Despite strong evidence the human papillomavirus (HPV) vaccine is effective in preventing certain anogenital cancers, only 69% of adolescent females and 63% of males in the U.S. have initiated the series. Research has demonstrated that the leading predictor of parents? decision to vaccinate their child against HPV is a strong recommendation from physicians. Recent interventions have focused on improving physicians? recommendations through education about national recommendations via presentations, webinars, electronic health record alerts, and quality improvement incentives. Despite the rigorous and innovative methods used, these studies have resulted in variable effects, perhaps, in part, because of the lack of immersive, deliberate practice of communicating vaccine recommendations. Our research team?s long-term goal is to increase HPV vaccination rates in adolescents, which will decrease rates of HPV-associated cancers and pre-cancers. The objective of this application is to evaluate the effectiveness of a novel virtual reality intervention, Virtual Immersive Communication Training on Recommending Immunizations (VICTORI), designed to enhance the strength of physicians? HPV vaccine recommendations through deliberate practice. We will evaluate whether VICTORI improves HPV vaccine initiation and completion rates among 11 to 17-year-old patients, as well as improves physicians? HPV vaccine attitudes, self-efficacy, and strength of recommendation. Our hypothesis is that the implementation of VICTORI will be positively associated with an increase in vaccine initiation and completion rates, and that this association will be mediated by improvements in physician attitudes, self-efficacy, and strength of recommendation. The rationale for the proposed research is that an evaluation of VICTORI will inform effective and scalable strategies to train physicians to provide strong vaccine recommendations, resulting in increased HPV vaccine rates and ultimately lower rates of HPV-associated cancers. To achieve our objective, we will accomplish these specific aims: (1) evaluate VICTORI for acceptability and feasibility, and (2) conduct a single- site intervention assessing the efficacy of VICTORI in increasing HPV vaccine rates. The proposed research is significant because it is the first step in determining the effect of deliberate practice using virtual reality simulations to increase HPV vaccine initiation and completion rates. The approach is innovative because it is the first rigorous effort to develop and evaluate the efficacy of virtual reality as a training platform to teach best-practice communication skills related to HPV vaccine counseling. The expected outcome of this work is successful implementation of VICTORI, designed to increase strong HPV vaccination recommendations by physicians, which in turn will increase HPV vaccination rates.

Public Health Relevance

Lack of strong recommendations by physicians for the human papillomavirus (HPV) vaccine is a primary reason why HPV vaccination rates in the U.S. are substantially below the Healthy People 2020?s objective of 80% coverage for adolescents. Evaluation of an intervention that includes an educational seminar followed by a virtual reality simulation is a vital first step in determining the effect of deliberate practice in increasing strong HPV vaccine recommendations from physicians, and in turn, increasing HPV vaccine initiation rates. The proposed research is relevant to public health because the results will lead to effective interventions utilizing deliberate practice principles to train physicians to strongly recommend the HPV vaccine and is relevant to NIH?s mission because it is expected to ultimately increase HPV vaccination rates, decreasing morbidity and mortality from HPV-associated cancers.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Exploratory/Developmental Grants (R21)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Kobrin, Sarah
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Cincinnati Children's Hospital Medical Center
United States
Zip Code