing the proposed intervention if it aligned with existing priorities and fit within clinic workflows. Facilitation needs included adequate time and external facilitation support for data tracking and analysis. CONCLUSIONS Qualitative interviews to understand clinic context and fit of an HPV Provider Communication intervention can inform implementation in settings with the highest potential for clinical impact.
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Affiliation(s)
- Juliana G Barnard
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rebekah Marsh
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Johnny L Williams
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael P Fisher
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Myles G Cockburn
- University of Colorado Cancer Center, Aurora, CO, USA; Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | | | - Jessica R Cataldi
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
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Mansfield LN, Silva SG, Merwin EI, Chung RJ, Gonzalez-Guarda RM. Factors Associated With Human Papillomavirus Vaccine Series Completion Among Adolescents. Am J Prev Med 2021; 61:701-708. [PMID: 34256974 PMCID: PMC9948546 DOI: 10.1016/j.amepre.2021.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Most cancers associated with the human papillomavirus are preventable through vaccination. However, adolescent series completion rates are at 75.8%. Two vaccine doses are recommended for adolescents, but factors influencing 2-dose series completion are not well explored. The purpose of this study is to examine individual-level and community-level factors associated with timely human papillomavirus vaccine series completion among adolescents in the Southeastern U.S. METHODS Series completion was assessed from January 2018 to February 2019 among a cohort of adolescents initiating vaccination in 2017. Factors influencing overall series completion and timely series completion were assessed using multivariable logistic regression. RESULTS Among the sample, 64.4% completed the vaccine series and 53.8% completed it timely (e.g., 14 months). Higher odds of series completion were among adolescents who were younger at vaccine initiation (AOR=1.94, 95% CI=1.50, 2.50), who traveled moderate distances to the clinic (AOR=1.62, 95% CI=1.03, 2.56), and who lived in low-deprivation neighborhoods (AOR=1.85, 95% CI=1.31, 2.60), and lower among Hispanic (AOR=0.62, 95% CI=0.45, 0.87) and non-Hispanic Black (AOR=0.66, 95% CI=0.54, 0.81) adolescents and among those without private insurance (AOR=0.68, 95% CI=0.56, 0.83). Timely series completion resulted in similar findings; however, lower odds were among Hispanic (AOR=0.63, 95% CI=0.43, 0.95) and non-Hispanic Black (AOR=0.68, 95% CI=0.50, 0.92) adolescents than among non-Hispanic other adolescents. CONCLUSIONS Individual-level and community-level factors continue to influence adolescent series completion, despite a reduction in doses. Future research is needed to understand racial/ethnic and regional disparities in human papillomavirus vaccine series completion and to develop interventions to promote series completion.
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Affiliation(s)
- Lisa N Mansfield
- Duke University School of Nursing, Duke University, Durham, North Carolina.
| | - Susan G Silva
- Duke University School of Nursing, Duke University, Durham, North Carolina
| | - Elizabeth I Merwin
- College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, Texas
| | - Richard J Chung
- Duke University School of Medicine, Duke Department of Pediatrics, Duke University, Durham, North Carolina
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Mansfield LN, Silva SG, Merwin EI, Chung RJ, Gonzalez-Guarda RM. Factors Associated With Human Papillomavirus Vaccine Series Completion Among Adolescents. Am J Prev Med 2021; 61:701-708. [PMID: 34256974 PMCID: PMC9948546 DOI: 10.1016/j.amepre.2021.04.031|] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Most cancers associated with the human papillomavirus are preventable through vaccination. However, adolescent series completion rates are at 75.8%. Two vaccine doses are recommended for adolescents, but factors influencing 2-dose series completion are not well explored. The purpose of this study is to examine individual-level and community-level factors associated with timely human papillomavirus vaccine series completion among adolescents in the Southeastern U.S. METHODS Series completion was assessed from January 2018 to February 2019 among a cohort of adolescents initiating vaccination in 2017. Factors influencing overall series completion and timely series completion were assessed using multivariable logistic regression. RESULTS Among the sample, 64.4% completed the vaccine series and 53.8% completed it timely (e.g., 14 months). Higher odds of series completion were among adolescents who were younger at vaccine initiation (AOR=1.94, 95% CI=1.50, 2.50), who traveled moderate distances to the clinic (AOR=1.62, 95% CI=1.03, 2.56), and who lived in low-deprivation neighborhoods (AOR=1.85, 95% CI=1.31, 2.60), and lower among Hispanic (AOR=0.62, 95% CI=0.45, 0.87) and non-Hispanic Black (AOR=0.66, 95% CI=0.54, 0.81) adolescents and among those without private insurance (AOR=0.68, 95% CI=0.56, 0.83). Timely series completion resulted in similar findings; however, lower odds were among Hispanic (AOR=0.63, 95% CI=0.43, 0.95) and non-Hispanic Black (AOR=0.68, 95% CI=0.50, 0.92) adolescents than among non-Hispanic other adolescents. CONCLUSIONS Individual-level and community-level factors continue to influence adolescent series completion, despite a reduction in doses. Future research is needed to understand racial/ethnic and regional disparities in human papillomavirus vaccine series completion and to develop interventions to promote series completion.
