Opel Douglas J, Robinson Jeffrey D, Spielvogle Heather, Spina Christine, Garrett Kathleen, Dempsey Amanda F, Perreira Cathryn, Dickinson Miriam, Zhou Chuan, Pahud Barbara, Taylor James A, O'Leary Sean T
Seattle Children's Research Institute, Seattle, Washington, USA
Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.
BMJ Open. 2020 Aug 11;10(8):e039299. doi: 10.1136/bmjopen-2020-039299.
A key contributor to underimmunisation is parental refusal or delay of vaccines due to vaccine concerns. Many clinicians lack confidence in communicating with vaccine-hesitant parents (VHP) and perceive that their discussions will do little to change parents' minds. Improving clinician communication with VHPs is critical to increasing childhood vaccine uptake.
We describe the protocol for a cluster randomised controlled trial to test the impact of a novel, multifaceted clinician vaccine communication strategy on child immunisation status. The trial will be conducted in 24 primary care practices in two US states (Washington and Colorado). The strategy is called Presumptively Initiating Vaccines and Optimizing Talk with Motivational Interviewing (PIVOT with MI), and involves clinicians initiating the vaccine conversation with all parents of young children using the presumptive format, and among those parents who resist vaccines, pivoting to using MI. Our primary outcome is the immunisation status of children of VHPs at 19 months, 0 day of age expressed as the percentage of days underimmunised from birth to 19 months for 22 doses of eight vaccines recommended during this interval. Secondary outcomes include clinician experience communicating with VHPs, parent visit experience and clinician adherence to the PIVOT with MI communication strategy.
This study is approved by the following institutional review boards: Colorado Multiple Institutional Review Board, Washington State Institutional Review Board and Swedish Health Services Institutional Review Board. Results will be disseminated through peer-reviewed manuscripts and conference presentations.
NCT03885232.
疫苗接种不足的一个关键因素是家长因对疫苗存在担忧而拒绝或延迟接种。许多临床医生在与对疫苗持犹豫态度的家长（VHP）沟通时缺乏信心，认为他们的讨论会对改变家长的想法收效甚微。改善临床医生与VHP的沟通对于提高儿童疫苗接种率至关重要。
我们描述了一项整群随机对照试验的方案，以测试一种新颖的、多方面的临床医生疫苗沟通策略对儿童免疫状况的影响。该试验将在美国两个州（华盛顿州和科罗拉多州）的24家初级保健机构进行。该策略称为“推定启动疫苗接种并通过动机性访谈优化沟通”（PIVOT with MI），包括临床医生使用推定方式与所有幼儿家长展开疫苗接种对话，对于那些拒绝接种疫苗的家长，则转而采用动机性访谈。我们的主要结局是19个月零天时VHP子女的免疫状况，以在此期间推荐的8种疫苗22剂次从出生到19个月未接种疫苗的天数百分比来表示。次要结局包括临床医生与VHP沟通的经验、家长就诊体验以及临床医生对PIVOT with MI沟通策略的依从性。
本研究已获得以下机构审查委员会的批准：科罗拉多州多机构审查委员会、华盛顿州机构审查委员会和瑞典医疗服务机构审查委员会。研究结果将通过同行评审的手稿和会议报告进行传播。
NCT03885232。
