University of North Carolina School of Medicine, United States of America; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States of America.
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States of America.
Prev Med. 2021 Jul;148:106554. doi: 10.1016/j.ypmed.2021.106554. Epub 2021 Apr 20.
Provider communication can be critically important to families as they consider HPV vaccination. We sought to characterize the association of provider communication and HPV vaccine uptake, and when communication better motivates vaccination. We searched four databases for studies published between 2006 and 2019. Eligible studies examined health care provider communication (defined as recommendation or discussion) and HPV vaccine uptake (defined as initiation, completion, or follow-through) in the US. Two coders independently identified eligible studies and coded effect sizes and study characteristics. We pooled effect sizes using random-effects meta-analysis. We identified 59 eligible studies of 265,083 patients. Receiving a provider recommendation was associated with higher HPV vaccine initiation (pooled OR = 10.1, 95% CI: 7.6-13.4). HPV vaccine initiation was 24% for patients without and 60% for patients with a provider recommendation. The pooled effect size for provider recommendation and initiation was smaller for probability samples, clinical records, and NIS-Teen (all p < 0.002). Recommendations were equally effective for males and females, for different patient ages, and over time. Provider recommendation was also associated with higher HPV vaccine series completion and follow-through. Provider discussion was similarly associated with higher HPV vaccine initiation (OR = 12.4, 95% CI: 6.3-24.3). In summary, provider communication was robustly associated with HPV vaccination initiation, completion, and follow-through. These findings suggest that US public health efforts to increase HPV vaccine coverage should continue to emphasize provider communication.
在考虑 HPV 疫苗接种时，提供者的沟通对于家庭来说可能至关重要。我们旨在描述提供者沟通与 HPV 疫苗接种率之间的关系，以及何时沟通能更好地促进疫苗接种。我们在四个数据库中搜索了 2006 年至 2019 年间发表的研究。合格的研究检查了美国医疗保健提供者的沟通（定义为建议或讨论）和 HPV 疫苗接种率（定义为开始、完成或跟进）。两名编目员独立确定了合格的研究，并对效果大小和研究特征进行了编码。我们使用随机效应荟萃分析汇总了效果大小。我们确定了 59 项涉及 265083 名患者的合格研究。接受提供者的建议与 HPV 疫苗接种率的增加有关（汇总 OR=10.1，95%CI：7.6-13.4）。未接受建议的患者 HPV 疫苗接种率为 24%，而接受建议的患者为 60%。对于概率样本、临床记录和 NIS-Teen（均 p<0.002），提供者建议与接种率之间的汇总效果大小较小。对于不同的患者年龄和不同的时间段，建议对男性和女性都同样有效。提供者的建议还与 HPV 疫苗系列的完成率和后续跟进率的增加有关。提供者的讨论与 HPV 疫苗接种率的增加也有关（OR=12.4，95%CI：6.3-24.3）。总之，提供者的沟通与 HPV 疫苗接种的开始、完成和后续跟进密切相关。这些发现表明，美国为提高 HPV 疫苗接种率而开展的公共卫生工作应继续强调提供者的沟通。
