Evett Stephanie, Walker Shelley, Ryan Grace W, Steere Eliza, Daly Eliza, Janio Emily A, Pedraza Marin Stephanie, Askelson Natoshia M
Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, Iowa, USA.
State Partnerships, American Cancer Society, Des Moines, Iowa, USA.
J Rural Health. 2025 Jan;41(1):e70006. doi: 10.1111/jrh.70006.
Despite the well-established link between vaccination against human papillomavirus (HPV) and a decreased risk of cancer, HPV vaccine uptake in rural communities is low. Evidence-based interventions (EBIs) to promote HPV vaccination exist but are not universally implemented in rural settings due to various challenges. To understand the support needed by rural clinics in implementing EBIs, the University of Iowa partnered with the American Cancer Society (ACS) to evaluate an ACS HPV Vaccinating Adolescents against Cancers Quality Improvement Learning Collaborative that was delivered to six clinics in two rural health systems. The study aimed to assess the effectiveness of the learning collaborative approach for helping rural clinics implement EBIs aimed at increasing HPV vaccine uptake.
Semistructured interviews were conducted with clinic staff at six time points throughout the 2-year intervention. Interviews were conducted over the phone and were recorded and transcribed. Members of the research team coded the interviews using codebooks informed by the interview guides. The analysis compared the health systems and identified the changes they made in response to assistance provided by the collaborative.
Clinic staff implemented the following EBIs: utilizing the immunization registry, strong provider recommendation, and provider education. Implementation of scheduling next dose fluctuated during the intervention. Differences were noted in the two health systems' implementation using electronic health records for patient and provider reminders.
Small, rural clinics can implement effective EBIs, given proper support. This is important as such EBIs can increase HPV vaccination rates and help prevent HPV-associated cancers.
尽管人乳头瘤病毒（HPV）疫苗接种与降低癌症风险之间的联系已得到充分证实，但农村社区的HPV疫苗接种率仍然很低。促进HPV疫苗接种的循证干预措施（EBIs）是存在的，但由于各种挑战，在农村地区并未得到普遍实施。为了解农村诊所实施循证干预措施所需的支持，爱荷华大学与美国癌症协会（ACS）合作，对一项针对两个农村卫生系统中六个诊所开展的ACS“为青少年接种HPV预防癌症质量改进学习协作项目”进行评估。该研究旨在评估学习协作方法在帮助农村诊所实施旨在提高HPV疫苗接种率的循证干预措施方面的有效性。
在为期2年的干预过程中的六个时间点，对诊所工作人员进行了半结构化访谈。访谈通过电话进行，录音并转录。研究团队成员使用基于访谈指南的编码手册对访谈进行编码。分析比较了两个卫生系统，并确定了它们因协作提供的帮助而做出的改变。
诊所工作人员实施了以下循证干预措施：利用免疫接种登记系统、医生强烈推荐以及医生教育。在干预期间，下一剂疫苗接种安排的实施情况有所波动。在使用电子健康记录进行患者和医生提醒方面，两个卫生系统的实施情况存在差异。
给予适当支持的情况下，小型农村诊所能够实施有效的循证干预措施。这一点很重要，因为此类循证干预措施可以提高HPV疫苗接种率，并有助于预防HPV相关癌症。
