Financial Incentives + Communication Training for HPV Vaccine Uptake

Overseen By Justin G Trogdon, PhD

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: UNC Lineberger Comprehensive Cancer Center

Disqualifiers: Non-pediatric clinics, Others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

34 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores methods to help clinics enhance their communication about the HPV vaccine to boost vaccination rates. Some clinics will receive special communication training, known as Healthcare Provider Communication Training, while others will receive training plus financial incentives and feedback on their progress. The trial focuses on clinics in North Carolina with lower HPV vaccination rates among children aged 9-12 and no recent training or financial programs related to the vaccine. As an unphased trial, this study provides a unique opportunity to contribute to the improvement of public health communication strategies.

Will I have to stop taking my current medications?

The trial does not specify whether participants need to stop taking their current medications. However, since the trial involves clinics and their staff rather than individual patients, it is unlikely that personal medication changes are required.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that training healthcare providers to communicate better is safe. Many studies have examined how this training helps providers discuss the HPV vaccine and found no safety issues or negative effects from the training itself.

Regarding financial incentives, research indicates they can effectively increase vaccination rates, including for the HPV vaccine. These incentives are considered safe because they reward reaching certain goals, like higher vaccination rates, and there is no evidence that they harm participants.

Both communication training and financial incentives are well-received. They aim to improve vaccine uptake without directly affecting patients' health. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it combines communication training with financial incentives to boost HPV vaccine uptake. Unlike traditional methods that focus solely on educating patients or parents about the vaccine's benefits, this approach enhances the way clinic staff communicate about the HPV vaccine through the Announcement Approach Training. Additionally, the financial incentive program at the clinic level is a novel strategy aimed at encouraging higher vaccination rates by providing monthly feedback reports. This dual approach could lead to more effective vaccine advocacy and increased vaccination rates, addressing a key barrier in public health.

What evidence suggests that this trial's treatments could be effective for increasing HPV vaccine uptake?

This trial compares two approaches to increase HPV vaccine uptake. One arm involves communication training for healthcare providers, which studies have shown can increase HPV vaccine rates by about 5.2%. This training helps doctors and nurses explain the vaccine more clearly, encouraging parents to agree to it for their children. The other arm combines communication training with a financial incentive program. Research has shown that offering financial rewards can boost the number of people starting the HPV vaccine by around 10%. These rewards motivate clinics or providers to focus more on vaccination efforts. Both methods aim to simplify the decision for patients and their families to choose the HPV vaccine. ^{2 4 6 7 8}

Who Is on the Research Team?

Justin G Trogdon, PhD

Principal Investigator

University of North Carolina, Chapel Hill

Are You a Good Fit for This Trial?

This trial is for pediatric or family medicine clinics in North Carolina with less than a 72% HPV vaccine initiation rate and at least 50 patients aged 9-12. Clinics must have at least two providers offering the HPV vaccine and no recent financial incentives or communication training aimed at increasing vaccination rates.

Inclusion Criteria

Clinics eligible if they are a pediatric or family medicine clinic in North Carolina

My clinic has seen 50 or more patients aged 9-12 last year.

My clinic offers the HPV vaccine from 2 or more providers.

Exclusion Criteria

Clinics had an HPV initiation rate greater than 72%

Clinics had an HPV vaccine-specific financial incentive program in the past two years

Clinics with a specialty other than pediatrics or family medicine

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Training and Intervention

Clinics receive communication training and some receive a financial incentive program with monthly data feedback

24 months

Follow-up

Participants are monitored for changes in HPV vaccination rates

24 months

What Are the Treatments Tested in This Trial?

Interventions

• Communication training
• Financial Incentive

Trial Overview The study is testing if giving clinics financial rewards, along with communication training, increases the number of kids getting the HPV vaccine. Some clinics will just get training, while others will also receive money based on their performance plus monthly progress reports.

How Is the Trial Designed?

Group I: HPV vaccine communication training. Experimental Treatment 1 Intervention

Staff in clinics randomized to this arm will receive an intervention called Announcement Approach Training (AAT). This training is designed to improve communication about HPV vaccination.

Group II: HPV vaccine communication training and clinic-level financial incentive program Experimental Treatment 2 Interventions

Staff in clinics randomized to this arm will receive the Announcement Approach Training and a clinic-level financial incentive program with a monthly data feedback report to increase HPV vaccine uptake.

