A stepped-wedge cluster randomized trial designed to improve completion of HPV vaccine series and reduce missed opportunities to vaccinate in rural primary care practices

Patricia A Carney, Brigit Hatch, Isabel Stock, Caitlin Dickinson, Melinda Davis, Rex Larsen, Steele Valenzuela, Miguel Marino, Paul M Darden, Rose Gunn, Laura Ferrara, Lyle J Fagnan, Patricia A Carney, Brigit Hatch, Isabel Stock, Caitlin Dickinson, Melinda Davis, Rex Larsen, Steele Valenzuela, Miguel Marino, Paul M Darden, Rose Gunn, Laura Ferrara, Lyle J Fagnan

Abstract

Objectives: To test the effectiveness of a comprehensive team-based intervention to improve human papillomavirus (HPV) vaccination completion rates and reduce missed opportunities to vaccinate in rural Oregon.

Design: Stepped-wedge cluster randomized trial.

Participants: Forty family physicians and pediatricians who are members of the Oregon Rural Practice-based Research Network.

Intervention: Tailored to individual practice needs, components will include (1) practice facilitation with clinicians, nurses, front office staff, and others who have patient contact to redesign patient care and communication strategies to optimize HPV vaccine series completion; (2) workflow mapping adapted to practice context to support HPV vaccine delivery; (3) a practice improvement model designed to firmly establish reminder and recall systems and then standing orders; (4) education for patients and parents that underscores HPV vaccination is safe, effective, and an important approach for reducing cancer risk; and (5) partnering with community organizations to plan and implement a social marketing campaign on HPV vaccination.

Main outcome measures: Initiation and completion of the HPV vaccine series as well as reduction in rates of missed opportunities to vaccinate derived from Oregon Immunization Program data.

Trial registration: ClinicalTrials.govPRS, NCT03604393 : .Trial was registered on July 11, 2018. The first participant was enrolled on September 11, 2018.

Keywords: Cancer prevention social media campaigns; Cervical cancer prevention; HPV vaccination; Practice-based research network; Stepped-wedge cluster randomized trial.

Conflict of interest statement

Ethics approval and consent to participate

All study activities have been approved by the Oregon Health & Science University Institutional Review Board (IRB #18660). All participants receive an information sheet about the study that describes the study in detail includes a statement that data collected as part of the study will be published in aggregate form.

Consent for publication

The information sheet includes a statement that data collected as part of the study will be published in aggregate form.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study design
Fig. 2
Fig. 2
RAVE CONSORT diagram, practice eligibility—aims 1 and 2. ORH Oregon Office of Rural Health, RUCA Rural-Urban Commuting Area, LHD Local Health Department, HIS Indian Health Services, VFC Vaccines for Children program, UTD up to date on HPV immunizations
Fig. 3
Fig. 3
Differences in immunization rates between Tdap and HPV: minding the gap

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Source: PubMed

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