Although the strongest predictor of human papillomavirus (HPV) vaccination is a high-quality
recommendation, physicians often provide weak recommendations. Thus, the authors developed
Virtual Immersive Communication Training on Recommending Immunizations (VICTORI),
a virtual reality (VR)‒based intervention that provided physicians the opportunity
to deliberately practice recommendation behaviors. VICTORI included VR simulations
during which participants counseled caregiver avatars hesitant to vaccinate. Before
participation in VICTORI, participants reviewed a smartphone application on recommendation
behaviors. A nonrandomized control trial of VICTORI was conducted with licensed and
resident physicians. The intervention group completed the application and VICTORI
simulations, whereas a comparison group completed only the application. The hypothesis
was that HPV vaccination rates would increase for patients in the intervention group.
The preintervention period was defined as the 6 months before allocated training (February 1, 2020–July 31,
2020), and the postintervention period was the 6 months after (October 1, 2020–March
31, 2021). The primary outcome was a change in the rates of human papillomavirus vaccine
initiation among eligible patients presenting to clinic before and after. Of 142 eligible
physicians, 134 (94%) chose to participate, with 93 of /97 (96%) intervention and
30 of 37 (81%) comparison participants completing study protocols. There was a statistically
significant increase in patients’ HPV vaccine initiation rates after training within
the intervention group (54.3%‒72.4%; 18.1% difference [95% CI=11.0, 25.8]; p<0.001) but not within the comparison group (59.5%‒63.4%; 3.9% difference [95% CI=
−11.0, 19.0]; p=0.609). In conclusion, HPV vaccine initiation increased after VR training, and further
study is warranted.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Preventive MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
How many cancers are linked with HPV each year?. Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/hpv/statistics/cases.htm. Updated December 13, 2021. Accessed September 3, 2020.
- National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years - United States, 2020.MMWR Morb Mortal Wkly Rep. 2021; 70: 1183-1190https://doi.org/10.15585/mmwr.mm7035a1
- Immunization and infectious diseases.Healthy People 2020, HHS, Office of Disease Prevention and Health promotion, February 6, 2022https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases/objectivesDate accessed: June 14, 2022
- Human papillomavirus vaccination: narrative review of studies on how providers’ vaccine communication affects attitudes and uptake.Acad Pediatr. 2018; 18: S23-S27https://doi.org/10.1016/j.acap.2017.09.001
- Provider communication and HPV vaccination: the impact of recommendation quality.Vaccine. 2016; 34: 1187-1192https://doi.org/10.1016/j.vaccine.2016.01.023
- Providers’ attitudes toward human papillomavirus vaccination in young men: challenges for implementation of 2011 recommendations.Am J Mens Health. 2012; 6: 320-323https://doi.org/10.1177/1557988312438911
- Understanding attitudes toward adolescent vaccination and the decision-making dynamic among adolescents, parents and providers.BMC Public Health. 2012; 12: 509https://doi.org/10.1186/1471-2458-12-509
- HPV vaccine decision making in pediatric primary care: a semi-structured interview study.BMC Pediatr. 2011; 11: 74https://doi.org/10.1186/1471-2431-11-74
- HPV vaccine hesitancy: findings from a statewide survey of health care providers.J Pediatr Health Care. 2014; 28: 541-549https://doi.org/10.1016/j.pedhc.2014.05.003
- Effect of training pediatric clinicians in human papillomavirus communication strategies on human papillomavirus vaccination rates: a cluster randomized clinical trial.JAMA Pediatr. 2021; 175: 901-910https://doi.org/10.1001/jamapediatrics.2021.0766
- Announcements versus conversations to improve HPV vaccination coverage: a randomized trial.Pediatrics. 2017; 139e20161764https://doi.org/10.1542/peds.2016-1764
- Increasing human papillomavirus vaccine initiation among publicly insured Florida adolescents.J Adolesc Health. 2015; 56: S40-S46https://doi.org/10.1016/j.jadohealth.2014.11.024
