使用概念图为参与式参与方法提供信息,以便在安全网诊所实施循证人乳头瘤病毒疫苗接种策略。

Jennifer Tsui, Michelle Shin, Kylie Sloan, Thomas I Mackie, Samantha Garcia, Anne E Fehrenbacher, Benjamin F Crabtree, Lawrence A Palinkas
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引用次数: 0

摘要

背景:目前有多种循证策略 (EBS) 用于推广 HPV 疫苗接种。然而,在HPV相关癌症高风险社区和安全网诊所服务的青少年中,HPV疫苗接种率仍低于目标水平。需要采取参与式方法,充分利用社区和临床合作伙伴的专业知识,选择适合当地情况的 EBS。我们采用概念绘图法为采用和调整 EBS 提供信息,旨在使实施伙伴有能力优先考虑、选择并最终实施与 HPV 疫苗接种背景相关的 EBS:我们利用从定性访谈和国家 HPV 疫苗宣传资料中获得的 38 个 EBS 语句,与安全网诊所内部的合作伙伴以及大型实施研究的两个研究地点(大洛杉矶地区和新泽西州)的外部社区成员一起开展了一项修改后的概念绘图活动,将 EBS 分成若干组,并根据重要性和可行性对每个 EBS 进行评分,以提高安全网诊所内的 HPV 疫苗接种率。概念图绘制结果(EBS 报表评级、阶梯图和分区)与一个大型联邦合格医疗中心 (FQHC) 系统(重点是三个诊所)的领导者共享,以选择并实施为期 12 个月的 EBS:概念图绘制参与者(23 人)对陈述进行了分类和评级,最终形成了八组解决方案:1) 社区教育和外联;2) 宣传和政策;3) 数据访问/质量改进监控;4) 提供者跟踪/审核和反馈;5) 提供者建议/沟通;6) 扩大疫苗使用范围;7) 减少错失机会;8) 护士/员工工作流程和培训。研究小组通过实施三个多层次的干预策略(如医生沟通培训、员工培训和工作流程评估、诊所流程审计和反馈)来解决这些问题:概念图提供了一种强大的参与式方法,用于确定与当地安全网诊所相关的 HPV 疫苗接种的多层次 EBS,尤其是在存在多种策略且有必要确定优先次序的情况下。本研究展示了诊所系统如何直接受益于多层次诊所和社区合作伙伴在更广泛的安全网诊所背景下对 EBS 的评级和优先排序,以确定和调整推进 HPV 疫苗公平性所需的优先解决方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Use of concept mapping to inform a participatory engagement approach for implementation of evidence-based HPV vaccination strategies in safety-net clinics.

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.

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