anonymous. You will be asked to complete this survey again after January 2, 2018. In order to compare the results, please write a unique identifier in the space below. This identifier should not have identifying information (initials, birthdays, etc.). Please write this ID down and use it for all future assessments related to your participation in this DNP project.
2 How many years have you been in practice?
1 = Fewer than 5 years 2 = 5-9 years
3 = 10-14 years 4 = 15-19 years 5 = 20 or more years 3 What type of provider are you? 1. Pediatrician
2. Pediatric Nurse Practitioner 3. Physician assistant
4 Do you provide preventative care, including vaccinations, to
adolescents ages 11-12 years?
yes no
5 For 11-12 year olds, which
adolescent vaccine do you usually discuss first?
1 = Tdap vaccine
2 = Meningococcal vaccine 3 = HPV vaccine
4 = No particular order 6 For 11-12 year olds, which
adolescent vaccine do you usually
1 = Tdap vaccine
vaccine for 11-12 year olds, I say it is... 2 = Slightly important 3 = Moderately important 4 = Very important 5 = Extremely important 8 When I recommend the
meningococcal vaccine for 11-12 year olds, I say it is...
1 = Not important 2 = Slightly important 3 = Moderately important 4 = Very important 5 = Extremely important 9 When I recommend the HPV
vaccine for 11-12 year olds, I say it is... 1 = Not important 2 = Slightly important 3 = Moderately important 4 = Very important 5 = Extremely important 10 For 11-12 year olds, how long
does it normally take for you to talk about...
Tdap vaccine?
Free text
11 For 11-12 year olds, how long does it normally take for you to talk about...
Meningococcal vaccine?
Free text
12 For 11-12 year olds, how long does it normally take for you to talk about...
HPV vaccine?
Free text
13 Parents feel that the Tdap vaccine for their 11-12 year olds is...
1 = Not important 2 = Slightly important 3 = Moderately important 4 = Very important 5 = Extremely important 14 Parents feel that the 1 = Not important
11-12 year olds is... 3 = Moderately important 4 = Very important 5 = Extremely important 15 Parents feel that the HPV vaccine
for their 11-12 year olds is...
1 = Not important 2 = Slightly important 3 = Moderately important 4 = Very important 5 = Extremely important 16 At sick visits with 11-12 year olds
who have mild complaints, I usually discuss...(check all that apply)
1 = Tdap vaccine
2 = Meningococcal vaccine 3 = HPV vaccine
4 = I do not discuss adolescent vaccines at sick visits
17 I do not discuss ____ vaccine at sick visits because... (check all that apply; choose vaccine and reason for not discussing the vaccine)
1 = Vaccination takes too long to discuss
2 = Vaccination requires extra paperwork 3 = Vaccination is better suited for a well visit
4 = Parents may blame the vaccine if the current illness worsens
5 = Vaccine reimbursement is inadequate for sick visits 6 = Other [TEXT BOX] 18 I start routinely recommending the
HPV vaccine when female patients turn... 1 = 9 or 10 2 = 11 or 12 3 = 13 or 14 4 = 15 or 16 5 = 17 or 18 6 = 19 or older
7 = I don’t base recommendations on age 8 = I don’t routinely recommend
HPV vaccine when male patients turn... 2 = 11 or 12 3 = 13 or 14 4 = 15 or 16 5 = 17 or 18 6 = 19 or older
7 = I don’t base recommendations on age 8 = I don’t routinely recommend
HPV vaccine 20 When you bring up HPV vaccine,
which of these things do you do first?
1 = I say the child is due to get HPV vaccine
2 = I give information about it 3 = I ask if there are any questions 4 = I suggest that we give the child HPV vaccine
5 = I say that we’ll give it at the end of the visit
21 After (answer from previous question) what do you do next?
1 = Nothing else
2 = I say the child is due to get HPV vaccine
3 = I give information about it
4 = I ask if there are any questions5 = I suggest that we give the child
HPV vaccine
6 = I say that we’ll give it at the end of the visit
22 When I discuss the HPV vaccine, I say it can prevent...(Check all that apply)
1 = Cervical cancer 2 = Other cancers 3 = Genital warts 4 = None of these 23 When I discuss the HPV vaccine,
parents are most receptive when I keep my tone...
1 = Concerned 2 = Non-judgmental 3 = Informative 4 = Upbeat
5 = Humorous 6 = Warm
7 = My tone doesn’t matter 24 How important is your tone when
discussing the HPV vaccine?
