Investigating Behavioral Mechanisms and Efficacy of a Provider-Directed Intervention for HPV Vaccine Promotion in Real-World Dental Settings

Healthpartners Institute, Minneapolis MN

Investigators

Abstract

Project Summary Human papillomavirus (HPV) is the leading cause of oropharyngeal cancers in the US. Despite the safety and effectiveness of the HPV vaccine (HPV-V), coverage is far below that for other routine adolescent vaccines and the Healthy People 2030 goal of 80%. HPV-V promotion at dental visits is seen as a prime opportunity to prevent oropharyngeal and other cancers, yet many dental providers are not comfortable doing so due to lack of knowledge and self-efficacy, and fear of harming the patient-provider relationship. Using the NIH Stage Model of Behavioral Intervention Development as our guide, we propose to develop a theory-based intervention to address dental provider barriers to HPV-V promotion, elucidate the intervention's behavioral mechanisms, and test the real-world efficacy of the intervention in catalyzing provider HPV-V promotion. The intervention will consist of 1) provider training about HPV/HPV-V; 2) tailored scripts to aid providers in responding to patient/parent/guardian concerns about HPV-V. During the UG3 phase, we will randomize 21 HealthPartners Dental Group clinics to intervention vs. usual care (UC; n=~131 providers). UG3 aims are to: develop survey measures and pilot-test provider HPV-V promotion training (Aim 1) and tailored scripts (Aim 2); develop measures and methods for monitoring provider fidelity to the training and intervention activities (Aim 3); and draft compliance/study documents and obtain IRB/NIDCR approvals (Aim 4). During the UH3 phase, we will conduct a cluster (clinic)-randomized clinical trial (intervention vs. UC) to test the real-world efficacy of the intervention to increase HPV-V promotion activity (Aim 5). We will assess whether the intervention impacted the three intended behavioral mechanism targets: increased knowledge of HPV/HPV-V; increased self-efficacy for HPV-V promotion; and reduced fear of HPV-V promotion negatively affecting the patient- provider relationship (Aim 6). For each target, we will also assess whether the intervention's effects followed the full mechanistic pathway to the endpoint behavior, HPV-V promotion (Aim 7). Beyond our aims, we will conduct exploratory work examining two additional candidate behavioral mechanisms: adequacy of material resources to support dental providers in promoting HPV-V, and providers' perception that HPV-V promotion comports with their professional identity. We will also conduct an exploratory analysis of the intervention's efficacy in increasing HPV-V uptake (30-day post-visit patient vaccination rates). Our long-term goal is to reduce HPV and oropharyngeal cancer prevalence through HPV-V promotion by dental providers. Significant impact of the project includes: 1) developing the first theory-based behavioral intervention for HPV-V promotion aimed at dental providers; 2) delivering the first evidence of real-world efficacy of such an intervention; 3) illuminating behavioral mechanisms purported to underlie provider behavior change; 4) producing fundamental knowledge to guide future HPV-V promotion intervention development; and 5) advancing the science of behavior change by revealing behavioral principles underlying provider behavior change.