Abstract
Objective
To evaluate the effectiveness of a multilevel intervention using national partnerships
on human papillomavirus (HPV) vaccination rates.
Methods
The American Cancer Society's Vaccinate Adolescents against Cancer program is a multilevel
intervention focusing on systems and providers. The 2017 cohort introduced national
partnerships to deliver intervention elements and Maintenance of Certification and
continuing medical education credits for physicians. Eleven federally qualified health
center (FQHC) systems completed interventions in 2017. Interventions included provider
training and ≥1 other evidence-based systems improvement. We compared adolescent vaccination
rates in the preintervention period (2016) and intervention period (2017) among adolescents
who turned 13 during the calendar year. Intervention effectiveness was assessed using
repeated measures paired t tests and Cohen's d effect size for vaccination rate change.
Results
All FQHC systems implemented provider training plus an average of 2.3 additional systems
improvements. Series initiation increased by an average of 23.6 percentage points
(47.2%–70.8%). HPV completion rates increased by an average of 22.7 percentage points
(24.6%–46.3%). Meningococcal and Tdap vaccination rates increased by 23.3 and 25.9
percentage points respectively (47.9%–71.2% and 48.8%–74.7%). All changes were statistically
significant (all P < .05) and indicated large effect sizes (Cohen's d3 1.15). Among clinicians completing postintervention surveys, 90% reported making
changes to their health care system or direct patient care based on what they had
learned.
Conclusions
Multilevel interventions focusing on provider training and systems changes can substantially
improve on-time adolescent vaccination coverage and can be successfully performed
using national partnerships and a train-the-trainer model.
Keywords
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Article Info
Publication History
Published online: May 20, 2021
Accepted:
May 13,
2021
Received:
January 4,
2021
Footnotes
The authors have no conflicts of interest to disclose.
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of Academic Pediatric Association
