The human papillomavirus (HPV) vaccine offers the unprecedented opportunity to prevent nearly all cervical
and anal cancers and a high proportion of vaginal, oropharyngeal, vulvar and penile cancers, where HPV is the
etiologic agent. HPV vaccination is recommended for all children ages 11-12, with catch up for females to age
26 and males to age 21. However, despite clear and indisputable value in cancer prevention, uptake and
completion of the HPV vaccine series has lagged far behind the goal of 80%. Provider recommendation is the
strongest determinant of HPV vaccination, but slow translation of guidelines for preventive services, such as
immunizations, into practice is a known challenge. Practice Facilitation (PF) is a multicomponent quality
improvement intervention approach that has well-established efficacy, in which external support and resources
are provided to build the internal capacity of practices to improve quality of care and patient outcomes. Our
central goal is to identify the optimal approach to implementing an evidence-based intervention for the uptake
and completion of HPV vaccine among adolescents receiving care in the community, guided by
implementation science theory. AIM 1: Determine the clinical effectiveness and cost-effectiveness of two
modalities for delivering a multi-component PF intervention to increase HPV vaccination initiation and
completion in community-based pediatric practices. We will compare the traditional in-person Coach PF
modality to a lower-resource Web-Based PF modality. The primary patient outcome is HPV vaccination. We
will also examine and compare the sustainability of practice changes on vaccination rates and the effects over
time for each intervention modality. H1: Both interventions will result in significant increases in HPV vaccination
from baseline over time. H2: Increases in the rate of HPV vaccination will be higher and sustained for a longer
period of time in the Coach PF Arm as compared with the Web-Based PF Arm. H3: The Web-Based PF Arm
will be more cost-effective than the Coach PF Arm. AIM 2. Understand mechanisms of why the PF intervention
may work better for some pediatric practices than others for HPV vaccination. We will examine theory-based
determinants at the organizational, provider, and patient levels that may mediate (explain) or moderate
(change) the effects of the PF intervention on vaccination outcomes. H4: Adoption of changes (process
variables) and patient factors will mediate effects of the intervention on HPV vaccination outcomes. H5:
Organizational factors, provider attitudes, and intervention characteristics will moderate intervention effects on
HPV vaccination outcomes. The findings will inform organizations about which PF modality to use among their
constituent practices to improve HPV vaccination rates, with potential for future national dissemination.
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