Using intervention mapping to develop training for US dental providers to recommend the HPV vaccine

Iowa has the highest incidence of oropharyngeal cancer (OPC) in the US, and human papillomavirus (HPV) is the most common cause of that disease. An HPV vaccine is approved for OPC prevention, but its uptake is low. We identified dental offices as novel settings in which the HPV vaccine can be recommended to patients, and we describe our use of the Intervention Mapping (IM) framework to develop an intervention that prepares dental providers to recommend the vaccine to parents of patients aged 9-17.

Our planning group used IM to engage in (1) needs assessment, which involved surveying dental hygienists (n = 470) and interviewing dental hygienists (n = 19) and dentists (n = 20); (2) method and (3) theory identification; and (4) intervention development, (5) implementation, and (6) evaluation, resulting in our "Educate, Recommend, Refer" intervention.

The needs assessment showed dental providers were willing to learn more about the HPV vaccine but needed training to confidently recommend it. We chose training methods that increase self-efficacy, in accordance with behavior change theory. Multiple health behavior theories and frameworks also prompted our development of supporting materials, that encouraged participants to engage in vaccine promotion, as well as an evaluation plan.

IM guided our integration of theory, existing evidence, and stakeholder input to create an intervention that comprehensively addressed the needs of our target audience and overcame limitations of other similar interventions. Presenting intervention development in accordance with the IM framework also gives practitioners clear information for its replication or adoption.