title: Announcements Versus Conversations to Improve HPV Vaccination Coverage: A Randomized Trial.
abstract: Improving provider recommendations is critical to addressing low human papillomavirus (HPV) vaccination coverage. Thus, we sought to determine the effectiveness of training providers to improve their recommendations using either presumptive "announcements" or participatory "conversations."
  
  
  
  In 2015, we conducted a parallel-group randomized clinical trial with 30 pediatric and family medicine clinics in central North Carolina. We randomized clinics to receive no training (control), announcement training, or conversation training. Announcements are brief statements that assume parents are ready to vaccinate, whereas conversations engage parents in open-ended discussions. A physician led the 1-hour, in-clinic training. The North Carolina Immunization Registry provided data on the primary trial outcome: 6-month coverage change in HPV vaccine initiation (≥1 dose) for adolescents aged 11 or 12 years.
  
  
  
  The immunization registry attributed 17 173 adolescents aged 11 or 12 to the 29 clinics still open at 6-months posttraining. Six-month increases in HPV vaccination coverage were larger for patients in clinics that received announcement training versus those in control clinics (5.4% difference, 95% confidence interval: 1.1%-9.7%). Stratified analyses showed increases for both girls (4.6% difference) and boys (6.2% difference). Patients in clinics receiving conversation training did not differ from those in control clinics with respect to changes in HPV vaccination coverage. Neither training was effective for changing coverage for other vaccination outcomes or for adolescents aged 13 through 17 (n = 37 796).
  
  
  
  Training providers to use announcements resulted in a clinically meaningful increase in HPV vaccine initiation among young adolescents.
authors.affiliation: Department of Health Behavior, Gillings School of Global Public Health, and ntb@unc.edu.|Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Noel T
authors.initials: NT
authors.lastname: Brewer
authors.affiliation: Department of Health Behavior, Gillings School of Global Public Health, and.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Hall
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Teri L
authors.initials: TL
authors.lastname: Malo
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; and.
authors.forename: Melissa B
authors.initials: MB
authors.lastname: Gilkey
authors.affiliation: North Carolina Immunization Branch, Raleigh, North Carolina.
authors.forename: Beth
authors.initials: B
authors.lastname: Quinn
authors.affiliation: Department of Health Behavior, Gillings School of Global Public Health, and.
authors.forename: Christine
authors.initials: C
authors.lastname: Lathren
mesh_terms: D000293:Adolescent; D002648:Child; D005194:Family Practice / Q000193:education; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007318:Inservice Training; D008297:Male; D009042:Motivation; D009657:North Carolina; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010290:Parents / Q000193:education*; D010372:Pediatrics / Q000193:education; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D015397:Program Evaluation / Q000706:statistics & numerical data; D012042:Registries
chemical_list: D053918:Papillomavirus Vaccines