Abstract
Who Gets a Provider Recommendation? Reducing Missed Opportunities to Promote the HPV Vaccine to Male and Female Teens in the U.S
Melinda Krakow, Ph.D.1, Olivia Cosides, MHS2, Anna Beavis, MD3 and Anne Rositch, PhD2
(1)National Cancer Institute, Bethesda, MD, (2)Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (3)Johns Hopkins Medicine, Baltimore, MD
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Objectives. To address low adolescent HPV vaccination rates, the President's Cancer Panel called for increasing communication to reduce missed vaccination opportunities. Therefore, we examined the association between receiving a provider recommendation for the HPV vaccine and subsequent initiation of the HPV vaccine series between ages 13-17. Furthermore, we sought to identify important subgroups less likely to receive recommendations.
Methods. We analyzed provider-verified HPV vaccine initiation as reported in the CDC's 2014 National Immunization Survey for Teens (unweighted n =19,338). Survey-weighted log-binomial regression models assessed prevalence ratios of vaccination among teens whose parents reported receiving a recommendation compared to those who did not. Chi-square analyses identified differences in groups with/without provider recommendation.
Results. Overall, teens who received a provider recommendation were more likely to initiate vaccination compared those missing this communication (PR:2.66; 95% CI:2.43-2.91). Females with recommendation were twice as likely to vaccinate (PR:1.93; 95% CI:1.72-2.17), and males with recommendation were three times more likely (PR:3.29; 95% CI:2.88-3.76), although less males received recommendations (53% vs. 74% in females). In addition, teens in Southern states and those without an 11/12-year-old wellness exam were less likely to receive a recommendation.
Conclusions. Provider recommendation is significantly associated with teen initiation of the HPV vaccine. Encouraging providers to share clear, timely recommendations is a simple and cost-effective intervention to improve vaccination rates among adolescents in the U.S. Intervention efforts can be targeted to subgroups we have identified as less likely to have received such recommendations, including males and teens in the South, to improve nationwide vaccination rates.
Communication and informatics Epidemiology Public health or related research Social and behavioral sciences
Abstract
Health Care Providers' Understanding of Patients' and Parents' of Patients Perceptions of Vaccinations
Marilee Long, Ph.D.1, Greg Boiarsky, Ph.D.2 and Danielle Stomberg, PhD Student1
(1)Colorado State University, Fort Collins, CO, (2)Fort Collins, CO
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
The U.S. population has vaccination rates well below desired levels for preventable diseases like measles, mumps, rubella, influenza, and HPV. These rates result in part from public misperceptions of vaccination risks, mistrust of the medical establishment, and rarity of vaccine-preventable diseases. Such barriers to vaccination cannot be addressed solely by providing accurate information. Non-rational factors like people's motivations, values, and information-processing strategies must also be considered. These factors are often more important than scientific evidence when consumers make vaccination decisions.
Current research focuses on the patient side of the equation; the health-care-provider side receives much less attention. Knowledge of providers' communication strategies and their perceptions of patients' vaccine-related beliefs (providers' metacognitions about patients' beliefs) is particularly low. These strategies and perceptions partly determine how providers communicate about vaccines, affecting patient/child vaccination decisions. Better understanding of providers' metacognitions regarding patients' vaccination knowledge, attitudes, beliefs, intentions, and information sources is mandatory, as is deeper understanding of providers' vaccine “scripts”—strategies providers rely on when communicating complex information in time-limited circumstances.
This qualitative study examines health care providers in northern Colorado, a state with the eighth-highest rate of non-medical vaccine exemptions and the lowest national immunization rates for MMR, DTaP, and varicella. Northern Colorado is particularly important, as it has experienced recent pertussis outbreaks.
The study employs semi-structured, in-depth interviews to investigate medical providers' perceptions, knowledge, and information sources. Particular attention is paid to patterns in providers' perceptions of patient barriers and their communication styles. Understanding these patterns may improve patient vaccination compliance.
Protection of the public in relation to communicable diseases including prevention or control Social and behavioral sciences
Abstract
Primary Care Provider Communication about Adolescent HPV Vaccination: Time Spent and Tools Used
Amanda Dempsey, MD, PhD, MPH1, Sean O'Leary, MD, MPH2, Steven Lockhart, MPH1, Jennifer Pyrzanowski, MPH1, Elizabeth Campagna, MS3 and Jenna Reno, PhD4
(1)University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, (2)University of Colorado, Aurora, CO, (3)University of Colorado Denver, Aurora, CO, (4)U Colorado- Denver, Aurora, CO
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: There has been no prior research on what tools are currently used by primary care providers to communicate about adolescent human papillomavirus (HPV) vaccine recommendations, or how these tools impact the quality of providers' vaccine recommendations during clinical visits.
Objective: To assess HPV vaccine communication tools currently used by providers, and how these impact the quality of their HPV vaccine recommendations at clinical visits.
