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Randomized Controlled Trial
. 2017 Jan;139(1):e20161764.
doi: 10.1542/peds.2016-1764. Epub 2016 Dec 5.

Announcements Versus Conversations to Improve HPV Vaccination Coverage: A Randomized Trial

Noel T Brewer  1   2 , Megan E Hall  3 , Teri L Malo  2 , Melissa B Gilkey  4 , Beth Quinn  5 , Christine Lathren  3
Affiliations
Randomized Controlled Trial

Announcements Versus Conversations to Improve HPV Vaccination Coverage: A Randomized Trial

Noel T Brewer et al. Pediatrics. 2017 Jan.

Abstract

Objective: Improving provider recommendations is critical to addressing low human papillomavirus (HPV) vaccination coverage. Thus, we sought to determine the effectiveness of training providers to improve their recommendations using either presumptive "announcements" or participatory "conversations."

Methods: In 2015, we conducted a parallel-group randomized clinical trial with 30 pediatric and family medicine clinics in central North Carolina. We randomized clinics to receive no training (control), announcement training, or conversation training. Announcements are brief statements that assume parents are ready to vaccinate, whereas conversations engage parents in open-ended discussions. A physician led the 1-hour, in-clinic training. The North Carolina Immunization Registry provided data on the primary trial outcome: 6-month coverage change in HPV vaccine initiation (≥1 dose) for adolescents aged 11 or 12 years.

Results: The immunization registry attributed 17 173 adolescents aged 11 or 12 to the 29 clinics still open at 6-months posttraining. Six-month increases in HPV vaccination coverage were larger for patients in clinics that received announcement training versus those in control clinics (5.4% difference, 95% confidence interval: 1.1%-9.7%). Stratified analyses showed increases for both girls (4.6% difference) and boys (6.2% difference). Patients in clinics receiving conversation training did not differ from those in control clinics with respect to changes in HPV vaccination coverage. Neither training was effective for changing coverage for other vaccination outcomes or for adolescents aged 13 through 17 (n = 37 796).

Conclusions: Training providers to use announcements resulted in a clinically meaningful increase in HPV vaccine initiation among young adolescents.

Trial registration: ClinicalTrials.gov NCT02377843.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Brewer reports receiving commercial research grants from Merck, Pfizer, and GSK and serving on a paid advisory board for Merck. Dr Brewer did not use Merck resources to support this trial. The other authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Trial flow diagram. QI, quality improvement; vax, vaccine.
FIGURE 2
FIGURE 2
Announcement and conversation training content.
See this image and copyright information in PMC

References

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    1. Gilkey MB, Malo TL, Shah PD, Hall ME, Brewer NT. Quality of physician communication about human papillomavirus vaccine: findings from a national survey. Cancer Epidemiol Biomarkers Prev. 2015;24(11):1673–1679 - PMC - PubMed

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