1 = Less important than what I say 2 = As important as what I say 3 = More important than what I say 25 When I think about recommending
the HPV vaccine for 11-12 year olds, I anticipate having an uncomfortable conversation.
1 = Strongly disagree 2 = Somewhat disagree 3 = Neither disagree or agree 4 = Somewhat agree
5 = Strongly agree 26 Having school entry requirement
for Tdap vaccine, but not for HPV vaccine, makes some parents think HPV vaccine is less important.
1 = Strongly disagree 2 = Somewhat disagree 3 = Neither disagree or agree 4 = Somewhat agree
5 = Strongly agree 27 Having to talk about a sexually
transmitted infection makes conversations about the HPV vaccine uncomfortable.
1 = Strongly disagree 2 = Somewhat disagree 3 = Neither disagree or agree 4 = Somewhat agree
5 = Strongly agree 28 I recommend the HPV vaccine
more often for adolescents at higher risk for getting HPV.
1 = Strongly disagree 2 = Somewhat disagree 3 = Neither disagree or agree 4 = Somewhat agree
5 = Strongly agree 29 Which adolescents do you think
are at higher risk for getting HPV. (Check all that apply)
1 = Older adolescents
2 = Adolescents who are sexually active 3 = Adolescents who have had a
sexually transmitted infection
4 = Gay or bisexual male adolescents 5 = Black or Latino adolescents
care
7 = All adolescents are at equal risk for getting HPV
30 For 11-12 year olds, you usually... 1 = Recommend they get HPV vaccine at the current visit 2 = Recommend they get HPV vaccine at a later visit
3 = Give a choice about when to get HPV vaccine
4 = Don’t discuss when to get HPV vaccine
5 = Recommend not getting HPV vaccine
31 What is the most effective thing to say to parents to persuade them to get the HPV vaccine for their 11- 12 year old?
Free text
32 Which of these statements would you use to persuade parents to get the HPV vaccine for their 11-12 year olds? (Check all that apply.)
1 = Would you wait until your child is in a car accident before you tell him or her to wear a seatbelt?
2 = I see you got hepatitis B vaccine for your child. That’s also a cancer vaccine for an infectious disease.
3 = Your daughter can get cervical cancer as an adult, but you can stop that right now. HPV vaccine prevents most cervical cancers. 4 = There will be many things in your son’s life that you can’t control. But you can control whether he gets some dangerous kinds of HPV.
5 = My
son/daughter/grandchild/niece/nephew/friend ’s children have gotten HPV vaccine. Your
child should, too.
6 = I strongly believe in the importance of this cancer- preventing vaccine.
7 = None of these 33 Some healthcare providers
introduce the HPV vaccine by using a direct statement that assumes parents want to
vaccinate. They might say: "It's time for your child to get the HPV vaccine. We'll give it at the end of your visit."
Based on your experience, taking this approach would usually... (Check all that apply)
1 = Instill confidence 2 = Cause mistrust
3 = Lead to same day vaccination
34 Some healthcare providers introduce the HPV vaccine by trying to engage parents in a conversation about the
vaccine. They might give the information about the HPV vaccine, recommend it and then ask: "Do you have any questions?" Based on your experience, taking this approach would
usually...(Check all that apply)
1 = Instill confidence 2 = Cause mistrust
3 = Lead to same day vaccination
Note. Adapted from “Quality of physician communication about Human Papillomavirus vaccine: Findings from a national survey” by M. Gilkey, T. Malo, P. Shah, M. Hall, & N. Brewer, 2015,
Cancer Epidemiology, Biomarkers, and Prevention, 24(11), p. 1673-1679. Table retrieved from www.unc.edu/∼ntbrewer/hpv.htm
APPENDIX 3: POST- MODIFIED PROVIDER COMMUNICATION SURVEY 1 Thank you for your participation in
this DNP project. Over the past 3 months, what percentage of the time did you use the AAP HPV Champion Toolkit communication tool for the recommendation of the HPV vaccine in the 11-12 year old age group at well visits?
2 How many years have you been in practice?
1 = Fewer than 5 years 2 = 5-9 years
3 = 10-14 years 4 = 15-19 years 5 = 20 or more years 3 What type of provider are you? 1. Pediatrician
2. Pediatric Nurse Practitioner 3. Physician assistant
4 Do you provide preventative care, including vaccinations, to
adolescents ages 11-12 years?
