Improving HPV Vaccine Delivery through the Local Adaptation of Evidence-Based Strategies

Introduction. Training providers to improve their communication is an evidence-based approach to increasing uptake of human papillomavirus (HPV) vaccine. However, scaling up communication interventions in real-world clinical practice remains challenging because of the difficulty of reaching busy providers. We sought to improve the reach and impact of an evidence-based provider communication training intervention through local adaptation and implementation in a large, not-for-profit pediatric healthcare system.

Methods. In 2017, we adapted an existing HPV vaccine communication training program to reflect local stakeholders and settings. We trained local physicians with high HPV vaccination rates to deliver the 1-hour, in-clinic training sessions. Using cluster randomization, we assigned 25 clinics with 77 physicians to receive communication training or waitlist control. Hierarchical linear models assessed HPV vaccination coverage (≥1 dose) over a 6-month period, using electronic medical record data for patients ages 12-14.

Results. Of 45 physicians allocated to communication training, 43 (or 95%) participated. In the overall sample, HPV vaccination coverage increased in both the communication training and control arms (8.6 versus 6.4 percentage points, respectively), although the 2.2 percentage point difference did not reach statistical significance. Intent-to-treat and per-protocol analyses that excluded physicians with poor data quality indicated statistically significant advantages of 3.3-4.2 percentage points for communication training versus control (both b=.034, SE=.015, p<.05).

Conclusions. Our locally-adapted communication training program achieved excellent reach, with modest increases in HPV vaccination coverage. Our findings suggest that adapting existing materials and harnessing local “talent” (in the form of physicians who are already high-performers) are feasible, and may be strategies of interest to other interventionists who seek to improve provider communication. Given the persistent “know-do” gap between research evidence and clinical practice, additional work is urgently needed to support health systems in leveraging local resources to efficiently implement programs to improve the delivery of HPV vaccine and other preventive services for youth.