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Affiliation(s)
- Lisa N Mansfield
- Duke University School of Nursing, Duke University, Durham, North Carolina.
| | - Susan G Silva
- Duke University School of Nursing, Duke University, Durham, North Carolina
| | - Elizabeth I Merwin
- College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, Texas
| | - Richard J Chung
- Duke University School of Medicine, Duke Department of Pediatrics, Duke University, Durham, North Carolina
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Steiner CR, Dechant J, Brungo L, Cassidy B. An Evidence-based Protocol to Improve HPV Vaccine Initiation Rates at a County Immunization Clinic. J Community Health Nurs 2021; 38:73-84. [PMID: 33949264 DOI: 10.1080/07370016.2021.1894819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Human Papillomavirus (HPV) is responsible for 26,900 cancer cases yearly, including genital and oropharyngeal cancers. Despite providing nearly 100% protection against cancer-causing strains of HPV, only 68.9% of teenagers receive even one dose of the HPV9 vaccine. To increase HPV9 vaccine series initiation rates among 11-14 year-olds. Vaccine rates were examined before and after multi-modal protocol implementation at a nurse-run, walk-in immunization clinic. Initiation increased from 17.9% in 2017 to 35.5% in 2018. Use of same way/same day recommendation practices and inclusion of non-clinician staff could improve quality of care and decrease HPV-related disease.
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Affiliation(s)
- Claire R Steiner
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jason Dechant
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lauren Brungo
- Allegheny County Department of Health, Pittsburgh, Pennsylvania, USA
| | - Brenda Cassidy
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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11
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Yared N, Malone M, Welo E, Mohammed I, Groene E, Flory M, Basta NE, Horvath KJ, Kulasingam S. Challenges related to human papillomavirus (HPV) vaccine uptake in Minnesota: clinician and stakeholder perspectives. Cancer Causes Control 2021; 32:1107-1116. [PMID: 34247291 PMCID: PMC8416869 DOI: 10.1007/s10552-021-01459-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/09/2021] [Indexed: 11/30/2022]
Abstract
Background Human papillomavirus (HPV) vaccination rates among adolescents are increasing in Minnesota (MN) but remain below the Healthy People 2020 goal of 80% completion of the series. The goal of this study was to identify messaging and interventions impacting HPV vaccine uptake in MN through interviews with clinicians and key stakeholders. Methods We conducted semi-structured key participant interviews with providers and stakeholders involved in HPV vaccination efforts in MN between 2018 and 2019. Provider interview questions focused on messaging around the HPV vaccine and clinic-based strategies to impact HPV vaccine uptake. Stakeholder interview questions focused on barriers and facilitators at the organizational or state level, as well as initiatives and collaborations to increase HPV vaccination. Responses to interviews were recorded and transcribed. Thematic content analysis was used to identify themes from interviews. Results 14 clinicians and 13 stakeholders were interviewed. Identified themes were grouped into 2 major categories that dealt with messaging around the HPV vaccine, direct patient–clinician interactions and external messaging, and a third thematic category involving healthcare system-related factors and interventions. The messaging strategy identified as most useful was promoting the HPV vaccine for cancer prevention. The need for stakeholders to prioritize HPV vaccination uptake was identified as a key factor to increasing HPV vaccination rates. Multiple providers and stakeholders identified misinformation spread through social media as a barrier to HPV vaccine uptake. Conclusion Emphasizing the HPV vaccine’s cancer prevention benefits and prioritizing it among healthcare stakeholders were the most consistently cited strategies for promoting HPV vaccine uptake. Methods to combat the negative influence of misinformation about HPV vaccines in social media are an urgent priority.