Who Is Running the Clinical Trial?

UNC Lineberger Comprehensive Cancer Center

Lead Sponsor

Trials

377

Recruited

95,900+

National Cancer Institute (NCI)

Collaborator

Trials

14,080

Recruited

41,180,000+

Published Research Related to This Trial

A $1 increase in median provider payments for HPV vaccination is linked to a 0.48-percentage-point rise in the likelihood of adolescents starting the vaccine series, and a 0.25-percentage-point increase in those receiving two or more doses, indicating that financial incentives can significantly boost vaccination rates.

The impact of provider payments on HPV vaccine uptake is particularly pronounced in younger adolescents (ages 11-12) and those living in urban areas, suggesting targeted financial strategies could enhance vaccination efforts in these groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Provider Payments And The Receipt Of Human Papillomavirus Vaccine Among Privately Insured Adolescents. Tsai, Y., Lindley, MC., Zhou, F., et al.[2019]

This trial will evaluate two ECHO-delivered interventions aimed at increasing HPV vaccination rates among adolescents aged 11-14 in 36 primary care clinics, focusing on the effectiveness of provider training and parent recall notices.

The study aims to demonstrate that these interventions can improve HPV vaccination uptake, ultimately helping to prevent HPV-related cancers by addressing communication needs for both healthcare providers and parents.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Increasing the adoption of evidence-based communication practices for HPV vaccination in primary care clinics: The HPV ECHO study protocol for a cluster randomized controlled trial. Calo, WA., Shah, PD., Fogel, BN., et al.[2023]

An intervention combining behavioral nudges and provider communication training led to increased HPV vaccination rates in some pediatric practices, with 72% of parents reporting their child received the vaccine during the study visit.

Despite the overall increase in vaccination rates, concerns about vaccine safety and necessity persisted among some parents, highlighting the need for continued education and communication about HPV vaccinations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A pilot intervention combining assessment and feedback with communication training and behavioral nudges to increase HPV vaccine uptake. Bradley-Ewing, A., Lee, BR., Doctor, JN., et al.[2022]

A study involving 1,458 adolescents in France found that emphasizing protection against cancer significantly increased the likelihood of accepting the HPV vaccine, while protection against genital warts did not motivate acceptance.

Communicating that over 80% of young people in other countries are vaccinated was highly effective in encouraging vaccine uptake, whereas mentioning serious side effects had a strong negative impact on acceptance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Optimising HPV vaccination communication to adolescents: A discrete choice experiment. Chyderiotis, S., Sicsic, J., Raude, J., et al.[2021]

In a study involving postpartum patients at two hospitals, an electronic medical record (EMR) prompt significantly increased HPV vaccination rates, with 66% of eligible patients receiving the vaccine compared to only 32% with a nurse-based protocol.

Patients at the hospital using the EMR prompt were nearly 6 times more likely to receive the HPV vaccine than those at the hospital using the nurse protocol, highlighting the effectiveness of integrating technology into vaccination strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Success of an EMR-Driven Postpartum Intervention to Improve HPV Vaccination Rates. Park, SK., Holschneider, CH., Chen, J., et al.[2021]

The structured communication training program for medical students, consisting of four interactive lab sessions, significantly enhances their skills in patient-physician communication, which is crucial for improving patient satisfaction and treatment compliance.

Students reported increased confidence and understanding of their roles as future physicians after participating in the program, indicating that such training effectively prepares them for real patient interactions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Teaching communication skills: a skills-based approach. Wagner, PJ., Lentz, L., Heslop, SD.[2022]

An advanced communication skills training program for oncology clinicians, consisting of nine modules, has been successfully implemented at a major cancer center, involving 515 participants since 2006.

The training significantly improved participants' self-efficacy in communicating with cancer patients, indicating that such programs can be both feasible and impactful in enhancing communication skills in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Developing and implementing an advanced communication training program in oncology at a comprehensive cancer center. Bylund, CL., Brown, RF., Bialer, PA., et al.[2022]

Patients who received communication skills training showed significantly higher compliance with treatment recommendations compared to those who were either informed or untrained, indicating the effectiveness of such training.

