Adaptation and Evaluation of the Clinic-Based Adolescent Vaccination Program (AVP): A Replication Study
Introduction
Underutilization of HPV vaccination in the United States is a persistent problem. We developed the clinic-based multi-component intervention, the Adolescent Vaccination Program (AVP), which comprises six evidence-based strategies that target clinic systems, providers, and parents. Previous examination of the AVP determined its effectiveness in increasing HPV vaccination initiation and completion in a 51-clinic pediatric network in Houston, Texas. This replication study aimed to adapt, implement, and evaluate the AVP effect on vaccination outcomes in a five-clinic pediatric network in San Antonio.
Methods
In 2017, we conducted focus groups and surveys with clinical staff and clinic managers to assess factors affecting provider HPV vaccination recommendations (e.g. provider perceptions of parent hesitancy and sources of hesitancy), and structural factors that affect the implementation of AVP strategies (e.g., EHR capabilities and staff capacity). From 2018 to 2021, we conducted a single group pre- and post-study design to examine the adapted AVP intervention’s effect on HPV vaccination initiation and completion rates.
Results
Formative work revealed new provider perceptions of parent barriers, including increased parental use of social media to inform their vaccination decisions and increased demands on providers to engage with hesitant parents in vaccination conversations. Based on these findings, we adapted the parent education and provider continuing education content. Examination of EHR capabilities also informed the integration of new technical assistance strategies, and adaptation of the assessment and feedback and parent reminder prompt strategies. Among the 6,438 patients (11-17 years) with clinic visits in the evaluation period, (52% female; 43% Hispanic, 39% NH white, 4% NH African American, and 13% other race/ethnicity), HPV vaccination initiation rates increased from 64.7% to 80.2% (p<0.05) and completion rates increased from 43.1% to 60.1% (p<0.05). (See Figure)
Conclusion
Formative work to guide the adaptation and implementation of the AVP promoted the program’s relevance and fit within the new clinic system’s capacity to implement the AVP strategies. Clinic HPV vaccination initiation rates increased corresponding to the AVP rollout, with a leveling of the increase occurring once clinic initiation rates reached 80% of patients. Results successfully replicated the findings of the original 3-year effectiveness trial, which increased rates from 50% to 80%.