Why is announcement training more effective than conversation training for introducing HPV vaccination? A theory-based investigation

Abstract

Background: Improving healthcare providers' communication about HPV vaccination is critical to increasing uptake. We previously demonstrated that training providers to use presumptive announcements to introduce HPV vaccination improved uptake, whereas training them to use participatory conversations had no effect. To understand how communication training changed provider perceptions and communication practices, we evaluated intermediate outcomes and process measures from our randomized clinical trial, with a particular focus on identifying mechanisms that might explain the announcement training's impact.

Methods: In 2015, a physician educator delivered 1-h in-clinic HPV vaccination recommendation trainings at 20 primary care clinics in North Carolina serving 11,578 patients age 11 or 12. Clinics were randomized to receive training to use "announcements" that presume parents are ready to vaccinate or "conversations" that invite dialog about vaccination. Training participants were 83 HPV vaccine providers. Pre- and post-training surveys assessed constructs from the theory of planned behavior (TPB), including providers' attitudes and subjective norms about HPV vaccination and their perceived behavioral control to recommend HPV vaccination. Surveys also assessed providers' perceptions of the announcement and conversation communication strategies.

Results: Both trainings improved TPB-related constructs, including providers' positive attitudes toward HPV vaccination, subjective norms, and perceived behavioral control to recommend the vaccine (all p < .001, Cohen's d = .62-.90). Furthermore, in both trainings, the amount of time providers reported needing to discuss HPV vaccination with parents decreased from pre-training to 1-month follow-up (mean = 3.8 vs. 3.2 min, p = .01, d = .28). However, announcement trainings outperformed conversation trainings on other measures. For example, providers who received announcement training more often reported that the communication strategy saved them time, was easy to use, helped them promote HPV vaccination as routine care, and increased HPV vaccination coverage in their clinics (all p < .05; d = .44-.60).

Conclusions: Both announcement and conversation trainings improved providers' HPV vaccine-related perceptions. However, providers viewed announcements as easier to use and more effective, which may help to explain the success of this training approach. Future provider communication interventions should consider implementation outcomes, including acceptability, alongside more traditional TPB constructs.

Trial registration: clinicaltrials.gov, NCT02377843 . Registered on February 27, 2015.

Keywords: Adolescent health; Cancer; Health communication; Healthcare providers; Human papillomavirus vaccines; Process assessment.

Conflict of interest statement

Ethics approval and consent to participate

The University of North Carolina Institutional Review Board approved the trial protocol (IRB #14-1873). Immediately preceding the training session, research staff disseminated study fact sheets to participants. The IRB granted a waiver of written documentation of informed consent.

Consent for publication

Not applicable.

Competing interests

N.T. Brewer has received research grants from Merck and Pfizer and has served on a paid advisory board for Merck. The remaining authors (TM, MH, CL, MG) 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

Frequency of using announcement and conversation recommendation strategies (n = 83)

Fig. 2

Time it takes to discuss adolescent vaccines (n = 83)

Fig. 3

Increases in HPV vaccination attitudes, subjective norms, and perceived behavioral control (n = 83)