Despite national guidelines for routine administration of human papillomavirus (HPV) vaccine, only 33% of adolescent girls and 7% of adolescent boys in the U.S. currently receive all three recommended doses. Healthcare providers are highly influential in parents'decisions to get their adolescent children HPV vaccine, and yet providers often fail to recommend it. Further, recommendations providers do deliver are often weak. The overall goal of this study is to develop and evaluate a brief training program to improve providers' communication about HPV vaccine. This study will focus specifically on providers in Federally Qualified Health Centers because the low-income and minority adolescents served by these clinics are more likely to suffer from HPV-related cancers later in life. HPV vaccination is, thus, especially important in this setting. In terms of methods, we will first identify provider communication characteristics associated with HPV vaccine delivery (Aim 1). Using existing data, we will conduct a mixed-methods analysis of 204 audio-recorded medical encounters between providers, adolescent patients, and their parents. We will use findings from this analysis to develop a brief educational intervention for providers practicing in low-resource settings (Aim 2). Informed by social cognitive theory, the training's purpose will be to improve providers'knowledge, skills, and confidence for communicating about HPV vaccine. Finally, we will deliver the training to 16 providers in 4 Federally Qualified Health Centers to investigate the intervention's feasibility (Aim 3). Using audio-recordings of medical encounters and surveys of providers, patients, and parents, we will assess the intervention's ability to improve provider perceptions and recommendation practices as well as its acceptability to providers and families. The proposed study builds on Dr. Melissa Gilkey's prior work in survey research and program evaluation aimed at identifying and overcoming barriers to HPV vaccination. The candidate's long-term career goal is to translate research into evidence-based cancer prevention programs for adolescents. Her immediate career goals are to gain content knowledge in patient-provider communication, skills in developing behavioral interventions, and expertise in conducting randomized clinical trials to test those interventions. The proposed career development award will enable Dr. Gilkey to grow as an independent investigator by providing focused training as well as protected time for research. The proposed program of research will lay the groundwork for Dr. Gilkey's first R01-level study to establish the effectiveness of communication training for raising coverage of HPV vaccine.

Public Health Relevance

Human papillomavirus (HPV) vaccination protects against serious diseases, including cervical cancer, but healthcare providers often fail to recommend HPV vaccine according to national guidelines. This study will develop and evaluate a brief training program aimed at increasing providers'knowledge, skills, and confidence to communicate about HPV vaccine with adolescent patients. If effective, this training will offer a low-cost way to support guideline-driven delivery of HPV vaccine to the many adolescents a provider may see each year.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Career Transition Award (K22)
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Special Emphasis Panel (ZCA1-RTRB-A (M2))
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Jakowlew, Sonia B
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Harvard Pilgrim Health Care, Inc.
United States
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Kornides, Melanie L; Fontenot, Holly B; McRee, Annie-Laurie et al. (2018) Associations between parents' satisfaction with provider communication and HPV vaccination behaviors. Vaccine 36:2637-2642
Kornides, Melanie L; McRee, Annie-Laurie; Gilkey, Melissa B (2018) Parents Who Decline HPV Vaccination: Who Later Accepts and Why? Acad Pediatr 18:S37-S43
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Lazalde, Gabriela E; Gilkey, Melissa B; Kornides, Melanie L et al. (2018) Parent perceptions of dentists' role in HPV vaccination. Vaccine 36:461-466
Fontenot, Holly B; Kornides, Melanie L; McRee, Annie-Laurie et al. (2018) Importance of a team approach to recommending the human papillomavirus vaccination. J Am Assoc Nurse Pract 30:368-372
Kornides, Melanie L; Calo, William A; Heisler-MacKinnon, Jennifer A et al. (2018) U.S. Primary Care Clinics' Experiences During Introduction of the 9-Valent HPV Vaccine. J Community Health 43:291-296
Gilkey, Melissa B; Calo, William A; Marciniak, Macary W et al. (2017) Parents who refuse or delay HPV vaccine: Differences in vaccination behavior, beliefs, and clinical communication preferences. Hum Vaccin Immunother 13:680-686
Calo, William A; Gilkey, Melissa B; Shah, Parth et al. (2017) Parents' willingness to get human papillomavirus vaccination for their adolescent children at a pharmacy. Prev Med 99:251-256

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