Human papillomavirus (HPV) represents a significant threat to global health, which points to the need for implementing effective interventions targeted at its elimination. Vaccinations have been shown to be effective in preventing HPV-related cancers and other complications and are now approved for use in both males and females (Fu, Bonhomme, Chenoa Cooper, Joseph, & Zimet, 2014). Despite the vaccine’s efficacy, current efforts to increase its uptake are inadequate, with deficiencies in the number of people receiving the full series of treatment to eliminate the risks of HPV.
Since HPV is preventable and can be managed with the help of a vaccine, an intervention that is implemented with due consideration of all appropriate steps can reduce its occurrence significantly (Centers for Disease Control and Prevention, 2017). Stopping the virus from spreading at an alarming rate will require better coverage by a vaccination that will be administered to the population at the recommended age of eleven to twelve years (Dempsey et al., 2018). The main barrier to uptake has been linked to parents’ hesitation to allow vaccine administration due to possible side effects, usually lacking awareness of the serious health damage the virus can cause. Therefore the proposal will target the lack of parents’ education by increasing awareness of the HPV vaccine and by administering it at the recommended age.
Provider-focused communication interventions were chosen as the focus of the proposal because they foster strong relationships and collaboration between healthcare professionals and their patients. Because patients between the ages of 11 and 12 cannot make their own decisions regarding vaccine administration, targeting interventions at parents is the first step toward increasing awareness of the persistence of this problem. In the current project proposal, efforts to increase vaccination coverage will be discussed and evaluated. The PICOT question that has been developed is the following: Among parents of adolescent children (P), do provider-focused communication interventions (I) versus no interventions (C) increase acceptance of the HPV vaccine (O) during adolescence (T)?
Appraisal of Evidence
The issue of high rates of HPV among adolescents has received wide attention in the research literature. Most scholars have concluded that the problem requires enhanced efforts associated with both professionals’ and parents’ education. Dempsey et al. (2018), who implemented an intervention for parents’ education with five components, discovered that adolescents whose parents had been educated about the issue had higher rates of vaccine initiation and completion. Similarly, McLean et al. (2017) found that staff education increased the rates of vaccinations, especially within the 11-12 age group. One issue with both interventions is the absence of comparisons with other projects.
Perkins et al. (2015) also studied HPV maintenance programs, finding that focused education and preventative contacts were effective in increasing vaccination rates on a short-term basis. However, the study was flawed due to an inability to consider differences in time trajectories. Cassidy, Braxter, Charron-Prochownik, and Schlenk (2014) only focused on preteen girls and improving their education with the help of briefs, brochures, electronic messages, and provider-administered interventions. Their study was flawed by not including boys in the intervention.
Reno et al. (2018) specifically targeted parents who were hesitant to administer an HPV vaccine to their adolescent children. They implemented a motivational training intervention to educate parents and allow them to provide feedback on any concerns they might have. As a result, the intervention’s outcome was positive – parents increased their self-efficacy and became less hesitant to have the vaccine administered to their children. However, the study was limited by the providers’ lack of proficiency in administering motivational interviewing outside their training sessions.
Overall, the evidence found in the research literature points to large gaps in the proficiency of pediatric health providers in understanding how to convince parents to initiate HPV vaccinations. Most parents are not prepared to talk about the topic of HPV and so are highly likely to overlook its importance. Therefore an intervention should be developed that will consider the need to enhance the education of pediatric healthcare providers, improve their collaboration with parents, and include a diverse sample of patients in order to affect as many adolescents as possible. In addition, there is a need for comparing the outcomes of a provider-oriented intervention with the outcomes for groups that did not participate in an intervention.
The PICOT question concerning HPV vaccinations has both quantitative and qualitative characteristics. A qualitative design provides a systematic subjective approach that will be used for describing the experiences of participants and giving meaning to what they have gone through. Qualitative approaches are often implemented in studying human behaviors, opinions, and themes, and the topic of communicative interventions for HPV prevention will require the exploration of participants’ attitudes and opinions toward a phenomenon.
In contrast, quantitative designs relate to quantities, measurements, and amounts. The quantitative aspect is necessary due to the need to compare HPV vaccination rates between control and intervention groups. With the help of the Florida SHOTS online tracking system, vaccination rates will be monitored in order to evaluate the effectiveness of the proposed provider-focused communication interventions.
Thus the project is expected to make use of a mixed methods design: the comparison of vaccination rates between intervention and control groups as well as the evaluation of providers’ feedback regarding communication intervention. A mixed methods design will make it possible to study the subject in great detail while ensuring that all measurable outcomes are considered. This approach is expected to provide both the breadth and the depth needed for understanding the subject and corroborating hypotheses, as well as for reducing the influence of weaknesses inherent in both quantitative and qualitative designs.
Sample and Setting
The setting of the intervention will include pediatric primary care offices in Florida. It is expected to address at least 200 adolescent patients eligible for receiving a vaccine to prevent HPV. The sample of participants will be divided into an intervention and a control group in order to compare the outcomes of the proposed communication intervention among providers. Both quantitative and qualitative outcome measures will be included in the comparison.
Due to the mixed methods nature of the study, selecting an appropriate sample of participants is necessary. For the implementation of provider-focused communication interventions, a sample of at least forty providers is necessary for the equal division into two groups. Twenty participants in each group will be enough for conducting the intervention as well as for following up on the project with interviews regarding the effectiveness of the program. Also, since the project is expected to last six months, forty participants comprises a group of manageable size for the researcher, and a group with which contact can be maintained.
