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Principal Investigator: William Alexis Calo
Organization: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
Fiscal Year: 2024
Award: $63,731
Funding agency: National Cancer Institute
ABSTRACT
Despite the availability of the human papillomavirus (HPV) vaccine that can prevent over 34,800 HPV-related
cancers in the US every year, only 51% of girls and boys were up-to-date by 2018. Rural populations are the
most impacted by HPV-related cancers. Best practices like the Announcement Approach training and systems
communication have proven effective in increasing HPV vaccination, but rural providers struggle to access and
implement such best practices. These data prompt the question: “How can academic centers support HPV
vaccination in rural primary care practices?” Although never tested for HPV vaccination, the ECHO (Extension
for Community Healthcare Outcomes) Model is a promising implementation strategy (practice facilitation) that
allows “experts” at academic centers to connect with primary care providers to discuss best practices in care
and complex cases managed within local practices. The objective of this R01 is to test two ECHO-delivered
HPV vaccination communication interventions in rural primary care clinics. The first will provide Announcement
Approach training (HPV ECHO); the second will provide this approach plus systems strategies to communicate
with parents who initially decline vaccination (HPV ECHO+). The rationale for the project is that ECHO is a
robust, highly-accessible platform to deliver best practices to rural providers and address the context-specific
communication needs of parents. Our long-term goal is to improve HPV vaccination rates in rural clinics and
reduce the health inequity rural populations experience in cancer outcomes. Aim 1 is to evaluate the impact of
HPV ECHO and HPV ECHO+ on HPV vaccination among adolescents. We will conduct a 3-arm cluster
randomized trial with 36 primary care clinics in rural Pennsylvania. Clinics will be randomized to: HPV ECHO,
HPV ECHO+, or control. Our primary outcome will be change in HPV vaccine initiation (≥1 doses) among
adolescents, ages 11-14, at 12-month follow-up. Aim 2 is to evaluate the impact of HPV ECHO and HPV
ECHO+ on implementation outcomes. Guided by implementation science frameworks, we will conduct a
mixed-methods evaluation to compare interventions on acceptability, adoption, cost, penetration, and
sustainability. Aim 3 is to evaluate the impact of interventions’ vaccine information on secondary acceptance of
HPV vaccination at the clinic level. We will also follow a subset of 200 vaccine-declining parents for up to 12
months to assess exposure to and impact of vaccine information from study arms versus naturally-occurring
sources (e.g., social media) on secondary acceptance. Our expected outcome is to demonstrate the
effectiveness of a highly efficient and scalable implementation strategy, ECHO, to support HPV vaccination in
rural clinics. This study is innovative in leveraging existing infrastructure at academic centers to deliver best
practices for HPV vaccination where they are needed most and in developing a greater understanding of the
influences on decision making among vaccine-declining parents. We expect the project to have a significant
impact on HPV vaccine uptake as we address the communication needs of both rural providers and parents.
Terms: <17 year old><17 years of age><Active Follow-up><Address><Adolescent><Adolescent Youth><Adoption><Age><Area><Behavioral><Cancers><Caring><Case Management><Clinic><Clinic Visits><Clinical><Cluster randomization trial><Cluster randomized trial><Communication><Community Health Care><Community Healthcare><Community Networks><Complex><Consolidated Framework for Implementation Research><Consolidated Framework for Implementation Science><Consolidated Framework for Implementing Change><Data><Decision Making><Dose><Effectiveness><Electronic Health Record><Evaluation><Exposure to><Family Practice><Goals><HPV><HPV Vaccination><HPV Vaccine><HPV induced cancer><HPV infection><HPV malignancy><HPV vaccination acceptability><HPV vaccination acceptance><HPV vaccination confidence><HPV vaccination uptake><HPV vaccine acceptability><HPV vaccine acceptance><HPV vaccine confidence><HPV vaccine uptake><HPV+ cancer><HPV-Related Malignancy><HPV-associated cancer><HPV-associated malignancy><HPV-related cancer><Health Inequity><Healthcare><Human Papilloma Virus><Human Papilloma Virus Vaccination><Human Papilloma Virus Vaccine><Human Papilloma Virus-Related Malignancy><Human Papilloma Virus-Related Malignant Neoplasm><Human Papilloma Virus-associated cancer><Human Papilloma Virus-associated malignancy><Human Papilloma Virus-related cancer><Human Papillomavirus><Human Papillomavirus Vaccination><Human papilloma virus infection><Human papillomavirus Vaccine><Human papillomavirus cancer><Human papillomavirus induced cancer><Human papillomavirus infection><Human papillomavirus malignancy><Human papillomavirus-Related Malignancy><Human papillomavirus-Related Malignant Neoplasm><Inequalities in Health><Inequities in Health><Inequity><Infectious Human Wart Virus><Infrastructure><Intervention><Intervention Strategies><Interview><Investigators><Malignant Neoplasms><Malignant Tumor><Methods><Modeling><Monitor><Notification><Outcome><Parents><Penetration><Pennsylvania><Physicians><President's Cancer Panel><Prevention Research><Provider><Public Health><Randomized><Recommendation><Reporting><Research><Research Personnel><Research Resources><Researchers><Resources><Risk><Rural><Rural Community><Rural Population><Rural group><Rural people><Schedule><Scientist><Source><Structure><Survey Instrument><Surveys><System><Testing><Time><Training><Use Effectiveness><Vaccination><Vaccines><Woman><Work><accept HPV vaccination><accept HPV vaccine><accept human papilloma virus vaccination><accept human papilloma virus vaccine><active followup><age 17 years><ages><arm><assess effectiveness><boys><cancer prevention><care outcomes><community care><compare intervention><compare to control><comparison control><comparison intervention><cost><design><designing><determine effectiveness><effective intervention><effectiveness assessment><effectiveness evaluation><effectiveness testing><effectiveness using><electronic health care record><electronic health medical record><electronic health plan record><electronic health registry><electronic medical health record><evaluate effectiveness><evidence base><examine effectiveness><experience><family medicine><follow up><follow-up><followed up><followup><girls><health care><health care outcomes><health inequalities><healthcare outcomes><hesitant to vaccination><human papilloma virus vaccination acceptability><human papilloma virus vaccination acceptance><human papilloma virus vaccination confidence><human papilloma virus vaccination uptake><human papilloma virus vaccine acceptability><human papilloma virus vaccine acceptance><human papilloma virus vaccine confidence><human papilloma virus vaccine uptake><human papillomavirus associated malignancy><human papillomavirus-associated cancer><human papillomavirus-related cancer><implementation framework><implementation outcomes><implementation research framework><implementation science framework><implementation strategy><improved><innovate><innovation><innovative><intervention arm><interventional strategy><juvenile><juvenile human><malignancy><men><neoplasm/cancer><parent><post intervention><prevent><preventing><primary care clinic><primary care practice><primary care provider><primary outcome><providers from primary care><providers of primary care><randomisation><randomization><randomly assigned><rural America><rural clinic><rural health clinic><rural individual><secondary outcome><seventeen year old><seventeen years of age><sex><social cultural factor><social culture determinant><social media><sociocultural determinant><sociocultural factor><strategies for implementation><treatment arm><vaccination hesitancy><vaccine hesitancy><vaccine hesitant><video based session><video session><wart virus>