背景:存在多种促进HPV疫苗接种的循证策略(EBS)。然而,在HPV相关癌症高危社区,青少年HPV疫苗接种率仍低于目标水平,并由安全网诊所提供服务.需要参与式参与方法来利用社区和临床合作伙伴的专业知识来选择与其当地环境相关的EBS。我们采用概念映射作为一种方法来告知EBS的采用和适应,旨在使实施合作伙伴能够优先考虑,选择,并最终实施与上下文相关的EBS用于HPV疫苗接种。
方法:使用来自定性访谈和国家HPV疫苗宣传来源的38份EBS声明,我们在一个更大的实施研究的两个研究地点(大洛杉矶和新泽西),与安全网诊所内部的合作伙伴和外部社区成员进行了修改的概念图活动,对EBS进行分类,并根据在安全网诊所内增加HPV疫苗接种的重要性和可行性对每种EBS进行评级。概念图调查结果(EBS声明评级,梯形图和去区)与来自大型联邦合格医疗中心(FQHC)系统(专注于三个诊所)的领导者共享,选择和实施EBS超过12个月。
结果:概念图参与者(n=23)对陈述进行排序和评级,导致八组解决方案:1)社区教育和外展;2)宣传和政策;3)数据访问/质量改进监测;4)提供商跟踪/审核和反馈;5)提供商推荐/沟通;6)扩大疫苗获取;7)减少错过的机会;8)护士/员工工作流程和培训。然后,FQHC合作伙伴选择干预“前进区”中的17个EBS声明中的8个以采取行动,其中三个来自“减少错失的机会,“两个来自”护士/工作人员的工作流程和培训,\"和一个来自\"供应商跟踪/审计和反馈,\"\"提供者推荐/沟通,“和”扩大疫苗准入,“研究小组通过实施三个多层次干预策略(例如,医师沟通培训,员工培训和工作流程评估,临床流程的审计和反馈)。
结论:概念图提供了一种强有力的参与式方法来确定与当地安全网临床背景相关的HPV疫苗接种的多级EBS,特别是当存在几种策略时,和优先次序是必要的。这项研究表明,在更广泛的安全网诊所背景下,多层次诊所和社区合作伙伴如何直接从EBS的评级和优先排序中受益,以确定和调整推进HPV疫苗公平性所需的优先解决方案。
BACKGROUND: Multiple evidence-based strategies (EBS) for promoting HPV vaccination exist. However, adolescent HPV vaccination rates remain below target levels in communities at high risk for HPV-associated cancers and served by safety-net clinics. Participatory engaged approaches are needed to leverage the expertise of community and clinical partners in selecting EBS relevant to their local context. We engaged concept mapping as a method to inform the adoption and adaptation of EBS that seeks to empower implementation partners to prioritize, select, and ultimately implement context-relevant EBS for HPV vaccination.
METHODS: Using 38 EBS statements generated from qualitative interviews and national HPV vaccine advocacy sources, we conducted a modified concept mapping activity with partners internal to safety-net clinics and external community members in two study sites of a larger implementation study (Greater Los Angeles and New Jersey), to sort EBS into clusters and rate each EBS by importance and feasibility for increasing HPV vaccination within safety-net clinics. Concept mapping findings (EBS statement ratings, ladder graphs and go-zones) were shared with leaders from a large federally qualified health center (FQHC) system (focusing on three clinic sites), to select and implement EBS over 12 months.
RESULTS: Concept mapping participants (n=23) sorted and rated statements, resulting in an eight-cluster solution: 1) Community education and outreach; 2) Advocacy and policy; 3) Data access/quality improvement monitoring; 4) Provider tracking/audit and feedback; 5) Provider recommendation/communication; 6) Expanding vaccine access; 7) Reducing missed opportunities; and 8) Nurse/staff workflow and training. The FQHC partner then selected to intervene on eight of 17 EBS statements in the \"go-zone\" for action, with three from \"reducing missed opportunities,\" two from \"nurse/staff workflow and training,\" and one each from \"provider tracking/audit and feedback,\" \"provider recommendation/communication,\" and \"expanding vaccine access,\" which the research team addressed through the implementation of three multi-level intervention strategies (e.g., physician communication training, staff training and workflow assessment, audit and feedback of clinic processes).
CONCLUSIONS: Concept mapping provided a powerful participatory approach to identify multilevel EBS for HPV vaccination relevant to the local safety-net clinic context, particularly when several strategies exist, and prioritization is necessary. This study demonstrates how a clinic system benefited directly from the ratings and prioritization of EBS by multilevel clinic and community partners within the broader safety-net clinic context to identify and adapt prioritized solutions needed to advance HPV vaccine equity.