The overarching goal of this proposal is to develop and test a 3-component intervention to improve provider-level communication and recommendation for the HPV vaccine for adolescent patients. Our intervention is based on principals of the Precaution Adoption Process Model and will target provider-patient communication before, during and after the clinical encounter so as to have the potential to impact many stages of parents'decision-making about the vaccine. The intervention will incorporate two tools developed previously by our research team that have been shown in pilot studies to be effective at improving HPV vaccine decision-making. One is VaxFacts-HPV - a web-based educational tool that will be given to parents prior to the scheduled visit that provides them with individually-tailored educational information about the vaccine reflecting each parent's unique concerns, attitudes and beliefs. The second is our Decision Aid for HPV Vaccines that will be given to parents who remain unconvinced about HPV vaccination at the end of the clinical encounter in order to enable them to prioritize their health goals for their children and make decisions about HPV vaccination that align with those goals. The third, and core, component of our intervention is delivered in the clinic by providers. It consists of a provider-developed, clinic-specific, HPV Fact Sheet, combined with enhanced provider communication skills obtained via a specialized communication training session that is based on the principles of Motivational Interviewing. A cluster-randomized controlled trial design will be used to assess the impact of the provider communication intervention "package" compared to usual practice. Extensive provider feedback will be used to develop the HPV Fact Sheet and the intervention implementation procedures.
The Specific Aims of the project are: 1. To assess baseline adolescent vaccination levels and HPV vaccine communication activities among the study practices. We will use a mixed-methods approach to achieve this Aim. 2. To develop in conjunction with provider feedback the in-clinic HPV Fact Sheet, and overall study implementation procedures. A procedure called "Process Mapping" will be used to develop an implementation plan for the intervention components to optimize their sustainability and acceptability. 3. To implement and assess the impact of the intervention on adolescent vaccine utilization, clinical practice and provider communication. We will assess the impact of the intervention on levels of adolescent HPV vaccination, whether there are "spill over" affects on the use other adolescent vaccines, and whether it impacts clinical practice and parent perceptions about provider's communication about adolescent vaccines.
If our intervention proves efficacious it could have a significant public health benefit by decreasing adolescents'risk for the sequelae from HPV infection. Because our communication-based intervention may impact provider communication about adolescent vaccines more broadly, it may also potentially impact adolescent Tdap, MCV and Flu vaccine utilization. By designing our intervention to facilitate provider-parent communication about vaccines throughout the continuum of the vaccine decision-making process, and incorporating significant provider feedback into the intervention components, our intervention is more likely to be acceptable, feasible and sustainable across a variety of clinical practice types and patient populations.