The sample of patients whom the health providers will serve is expected to reach at least two hundred individuals, with the sample of their parents depending on the family situation. Since these individuals will not be directly involved in the research project, they will not be subject to specific inclusion criteria. The only thing that the researcher will monitor is the eligibility of patients to get vaccinated for HPV.
Inclusion criteria for providers who will be asked to participate in the intervention will include a minimum of three years of experience in the area of pediatric primary care and a desire to contribute to the study. Providers will be approached in randomly selected primary care offices in Florida, likely chosen through convenience sampling due to the need to be accessible to the researcher.
Providing education to health care providers regarding the importance of communicating the need for HPV vaccinations is the key objective of the proposed intervention. The project will encompass such steps as offering HPV intervention training and the integration of an educational tool that providers will then use in their practice. Participants will be asked to take part in several one-hour training sessions run by qualified specialists to increase their awareness of the problem and facilitate discussions on the subject.
Improved provider communication with patients is an integral part of overcoming the burden of HPV vaccination inconsistencies, which is why the proposed intervention will focus on the communicative aspect (Reno et al., 2018). Each training session will include a 20-minute PowerPoint presentation and a 40-minute discussion and training section. During the lessons, participants will focus on the presumptive approach as well as motivational interviewing of their clients when addressing the issue of HPV vaccinations.
A brochure that will include important facts about HPV, images, statistics, and contact information represents an educational tool that participants can use in their future practice. This tool will reduce the knowledge gap that exists within the population of parents with adolescent children and increase the likelihood of more children getting vaccinated. Due to the need to compare pre- and post-intervention rates of HPV vaccinations in the facilities where the providers work, participants in the study will be motivated to use the educational tool to convince as many parents as possible to proceed with vaccinations (Stubbs et al., 2014).
Overall, the education of parents will be the main focus of the intervention because of the need to increase the rate of HPV vaccination among adolescents. As shown by Cassidy et al. (2014), initiatives associated with the education of parents about the importance of HPV vaccinations can improve the uptake of the medication in pediatric practice settings.
After the completion of the proposed intervention, it is expected that several outcome measures will be revealed. First, as a result of educational sessions with healthcare providers in pediatric settings, qualitative outcomes such as feedback from participants regarding the usefulness of the sessions will be collected. Short interviews will assist the researcher in measuring participants’ feedback. Second, changes in vaccination rates will be measured before the intervention and after its implementation to determine whether the educational intervention served its purpose.
In order to record the number of vaccinations performed in the selected healthcare facilities, the Florida SHOTS tracking system will be utilized. Conclusions about the effects of the intervention will be finalized after six months of the project’s implementation. Six months is a viable time period that will show whether the intervention played a positive role in enhancing the practice of pediatric health providers and whether they were able to educate the parents of their patients. Since many providers often feel unprepared to address the concerns of parents about the vaccine, it is essential to measure both their feedback about the educational sessions as well as changes in the vaccination rate.
To collect qualitative data about either the positive or negative effects of the educational intervention, brief interviews will be used. A set of ten open-ended questions will be developed. Then the researcher will contact each intervention participant to ask questions about their perception of the effectiveness of the educational program. To collect quantitative data on the changes in the HPV vaccination rates, the SHOTS tracking system will be used (Bonanni et al., 2015).
Before the implementation of the intervention, the researcher will collect the latest data on HPV vaccinations in the facilities of the providers who will be involved in the intervention. The results will be kept in an Excel document to maintain an effective organization of information. After the educational intervention is implemented, the researcher will collect the latest HPV vaccination data from the same facilities to compare the pre- and post-intervention outcomes.
For analyzing data collected with the help of interviews, a thematic analysis will be used. The researcher will transcribe the responses of the participants into a Word document and then use thematic analysis software for identifying the main trends and topics that the responses have in common (Sutton & Austin, 2015).
It is expected that hesitation to talk to parents about HPV occurrence, issues with finding the right words to describe the problem, the lack of parents’ support for vaccinations, inappropriate training, and other themes will be identified in the course of the analysis (McLean et al., 2017). The analysis of qualitative information will give the researcher a depth of knowledge about the most persistent problems associated with increasing parents’ awareness about HPV and the need for vaccinations.
In order to determine the actual effectiveness of the HPV educational intervention, the difference between the pre- and post-intervention vaccination rates will be measured. The t-test was chosen as the statistical analysis method best suited for comparing the differences in vaccination rates between the intervention and control groups involved in the project. This type of analysis framework is appropriate when studies involve small population sizes and there is a need for testing differences between samples when the variance of normal distributions is unknown (Koricheva, Gurevitch, & Mengersen, 2013). Based on the results of the quantitative and qualitative analysis, the researcher will make conclusions about the effectiveness of the intervention.
The intervention is expected to have several limitations. First, the sample size of only twenty participants for the intervention group is not representative of the entire population of pediatric health providers. Second, it is expected that providers will encounter resistance from their patients’ parents regarding HPV vaccinations (Shay et al., 2016). Third, the inclusion of only several facilities may not be enough to measure the true effect of educational interventions. Because of these barriers, it is recommended to expand the scope of the intervention in the future, especially by involving more pediatric facilities in Florida and measuring the rates of HPV vaccinations in the entire state.
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