Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, School of Medicine, Sacramento, California, USA.
University of California, Davis Comprehensive Cancer Center, Sacramento, California, USA.
J Rural Health. 2023 Jan;39(1):136-141. doi: 10.1111/jrh.12690. Epub 2022 Jul 7.
Geographic disparities exist in uptake of the human papillomavirus vaccine (HPV). In 2020, the National Immunization Survey-Teen reported that adolescents living in nonmetropolitan statistical areas (MSAs) had lower HPV vaccination coverage (≥ 1 dose) compared to adolescents living in MSA principal cities. This paper describes the implementation and evaluation of a multilevel pilot intervention study to increase uptake of the HPV vaccine among adolescent patients ages 11-17 of a rural health clinic.
This parent, primary care team, and clinic multilevel pilot intervention was guided by evidence-based approaches to increase HPV vaccinations, formative research, and input from the community. HPV vaccination initiation and completion rates were analyzed at baseline and 23 months follow-up.
The proportion of adolescent patients ages 11-17 who had initiated the HPV vaccine series was significantly greater at follow-up compared to baseline, (82.7% compared to 52.4%), χ (1, n = 498) = 49.2, P < .0001. The proportion of adolescent patients ages 11-17 who had completed the HPV vaccine series was also significantly greater at follow-up compared to baseline, (58.0% compared to 27.0%), χ (1, n = 498) = 50.8, P < .0001.
The multilevel intervention significantly increased HPV initiation and completion rates among adolescent patients ages 11-17 at this rural health clinic. This study demonstrates the feasibility of utilizing a multilevel intervention to address low HPV vaccination rates among rural adolescents and the potential of employing this strategy for a large-scale randomizing-controlled trial.
人乳头瘤病毒（HPV）疫苗的接种存在地域差异。2020 年，国家免疫调查-青少年报告称，居住在非都市区（MSA）的青少年与居住在 MSA 主要城市的青少年相比，HPV 疫苗接种率（≥1 剂）较低。本文描述了一项多层次试点干预研究的实施和评估，该研究旨在提高农村诊所 11-17 岁青少年患者对 HPV 疫苗的接种率。
该家长、初级保健团队和诊所多层次试点干预措施以增加 HPV 疫苗接种的循证方法、形成性研究和社区投入为指导。在基线和 23 个月随访时分析 HPV 疫苗接种起始率和完成率。
与基线相比，在随访时，11-17 岁青少年患者开始 HPV 疫苗系列接种的比例显著增加（82.7%对比 52.4%），χ²（1，n=498）=49.2，P<0.0001。在随访时，11-17 岁青少年患者完成 HPV 疫苗系列接种的比例也显著高于基线（58.0%对比 27.0%），χ²（1，n=498）=50.8，P<0.0001。
多层次干预措施显著提高了农村健康诊所 11-17 岁青少年患者的 HPV 接种起始率和完成率。本研究表明，利用多层次干预措施来解决农村青少年 HPV 疫苗接种率低的问题是可行的，并且有潜力采用这种策略进行大规模随机对照试验。
