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Abstract：
BACKGROUND: Despite the availability of school-based human papillomavirus (HPV) vaccination programs, disparities in vaccine coverage persist. Barriers to HPV vaccine acceptance and uptake include parental attitudes, knowledge, beliefs, and system-level barriers. A total of 3 interventions were developed to address these barriers: an in-person presentation by school nurses, an email reminder with a web-based information and decision aid tool, and a telephone reminder using motivational interviewing (MI) techniques.
OBJECTIVE: Here we report on the development and formative evaluation of interventions to improve HPV vaccine acceptance and uptake among grade 4 students\' parents in Quebec, Canada.
METHODS: In the summer of 2019, we conducted a formative evaluation of the interventions to assess the interventions\' relevance, content, and format and to identify any unmet needs. We conducted 3 focus group discussions with parents of grade 3 students and nurses. Interviews were recorded, transcribed, and analyzed for thematic content using NVivo software (Lumivero). Nurses received training on MI techniques and we evaluated the effect on nurses\' knowledge and skills using a pre-post questionnaire. Descriptive quantitative analyses were carried out on data from questionnaires relating to the training. Comparisons were made using the proportions of the results. Finally, we developed a patient decision aid using an iterative, user-centered design process. The iterative refinement process involved feedback from parents, nurses, and experts to ensure the tool\'s relevance and effectiveness. The evaluation protocol and data collection tools were approved by the CHU (Centre Hospitalier Universitaire) de Québec Research Ethics Committee (MP-20-2019-4655, May 16, 2019).
RESULTS: The data collection was conducted from April 2019 to March 2021. Following feedback (n=28) from the 3 focus group discussions in June 2019, several changes were made to the in-person presentation intervention. Experts (n=27) and school nurses (n=29) recruited for the project appreciated the visual and simplified information on vaccination in it. The results of the MI training for school nurses conducted in August 2019 demonstrated an increase in the skills and knowledge of nurses (n=29). School nurses who took the web-based course (n=24) filled out a pretest and posttest questionnaire to evaluate their learning. The rating increased by 19% between the pretest and posttest questionnaires. Several changes were made between the first draft of the web-based decision-aid tool and the final version during the summer of 2019 after an expert consultation of experts (n=3), focus group participants (n=28), and parents in the iterative process (n=5). More information about HPV and vaccines was added, and users could click if more detail is desired.
CONCLUSIONS: We developed and pilot-tested 3 interventions using an iterative process. The interventions were perceived as potentially effective to increase parents\' knowledge and positive attitudes toward HPV vaccination, and ultimately, vaccine acceptance. Future research will assess the effectiveness of these interventions on a larger scale.
OBJECTIVE: Here we report on the development and formative evaluation of interventions to improve HPV vaccine acceptance and uptake among grade 4 students\' parents in Quebec, Canada.
METHODS: In the summer of 2019, we conducted a formative evaluation of the interventions to assess the interventions\' relevance, content, and format and to identify any unmet needs. We conducted 3 focus group discussions with parents of grade 3 students and nurses. Interviews were recorded, transcribed, and analyzed for thematic content using NVivo software (Lumivero). Nurses received training on MI techniques and we evaluated the effect on nurses\' knowledge and skills using a pre-post questionnaire. Descriptive quantitative analyses were carried out on data from questionnaires relating to the training. Comparisons were made using the proportions of the results. Finally, we developed a patient decision aid using an iterative, user-centered design process. The iterative refinement process involved feedback from parents, nurses, and experts to ensure the tool\'s relevance and effectiveness. The evaluation protocol and data collection tools were approved by the CHU (Centre Hospitalier Universitaire) de Québec Research Ethics Committee (MP-20-2019-4655, May 16, 2019).
RESULTS: The data collection was conducted from April 2019 to March 2021. Following feedback (n=28) from the 3 focus group discussions in June 2019, several changes were made to the in-person presentation intervention. Experts (n=27) and school nurses (n=29) recruited for the project appreciated the visual and simplified information on vaccination in it. The results of the MI training for school nurses conducted in August 2019 demonstrated an increase in the skills and knowledge of nurses (n=29). School nurses who took the web-based course (n=24) filled out a pretest and posttest questionnaire to evaluate their learning. The rating increased by 19% between the pretest and posttest questionnaires. Several changes were made between the first draft of the web-based decision-aid tool and the final version during the summer of 2019 after an expert consultation of experts (n=3), focus group participants (n=28), and parents in the iterative process (n=5). More information about HPV and vaccines was added, and users could click if more detail is desired.
