Usability and Feasibility of AVP-IT: An Online Tool to Facilitate the Implementation of Evidence-Based Strategies to Increase HPV Vaccination Rates in Pediatric Clinics
Introduction
Human papillomavirus (HPV) vaccination rates remain below national goals in the United States despite the availability of evidence-based strategies to increase rates in clinic settings. The Adolescent Vaccination Program (AVP) is a multi-component intervention demonstrated to increase HPV vaccination rates in pediatric clinics by implementing six evidence-based strategies: 1) Immunization champions, 2) assessment and feedback, 3) provider continuing education, 4) provider prompts, 5) parent reminders, and 6) parent education. Online decision support has been demonstrated efficacious in assisting HCPs enhance implementation of clinical protocols.
Methods
The purpose of this study, conducted in Houston, Texas, from 2019-2021, was to adapt the AVP into an online decision support implementation tool for standalone use by clinic staff and to evaluate its feasibility for use in community clinics. Phase 1 (Adaptation) comprised clinic interviews (n=23), literature review, development of an Adolescent Vaccination Program Implementation Tool (AVP-IT) design document, and programming of the online AVP-IT. Phase 2 (Evaluation) comprised usability testing with five healthcare providers (HCPs) and case study feasibility testing in two community-based clinics.
Results
The AVP-IT is housed on a secure UTHealth server and is available at: https://avptexas.org. It comprises four components: 1) ‘About AVP-IT’, 2) ‘My Action Plan’, 3) ‘My Toolkit’, and 4) ‘Contact Us’. It provides user-friendly and tailored guidance to implement AVP strategies regardless of clinic characteristics (e.g., size, network affiliation, and current engagement with strategy implementation) and an Action Plan with tailored guidance (from a possible 14,580 unique tailored combinations) on implementing the six AVP evidence-based strategies. Decision templates (n=31) are provided within the tailored Action Plans or can be accessed individually in the ‘My Toolkit’ section. HCPs rated the AVP-IT as acceptable, credible, easy, helpful, impactful and appealing (≥80% agreement). They rated AVP-IT supported implementation as easier and more effective compared to usual practice (p≤0.05). By three-month follow-up, the participating case study clinic demonstrated implementation of AVP champions and at least partial implementation of provider prompts, patient education, and patient reminders. Strategies of assessment and feedback and CME remained ‘pending.’ Critical facilitators to aid future AVP-IT implementation include leadership support, access to HPV vaccination EHR data, prioritization by staff to include AVP-IT activities in their workflow, and provision of bilingual education materials.
Conclusion
The AVP-IT promises accessible, utilitarian, and scalable decision support on strategies to increase HPV vaccination rates in a variety of pediatric clinic settings. Further feasibility testing was indicated and is currently ongoing in community clinic networks. The effectiveness of the AVP-IT has yet to be determined.