- Effectiveness of a provider-focused intervention to improve HPV vaccination rates in boys and girls.Vaccine. 2015; 33: 1223-1229https://doi.org/10.1016/j.vaccine.2014.11.021
- Results of a multilevel intervention trial to increase human papillomavirus (HPV) vaccine uptake among adolescent girls.Cancer Epidemiol Biomarkers Prev. 2016; 25: 593-602https://doi.org/10.1158/1055-9965.EPI-15-1243
- Effect of a health care professional communication training intervention on adolescent human papillomavirus vaccination: a cluster randomized clinical trial.JAMA Pediatr. 2018; 172e180016https://doi.org/10.1001/jamapediatrics.2018.0016
- Simple and elaborated clinician reminder prompts for human papillomavirus vaccination: a randomized clinical trial.Acad Pediatr. 2018; 18: S66-S71https://doi.org/10.1016/j.acap.2017.11.002
- Effectiveness of decision support for families, clinicians, or both on HPV vaccine receipt.Pediatrics. 2013; 131: 1114-1124https://doi.org/10.1542/peds.2012-3122
- Improving HPV vaccination rates using maintenance-of-certification requirements.Pediatrics. 2016; 137e20150675https://doi.org/10.1542/peds.2015-0675
- A content analysis of HPV vaccine online continuing medical education purpose statements and learning objectives.Hum Vaccin Immunother. 2019; 15: 1508-1518https://doi.org/10.1080/21645515.2019.1587273
- Technology-enhanced simulation for health professions education: a systematic review and meta-analysis.JAMA. 2011; 306: 978-988https://doi.org/10.1001/jama.2011.1234
- Virtual reality simulation in nontechnical skills training for healthcare professionals: a systematic review.Simul Healthc. 2019; 14: 188-194https://doi.org/10.1097/SIH.0000000000000347
- A self-administered virtual reality intervention increases COVID-19 vaccination intention.Vaccine. 2021; 39: 6746-6753https://doi.org/10.1016/j.vaccine.2021.10.004
- Using immersive virtual reality to improve the beliefs and intentions of influenza vaccine avoidant 18-to-49-year-olds: considerations, effects, and lessons learned.Vaccine. 2020; 38: 1225-1233https://doi.org/10.1016/j.vaccine.2019.11.009
- The role of deliberate practice in the acquisition of expert performance.Psychological Review. 1993; 100: 363-406https://doi.org/10.1037/0033-295X.100.3.363
- A virtual reality curriculum for pediatric residents decreases rates of influenza vaccine refusal.Acad Pediatr. 2017; 17: 431-435https://doi.org/10.1016/j.acap.2017.01.010
- Effective virtual patient simulators for medical communication training: a systematic review.Med Educ. 2020; 54: 786-795https://doi.org/10.1111/medu.14152
Unity. https://unity3d.com/unity. Accessed June 14, 2022.
- The influence of provider communication behaviors on parental vaccine acceptance and visit experience.Am J Public Health. 2015; 105: 1998-2004https://doi.org/10.2105/AJPH.2014.302425
- Collaborative patient-provider communication and uptake of adolescent vaccines.Soc Sci Med. 2016; 159: 100-107https://doi.org/10.1016/j.socscimed.2016.04.030
- The architecture of provider-parent vaccine discussions at health supervision visits.Pediatrics. 2013; 132: 1037-1046https://doi.org/10.1542/peds.2013-2037
- The effect of provider communication about vaccination on mothers’ willingness to vaccinate their children against HPV and influenza: a randomized trial of illustrated health messaging vignettes.J Adolesc Health. 2016; 58 (S117–S117)https://doi.org/10.1016/j.jadohealth.2015.10.244
- What is motivational interviewing?.Behav Cogn Psychother. 1995; 23: 325-334https://doi.org/10.1017/S135246580001643X
- Provider and parent perspectives on enhanced communication tools for human papillomavirus vaccine-hesitant parents.Acad Pediatr. 2018; 18: 776-782https://doi.org/10.1016/j.acap.2018.05.012
- Usability matters for virtual reality simulations teaching communication.Med Educ. 2020; 54: 1067-1068https://doi.org/10.1111/medu.14314
Academic Pediatric Association and American Academy of Pediatrics in collaboration Kognito™. HPV Vaccine: Same Way Same Day. Apple. https://apps.apple.com/us/app/hpv-vaccine-same-way-same-day/id1356847181. Updated March 19, 2018. Accessed June 14, 2022.
