Elsevier

Academic Pediatrics

Volume 18, Issue 8, November–December 2018, Pages 882-888
Academic Pediatrics

Evaluation of the Implementation of a Multicomponent Intervention to Improve Health Care Provider Communication About Human Papillomavirus Vaccination

https://doi.org/10.1016/j.acap.2018.08.004Get rights and content

Abstract

Objective

To evaluate the relative use, usefulness, and facilitators and barriers to use as perceived by providers of 5 different components in a human papillomavirus vaccine communication intervention—which was found to be effective at improving human papillomavirus vaccination rates.

Methods

Four serial surveys of 108 providers (doctor of medicine, nurse practitioner, or doctor of osteopathic medicine) from intervention clinics involved in the study assessed the use and usefulness of the 5 communication intervention components during a 12-month period.

Results

Survey response rates were 79% to 86%. The fact sheet (64%–77%) and motivational interviewing techniques (MI; 86%) were the most used components—use was sustained during the 12-month period. These components also were perceived as somewhat or very useful by most providers, and this perceived usefulness increased over time (very or somewhat useful at end of study, 97% fact sheet, 98% MI, respectively). Although fewer providers reported using the Web site (15%–42%), or disease images (6%–17%), when these were used, most providers (67%–87%) felt they were somewhat or very useful. The decision aid was not used frequently (17%–41% of providers), and 43% of providers felt it was not very or not at all useful. Facilitators and barriers were identified for each component. The fact sheet and MI were perceived as the easiest to integrate into the clinic workflow.

Conclusions

The fact sheet and MI were the most used and most useful intervention components. Both were easy to integrate into clinic workflow, and their use was sustained over time. Dissemination of similar interventions in the future should focus on these 2 specific components.

Section snippets

Intervention Overview

A full description of the randomized controlled trial (RCT) can be found elsewhere14; here, we provide a brief overview. Practices recruited for the trial came from a practice-based research network in central Colorado. Eligibility criteria included having 1) a minimum of 400 active adolescent patients, 2) baseline HPV vaccination rates of <80%, and 3) HPV vaccines available at the clinic. Eight intervention and 8 control practices participated in the 12-month (February 2015–January 2016)

Results

Across the 4 study surveys, between 67% and 78% of total providers participating in the intervention completed surveys. Overall, 108 providers completed 1 or more of the surveys. Table 1 describes the respondents’ characteristics.

Discussion

Overall, results demonstrate that the fact sheet and MI were the most-used intervention components throughout the 12-month intervention period and thus likely the most impactful components of our intervention. This conclusion was further strengthened by the finding that providers also reported that the fact sheet and MI were the most useful of the intervention components. Additionally, in comparison with the other components, few providers reported that other intervention tools were sufficient

Conclusions

Overall, the current study suggests that the fact sheet and MI components of our multi-item provider HPV vaccine communication intervention were likely critical elements underlying the effectiveness of the intervention in our larger randomized trial. However, although the other intervention components were less used, when they were used, they were perceived as useful. Intervention component use overall was significantly lower in public clinics compared with private ones, likely explaining

Acknowledgments

Financial disclosure: The funding source for this study was the Centers for Disease Control and Prevention (5U01IP000801), who provided input into the main study (randomized controlled trial) design and data interpretation. The funding source had no direct involvement in the preparation of the manuscript.

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    The authors have no conflicts of interest to disclose.

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