Lineberger Comprehensive Cancer Center, University of North Carolina, CB7293, Chapel Hill, NC, 27599, USA.
Department of Health Behavior, Gillings School of Global Pubic Health, University of North Carolina, CB7440, Chapel Hill, NC, 27599, USA.
Implement Sci. 2018 Apr 19;13(1):57. doi: 10.1186/s13012-018-0743-8.
Improving healthcare providers' communication about HPV vaccination is critical to increasing uptake. We previously demonstrated that training providers to use presumptive announcements to introduce HPV vaccination improved uptake, whereas training them to use participatory conversations had no effect. To understand how communication training changed provider perceptions and communication practices, we evaluated intermediate outcomes and process measures from our randomized clinical trial, with a particular focus on identifying mechanisms that might explain the announcement training's impact.
In 2015, a physician educator delivered 1-h in-clinic HPV vaccination recommendation trainings at 20 primary care clinics in North Carolina serving 11,578 patients age 11 or 12. Clinics were randomized to receive training to use "announcements" that presume parents are ready to vaccinate or "conversations" that invite dialog about vaccination. Training participants were 83 HPV vaccine providers. Pre- and post-training surveys assessed constructs from the theory of planned behavior (TPB), including providers' attitudes and subjective norms about HPV vaccination and their perceived behavioral control to recommend HPV vaccination. Surveys also assessed providers' perceptions of the announcement and conversation communication strategies.
Both trainings improved TPB-related constructs, including providers' positive attitudes toward HPV vaccination, subjective norms, and perceived behavioral control to recommend the vaccine (all p < .001, Cohen's d = .62-.90). Furthermore, in both trainings, the amount of time providers reported needing to discuss HPV vaccination with parents decreased from pre-training to 1-month follow-up (mean = 3.8 vs. 3.2 min, p = .01, d = .28). However, announcement trainings outperformed conversation trainings on other measures. For example, providers who received announcement training more often reported that the communication strategy saved them time, was easy to use, helped them promote HPV vaccination as routine care, and increased HPV vaccination coverage in their clinics (all p < .05; d = .44-.60).
Both announcement and conversation trainings improved providers' HPV vaccine-related perceptions. However, providers viewed announcements as easier to use and more effective, which may help to explain the success of this training approach. Future provider communication interventions should consider implementation outcomes, including acceptability, alongside more traditional TPB constructs.
clinicaltrials.gov, NCT02377843 . Registered on February 27, 2015.
提高医疗保健提供者在 HPV 疫苗接种方面的沟通能力对于提高接种率至关重要。我们之前的研究表明，培训提供者使用假设性公告来介绍 HPV 疫苗接种可以提高接种率，而培训他们使用参与性对话则没有效果。为了了解沟通培训如何改变提供者的看法和沟通实践，我们从我们的随机临床试验中评估了中间结果和过程测量，特别关注识别可能解释公告培训影响的机制。
2015 年，一位医师教育家在北卡罗来纳州的 20 家初级保健诊所进行了 1 小时的 HPV 疫苗接种推荐培训，这些诊所为 11578 名 11 或 12 岁的患者提供服务。诊所被随机分配接受使用“公告”或“对话”的培训，假设父母准备接种疫苗或邀请他们讨论疫苗接种。培训参与者是 83 名 HPV 疫苗提供者。培训前后的调查评估了计划行为理论（TPB）的构建，包括提供者对 HPV 疫苗接种的态度和主观规范以及他们推荐 HPV 疫苗接种的感知行为控制。调查还评估了提供者对公告和对话沟通策略的看法。
两种培训都改善了与 TPB 相关的构建，包括提供者对 HPV 疫苗接种的积极态度、主观规范和推荐疫苗接种的感知行为控制（均<0.001，Cohen's d=0.62-0.90）。此外，在两种培训中，提供者报告与父母讨论 HPV 疫苗接种所需的时间都从培训前减少到 1 个月随访（平均=3.8 分钟与 3.2 分钟，p=0.01，d=0.28）。然而，公告培训在其他方面优于对话培训。例如，接受公告培训的提供者更常报告说，沟通策略为他们节省了时间，易于使用，有助于他们将 HPV 疫苗接种作为常规护理进行推广，并提高了他们诊所的 HPV 疫苗接种率（均<0.05；d=0.44-0.60）。
公告和对话培训都改善了提供者对 HPV 疫苗接种的相关看法。然而，提供者认为公告更容易使用且更有效，这可能有助于解释这种培训方法的成功。未来的提供者沟通干预措施应考虑实施结果，包括可接受性，以及更传统的 TPB 结构。
clinicaltrials.gov，NCT02377843。于 2015 年 2 月 27 日注册。
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