Dr. Noel T. Brewer studies how people make decisions about cancer prevention. His current work focuses on increasing HPV vaccination, improving cigarette pack warnings, and communicating the harms of medical screening. Dr. Brewer is Professor of Health Behavior in the Gillings School of Global Public Health at the University of North Carolina and a member of the UNC Lineberger Comprehensive Cancer Center. He is Chair of the National HPV Vaccination Roundtable and Associate Editor of Health Psychology Review. Dr. Brewer has published over 200 papers and co-edited the FDA’s book, Communicating Risks and Benefits: An Evidence-Based User's Guide.
Questions & Answers
The key elements of the program are that:
- the educator is a physician,
- the training is brief (60 mins),
- presumptive announcements and HPV vaccination are the focus, and
- providers practice using presumptive announcement during the training.? ?
Any implementation should have these minimum elements.
Changes that we see as reasonable include to:
- Use online instead of in-person presentation.
- Embed the training in other quality improvement activities, such as AFIX visits or maintenance of certification.
- Offer different incentives. We provided providers with CMEs for attending and physicians an additional $100 to complete a 2-week follow-up survey. The program could instead provide food, new introductions connections to other providers, or public acknowledgment of the excellence of the clinic. Attendance could satisfy training requirements or be compulsory. Increases in vaccination coverage could help meet quality standards such as HEDIS.
- It is increasingly important that all staff at a clinic be on the same page about vaccination. Having all clinical and administrative staff attend the training could help the clinic achieve shared goals.
- The training is well-suited to smaller clinics as well as integrated health systems.
- The training is for professionals who provide adolescent vaccination or other staff who directly support these clinicians. The training is not for academic researchers, parents, children or vaccination policymakers, although they may find the research summary of the trial to be of interest.
A key challenge is recruiting clinics and ensuring providers attend the training. Having a vaccine champion at the clinic who advocates for the training is helpful, especially if the person is a senior clinician. It also helps to communicate that the training saves providers time in every patient visit by structuring these interactions and teaches how to make HPV vaccine discussions comfortable. Thus, the training addresses two main problems providers face: little time and expecting uncomfortable conversations with parents.
Our evaluation instruments are available at HPViq.org.
Process evaluation is relatively cheap; we suggest always assessing how much dose providers received (e.g., how long they were in the training), who attended (percentage of the vaccine prescribers in the clinic), and their satisfaction with the training.
Outcome evaluation can require more resources; as resources permit, we suggest using the state vaccine registry or clinic’s electronic health records to examine changes in HPV vaccination coverage among 11-12-year-olds, preferably those who were seen in the clinic between the intervention time and the follow-up time. An outcome evaluation could also assess increases in positive attitudes toward HPV vaccine discussions, social norms for providing the vaccine, self-efficacy for discussion briefly and effectively, and intention to use presumptive announcements.
Finally, consider adding an “implementation intention” question at the end of the training which can act as a booster to increase use of the approach.