Staras Stephanie A S, Vadaparampil Susan T, Livingston Melvin D, Thompson Lindsay A, Sanders Ashley H, Shenkman Elizabeth A
Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida; Institute for Child Health Policy, University of Florida, Gainesville, Florida.
Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center, Tampa, Florida.
J Adolesc Health. 2015 May;56(5 Suppl):S40-6. doi: 10.1016/j.jadohealth.2014.11.024.
We evaluated the feasibility of a multilevel intervention to increase the human papillomavirus (HPV) vaccine initiation among adolescents.
We used a four-arm factorial, quasi-experimental trial to assess feasibility and short-term, preliminary effectiveness of a health system-level, gender-specific postcard campaign and an in-clinic health information technology (HIT) system. Between August and November 2013, we tested the intervention among 11- to 17-year-olds without prior HPV vaccine claims in the Florida Medicaid or Children's Health Insurance Program encounters (2,773 girls and 3,350 boys) who attended or were assigned to primary care clinics in North Central Florida.
At least one postcard was deliverable to 95% of the parents. Most parents (91% boys' and 80% girls') who participated in the process evaluation survey (n = 162) reported seeking additional information about the vaccine after receiving the postcard. Only 8% (57 of 1,062) of the adolescents assigned to a HIT provider with an office visit during the study used the HIT system. When compared with arms not containing that component, HPV vaccine initiation increased with the postcard campaign (girls, odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.1-2.3 and boys, not significant), the HIT system (girls, OR = 1.5; 95% CI = 1.0-2.3 and boys, OR = 1.4; 95% CI = 1.0-2.0), and the combined HIT and postcard intervention (girls, OR = 2.4; 95% CI = 1.4-4.3 and boys, OR = 1.6; 95% CI = 1.0-2.5).
A system-level postcard campaign was feasible. Despite low recruitment to the in-clinic HIT system, the intervention demonstrated short-term, preliminary effectiveness similar to prior HPV vaccine interventions.
我们评估了一项多级干预措施在增加青少年人乳头瘤病毒（HPV）疫苗接种率方面的可行性。
我们采用了一项四臂析因准实验性试验，以评估卫生系统层面、针对性别的明信片宣传活动以及诊所内健康信息技术（HIT）系统的可行性和短期初步效果。在2013年8月至11月期间，我们在佛罗里达州医疗补助计划或儿童健康保险计划就诊记录中无HPV疫苗接种史的11至17岁青少年（2773名女孩和3350名男孩）中测试了该干预措施，这些青少年在佛罗里达州中北部地区就诊或被分配到初级保健诊所。
至少有一张明信片可送达95%的家长手中。参与过程评估调查（n = 162）的大多数家长（男孩为91%，女孩为80%）报告称在收到明信片后会寻求有关该疫苗的更多信息。在研究期间被分配到有门诊的HIT医疗服务提供者处的青少年中，只有8%（1062名中的57名）使用了HIT系统。与不含该组件的组相比，明信片宣传活动使HPV疫苗接种率有所提高（女孩，优势比[OR] = 1.6；95%置信区间[CI] = 1.1 - 2.3，男孩无显著差异），HIT系统使接种率提高（女孩，OR = 1.5；95% CI = 1.0 - 2.3，男孩，OR = 1.4；95% CI = 1.0 - 2.0），HIT与明信片联合干预使接种率提高（女孩，OR = 2.4；95% CI = 1.4 - 4.3，男孩，OR = 1.6；95% CI = 1.0 - 2.5）。
系统层面的明信片宣传活动是可行的。尽管诊所内HIT系统的招募率较低，但该干预措施显示出与先前HPV疫苗干预措施相似的短期初步效果。
