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Abstract

Background: The CDC recommends HPV vaccine for all adolescents to prevent cervical, anal, oropharyngeal, vaginal, vulvar, and penile cancers, and genital warts. HPV vaccine rates currently fall short of national vaccination goals. Despite evidence-based strategies with demonstrated efficacy to increase HPV vaccination rates, adoption and implementation of these strategies within clinics is lacking. The Adolescent Vaccination Program (AVP) is a multicomponent systems-based intervention designed to implement five evidence-based strategies within primary care pediatric practices. The AVP has demonstrated efficacy in increasing HPV vaccine initiation and completion among adolescents 10-17 years of age. The purpose of this paper is to describe the application of Intervention Mapping (IM) toward the development, implementation, and formative evaluation of the clinic-based AVP prototype. Methods: Intervention Mapping (IM) guided the development of the Adolescent Vaccination Program (AVP). Deliverables comprised: a logic model of the problem (IM Step 1); matrices of behavior change objectives (IM Step 2); a program planning document comprising scope, sequence, theory-based methods, and practical strategies (IM Step 3); functional AVP component prototypes (IM Step 4); and plans for implementation (IM Step 5) and evaluation (IM Step 6). Results: The AVP consists of six evidence-based strategies implemented in a successful sequenced roll-out that (1) established immunization champions in each clinic, (2) disseminated provider assessment and feedback reports with data-informed vaccination goals, (3) provided continued medical and nursing education (with ethics credit) on HPV, HPV vaccination, message bundling, and responding to parent hesitancy, (4) electronic health record cues to providers on patient eligibility, and (5) patient reminders for HPV vaccine initiation and completion. Conclusions: IM provided a logical and systematic approach to developing and evaluating a multicomponent systems-based intervention to increase HPV vaccination rates among adolescents in pediatric clinics.

Key Take Away Points

  • Evidence-based strategies for HPV vaccination include assessment and feedback, provider skills training, provider EMR cues, and patient reminders.
  • These strategies exist that can enhance clinic HPV vaccination rates but broad implementation within clinics remains a challenge.
  • Intervention Mapping, a stepped systematic development framework, can be used to develop a systems-based intervention for pediatric clinics to implement evidence based strategies.
  • The Adolescent Vaccination Program is a successful theory- and empirically-founded multicomponent systems-based approach, mediated by clinic AVP champions.

Author Biography

Claire Crawford assisted with intervention development and data collection, drafted the initial manuscript, and approved the final manuscript as submitted. Ross Shegog served as a Co-Investigator on the study, contributed to the conceptualization of the intervention and study design, drafted sections of the initial manuscript, critically reviewed and revised the manuscript, and approved the final manuscript as submitted. Sally Vernon served as joint Principal Investigator with Lara Savas on the conceptualization of the intervention and design of the study. Drs. Vernon and Savas oversaw all facets of the study, critically reviewed and revised the manuscript, and approved the final manuscript as submitted. Erica Frost directed all facets of the study, including intervention development, drafted sections of the initial manuscript, critically reviewed and revised the manuscript, and approved the final manuscript as submitted. Mary Healy led the development of the provider continuing education component, contributed her clinical expertise at all stages of the study, critically reviewed and revised the manuscript, and approved the final manuscript as submitted. Sharon Coan assisted with intervention development and data collection, critically reviewed and revised the manuscript, and approved the final manuscript as submitted. Efrat Gabay co-directed intervention development and data collection, critically reviewed and revised the manuscript, and approved the final manuscript as submitted. Stanley Spinner facilitated access to the clinic network, provided expert feedback to develop and refine intervention strategies, critically reviewed and revised the manuscript, and approved the final manuscript as submitted.

Acknowledgements

This research was funded by Prevention Grant #PP140183 and Research Grant #RP150014 from the Cancer Prevention and Research Institute of Texas (CPRIT). We extend our deepest appreciation to the patients and clinicians who participated in the development and testing of the Adolescent Vaccination Program and to the support of the Cancer Prevention and Research Institute of Texas (CPRIT). This research received human research approval from the local human subject research institutional review boards at the University of Texas Health Science Center at Houston (UTHealth) and Baylor College of Medicine. The authors declare that this research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors and their academic institution have received no payment or services from a third party for any aspect of this research. There are no financial relationships with organizations or entities that could be perceived to influence, or that give the appearance of potentially influencing, what has been written in this work. No commercial patents or copyrights are or have been pending, issued, licensed and/or received and no royalties have been received from this research.

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