Kornides Melanie L, Garrell Jacob M, Gilkey Melissa B
Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA 02215, USA.
Department of Community Health, Tufts University, 574 Boston Avenue, Suite 208, Medford, MA 02155, USA.
Vaccine. 2017 Aug 16;35(35 Pt B):4510-4514. doi: 10.1016/j.vaccine.2017.07.038. Epub 2017 Jul 22.
Addressing low HPV vaccination coverage will require U.S. health care providers to improve their recommendation practices and vaccine delivery systems. Because readily available continuing medical education (CME) could be an important tool for supporting providers in this process, we sought to assess the content of web-based CME activities related to HPV vaccination.
We conducted a content analysis of web-based CME activities about HPV vaccination available to U.S. primary care providers in May-September 2016. Using search engines, educational clearinghouses, and our professional networks, we identified 15 activities eligible for study inclusion. Through a process of open coding, we identified 45 commonly occurring messages in the CME activities, which we organized into five topic areas: delivering recommendations for HPV vaccination, addressing common parent concerns, implementing office-based strategies to increase HPV vaccination coverage, HPV epidemiology, and guidelines for HPV vaccine administration and safety. Using a standardized abstraction form, two coders then independently assessed which of the 45 messages each CME activity included.
CME activities varied in the amount of content they delivered, with inclusion of the 45 messages ranging from 17% to 86%. Across activities, the most commonly included messages were related to guidelines for HPV vaccine administration and safety. For example, all activities (100%) specified that routine administration is recommended for ages 11 and 12. Most activities (73%) also noted that provider recommendations are highly influential. Fewer activities modeled examples of effective recommendations (47%), gave specific approaches to addressing common parent concerns (47%), or included guidance on office-based strategies to increase coverage (40%).
Given that many existing CME activities lack substantive content on how to change provider practice, future activities should focus on the practical application of interpersonal and organizational approaches for improving HPV vaccine delivery in the clinical setting.
提高人乳头瘤病毒（HPV）疫苗接种率需要美国医疗保健提供者改进其推荐做法和疫苗接种系统。由于随时可用的继续医学教育（CME）可能是在此过程中支持提供者的重要工具，我们试图评估与HPV疫苗接种相关的基于网络的CME活动的内容。
我们对2016年5月至9月期间美国初级保健提供者可获得的关于HPV疫苗接种的基于网络的CME活动进行了内容分析。通过搜索引擎、教育信息中心和我们的专业网络，我们确定了15项符合研究纳入标准的活动。通过开放编码过程，我们在CME活动中确定了45条常见信息，我们将其分为五个主题领域：提供HPV疫苗接种建议、解决家长常见担忧、实施基于办公室的策略以提高HPV疫苗接种率、HPV流行病学以及HPV疫苗接种和安全性指南。然后，两名编码员使用标准化的摘要表格独立评估每项CME活动包含45条信息中的哪些。
CME活动提供的内容量各不相同，包含45条信息的比例从17%到86%不等。在各项活动中，最常包含的信息与HPV疫苗接种和安全性指南有关。例如，所有活动（100%）都规定建议对11岁和12岁的人群进行常规接种。大多数活动（73%）还指出提供者的建议具有很大影响力。较少的活动展示了有效建议的示例（47%），给出了解决家长常见担忧的具体方法（47%），或包含了关于提高接种率的基于办公室的策略的指导（40%）。
鉴于许多现有的CME活动缺乏关于如何改变提供者做法的实质性内容，未来的活动应侧重于人际和组织方法在临床环境中改善HPV疫苗接种的实际应用。