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Affiliation(s)
- Nicholas Yared
- Division of Infectious Disease, Department of Medicine, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, 48202, USA.
| | - Molly Malone
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Estee Welo
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Inari Mohammed
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Emily Groene
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Matthew Flory
- Minnesota Cancer Alliance, American Cancer Society, Saint Paul, MN, USA
| | - Nicole E Basta
- Department of Epidemiology, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Shalini Kulasingam
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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12
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Glenn BA, Nonzee NJ, Tieu L, Pedone B, Cowgill BO, Bastani R. Human papillomavirus (HPV) vaccination in the transition between adolescence and adulthood. Vaccine 2021; 39:3435-3444. [PMID: 33992435 DOI: 10.1016/j.vaccine.2021.04.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/27/2021] [Accepted: 04/09/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Young adulthood is characterized by changes in health care decision-making, insurance coverage, and sexual risk. Although the human papillomavirus (HPV) vaccine is now approved for adults up to age 45, and catch-up vaccination is currently recommended up through age 26, vaccination rates remain low in young adults. This study explored perspectives on HPV vaccination among young adults receiving care at the student health center of a large public university. METHODS We conducted semi-structured interviews (n = 27) and four focus groups with female and male undergraduate and graduate students (n = 18) and semi-structured interviews with health care providers (n = 6). Interviews and focus groups explored perceived risk of HPV infection, benefits of the HPV vaccine, and motivations for and barriers to HPV vaccination. RESULTS Many young adults cited their parents' views and recommendations from medical providers as influential on their decision-making process. Students perceived that cervical cancer prevention was a main benefit of the HPV vaccine and sexual activity was a risk factor for HPV infection. Students often lacked knowledge about the vaccine's benefits for males and expressed some concerns about the safety and side effects of a vaccine perceived as new. Logistical barriers to vaccination included uncertainty over vaccination status and insurance coverage for the vaccine, and concerns about balancing the vaccine schedule with school obligations. Providers' vaccine recommendations were impacted by health system factors, including clinical infrastructure, processes for recommending and documenting vaccination, and office visit priorities. Suggested vaccination promotion strategies included improving the timing and messaging of outreach efforts on campus and bolstering clinical infrastructure. CONCLUSIONS Although college may be an opportune time to reach young adults for HPV vaccination, obstacles including navigating parental influence and independent decision-making, lack of awareness of vaccination status, and numerous logistical and system-level barriers may impede vaccination during this time.
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Affiliation(s)
- Beth A Glenn
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, 650 Charles Young Drive South Drive, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
| | - Narissa J Nonzee
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, 650 Charles Young Drive South Drive, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
| | - Lina Tieu
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, 650 Charles Young Drive South Drive, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
| | - Bettina Pedone
- UCLA Arthur Ashe Student Health & Wellness Center, University of California, Los Angeles, 221 Westwood Plaza, Los Angeles, CA 90095, USA.
| | - Burt O Cowgill
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, 650 Charles Young Drive South Drive, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
| | - Roshan Bastani
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, 650 Charles Young Drive South Drive, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
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13
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Suryadevara M, Bonville CA, Cibula DA, Domachowske JB. Multi-component cancer prevention awareness program to improve adolescent HPV vaccine uptake. Hum Vaccin Immunother 2021; 17:1052-1058. [PMID: 33064046 DOI: 10.1080/21645515.2020.1812316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE We introduced a multi-component cancer prevention awareness program to primary care practices across New York State to evaluate its impact on adolescent human papillomavirus (HPV) vaccination rates. METHODS Eight pediatric and three family medicine practices were recruited to participate in this program. On-site training sessions were provided for all practice providers and staff to discuss the importance of HPV vaccine and cancer prevention and teach strategies for delivering a strong vaccine recommendation. Each practice received a study-specific booklet that included HPV vaccine information and other commonly provided cancer prevention guidance. These booklets were distributed to all adolescents and their parents during well visits over a one-year period. Practice specific and county-wide HPV vaccination rates were assessed before and 12 months after the program training session. RESULTS One year after program initiation, aggregate data show statistically higher vaccine series initiation rates among 11-12 and 13-18-year-olds and higher vaccine series completion rates among 13-18-year-olds. The greatest and most consistent improvements were seen in vaccine initiation rates for the 11-12-year-old cohort. Disparities in vaccine uptake were observed by gender and medical specialty. CONCLUSION Cancer prevention education targeting providers, office staff, patients, and parents, improved adolescent HPV vaccine series initiation rates.
