Comparative Effectiveness of System Interventions to Increase HPV Vaccine Receipt in FQHCs

NCT ID: NCT03726151

Last Updated: 2023-05-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

17000 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-05-01

Study Completion Date

2023-10-31

Brief Summary

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UCLA and Northeast Valley Health Center (NEVHC), a large, multi-site Federally Qualified Health Center (FQHC), are partnering to address underutilization of the prophylactic HPV vaccine among underserved, ethnic minority adolescents receiving care through FQHCs. We will use a cluster randomized 2x2 stepped-wedge factorial study design, implemented in seven NEVHC clinics, to compare the effectiveness of parent reminders (mailed and text), multi-component clinic system strategies, a combined intervention (parent reminders + clinic system strategies) and usual care on HPV vaccine series completion among NEVHC adolescent patients. FQHCs provide essential health care to underserved groups and have the infrastructure to sustain effective strategies to improve preventive care delivery. Therefore, study findings will be invaluable for informing future efforts to improve HPV vaccination at the population-level.

Detailed Description

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The primary aims of this study are to: 1) Examine the effects of two types of parent reminders (mailed, text) and multicomponent clinic system strategies on HPV vaccine completion compared to usual care, 2) Examine the comparative effectiveness of the reminders versus the clinic system strategies and 3) Examine whether combining parent reminders with the clinic system strategies produces larger effects compared to either type of intervention implemented alone.

Additional aims include:

* Explore the relationship between child age (12-14 years versus 15-17 years) and intervention effectiveness, due to the difference in dosing schedules for the two age groups.
* Examine parent (e.g., language preference) and provider (e.g., specialty) characteristics that may act as moderators of intervention effectiveness.
* Assess parent perspectives and experiences related to the different interventions.
* Examine the implementation process (including adaptations) for each of the interventions.
* Disseminate study findings widely to a local and national audience of relevant stakeholders.

The multicomponent clinic system strategies include workflow modifications to minimize missed opportunities for vaccination, provider- and clinic-level audit and feedback, establishment of clinic-level policies and protocols, and will also include provider and staff training regarding workflow modifications and patient communication strategies.

The study will be implemented across six study periods of 12 months each. The seven NEVHC clinics will be randomized into three groups (A, B, C). Following a 12-month start-up and observation period (Period 1), as part of a stepped wedge design, Group A will implement the parent reminders beginning in Period 2, Group B will implement the clinic-based intervention beginning in Period 3, and Group C will implement the combined condition beginning in period 4. In Period 5, Group A will crossover to the combined condition. This change from the original protocol was approved by the study funder as of Fall 2021.

Conditions

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Human Papillomavirus Infection

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Usual Care

Group Type NO_INTERVENTION

No interventions assigned to this group

Parent Reminders

Group Type EXPERIMENTAL

Parent Reminders

Intervention Type BEHAVIORAL

Automated, system-generated mailed or text message reminders

Multicomponent clinic-system strategies

Group Type EXPERIMENTAL

Multicomponent clinic-system strategies

Intervention Type BEHAVIORAL

1. Workflow modifications to reduce missed opportunities for vaccination
2. Provider- and clinic-level audit and feedback
3. Provider \& staff training on workflow modifications and communication strategies

Combined Condition

Group Type EXPERIMENTAL

Combined Condition

Intervention Type BEHAVIORAL

Parent reminders and multicomponent clinic-system strategies

Interventions

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Parent Reminders

Automated, system-generated mailed or text message reminders

Intervention Type BEHAVIORAL

Multicomponent clinic-system strategies

1. Workflow modifications to reduce missed opportunities for vaccination
2. Provider- and clinic-level audit and feedback
3. Provider \& staff training on workflow modifications and communication strategies

Intervention Type BEHAVIORAL

Combined Condition

Parent reminders and multicomponent clinic-system strategies

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Must be a patient at one of the seven Northeast Valley Health Corporation (NEVHC) clinics participating in this study
* Has had at least one appointment at NEVHC in the last 2 years
* Must be aged 11-17

Exclusion Criteria

* Is not a patient at one of the seven Northeast Valley Health Corporation (NEVHC) clinics participating in this study
* Has not had an appointment at NEVHC in the last 2 years
* Is not aged 11-17
Minimum Eligible Age

11 Years

Maximum Eligible Age

17 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Patient-Centered Outcomes Research Institute

OTHER

Sponsor Role collaborator

University of California, Los Angeles

OTHER

Sponsor Role lead

Responsible Party

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Roshan Bastani

Professor, Health Policy and Management, UCLA Fielding School of Public Health

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Roshan Bastani, PhD

Role: PRINCIPAL_INVESTIGATOR

Professor, Health Policy and Management, UCLA Fielding School of Public Health

Beth Glenn, PhD

Role: PRINCIPAL_INVESTIGATOR

Professor, Health Policy and Management, UCLA Fielding School of Public Health

Locations

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Northeast Valley Health Corporation- Canoga Park

Canoga Park, California, United States

Site Status

Northeast Valley Health Corporation- Pacoima

Pacoima, California, United States

Site Status

Northeast Valley Health Corporation- San Fernando

San Fernando, California, United States

Site Status

Northeast Valley Health Corporation- Santa Clarita

Santa Clarita, California, United States

Site Status

Northeast Valley Health Corporation- Sun Valley

Sun Valley, California, United States

Site Status

Northeast Valley Health Corporation- Valencia

Valencia, California, United States

Site Status

Northeast Valley Health Corporation- Van Nuys

Van Nuys, California, United States

Site Status

Countries

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United States

Other Identifiers

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PCS-2017C1-6482

Identifier Type: -

Identifier Source: org_study_id

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