Leung Shuk On Annie, Akinwunmi Babatunde, Elias Kevin M, Feldman Sarah
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA, United States.
Department of Global Education, Harvard Medical School, Boston, MA, United States.
Vaccine X. 2019 Aug 5;3:100037. doi: 10.1016/j.jvacx.2019.100037. eCollection 2019 Dec 10.
HPV vaccination rates in the United States lag behind other developed countries. Educational interventions are primarily directed at patients and parents rather than healthcare providers (HCPs), despite evidence that provider recommendation is a key determinant of vaccine uptake. The objectives for this review are to synthesize the available evidence related to the knowledge, attitudes, and beliefs of HCPs surrounding HPV vaccination, to summarize provider-specific educational interventions which have been evaluated, and to review existing provider-specific educational resources from national organizations and whether they align with the gaps identified.
A systematic search was performed using PubMed, Web of Science, CINAHL, and ERIC with MeSH terms human papillomavirus, vaccine, education, workshop, training, knowledge, attitude, belief, intention, and healthcare provider. Full text articles were obtained for studies that described the knowledge and attitudes of providers and/or impact of educational interventions. Data extraction was performed by four independent reviewers. Websites of American organizations with an interest in HPV vaccination were manually searched for provider resources.
1066 publications were identified, and 98 articles were fully reviewed with 40 ultimately included. Providers' knowledge on HPV was generally low with a correspondingly low vaccine recommendation rate. Provider-specific education (e.g., didactic session and communication training) with complimentary interventions demonstrated increased knowledge and vaccine series initiation and completion. Themes identified in descriptive studies highlighted providers' lack of general HPV and vaccine knowledge, low self-confidence in counselling and addressing parental concerns, and discomfort in discussing sexual issues related to vaccination. Many American organizations have provider-specific resources; however, the effectiveness of these materials has not been established.
HPV knowledge among providers remains low. Educational interventions to improve knowledge and communication appear to be effective. A breadth of resources from national organizations are available but their efficacy and level of utilization is largely unknown. Coordinated efforts are needed to evaluate provider-specific educational resources to improve vaccine uptake in the US.
美国的人乳头瘤病毒（HPV）疫苗接种率落后于其他发达国家。尽管有证据表明医疗服务提供者的推荐是疫苗接种的关键决定因素，但教育干预主要针对患者和家长，而非医疗服务提供者（HCPs）。本综述的目的是综合有关HCPs对HPV疫苗接种的知识、态度和信念的现有证据，总结已评估的针对医疗服务提供者的教育干预措施，并审查国家组织现有的针对医疗服务提供者的教育资源以及它们是否与所发现的差距相符。
使用PubMed、科学网、护理学与健康领域数据库（CINAHL）和教育资源信息中心（ERIC）进行系统检索，检索词为人乳头瘤病毒、疫苗、教育、研讨会、培训、知识、态度、信念、意愿和医疗服务提供者。获取描述医疗服务提供者的知识和态度及/或教育干预影响的研究的全文文章。由四名独立评审员进行数据提取。手动搜索对HPV疫苗接种感兴趣的美国组织的网站以查找针对医疗服务提供者的资源。
共识别出1066篇出版物，对98篇文章进行了全面审查，最终纳入40篇。医疗服务提供者对HPV的知识普遍较低，相应地疫苗推荐率也较低。针对医疗服务提供者的教育（如讲授课程和沟通培训）及补充干预措施显示知识有所增加，且疫苗系列接种的起始和完成情况有所改善。描述性研究中确定的主题突出了医疗服务提供者普遍缺乏HPV和疫苗知识、在咨询和解决家长担忧方面缺乏自信以及在讨论与疫苗接种相关的性问题时感到不适。许多美国组织有针对医疗服务提供者的资源；然而，这些材料的有效性尚未得到证实。
医疗服务提供者中的HPV知识仍然较低。旨在提高知识和沟通能力的教育干预似乎是有效的。国家组织有大量资源可用，但其功效和利用程度在很大程度上尚不清楚。需要协调各方努力来评估针对医疗服务提供者的教育资源，以提高美国的疫苗接种率。
