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Theory-based development of an implementation intervention to increase HPV vaccination in pediatric primary care practices
BACKGROUND: The national guideline for use of the vaccine targeting oncogenic strains of the human papillomavirus (HPV) is an evidence-based practice that is poorly implemented in primary care. Recommendations include completion of the vaccine series before the 13th birthday for girls and boys, givi...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850961/ https://www.ncbi.nlm.nih.gov/pubmed/29534761 http://dx.doi.org/10.1186/s13012-018-0729-6 |
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author | Garbutt, Jane M. Dodd, Sherry Walling, Emily Lee, Amanda A. Kulka, Katharine Lobb, Rebecca |
author_facet | Garbutt, Jane M. Dodd, Sherry Walling, Emily Lee, Amanda A. Kulka, Katharine Lobb, Rebecca |
author_sort | Garbutt, Jane M. |
collection | PubMed |
description | BACKGROUND: The national guideline for use of the vaccine targeting oncogenic strains of the human papillomavirus (HPV) is an evidence-based practice that is poorly implemented in primary care. Recommendations include completion of the vaccine series before the 13th birthday for girls and boys, giving the first dose at the 11- to 12-year-old check-up visit, concurrent with other recommended vaccines. Interventions to increase implementation of this guideline have had little impact, and opportunities to prevent cancer continue to be missed. METHODS: We used a theory-informed approach to develop a pragmatic intervention for use in primary care settings to increase implementation of the HPV vaccine guideline recommendation. Using a concurrent mixed methods design in 10 primary care practices, we applied the Consolidated Framework for Implementation Research (CFIR) to systematically investigate and characterize factors strongly influencing vaccine use. We then used the Behavior Change Wheel (BCW) and the Theoretical Domains Framework (TDF) to analyze provider behavior and identify behaviors to target for change and behavioral change strategies to include in the intervention. RESULTS: We identified facilitators and barriers to guideline use across the five CFIR domains: most distinguishing factors related to provider characteristics, their perception of the intervention, and their process to deliver the vaccine. Targeted behaviors were for the provider to recommend the HPV vaccine the same way and at the same time as the other adolescent vaccines, to answer parents’ questions with confidence, and to implement a vaccine delivery system. To this end, the intervention targeted improving provider’s capability (knowledge, communication skills) and motivation (action planning, belief about consequences, social influences) regarding implementing guideline recommendations, and increasing their opportunity to do so (vaccine delivery system). Behavior change strategies included providing information and communication skill training with graded tasks and modeling, feedback of coverage rates, goal setting, and social support. These strategies were combined in an implementation intervention to be delivered using practice facilitation, educational outreach visits, and cyclical small tests of change. CONCLUSIONS: Using CFIR, the BCW and the TDF facilitated the development of a pragmatic, multi-component implementation intervention to increase use of the HPV vaccine in the primary care setting. |
format | Online Article Text |
id | pubmed-5850961 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-58509612018-03-21 Theory-based development of an implementation intervention to increase HPV vaccination in pediatric primary care practices Garbutt, Jane M. Dodd, Sherry Walling, Emily Lee, Amanda A. Kulka, Katharine Lobb, Rebecca Implement Sci Research BACKGROUND: The national guideline for use of the vaccine targeting oncogenic strains of the human papillomavirus (HPV) is an evidence-based practice that is poorly implemented in primary care. Recommendations include completion of the vaccine series before the 13th birthday for girls and boys, giving the first dose at the 11- to 12-year-old check-up visit, concurrent with other recommended vaccines. Interventions to increase implementation of this guideline have had little impact, and opportunities to prevent cancer continue to be missed. METHODS: We used a theory-informed approach to develop a pragmatic intervention for use in primary care settings to increase implementation of the HPV vaccine guideline recommendation. Using a concurrent mixed methods design in 10 primary care practices, we applied the Consolidated Framework for Implementation Research (CFIR) to systematically investigate and characterize factors strongly influencing vaccine use. We then used the Behavior Change Wheel (BCW) and the Theoretical Domains Framework (TDF) to analyze provider behavior and identify behaviors to target for change and behavioral change strategies to include in the intervention. RESULTS: We identified facilitators and barriers to guideline use across the five CFIR domains: most distinguishing factors related to provider characteristics, their perception of the intervention, and their process to deliver the vaccine. Targeted behaviors were for the provider to recommend the HPV vaccine the same way and at the same time as the other adolescent vaccines, to answer parents’ questions with confidence, and to implement a vaccine delivery system. To this end, the intervention targeted improving provider’s capability (knowledge, communication skills) and motivation (action planning, belief about consequences, social influences) regarding implementing guideline recommendations, and increasing their opportunity to do so (vaccine delivery system). Behavior change strategies included providing information and communication skill training with graded tasks and modeling, feedback of coverage rates, goal setting, and social support. These strategies were combined in an implementation intervention to be delivered using practice facilitation, educational outreach visits, and cyclical small tests of change. CONCLUSIONS: Using CFIR, the BCW and the TDF facilitated the development of a pragmatic, multi-component implementation intervention to increase use of the HPV vaccine in the primary care setting. BioMed Central 2018-03-13 /pmc/articles/PMC5850961/ /pubmed/29534761 http://dx.doi.org/10.1186/s13012-018-0729-6 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Garbutt, Jane M. Dodd, Sherry Walling, Emily Lee, Amanda A. Kulka, Katharine Lobb, Rebecca Theory-based development of an implementation intervention to increase HPV vaccination in pediatric primary care practices |
title | Theory-based development of an implementation intervention to increase HPV vaccination in pediatric primary care practices |
title_full | Theory-based development of an implementation intervention to increase HPV vaccination in pediatric primary care practices |
title_fullStr | Theory-based development of an implementation intervention to increase HPV vaccination in pediatric primary care practices |
title_full_unstemmed | Theory-based development of an implementation intervention to increase HPV vaccination in pediatric primary care practices |
title_short | Theory-based development of an implementation intervention to increase HPV vaccination in pediatric primary care practices |
title_sort | theory-based development of an implementation intervention to increase hpv vaccination in pediatric primary care practices |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850961/ https://www.ncbi.nlm.nih.gov/pubmed/29534761 http://dx.doi.org/10.1186/s13012-018-0729-6 |
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