Implementation strategies to increase Malawian health care workers' knowledge about and self-efficacy to recommend...

Health workers' recommendation of HPV vaccination is a highly effective evidence-based intervention for increasing the uptake of this important cancer prevention tool. In Malawi, as in many countries, HPV vaccine uptake is low. In preparation for an implementation science study using an intervention optimization design, we pilot tested two implementation strategies aimed at increasing Malawian health workers'knowledge and self-efficacy to counsel about HPV vaccination. Health workers were recruited from six large health facilities in Southern Malawi; each participant took a brief assessment before and after viewing the pilot strategy: either a training (aimed to increase knowledge) or video vignettes of counseling discussions (to increase self-efficacy to counsel). There were 45 health workers who participated, 19 attended the training, and 26 viewed the videos. Knowledge increased approximately 20 points on average (0-100 scale), and knowledge increases were greater among health workers who participated in the training (24.1 points versus 16.5 points for those who watched the videos). Self-efficacy increased 13.7 points on average (0-100 scale) and to a greater extent among those who viewed the videos (14.2 point increase) than those who attended the training (13.1 point increase). Both training and videos were rated very high for acceptability. These results suggest that brief training and video vignettes may be effective and offer complementary benefits for increasing health workers' knowledge and self-efficacy to counsel about HPV vaccination. We will next test these strategies in a large cluster randomized controlled trial using the multi-phase optimization strategy to identify the most effective and implementable set of implementation strategies for increasing health worker recommendation of, and ultimately coverage of, the HPV vaccine in Malawi.