Investigating Behavioral Mechanisms and Efficacy of a Provider-Directed Intervention for HPV Vaccine Promotion in Real-World Dental Settings

Project Summary Human papillomavirus (HPV) is the leading cause of oropharyngeal cancers in the US. Despite the safety and effectiveness of the HPV vaccine (HPV-V), coverage is far below that for other routine adolescent vaccines and the Healthy People 2030 goal of 80%. HPV-V promotion at dental visits is seen as a prime opportunity to prevent oropharyngeal and other cancers, yet many dental providers are not comfortable doing so due to lack of knowledge and self-efficacy, and fear of harming the patient-provider relationship. Using the NIH Stage Model of Behavioral Intervention Development as our guide, we propose to develop a theory-based intervention to address dental provider barriers to HPV-V promotion, elucidate the intervention's behavioral mechanisms, and test the real-world efficacy of the intervention in catalyzing provider HPV-V promotion. The intervention will consist of 1) provider training about HPV/HPV-V; 2) tailored scripts to aid providers in responding to patient/parent/guardian concerns about HPV-V. During the UG3 phase, we will randomize 21 HealthPartners Dental Group clinics to intervention vs. usual care (UC; n=~131 providers). UG3 aims are to: develop survey measures and pilot-test provider HPV-V promotion training (Aim 1) and tailored scripts (Aim 2); develop measures and methods for monitoring provider fidelity to the training and intervention activities (Aim 3); and draft compliance/study documents and obtain IRB/NIDCR approvals (Aim 4). During the UH3 phase, we will conduct a cluster (clinic)-randomized clinical trial (intervention vs. UC) to test the real-world efficacy of the intervention to increase HPV-V promotion activity (Aim 5). We will assess whether the intervention impacted the three intended behavioral mechanism targets: increased knowledge of HPV/HPV-V; increased self-efficacy for HPV-V promotion; and reduced fear of HPV-V promotion negatively affecting the patient- provider relationship (Aim 6). For each target, we will also assess whether the intervention's effects followed the full mechanistic pathway to the endpoint behavior, HPV-V promotion (Aim 7). Beyond our aims, we will conduct exploratory work examining two additional candidate behavioral mechanisms: adequacy of material resources to support dental providers in promoting HPV-V, and providers' perception that HPV-V promotion comports with their professional identity. We will also conduct an exploratory analysis of the intervention's efficacy in increasing HPV-V uptake (30-day post-visit patient vaccination rates). Our long-term goal is to reduce HPV and oropharyngeal cancer prevalence through HPV-V promotion by dental providers. Significant impact of the project includes: 1) developing the first theory-based behavioral intervention for HPV-V promotion aimed at dental providers; 2) delivering the first evidence of real-world efficacy of such an intervention; 3) illuminating behavioral mechanisms purported to underlie provider behavior change; 4) producing fundamental knowledge to guide future HPV-V promotion intervention development; and 5) advancing the science of behavior change by revealing behavioral principles underlying provider behavior change.