指定还是选择？提供者的语言与 HPV 疫苗接种的关联。
Indicated or elective? The association of providers' words with HPV vaccine receipt.
机构信息
a Harvard University , Cambridge , MA , USA.
b Boston Medical Center , Boston , MA , USA.
出版信息
Hum Vaccin Immunother. 2018;14(10):2503-2509. doi: 10.1080/21645515.2018.1480237. Epub 2018 Jun 28.
BACKGROUND
Appropriate provider recommendation is crucial to raising HPV vaccination uptake, yet scant research has explored actual conversations between providers and parents, the effect of parental pre-visit vaccine intention on vaccination, or the effect of conversation style on parental satisfaction with that conversation.
METHODS
We analyzed 146 audio-recorded clinical encounters between providers, parents/guardians, and HPV vaccine-eligible adolescents, from May 2015 to March 2017, at eight practices in Northeastern U.S. Parents completed pre-visit measures of intent to vaccinate and post-visit assessments of satisfaction with vaccine conversations. We qualitatively analyzed transcribed audio recordings and evaluated associations between providers' vaccine introductions and vaccine receipt.
RESULTS
Provider recommendations were empirically defined as "indicated" (clear recommendation that the child receive HPV vaccination at that visit), "elective" (vaccination presented as optional), or "contraindicated" (delay recommended). The vaccination rates were 87%, 68%, and 0% following "indicated," "elective," and "contraindicated" presentations respectively. Providers' statements attesting to the vaccine's value to the child did not affect receipt. Parental pre-visit intent to vaccinate was associated with vaccine receipt: 100% for likely/very likely compared to 28% for very unlikely. The association between vaccine recommendation style and vaccine receipt was most pronounced with undecided parents, with 92% accepting vaccination after an "indicated" recommendation vs. 68% after an "elective" recommendation. Satisfaction with vaccine conversations was high regardless of recommendation style.
CONCLUSIONS
The results suggest that the words used to introduce HPV vaccination have the potential to inform parents' HPV vaccination decisions. Providers should be encouraged to simply state, "Your child is due for the HPV vaccine today."
背景
适当的提供者推荐对于提高 HPV 疫苗接种率至关重要，但几乎没有研究探讨提供者与父母之间的实际对话、父母就诊前疫苗接种意向对疫苗接种的影响，或对话风格对父母对该对话的满意度的影响。
方法
我们分析了 2015 年 5 月至 2017 年 3 月在东北部 8 个实践地点进行的 146 次临床接触，涉及提供者、父母/监护人以及 HPV 疫苗接种合格的青少年。父母在就诊前完成了接种意向的衡量和对疫苗接种对话的满意度的评估。我们对转录的音频记录进行了定性分析，并评估了提供者的疫苗介绍与疫苗接种之间的关联。
结果
提供者的推荐被定义为“建议”（明确建议在本次就诊时给孩子接种 HPV 疫苗）、“选择”（疫苗接种作为可选）或“禁忌”（建议延迟接种）。分别按照“建议”、“选择”和“禁忌”呈现，疫苗接种率分别为 87%、68%和 0%。提供者对疫苗对孩子价值的陈述并没有影响接种。父母就诊前接种疫苗的意向与疫苗接种有关：非常可能/很可能接种的比例为 100%，而非常不可能接种的比例为 28%。疫苗推荐风格与疫苗接种率之间的关联在未决定的父母中最为明显，在“建议”后有 92%的人接受接种，而在“选择”后有 68%的人接受接种。无论推荐风格如何，对疫苗接种对话的满意度都很高。
结论
结果表明，用于介绍 HPV 疫苗接种的词语有可能影响父母的 HPV 疫苗接种决策。应该鼓励提供者简单地说：“您的孩子今天需要接种 HPV 疫苗。”
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