Methods: This was a cross sectional survey of 183 primary care providers from 16 practices in central Colorado that were enrolled in a cluster-randomized, controlled trial evaluating a physician HPV vaccine communication toolkit. Chi-square and t-tests were used to assess the relationship between communication tool use with four measures of the quality of providers' HPV vaccine recommendations: communication style, continued recommendation despite initial resistance, strength of recommendation, and with the time spent discussing the vaccine.
Results: Response rate was 82%. Providers used an average of 2 communication tools during visits and 1 tool between visits with VIS sheets used most commonly. Providers spending >5 minutes discussing HPV vaccines used significantly more total tools than those spending <5 minutes in the discussion, for both HPV vaccine accepting (4.1 vs. 2.9, p<0.01) and hesitant (3.3 vs 2.6, p=0.02) parents. Number of tools used was not significantly associated with any other measure of HPV vaccine recommendation quality.
Conclusions: The communication tools currently used by providers regarding HPV vaccines are not time efficient nor do they promote high quality vaccine recommendations. Better tools are needed.
Administer health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Provision of health care to the public
Abstract
Influence of the "Protect Their Future" Video Intervention on Rural Parental Intentions to Vaccinate Adolescents
Elisia Cohen, PhD1, Robin Vanderpool, Dr.PH2, Phil Westgate, Ph.D.2, Jenna Reno3, Katharine Head, PhD4, Adam Parrish, MA5, Audrey Bachman2 and Sarah Vos, PhD2
(1)University of Kentucky College of Communications and Information Studies, Lexington, KY, (2)University of Kentucky, Lexington, KY, (3)U Colorado- Denver, Denver, CO, (4)Indiana University-Purdue University Indianapolis, Indianapolis, IN, (5)University of Kentucky, Lexington, KS
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
This study tested the influence of the “Protect Their Future” video intervention on adult intentions to vaccinate their adolescents. The study included 529 parents of 11- to 19-year-old adolescents in Appalachian Kentucky enrolled in group randomized controlled trial arms at 14 health clinic and community sites (seven in each arm) across eight counties. Approximately half the parents (n = 263) parents were enrolled in the full intervention. Participants in the intervention and control did not significantly differ by education, race, percentage working full-time, or gender. Both site type (clinic or community) and enrollment site clustering effects were examined. Individuals in the intervention were 1.67 times more likely (p = .09) to intend for their adolescent to receive influenza immunization; additionally, having a positive attitude was associated with influenza vaccination intention (p < .0001). Enrollment in the clinic or community setting and supportive parental norms was not significantly associated with FLU intent. The multivariate model for the TRA held for meningitis immunization. Parents with positive immunization attitudes and norms were more likely to intend to immunize against meningitis (p p > .10), parents recruited from the clinical setting were more likely to report meningitis immunization intentions (p =. 09). Individuals in the intervention were 3.3 times more likely (p = .005) to intend for their female adolescent to receive HPV immunization; having supportive parental attitudes was associated with intention to immunize females against HPV (p = .0002). However, there was no support for the multivariate model for male HPV immunization. This study suggests that a general “adolescent immunization platform” promotion video may be most supportive in vaccination contexts where the descriptive norms are well established, as is currently the case for meningitis, flu, and female HPV vaccination rates. Implications for male HPV parental education needs are discussed.
Advocacy for health and health education Communication and informatics Implementation of health education strategies, interventions and programs Public health or related education Public health or related research Social and behavioral sciences
Abstract
Millennials' Beliefs and Behaviors Regarding Immune Boosting Strategies for Flu Prevention: Implications for a Co-Branding Approach to Promote Flu Vaccination
Alec Ulasevich, PhD, Samantha Jacobs, MPH, Max van Over, MPH and Djass Mbangdadji, MS, MBA
EurekaFacts, LLC, Rockville, MD
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Previous studies have noted that beliefs in a “strong immune system” or engaging in “immune boosting” strategies were among some of the most important barriers to flu vaccine uptake. While a strong immune system is generally an advantage to one's health, relatively healthy adults can experience severe complications from flu, and can spread it to others. This study examines millennials' attitudes and behaviors towards seasonal flu vaccination in relationship to “immune boosting” strategies. Data were collected using an online survey administered to a panel of millennials, ages 18 to 34 (n=1,181). Over two-thirds of respondents believed that having a strong immune system would prevent them from getting the flu. Behaviors related to this belief (getting enough sleep, staying fit, and eating healthy) were considered more efficacious in preventing flu than the flu vaccine. Those who held the belief that a strong immune system prevents the flu were 63% less likely to get a flu shot, and were more likely to engage in other preventive strategies, such as eating special foods, wearing warm clothing and eating a healthy diet. Findings suggest that millennials' engagement in alternative strategies may be at the expense of getting vaccinated. A solution to this public health conundrum may lie in a co-branding approach. Convincing millennials that flu vaccination is both compatible and complementary to the alternative behaviors they are already engaged in to prevent the flu may help to engage the audience and leverage their existing motivations towards the recommended action.
Communication and informatics Protection of the public in relation to communicable diseases including prevention or control Public health or related research Social and behavioral sciences