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Effect of Training Pediatric Clinicians in Human Papillomavirus Communication Strategies on Human Papillomavirus
Peter G Szilagyi1, Sharon G Humiston2, Alisa J Stephens-Shields3
1Department of Pediatrics, University of California, Los Angeles, UCLA Mattel Children's Hospital, Los Angeles.
Insights
Online communication training for clinicians reduced missed opportunities for human papillomavirus (HPV) vaccination, especially for initiating the HPV vaccine during well-child care visits. This intervention shows promise for improving adolescent vaccination rates.
Area of Science:
- Public Health
- Vaccinology
- Health Communication
Background:
- Missed opportunities for human papillomavirus (HPV) vaccination are frequent during pediatric healthcare encounters.
- Effective clinician communication is crucial for addressing parental concerns and promoting HPV vaccination uptake.
- Standard pediatric care often fails to maximize vaccination opportunities, particularly for adolescents.
Purpose of the Study:
- To assess the impact of online communication training for clinicians on reducing missed opportunities for HPV vaccination.
- To evaluate the intervention's effect on HPV vaccination initiation and completion rates among adolescents.
- To determine if the training influences vaccination rates during well-child care (WCC) versus acute/chronic illness visits.
Main Methods:
- A longitudinal cluster randomized clinical trial involving 48 primary care pediatric practices.
- Clinicians in intervention practices received sequential online educational modules and weekly text message reinforcement.
- Outcomes measured included visit-level missed opportunities and person-level HPV vaccination rates for 11- to 17-year-olds.
Main Results:
- Intervention practices showed a statistically significant reduction in overall missed HPV vaccination opportunities compared to controls (-2.4%).
- Missed opportunities for HPV vaccine initiation during WCC visits decreased significantly more in the intervention group (-6.8%).
- A greater improvement in HPV vaccine initiation was observed in adolescents attending intervention practices (+3.4%).
Conclusions:
- Scalable, online communication training effectively increased HPV vaccination initiation, particularly during WCC visits.
- The intervention successfully reduced missed opportunities for HPV vaccination among adolescents.
- Findings support the dissemination of this communication training to improve adolescent immunization coverage.
Importance:
Missed opportunities for human papillomavirus (HPV) vaccination during pediatric health care visits are common.
Objectives:
To evaluate the effect of online communication training for clinicians on missed opportunities for HPV vaccination rates overall and at well-child care (WCC) visits and visits for acute or chronic illness (hereafter referred to as acute or chronic visits) and on adolescent HPV vaccination rates.
Design, Setting, And Participants:
From December 26, 2018, to July 30, 2019, a longitudinal cluster randomized clinical trial allocated practices to communication training vs standard of care in staggered 6-month periods. A total of 48 primary care pediatric practices in 19 states were recruited from the American Academy of Pediatrics Pediatric Research in Office Settings network. Participants were clinicians in intervention practices. Outcomes were evaluated for all 11- to 17-year-old adolescents attending 24 intervention practices (188 clinicians) and 24 control practices (177 clinicians). Analyses were as randomized and performed on an intent-to-treat basis, accounting for clustering by practice.
Interventions:
Three sequential online educational modules were developed to help participating clinicians communicate with parents about the HPV vaccine. Weekly text messages were sent to participating clinicians to reinforce learning. Statisticians were blinded to group assignment.
Main Outcomes And Measures:
Main outcomes were missed opportunities for HPV vaccination overall and for HPV vaccine initiation and subsequent doses at WCC and acute or chronic visits (visit-level outcome). Secondary outcomes were HPV vaccination rates (person-level outcome). Outcomes were compared during the intervention vs baseline.
Results:
Altogether, 122 of 188 clinicians in intervention practices participated; of these, 120, 119, and 116 clinicians completed training modules 1, 2, and 3, respectively. During the intervention period, 29 206 adolescents (14 664 girls [50.2%]; mean [SD] age, 14.2 [2.0] years) made 15 888 WCC and 28 123 acute or chronic visits to intervention practices; 33 914 adolescents (17 069 girls [50.3%]; mean [SD] age, 14.2 [2.0] years) made 17 910 WCC and 35 281 acute or chronic visits to control practices. Intervention practices reduced missed opportunities overall by 2.4 percentage points (-2.4%; 95% CI, -3.5% to -1.2%) more than controls. Intervention practices reduced missed opportunities for vaccine initiation during WCC visits by 6.8 percentage points (-6.8%; 95% CI, -9.7% to -3.9%) more than controls. The intervention had no effect on missed opportunities for subsequent doses of the HPV vaccine or at acute or chronic visits. Adolescents in intervention practices had a 3.4-percentage point (95% CI, 0.6%-6.2%) greater improvement in HPV vaccine initiation compared with adolescents in control practices.
Conclusions And Relevance:
This scalable, online communication training increased HPV vaccination, particularly HPV vaccine initiation at WCC visits. Results support dissemination of this intervention.
Trial Registration:
ClinicalTrials.gov Identifier: NCT03599557.
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