The study involved 150 patients and 25 family physicians across 9 primary care locations, demonstrating that training can enhance compliance not only with medications but also with behavioral treatments and follow-up appointments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of patient communication skills training on compliance. Cegala, DJ., Marinelli, T., Post, D.[2022]

Communication training for patients is effective in increasing their active participation in healthcare interactions, particularly in expressing concerns, based on a systematic review of 32 intervention studies.

Despite improvements in communication skills, most studies found no significant link between training and better health outcomes or psychosocial wellbeing, indicating a need for further research to identify the most effective training programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Promoting patient participation in healthcare interactions through communication skills training: A systematic review. D'Agostino, TA., Atkinson, TM., Latella, LE., et al.[2018]

Effective communication between healthcare providers and patients leads to improved treatment outcomes, highlighting its importance in patient care.

Providers need to recognize barriers to communication, understand the information that needs to be conveyed, and develop skills to enhance their communication effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving patient care and reducing risk through effective communication. McKerrow, W.[2007]

In a study of 494 females receiving the HPV4 vaccine from 2006 to 2009, only 21% of adolescents and 18% of adults completed all three doses on time, indicating low completion rates overall.

Offering the HPV4 vaccine for free did not significantly improve the likelihood of adults completing the vaccination series on time, suggesting that economic incentives alone may not be sufficient to enhance vaccination adherence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The influence of free quadrivalent human papillomavirus vaccine (HPV4) on the timely completion of the three dose series. Harper, DM., Verdenius, I., Harris, GD., et al.[2019]

The study analyzed 3,456,180 HPV vaccination visits from adolescents aged 11-17 between 2007 and 2014, finding that private providers generally received adequate reimbursements for HPV vaccine purchases, with 89.9% of claims exceeding the CDC's published price.

While the reimbursement for vaccine administration increased over the years, the overall profit margin for private providers remains small, indicating financial challenges despite sufficient coverage for vaccine costs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Insurance reimbursements for human papillomavirus vaccination in the private sector, 2007-2014. Tsai, Y., Lindley, MC., Zhou, F., et al.[2020]

Provider communication, particularly through recommendations, significantly increases HPV vaccine initiation rates, with a pooled odds ratio of 10.1, indicating that patients are much more likely to start the vaccine series when their healthcare provider recommends it.

The study analyzed 59 studies involving over 265,000 patients and found that provider discussions about the vaccine also led to higher initiation rates (odds ratio of 12.4), highlighting the importance of effective communication in improving HPV vaccination coverage.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Provider communication and HPV vaccine uptake: A meta-analysis and systematic review. Oh, NL., Biddell, CB., Rhodes, BE., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11209355/

Clinician Communication Training to Increase Human ... Our findings indicated that clinician communication training could enhance vaccination uptake rates by an average of 5.2%. Specifically, presumptive ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT06926062

Interpersonal Communication Training and Vaccination ... Interpersonal communication training and vaccination workflow training alone or in combination may improve communication and recommendations for HPV vaccination ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S009174352500091X

A scoping review of pediatric healthcare provider HPV ... The aim was to systematically analyze scientific literature assessing the use of implementation outcomes and behavior change theories to evaluate communication ...

4. publications.aap.org publications.aap.org/pediatrics/article/150/2/e2021052351/188506/Coaching-and-Communication-Training-for-HPV

Coaching and Communication Training for HPV Vaccination HPV vaccine initiation was 1.5% points higher in the QI coaching arm and 3.8% points higher in the combined intervention arm than in the control ...

5. jamanetwork.com jamanetwork.com/journals/jamapediatrics/fullarticle/2780244

Effect of Training Pediatric Clinicians in Human ... Online communication training reduced missed opportunities for HPV vaccination, particularly by improving receipt of the first HPV vaccine dose.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9535352/

Coaching and Communication Training for HPV Vaccination We sought to evaluate the effectiveness of combining QI coaching with remote provider communication training to improve impact.

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10298233/

Enhancing HPV Vaccine Uptake among Adolescents of Color This article focuses on provider communication strategies to promote HPV vaccine uptake effectively and equitably.

8. acsjournals.onlinelibrary.wiley.com acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21753

Clinician communication strategies associated with increased ... A growing body of literature examines specific communication strategies for promoting uptake of the HPV vaccine. A comprehensive review of the ...