Brewington Micaela K, Queen Tara L, Heisler-MacKinnon Jennifer, Calo William A, Weaver Sandra, Barry Chris, Kong Wei Yi, Kennedy Kathryn L, Shea Christopher M, Gilkey Melissa B
Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
Implement Sci Commun. 2024 Mar 22;5(1):28. doi: 10.1186/s43058-024-00557-0.
Implementation science researchers often cite clinical champions as critical to overcoming organizational resistance and other barriers to the implementation of evidence-based health services, yet relatively little is known about who champions are or how they effect change. To inform future efforts to identify and engage champions to support HPV vaccination, we sought to describe the key characteristics and strategies of vaccine champions working in adolescent primary care.
In 2022, we conducted a national survey with a web-based panel of 2527 primary care professionals (PCPs) with a role in adolescent HPV vaccination (57% response rate). Our sample consisted of pediatricians (26%), family medicine physicians (22%), advanced practice providers (24%), and nursing staff (28%). Our survey assessed PCPs' experience with vaccine champions, defined as health care professionals "known for helping their colleagues improve vaccination rates."
Overall, 85% of PCPs reported currently working with one or more vaccine champions. Among these 2144 PCPs, most identified the champion with whom they worked most closely as being a physician (40%) or nurse (40%). Almost all identified champions worked to improve vaccination rates for vaccines in general (45%) or HPV vaccine specifically (49%). PCPs commonly reported that champion implementation strategies included sharing information (79%), encouragement (62%), and vaccination data (59%) with colleagues, but less than half reported that champions led quality improvement projects (39%). Most PCPs perceived their closest champion as being moderately to extremely effective at improving vaccination rates (91%). PCPs who did versus did not work with champions more often recommended HPV vaccination at the earliest opportunity of ages 9-10 rather than later ages (44% vs. 33%, p < 0.001).
Findings of our national study suggest that vaccine champions are common in adolescent primary care, but only a minority lead quality improvement projects. Interventionists seeking to identify champions to improve HPV vaccination rates can expect to find them among both physicians and nurses, but should be prepared to offer support to more fully engage them in implementing interventions.
实施科学研究人员经常指出临床倡导者对于克服组织阻力和其他基于证据的卫生服务实施障碍至关重要，但对于倡导者是谁以及他们如何促成变革却知之甚少。为了为未来识别和吸引倡导者以支持人乳头瘤病毒（HPV）疫苗接种的工作提供信息，我们试图描述在青少年初级保健中工作的疫苗倡导者的关键特征和策略。
2022年，我们对一个由2527名在青少年HPV疫苗接种中发挥作用的初级保健专业人员组成的基于网络的小组进行了全国性调查（回复率为57%）。我们的样本包括儿科医生（26%）、家庭医学医生（22%）、高级执业提供者（24%）和护理人员（28%）。我们的调查评估了初级保健专业人员与疫苗倡导者的经历，疫苗倡导者被定义为“以帮助同事提高疫苗接种率而闻名”的医疗保健专业人员。
总体而言，85%的初级保健专业人员报告目前正在与一名或多名疫苗倡导者合作。在这2144名初级保健专业人员中，大多数人认为与他们合作最密切的倡导者是医生（40%）或护士（40%）。几乎所有被认定的倡导者都致力于总体提高疫苗接种率（45%）或特别是HPV疫苗接种率（49%）。初级保健专业人员普遍报告说，倡导者的实施策略包括与同事分享信息（79%）、鼓励（62%）和疫苗接种数据（59%），但不到一半的人报告说倡导者领导质量改进项目（39%）。大多数初级保健专业人员认为他们最密切的倡导者在提高疫苗接种率方面有中等至极高的成效（91%）。与没有与倡导者合作的初级保健专业人员相比，与倡导者合作的初级保健专业人员更常在9至10岁的最早机会而非更晚年龄推荐HPV疫苗接种（44%对33%，p<0.001）。
我们的全国性研究结果表明，疫苗倡导者在青少年初级保健中很常见，但只有少数人领导质量改进项目。寻求识别倡导者以提高HPV疫苗接种率的干预者可以期望在医生和护士中找到他们，但应准备好提供支持，以使他们更充分地参与实施干预措施。