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Affiliation(s)
- Manika Suryadevara
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Cynthia A Bonville
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Donald A Cibula
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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14
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Toh ZQ, Russell FM, Garland SM, Mulholland EK, Patton G, Licciardi PV. Human Papillomavirus Vaccination After COVID-19. JNCI Cancer Spectr 2021; 5:pkab011. [PMID: 33748668 PMCID: PMC7962726 DOI: 10.1093/jncics/pkab011] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/22/2020] [Accepted: 01/12/2021] [Indexed: 12/24/2022] Open
Abstract
The current global novel coronavirus disease 2019 (COVID-19) pandemic threatens to derail the uptake of human papillomavirus (HPV) vaccination in low- and lower-middle income countries with major disruptions to routine immunization and the introduction of new vaccines delayed. This has a major impact on the World Health Organization cervical cancer elimination strategy, where it is dependent on HPV vaccination as well as cervical cancer screening and treatment. We discuss current opportunities and barriers to achieve high uptake of HPV vaccination in low- and lower-middle income countries as well as the impact of COVID-19. Implementation of 4 key recommendations for HPV vaccination in low- and lower-middle income countries is needed: increased global financial investment; improved vaccine supply and accelerated use of a single-dose schedule; education and social marketing; and adoption of universal school-based delivery. With the commitment of the global health community, the adoption of these strategies would underpin the effective elimination of cervical cancer.
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Affiliation(s)
- Zheng Quan Toh
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Fiona M Russell
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Suzanne M Garland
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynecology, The University of Melbourne, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Parkville, Australia
| | - Edward K Mulholland
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - George Patton
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Paul V Licciardi
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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15
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Vu M, King AR, Jang HM, Bednarczyk RA. Practice-, provider- and patient-level facilitators of and barriers to HPV vaccine promotion and uptake in Georgia: a qualitative study of healthcare providers' perspectives. HEALTH EDUCATION RESEARCH 2020; 35:512-523. [PMID: 32879948 PMCID: PMC7768667 DOI: 10.1093/her/cyaa026] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/16/2020] [Indexed: 05/22/2023]
Abstract
Georgia experiences higher human papillomavirus (HPV)-associated cancer burden and lower HPV vaccine uptake compared with national estimates. Using the P3 model that concomitantly assesses practice-, provider- and patient-level factors influencing health behaviors, we examined facilitators of and barriers to HPV vaccine promotion and uptake in Georgia. In 2018, we conducted six focus groups with 55 providers. Questions focused on multilevel facilitators of and barriers to HPV vaccine promotion and uptake. Our analysis was guided by the P3 model and a deductive coding approach. We found that practice-level influences included organizational priorities of vaccinations, appointment scheduling, immunization registries/records, vaccine availability and coordination with community resources. Provider-level influences included time constraints, role, vaccine knowledge, self-efficacy to discuss HPV vaccine and vaccine confidence. Patient-level influences included trust, experiences with vaccine-preventable diseases, perceived high costs, perceived side effects and concerns with sexual activity. Findings suggest that interventions include incentives to boost vaccine rates and incorporate appointment scheduling technology. An emphasis should be placed on the use of immunization registries, improving across-practice information exchange, and providing education for providers on HPV vaccine. Patient-provider communication and trust emerge as intervention targets. Providers should be trained in addressing patient concerns related to costs, side effects and sexual activity.
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Affiliation(s)
- Milkie Vu
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health
- Correspondence to: M. Vu. E-mail:
| | - Adrian R King
- Hubert Department of Global Health, Rollins School of Public Health, Emory University
| | - Hyun Min Jang
- The Center for the Study of Human Health, Emory College of Arts and Sciences, Emory University, 201 Dowman Dr, Atlanta, GA 30322, USA
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University
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16
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Human Papillomavirus Immunization in Rural Primary Care. Am J Prev Med 2020; 59:377-385. [PMID: 32605866 PMCID: PMC7483409 DOI: 10.1016/j.amepre.2020.03.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Despite the safety and efficacy of the human papillomavirus vaccine, thousands are impacted by human papillomavirus and its related cancers. Rural regions have disproportionately low rates of human papillomavirus vaccination. Primary care clinics play an important role in delivering the human papillomavirus vaccine. A positive deviance approach is used to identify workflows, organizational factors, and communication strategies in rural clinics with higher human papillomavirus vaccine up-to-date rates. Positive deviance is a process by which exceptional behaviors and strategies are identified to understand factors that enable success. METHODS Rural primary care clinics were rank ordered by human papillomavirus vaccine up-to-date rates using 2018 Oregon Immunization Program data, then recruited via purposive sampling of clinics in the top and bottom quartiles. Two study team members conducted previsit interviews, intake surveys, and 2-day observation visits with 12 clinics and prepared detailed field notes. Data were collected October-December 2018 and analyzed using a thematic approach January-April 2019. RESULTS Four themes distinguished rural clinics with higher human papillomavirus vaccine up-to-date rates from those with lower rates. First, they implemented standardized workflows to identify patients due for the vaccine and had vaccine administration protocols. Second, they designated and supported a vaccine champion. Third, clinical staff in higher performing sites were comfortable providing immunizations regardless of visit type. Finally, they used clear, persuasive language to recommend or educate parents and patients about the vaccine's importance. CONCLUSIONS Positive deviance identified characteristics associated with higher human papillomavirus vaccine up-to-date rates in rural primary care clinics. These findings provide guidance for rural clinics to inform human papillomavirus vaccination quality improvement interventions.
