Coaching and Communication Training for HPV Vaccination: A Cluster Randomized Trial

Area of Science:

• Public Health
• Preventive Medicine
• Health Services Research

Background:

• US health departments use in-person quality improvement (QI) coaching to enhance vaccine delivery.
• This standard intervention shows limited and inconsistent success in improving human papillomavirus (HPV) vaccination rates.
• There is a need for more effective strategies to increase HPV vaccination uptake.

Purpose of the Study:

• To evaluate the effectiveness of combining QI coaching with remote provider communication training.
• To determine if a combined intervention improves HPV vaccination initiation and completion more than QI coaching alone or communication training alone.

Main Methods:

• A pragmatic 4-arm cluster randomized clinical trial involving 267 primary care clinics across 3 states.
• Clinics were assigned to receive in-person QI coaching, remote provider communication training, both combined, or a control.
• HPV vaccination status was assessed using immunization information systems for 176,189 patients aged 11-17.

Main Results:

• HPV vaccine initiation was 1.5% higher in the QI coaching arm and 3.8% higher in the combined intervention arm compared to the control for 11-12 year olds.
• These improvements were sustained at 18-month follow-up.
• The combined intervention also improved vaccination outcomes for older adolescents (13-17) and series completion; communication training alone did not significantly improve outcomes.

Conclusions:

• Combining QI coaching with remote provider communication training leads to more consistent improvements in HPV vaccination uptake.
• A higher intensity, multilevel intervention approach may be beneficial for health departments and organizations aiming to enhance HPV vaccine delivery.
• Remote communication training alone was not sufficient to improve HPV vaccination rates significantly.