Vaccines for human papillomavirus (HPV), which are typically given during adolescence, could prevent more than 32,000 cases of cancer in the United States each year. But rates of vaccination among young Americans are lagging far below the target of 80 percent set by the Centers for Disease Control and Prevention.
Recommendations from health care professionals are crucial to increasing these vaccination rates, which is why researchers at the UNC Gillings School of Global Public Health and the Lineberger Comprehensive Cancer Center are launching a new project to give providers the support necessary to improve HPV vaccine communication.
Led by Noel Brewer, PhD, Gillings Distinguished Professor in Public Health, the Improving Provider Announcement Communication Training (IMPACT) Program Project has received $11.7 million in funding from the National Cancer Institute. This five-year endeavor will study health care systems in both urban and rural settings to learn how a provider’s entire team can contribute to vaccine recommendations, what motivates providers to recommend HPV vaccines, who should facilitate training, and what kind of communication interventions are most cost-effective.
The communication interventions will leverage Announcement Approach Training (AAT) developed by Brewer and Melissa Gilkey, PhD, associate professor of health behavior. This training aims to make discussions about HPV vaccines quick and effective for primary care providers.
“Parents value vaccines, but they have more questions about the HPV vaccine than any other adolescent vaccine,” Brewer explained. “This might lead a provider to assume that recommending an HPV vaccine will take too long or that parents place low importance on it. Since HPV is a sexually transmitted infection, discussion of sex and related topics might be uncomfortable for some families and providers. To address these issues, we developed the Announcement Approach, which is a brief method for recommending the HPV vaccine as cancer prevention at the same time as recommending other adolescent vaccines, and we embedded that method into the AAT.”
Brewer and Gilkey are among IMPACT’s four research project leads, along with Professors Justin Trogdon, PhD, and Stephanie Wheeler, PhD, MPH, from the Department of Health Policy and Management, and Sachiko Ozawa, PhD, associate professor from the UNC Eshelman School of Pharmacy and adjunct associate professor of maternal and child health. Nisha Gottfredson, PhD, assistant professor of health behavior, will co-lead the data core with Trogdon.
The IMPACT study will use randomized controlled trials (RCTs) to test several approaches for putting communication strategies into practice. The first RCT, led by Brewer, will explore the impact of standing orders used by physicians to authorize nurses and medical assistants to recommend HPV vaccines. The second RCT, led by Trogdon, will test the effectiveness of provider incentives for meeting vaccination targets. The third RCT, led by Gilkey, will examine the influence of vaccine champions on the implementation of communication strategies. A fourth project, led by Wheeler and Ozawa, will investigate the cost-effectiveness of the three interventions studied in the RCTs.
“Financial incentives are becoming a central part of payment reform efforts that focus on better aligning financial incentives in health care systems with quality of care,” said Trogdon. “No studies have adequately established whether financial incentives motivate providers to recommend HPV vaccination. Our RCT is significant because it will demonstrate whether and how financial incentives improve provider communication and increase vaccine uptake to achieve their HPV vaccination goals.”
The researchers are interested in understanding how to adapt vaccine communication strategies in a variety of health care settings, especially in rural areas where HPV cancer rates are higher than in urban settings. Collaboration with decisionmakers in healthcare systems will be a key part of achieving full adoption of AAT-based communication strategies.
“The IMPACT program is exciting because it takes a ‘learning health care system’ approach to improving the delivery of HPV vaccines,” Gilkey said. “Each project seeks to help health care systems capitalize on existing resources, like vaccination data and clinical champions, to protect adolescents from future HPV cancers.”
Wheeler added, “This study will estimate the population health impact and cost of HPV vaccine communication interventions in both rural and urban areas to help motivate decision makers in diverse health care contexts to adopt these interventions to prevent cancer.”
The team aims to create an AAT Intervention Package – a valuable guide that health care system leaders can use to improve HPV vaccine communication in their organizations and ultimately protect more patients from cancer.