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17
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Dang JHT, Stewart SL, Blumberg DA, Rodriguez HP, Chen MS. "There's Always Next Year": Primary Care Team and Parent Perspectives on the Human Papillomavirus Vaccine. Hum Vaccin Immunother 2020; 16:1814-1823. [PMID: 32048896 DOI: 10.1080/21645515.2019.1710410] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Acceptance of the human papillomavirus (HPV) vaccination among parents and clinicians is high, but uptake remains low. Little is known about organizational and primary care team factors that influence the uptake of the HPV vaccine. Interviews with clinicians, clinic support staff, and parents of adolescent patients were conducted to better understand the interrelationships among the people and the organizational processes that influence HPV vaccine uptake at the point of care. Between July 2016 and February 2017, semi-structured interviews of 40 participants (18 clinicians, 12 clinic support staff, and 10 parents of adolescent patients) in a primary care network were conducted. Organizational structures and processes, such as electronic provider reminders, availability of "vaccination only" appointments, and knowledgeable primary care team members contributed to HPV vaccine uptake. Consistently high support of HPV vaccination was found among key informants; however, rather than refuse HPV vaccination, parents are opting to delay vaccination to a future visit. When parents express the desire to delay, clinicians and care team members described often recommending addressing HPV vaccination at a future visit, giving parents the impression that receiving the vaccine was not time-sensitive for their child. Discordance in HPV vaccination recommendations among providers and clinic support staff may contribute to delayed HPV vaccination. Strong, high-quality HPV vaccine recommendations are needed from all primary team members. Clinic interventions to accelerate HPV vaccine uptake may benefit from a team-based approach where every member of the primary care team is delivering the same consistent messaging about the importance of timely HPV vaccination.
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Affiliation(s)
- Julie H T Dang
- Davis Comprehensive Cancer Center, University of California, Sacramento, CA, USA
| | - Susan L Stewart
- Davis School of Medicine, Division of Biostatistics, Department of Public Health Sciences, University of California , Sacramento, CA, USA
| | - Dean A Blumberg
- Davis Health Department of Pediatrics, University of California , Sacramento, CA, USA
| | - Hector P Rodriguez
- Berkeley, School of Public Health, Division of Health Policy and Management, University of California , Berkeley, CA, USA
| | - Moon S Chen
- Davis Comprehensive Cancer Center, University of California, Sacramento, CA, USA
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18
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McGaffey A, Lombardo NP, Lamberton N, Klatt P, Siegel J, Middleton DB, Hughes K, Susick M, Lin CJ, Nowalk MP. A "Sense"-ational HPV Vaccination Quality Improvement Project in a Family Medicine Residency Practice. J Natl Med Assoc 2019; 111:588-599. [PMID: 31285042 DOI: 10.1016/j.jnma.2019.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/23/2019] [Accepted: 06/12/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination uptake for adolescents and young adults in the United States remains far from national goals. Using a multi-component intervention aligned with community-wide efforts, we implemented a quality improvement project to increase HPV vaccinations among 9-26 year-old male and female patients in an urban, low income, minority population family medicine residency practice. METHODS The pre-intervention year was November 2, 2014 to October 31, 2015 and the intervention year was November 1, 2015 to October 31, 2016. Based on community input and published literature, the interventions were creative, practice-specific provider-, patient-, and system-level strategies. To compare pre- and post-intervention vaccinations, HPV vaccination data were extracted from an electronic medical record request for age-eligible patients seen in the practice during the intervention year. Chi-square, McNemar's and 2-tailed, 2-sample Z tests were used to test differences in vaccination initiation (≥1 dose) and completion (3 doses) across groups and over time. RESULTS Despite high pre-intervention rates (58% and 75%), HPV vaccine initiation significantly increased 12.8 percentage points (PP) for males and 10.6 PP for females from pre- to post-intervention (P < 0.001). HPV vaccine completion also significantly increased 16 PP for males and 10.9 PP for females (P < 0.001). Young adult patients (18-26 years-old) had significant increases in completion rates (9.9 PP; P < 0.001), not observed among adolescents (20 PP; ns). CONCLUSIONS Consistent and abundant positive HPV vaccination messaging, low-cost sensory rewards, process change, and community, clinician, and nonclinical staff engagement were associated with higher HPV vaccine initiation and completion, especially among young adults.
