RECOMMENDING HPV VACCINATION FOR CHILDREN AGES 9-10 YEARS: COMMUNICATION ROLES AND TRAINING

Introduction. HPV vaccine prevents six cancers, and vaccine recommendations are a strong predictor of children getting vaccinated. Communication training supports frequent and effective recommendations by providers, nurses, and health care assistants. This dissertation aimed to understand the role of these clinical staff in HPV vaccine communication and explore the impact of communication training on recommendation behavior through psychosocial constructs. Methods. In Study 1, I analyzed survey data from a national sample of US clinical staff (n=2,527) describing their role in HPV vaccination for children ages 9-12 years. In Study 2, I conducted a mediation analysis evaluating communication training for clinical staff across two randomized clinical trials (n=500). In a third exploratory study, I described themes from interviews with healthcare system and clinic representatives that implemented the communication training in one of said trials (n=8). Results. In Study 1, providers were more likely than nurses and health care assistants to have communication roles: announce a child is due for HPV vaccine (95% vs. 85%), recommend it (98% vs. 72%), and address concerns about it (97% vs. 83%) (all p<.05). Use of standing orders predicted existing communication roles and future recommendation willingness among nurses and health care assistants (all p<.05). In Study 2, communication training led to increases in Theory of Planned Behavior (TPB) constructs, including HPV vaccine recommendation frequency to children ages 9-10 years (all p<.001). Change in recommendation intention mediated associations between change in recommendation attitudes, norms, and self-efficacy with change in recommendation frequency (a*b pathways=0.13-0.17, all p<.001). In the exploratory study, participants said communication training impacted staff beliefs and confidence about HPV vaccination, organizational and team dynamics, and led to considerations around sustaining training impact.Conclusions. Nurses and health care assistants occupy important roles in HPV vaccine communication for children ages 9-12 years, in partnership with providers. Communication training increased recommendation frequency for children ages 9-10 years through TPB constructs for all staff. These findings bolster the acceptability of beginning HPV vaccination at age 9 and importance of including nurses in vaccine communication, indicating that future work should explore how HPV vaccination interventions leverage these concepts for greater impact.