CONCLUSIONS: We developed and pilot-tested 3 interventions using an iterative process. The interventions were perceived as potentially effective to increase parents\' knowledge and positive attitudes toward HPV vaccination, and ultimately, vaccine acceptance. Future research will assess the effectiveness of these interventions on a larger scale.
摘要：
背景：尽管有基于学校的人乳头瘤病毒（HPV）疫苗接种计划，疫苗覆盖率的差异仍然存在。HPV疫苗接受和吸收的障碍包括父母的态度，知识,信仰,以及系统层面的障碍。总共开发了3种干预措施来解决这些障碍：学校护士的面对面介绍，带有基于Web的信息和决策辅助工具的电子邮件提醒，和使用动机面试(MI)技术的电话提醒。
目的：在这里，我们报告了旨在提高魁北克四年级学生父母对HPV疫苗的接受度和吸收的干预措施的发展和形成性评估，加拿大。
方法：在2019年夏天，我们对干预措施进行了形成性评估，以评估干预措施的相关性，内容,和格式，并确定任何未满足的需求。我们与三年级学生和护士的家长进行了3次焦点小组讨论。采访被记录下来，转录，并使用NVivo软件(Lumivero)分析主题内容。护士接受了MI技术培训，我们使用事前问卷评估了对护士知识和技能的影响。对与培训有关的问卷数据进行了描述性定量分析。使用结果的比例进行比较。最后,我们使用迭代开发了一个病人决策辅助工具，以用户为中心的设计过程。迭代细化过程涉及来自父母的反馈，护士,和专家，以确保工具的相关性和有效性。评估方案和数据收集工具由魁北克研究伦理委员会（MP-20-2019-4655，2019年5月16日）批准。
结果：数据收集于2019年4月至2021年3月进行。根据2019年6月3次焦点小组讨论的反馈（n=28），对面对面演示干预进行了一些更改。该项目招募的专家（n=27）和学校护士（n=29）赞赏其中有关疫苗接种的视觉和简化信息。2019年8月对学校护士进行MI培训的结果表明，护士的技能和知识有所增加（n=29）。参加网络课程的学校护士（n=24）填写了前测和后测问卷来评估他们的学习情况。在前测和后测问卷之间，评分提高了19％。经过专家咨询（n=3），基于网络的决策辅助工具的初稿和2019年夏季的最终版本之间进行了一些更改。焦点小组参与者(n=28)，和父母在迭代过程中(n=5)。添加了有关HPV和疫苗的更多信息，和用户可以点击，如果需要更多的细节。
结论：我们使用迭代过程开发并初步测试了3种干预措施。这些干预措施被认为可能有效地增加父母对HPV疫苗接种的知识和积极态度。最终,疫苗验收。未来的研究将在更大范围内评估这些干预措施的有效性。
目的：在这里，我们报告了旨在提高魁北克四年级学生父母对HPV疫苗的接受度和吸收的干预措施的发展和形成性评估，加拿大。
方法：在2019年夏天，我们对干预措施进行了形成性评估，以评估干预措施的相关性，内容,和格式，并确定任何未满足的需求。我们与三年级学生和护士的家长进行了3次焦点小组讨论。采访被记录下来，转录，并使用NVivo软件(Lumivero)分析主题内容。护士接受了MI技术培训，我们使用事前问卷评估了对护士知识和技能的影响。对与培训有关的问卷数据进行了描述性定量分析。使用结果的比例进行比较。最后,我们使用迭代开发了一个病人决策辅助工具，以用户为中心的设计过程。迭代细化过程涉及来自父母的反馈，护士,和专家，以确保工具的相关性和有效性。评估方案和数据收集工具由魁北克研究伦理委员会（MP-20-2019-4655，2019年5月16日）批准。
结果：数据收集于2019年4月至2021年3月进行。根据2019年6月3次焦点小组讨论的反馈（n=28），对面对面演示干预进行了一些更改。该项目招募的专家（n=27）和学校护士（n=29）赞赏其中有关疫苗接种的视觉和简化信息。2019年8月对学校护士进行MI培训的结果表明，护士的技能和知识有所增加（n=29）。参加网络课程的学校护士（n=24）填写了前测和后测问卷来评估他们的学习情况。在前测和后测问卷之间，评分提高了19％。经过专家咨询（n=3），基于网络的决策辅助工具的初稿和2019年夏季的最终版本之间进行了一些更改。焦点小组参与者(n=28)，和父母在迭代过程中(n=5)。添加了有关HPV和疫苗的更多信息，和用户可以点击，如果需要更多的细节。
结论：我们使用迭代过程开发并初步测试了3种干预措施。这些干预措施被认为可能有效地增加父母对HPV疫苗接种的知识和积极态度。最终,疫苗验收。未来的研究将在更大范围内评估这些干预措施的有效性。