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Affiliation(s)
- Ann McGaffey
- University of Pittsburgh Medical Center St. Margaret Family Medicine Residency and Bloomfield Garfield Family Health Center, Pittsburgh, PA, USA.
| | - Nicole Payette Lombardo
- University of Pittsburgh Medical Center St. Margaret Family Medicine Residency and Bloomfield Garfield Family Health Center, Pittsburgh, PA, USA
| | - Nathan Lamberton
- University of Pittsburgh Medical Center St. Margaret Family Medicine Residency and Bloomfield Garfield Family Health Center, Pittsburgh, PA, USA
| | - Patricia Klatt
- University of Pittsburgh Medical Center St. Margaret Family Medicine Residency and Bloomfield Garfield Family Health Center, Pittsburgh, PA, USA
| | - Jason Siegel
- University of Pittsburgh Medical Center St. Margaret Family Medicine Residency and Bloomfield Garfield Family Health Center, Pittsburgh, PA, USA
| | - Donald B Middleton
- University of Pittsburgh Medical Center St. Margaret Family Medicine Residency and University of Pittsburgh School of Medicine, Department of Family Medicine, Pittsburgh, PA, USA
| | - Kristin Hughes
- Carnegie Mellon University, School of Design, Pittsburgh, PA, USA
| | - Michael Susick
- University of Pittsburgh School of Medicine, Department of Family Medicine, Pittsburgh, PA, USA
| | - Chyongchiou Jeng Lin
- University of Pittsburgh School of Medicine, Department of Family Medicine, Pittsburgh, PA, USA
| | - Mary Patricia Nowalk
- University of Pittsburgh School of Medicine, Department of Family Medicine, Pittsburgh, PA, USA
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19
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Brandt HM, Vanderpool RC, Curry SJ, Farris P, Daniel-Ulloa J, Seegmiller L, Stradtman LR, Vu T, Taylor V, Zubizarreta M. A multi-site case study of community-clinical linkages for promoting HPV vaccination. Hum Vaccin Immunother 2019; 15:1599-1606. [PMID: 31158042 DOI: 10.1080/21645515.2019.1616501] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Human papillomavirus (HPV) vaccination rates in the U.S. are suboptimal, requiring innovative partnerships between community and clinical entities to remedy this issue. A rigorous evaluation of HPV-related community-clinical linkages (CCLs) was conducted to understand their components, processes, and outcomes to increase HPV vaccination. Cancer Prevention and Control Research Network (CPCRN) investigators explored CCLs in their communities employing an iterative, case study approach. Information describing nine CCLs on HPV vaccination was collected from representatives from the community organization and clinical setting. Thematic content analysis was used to analyze and interpret data. Five CCLs included a federally qualified health center as the clinical partner, and five included a non-profit organization as the community partner. Five reflected clinically focused integration wherein engagement occurs in the community but vaccine delivery and follow-up occur in the clinical setting. The main impetus was the need to improve HPV vaccination and a community's strong interest in preventing cancer. Noted critical components were a designated person to support the CCL and funding. Results will guide HPV vaccination promotion, education, and intervention efforts. CCLs provide an opportunity to study the adaption, integration, and enhancement of evidence-based approaches to increase HPV vaccination.
