Quality of Web-Based Educational Interventions for Clinicians on Human Papillomavirus Vaccine: Content and Usability Assessment

"Results from this study suggest best practices for designing, refining, and implementing Web-based interventions to promote HPV vaccination within the clinician population."

Missed opportunities for clinicians to recommend and administer the human papillomavirus (HPV) vaccine, as well as a lack of strong and consistent recommendations, are primary reasons for low HPV vaccination rates in the United States (US). To improve clinicians' HPV vaccine recommendations, numerous Web-based HPV vaccine educational interventions for clinicians have been created. However, these interventions have not been evaluated using health education and design principles. Thus, this study sought to systematically identify HPV vaccine Web-based educational interventions developed for clinicians and to evaluate their quality.

Current HPV vaccine Web-based educational interventions were identified from general search engines (e.g., Google), continuing medical education search engines, health department websites, and professional organisation websites. Web-based educational interventions were included if they were created for clinicians (defined as individuals qualified to deliver health care services, such as physicians, clinical nurses, and school nurses, to patients aged 9 to 26 years), delivered information about the HPV vaccine and how to increase vaccination rates, and provided continuing education (CE) credits. The interventions' content and usability were analysed using 6 key indicators: access, content, design, evaluation, interactivity, and use of theory or models.

The researchers conducted the search from April 2016 to August 2017 and identified a total of 178 interventions. Of these, 21 interventions met all 3 research criteria for this study. Of these, 7 (33%) were webinars, 7 (33%) were videos or lectures, and 7 (33%) were other (e.g., text articles, website modules). Of the 21 interventions, 17 (81%) identified the purpose of the intervention, 12 (57%) provided the date the information had been updated (7 of these were updated within the last 6 months), 14 (67%) provided the participants with the opportunity to provide feedback on the intervention, and 5 (24%) provided an interactive component. None of the educational interventions explicitly stated that a theory or model was used to develop the intervention. (Yet "interventions based in theory provide an advantage in changing behavior by providing a logical and systematic approach to increasing clinicians’ recommendation of the HPV vaccine.")

Strengths of the assessed Web-based educational interventions include: being developed by experts in the field; providing reliable references or sources; providing clinicians with access to CEs for no cost; following basic design principles with easy-to-read fonts, colours, and graphics; and consistently providing evaluation opportunities for participant knowledge outcomes. Weaknesses of the educational interventions included lack of: theory-based interventions; links to other sources or resources; interactivity throughout the intervention; opportunity for participants to provide feedback or evaluation of the intervention; and evaluation of outcomes including participants' attitudes about HPV vaccination, intention to recommended vaccination, and recommendation of behaviours. The latter weakness is an issue because "interventions should be designed with the goal of changing clinician attitudes and vaccine recommendations, and evaluation of these outcomes is a key component of successful interventions...Evaluation of outcomes is also important for the translation of health communication research into efforts to promote clinician recommendations of the HPV vaccine...Finally, evaluation is essential for understanding clinicians' educational needs and assessing program outcomes addressing important health issues..."

The researchers indicate that, given that professional organisations are cited by clinicians as an important and trusted source of HPV vaccine information, professional organisations should increase efforts to collaborate with health information websites and other organisations and institutions to provide evidence- and theory-based interventions. Interorganisational collaboration to provide clinicians with HPV vaccine Web-based interventions, they suggest, has the potential to improve outcomes related to HPV vaccination rates and cancer risk reduction.

Another recommendation: "More research should be conducted to determine the impact of interactive components in HPV-related Web-based educational interventions on clinicians' HPV vaccination recommendation behaviors."

In conclusion, "The findings suggest that those who develop Web-based educational interventions to promote HPV vaccine recommendations utilize design science principles, a powerful approach and process that includes participatory action research to iteratively develop and evaluate health education interventions...Additional qualitative, multi-approach evaluation research is needed to further assess the content (eg, the specific messages provided to clinicians about the HPV vaccine and recommendation behaviors) and usability of these interventions from the participants' perspective. Further evaluation research is needed to ensure that interventions are being developed using all design principles and are effective at increasing strong and consistent HPV vaccine recommendations from clinicians."