- Usability evaluation of the novel smartphone application, HPV vaccine: Same Way, Same Day, among pediatric residents.Acad Pediatr. 2021; 21: 742-749https://doi.org/10.1016/j.acap.2020.11.023
Vorderer P, Wirth W, Gouveia FR, et al. MEC Spatial Presence Questionnaire (MEC- SPQ): short documentation and instructions for application. Report to the European Community, project presence: MEC (IST-2001-37661); 2004. https://academic.csuohio.edu/kneuendorf/frames/MECFull.pdf. Accessed June 14, 2022.
- A virtual reality resident training curriculum on behavioral health anticipatory guidance: development and usability study.JMIR Pediatr Parent. 2021; 4: e29518https://doi.org/10.2196/29518
- Remote virtual reality teaching: closing an educational gap during a global pandemic.Hosp Pediatr. 2021; 11: e258-e262https://doi.org/10.1542/hpeds.2021-005927
- Research Electronic Data Capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inform. 2009; 42: 377-381https://doi.org/10.1016/j.jbi.2008.08.010
- Summer peaks in uptake of human papillomavirus and other adolescent vaccines in the United States.Cancer Epidemiol Biomarkers Prev. 2016; 25: 274-281https://doi.org/10.1158/1055-9965.EPI-15-0574
- R: A language and environment for statistical computing.R Foundation for Statistical Computing, Vienna, Austria2021https://www.r-project.org/Date accessed: August 3, 2019
- Fitting linear mixed-effects models using lme4.J Stat Soft. 2015; 67: 1-48https://doi.org/10.18637/jss.v067.i01
- lmerTest package: tests in linear mixed effects models.J Stat Soft. 2017; 82: 1-26https://doi.org/10.18637/jss.v082.i13
- ACS elimination statement on HPV cancers.American Cancer Society, Atlanta, GAJuly 2020https://www.cancer.org/content/dam/cancer-org/online-documents/en/pdf/flyers/acs-elimination-statement-on-hpv-cancers.pdf(Accessed June 14, 2022)Date accessed: June 14, 2022
Communicating with Families and Promoting Vaccine Confidence. https://www.aap.org/en/patient-care/immunizations/communicating-with-families-and-promoting-vaccine-confidence/. Updated July 30, 2021. Accessed June 14, 2022.
- For healthcare professionals. November 1, 2021; https://www.cdc.gov/hpv/hcp/index.htmlDate accessed: June 14, 2022
- Improving HPV vaccination rates: a stepped-wedge randomized trial.Pediatrics. 2020; 146e20192737https://doi.org/10.1542/peds.2019-2737
- Pediatrician-parent conversations about human papillomavirus vaccination: an analysis of audio recordings.J Adolesc Health. 2017; 61: 246-251https://doi.org/10.1016/j.jadohealth.2017.02.006
- Evaluation of HPV vaccine: Same Way, Same DayTM: a pilot study.J Health Commun. 2021; 26: 839-845https://doi.org/10.1080/10810730.2021.2021459
- A meta-analysis of motivational interviewing interventions for pediatric health behavior change.J Consult Clin Psychol. 2014; 82: 521-535https://doi.org/10.1037/a0035917
- Disparities and reverse disparities in HPV vaccination: a systematic review and meta-analysis.Prev Med. 2019; 123: 197-203https://doi.org/10.1016/j.ypmed.2019.03.037
Article Info
Publication History
Published online: June 28, 2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