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Affiliation(s)
- Heather M Brandt
- a Department of Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health , Columbia , SC , USA
| | - Robin C Vanderpool
- b Department of Health, Behavior and Society, University of Kentucky College of Public Health , Lexington , KY , USA
| | - Susan J Curry
- c Department of Health Management and Policy, University of Iowa , Iowa City , USA
| | - Paige Farris
- d Oregon Health and Science University School of Public Health , Portland , QR , USA
| | - Jason Daniel-Ulloa
- e Department of Community & Behavioral Health, University of Iowa College of Public Health , Iowa City , IA , USA
| | - Laura Seegmiller
- e Department of Community & Behavioral Health, University of Iowa College of Public Health , Iowa City , IA , USA
| | - Lindsay R Stradtman
- b Department of Health, Behavior and Society, University of Kentucky College of Public Health , Lexington , KY , USA
| | - Thuy Vu
- f Department of Health Services, University of Washington School of Public Health , Seattle , WA , USA
| | - Victoria Taylor
- f Department of Health Services, University of Washington School of Public Health , Seattle , WA , USA
| | - Maria Zubizarreta
- a Department of Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health , Columbia , SC , USA
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Organizational characteristics associated with high performance on quality measures in pediatric primary care: A positive deviance study. Health Care Manage Rev 2019; 46:196-205. [PMID: 31116122 PMCID: PMC6864254 DOI: 10.1097/hmr.0000000000000247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric health care quality in the United States varies, but the reasons for variation are not fully understood. Differences in pediatric practices' organizational characteristics, such as organizational structures, strategies employed to improve quality, and other contextual factors, may contribute to the variation observed. PURPOSE To assess the relationship between organizational characteristics and performance on clinical quality (CQ) and patient experience (PE) measures in primary care pediatric practices in Massachusetts. METHODOLOGY A 60-item questionnaire that assessed the presence of selected organizational characteristics was sent to 172 pediatric practice managers in Massachusetts between December 2017 and February 2018. The associations between select organizational characteristics and publicly available CQ and PE scores were analyzed using analysis of variance; open-ended survey questions were analyzed using qualitative content analysis. RESULTS Eighty-six practices (50.0%) responded; 80 (46.5%) were included in the primary analysis. Having a quality champion ( p = .03), offering co-located specialty services (e.g., behavioral health; p = .04), being a privately owned practice ( p = .04), believing that patients and families feel respected ( p = .03), and having a lower percentage of patients (10%-25%) covered by public health insurance ( p = .04) were associated with higher CQ scores. Higher PE scores were associated with private practice ownership ( p = .0006). Qualitative analysis suggested organizational culture and external factors, such as health care finance, may affect quality. CONCLUSIONS Both modifiable organizational practices and factors external to a practice may affect quality of care. Addressing differences in practice performance may not be reducible to implementation of changes in single organizational characteristics. PRACTICE IMPLICATIONS Pediatric practices seeking to improve quality of care may wish to adopt the strategies that were associated with higher performance on quality measures, but additional studies are needed to better understand the mechanisms behind these associations and how they relate to each other.
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21
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Franco M, Mazzucca S, Padek M, Brownson RC. Going beyond the individual: how state-level characteristics relate to HPV vaccine rates in the United States. BMC Public Health 2019; 19:246. [PMID: 30819149 PMCID: PMC6393974 DOI: 10.1186/s12889-019-6566-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 02/20/2019] [Indexed: 01/25/2023] Open
Abstract
Background The human papillomavirus (HPV) vaccine is an underutilized cancer control practice in the United States. Although individual contextual factors are known to impact HPV vaccine coverage rates, the impact of macro-level elements are still unclear. The aim of this analysis was to use HPV vaccination rates to explore the underuse of an evidence-based cancer control intervention and explore broader-level correlates influencing completion rates. Methods A comprehensive database was developed using individual-level date from the National Immunization Survey (NIS)-Teen (2016) and state-level data collected from publically available sources to analyze HPV vaccine completion. Multi-level logistic models were fit to identify significant correlates. Level-1 (individual) and level-2 (state) correlates were fitted to a random intercept model. Deviance and AIC assessed model fit and sampling weights were applied. Results The analysis included 20,495 adolescents from 50 U.S. states and the District of Columbia. Teen age, gender, race/ethnicity, and maternal education were significant individual predictors of HPV completion rates. Significant state-level predictors included sex education policy, religiosity, and HPV vaccine mandate. States with the lowest HPV coverage rates were found to be conservative and highly religious. Little variation in vaccine exemptions and enacted sex and abstinence education polices were observed between states with high and low HPV vaccine coverage suggesting various contextual and situational factors impact HPV vaccine completion rates. Conclusions Given that gender, religiosity, political ideology, and education policies are predictors of HPV vaccine completion, the interaction and underlying mechanism of these factors can be used to address the underutilization of the HPV vaccine.
