Pediatricians trained to use presumptive announcements vs. participatory conversation or no training for vaccination campaigns increased HPV vaccination uptake by 5% among younger adolescents, according to data published in Pediatrics.
“A high-quality recommendation by a health care provider is a uniquely potent motivator of HPV vaccine uptake, yet many providers make these recommendations hesitantly, late, or not at all,” Noel T. Brewer, PhD, from the department of health behavior at Gillings School of Global Public Health and Lineberger Comprehensive Cancer Center at the University of North Carolina, and colleagues wrote. “Provider concerns include the time it takes to recommend the vaccine, anticipation of an uncomfortable conversation related to sex and a false perception that parents do not value HPV vaccination.”
To determine whether enhanced communication in the forms of announcement training or conversation training would lead to increased HPV vaccination coverage compared with no training, Brewer and colleagues conducted a randomized clinical trial including 29 pediatric and family medicine practices in central North Carolina. The researchers randomly assigned clinics to receive announcement training, conversation training or no training. They defined announcements brief imperative statements that assume parents are ready to vaccinate their children. In contrast, they defined conversations as encouraging parents to participate in open-ended discussions.
A physician educator traveled to participating clinics to lead 1-hour training sessions on one or the other method of communication. The North Carolina Immunization Registry supplied data on the primary outcome of 6-month coverage change in HPV vaccine initiation of one does or less for children aged 11 to 12 years.
The immunization registry provided data on 17,173 adolescents aged 11 to 12 years and 13 to 17 years from baseline to 3 months and 6 months’ postintervention at the clinics. The data showed those who received announcement training had 37 more patients aged 11 to 12 years who initiated HPV vaccine vs. conversation training and no training (5.4%; 95% CI, 1.1-9.7). Further, stratified analysis indicated initiation increases of 4.6% for girls and 6.2% in boys who received announcements. However, neither training was effective in initiating increased vaccination among adolescents aged 13 to 17 years.
“By achieving a clinically meaningful improvement in HPV vaccine initiation coverage, the announcement training fills an important gap,” the researchers wrote. “Providers describe needing a brief recommendation approach that avoids discussing sex and gives parents an opportunity to ask questions should they wish to, issues that our trainings addressed.
“Additional research is need to better understand how trainings improve coverage and the extent to which providers use announcements in routine clinical practice.” – by Kate Sherrer
Disclosure: The researchers report no relevant financial disclosures.