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Affiliation(s)
- Melissa Franco
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Stephanie Mazzucca
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Margaret Padek
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.,Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, 63103, USA
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22
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Holloway GL. Effective HPV Vaccination Strategies: What Does the Evidence Say? An Integrated Literature Review. J Pediatr Nurs 2019; 44:31-41. [PMID: 30683279 DOI: 10.1016/j.pedn.2018.10.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/08/2018] [Accepted: 10/10/2018] [Indexed: 01/27/2023]
Abstract
PROBLEM The updated Advisory Committee on Immunization Practices (ACIP) 2016 guidelines recommends vaccination for the human papillomavirus (HPV) for all adolescents starting at ages 11-12 years. The United States continues to fall short of the benchmarks set by Healthy People 2020. The national vaccination rates hover at 49.5%, creating much room for improvement in health care systems. The purpose of this literature review was to identify evidence-based interventions to implement for improved outcomes. ELIGIBILITY CRITERIA An integrative literature review was conducted using the CINAHL, EBSCO, Academic Search Complete, ProQuest and Medline databases. The search was limited to studies published in peer reviewed journals in the last 10 years. SAMPLE Of the available studies, 201 met inclusion criteria with 46 studies meriting further review. RESULTS Barriers to vaccination included missed opportunities due to lack of provider recommendation and awareness of current guidelines, and parental vaccination hesitancy. Effective strategies included reminder systems and strong provider recommendations. CONCLUSIONS No one method has been effective in maintaining increases in vaccination rates. Multi-method strategies demonstrate the highest rates of maintaining increases in HPV vaccination. Strong provider recommendations are a cornerstone to any multi-method intervention. IMPLICATIONS Providers and nurses need to shift conversations to strong recommendations for the HPV vaccination and include additional reminder systems, including protocols to meet Healthy People 2020 goals for HPV vaccination.
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Vaughn VM, Saint S, Krein SL, Forman JH, Meddings J, Ameling J, Winter S, Townsend W, Chopra V. Characteristics of healthcare organisations struggling to improve quality: results from a systematic review of qualitative studies. BMJ Qual Saf 2018; 28:74-84. [PMID: 30045864 PMCID: PMC6373545 DOI: 10.1136/bmjqs-2017-007573] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 06/11/2018] [Accepted: 06/24/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Identifying characteristics associated with struggling healthcare organisations may help inform improvement. Thus, we systematically reviewed the literature to: (1) Identify organisational factors associated with struggling healthcare organisations and (2) Summarise these factors into actionable domains. METHODS Systematic review of qualitative studies that evaluated organisational characteristics of healthcare organisations that were struggling as defined by below-average patient outcomes (eg, mortality) or quality of care metrics (eg, Patient Safety Indicators). Searches were conducted in MEDLINE (via Ovid), EMBASE, Cochrane Library, CINAHL, and Web of Science from database inception through February 8 2018. Qualitative data were analysed using framework-based synthesis and summarised into key domains. Study quality was evaluated using the Critical Appraisal Skills Program tool. RESULTS Thirty studies (33 articles) from multiple countries and settings (eg, acute care, outpatient) with a diverse range of interviewees (eg, nurses, leadership, staff) were included in the final analysis. Five domains characterised struggling healthcare organisations: poor organisational culture (limited ownership, not collaborative, hierarchical, with disconnected leadership), inadequate infrastructure (limited quality improvement, staffing, information technology or resources), lack of a cohesive mission (mission conflicts with other missions, is externally motivated, poorly defined or promotes mediocrity), system shocks (ie, events such as leadership turnover, new electronic health record system or organisational scandals that detract from daily operations), and dysfunctional external relations with other hospitals, stakeholders, or governing bodies. CONCLUSIONS Struggling healthcare organisations share characteristics that may affect their ability to provide optimal care. Understanding and identifying these characteristics may provide a first step to helping low performers address organisational challenges to improvement. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42017067367.
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Affiliation(s)
- Valerie M Vaughn
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, Ann Arbor Veterans Affairs Medical Center/University of Michigan, Ann Arbor, Michigan, USA
| | - Sanjay Saint
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, Ann Arbor Veterans Affairs Medical Center/University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah L Krein
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, Ann Arbor Veterans Affairs Medical Center/University of Michigan, Ann Arbor, Michigan, USA
| | - Jane H Forman
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, Ann Arbor Veterans Affairs Medical Center/University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer Meddings
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, Ann Arbor Veterans Affairs Medical Center/University of Michigan, Ann Arbor, Michigan, USA.,Departmentof Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jessica Ameling
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, Ann Arbor Veterans Affairs Medical Center/University of Michigan, Ann Arbor, Michigan, USA
| | - Suzanne Winter
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, Ann Arbor Veterans Affairs Medical Center/University of Michigan, Ann Arbor, Michigan, USA
| | - Whitney Townsend
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, USA
| | - Vineet Chopra
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, Ann Arbor Veterans Affairs Medical Center/University of Michigan, Ann Arbor, Michigan, USA
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