Yes/no
5 For 11-12 year olds, which
adolescent vaccine do you usually discuss first?
1 = Tdap vaccine
2 = Meningococcal vaccine 3 = HPV vaccine
4 = No particular order 6 For 11-12 year olds, which
adolescent vaccine do you usually discuss last?
1 = Tdap vaccine
2 = Meningococcal vaccine 3 = HPV vaccine
7 When I recommend the Tdap vaccine for 11-12 year olds, I say it is... 1 = Not important 2 = Slightly important 3 = Moderately important 4 = Very important 5 = Extremely important
meningococcal vaccine for 11-12 year olds, I say it is...
2 = Slightly important 3 = Moderately important 4 = Very important 5 = Extremely important 9 When I recommend the HPV
vaccine for 11-12 year olds, I say it is... 1 = Not important 2 = Slightly important 3 = Moderately important 4 = Very important 5 = Extremely important 10 For 11-12 year olds, how long
does it normally take for you to talk about...
Tdap vaccine?
Free text
11 For 11-12 year olds, how long does it normally take for you to talk about...
Meningococcal vaccine?
Free text
12 For 11-12 year olds, how long does it normally take for you to talk about...
HPV vaccine?
Free text
13 Parents feel that the Tdap vaccine for their 11-12 year olds is...
1 = Not important 2 = Slightly important 3 = Moderately important 4 = Very important 5 = Extremely important 14 Parents feel that the
Meningococcal vaccine for their 11-12 year olds is...
1 = Not important 2 = Slightly important 3 = Moderately important 4 = Very important 5 = Extremely important 15 Parents feel that the HPV vaccine 1 = Not important
3 = Moderately important 4 = Very important 5 = Extremely important 16 At sick visits with 11-12 year olds
who have mild complaints, I usually discuss...(check all that apply)
1 = Tdap vaccine
2 = Meningococcal vaccine 3 = HPV vaccine
4 = I do not discuss adolescent vaccines at sick visits
17 I do not discuss ____ vaccine at sick visits because... (check all that apply; choose vaccine and reason for not discussing the vaccine)
1 = Vaccination takes too long to discuss 2 = Vaccination requires extra paperwork 3 = Vaccination is better suited for a well visit 4 = Parents may blame the vaccine if the current illness worsens
5 = Vaccine reimbursement is inadequate for sick visits
6 = Other [TEXT BOX] 18 I start routinely recommending the
HPV vaccine when female patients turn... 1 = 9 or 10 2 = 11 or 12 3 = 13 or 14 4 = 15 or 16 5 = 17 or 18 6 = 19 or older
7 = I don’t base recommendations on age 8 = I don’t routinely recommend
HPV vaccine 19 I start routinely recommending the
HPV vaccine when male patients turn... 1 = 9 or 10 2 = 11 or 12 3 = 13 or 14 4 = 15 or 16 5 = 17 or 18 6 = 19 or older
7 = I don’t base recommendations on age 8 = I don’t routinely recommend
HPV vaccine 20 When you bring up HPV vaccine,
which of these things do you do first?
1 = I say the child is due to get HPV vaccine 2 = I give information about it
3 = I ask if there are any questions 4 = I suggest that we give the child HPV vaccine
5 = I say that we’ll give it at the end of the visit
21 After (answer from previous question) what do you do next?
1 = Nothing else
2 = I say the child is due to get HPV vaccine 3 = I give information about it
4 = I ask if there are any questions 5 = I suggest that we give the child HPV vaccine
6 = I say that we’ll give it at the end of the visit
22 When I discuss the HPV vaccine, I say it can prevent...(Check all that apply)
1 = Cervical cancer 2 = Other cancers 3 = Genital warts 4 = None of these 23 When I discuss the HPV vaccine,
parents are most receptive when I keep my tone... 1 = Concerned 2 = Non-judgmental 3 = Informative 4 = Upbeat 5 = Humorous 6 = Warm
7 = My tone doesn’t matter 24 How important is your tone when
discussing the HPV vaccine?
1 = Less important than what I say 2 = As important as what I say 3 = More important than what I say 25 When I think about recommending
the HPV vaccine for 11-12 year
1 = Strongly disagree 2 = Somewhat disagree
uncomfortable conversation. 4 = Somewhat agree 5 = Strongly agree 26 Having school entry requirement
for Tdap vaccine, but not for HPV vaccine, makes some parents think HPV vaccine is less important.
1 = Strongly disagree 2 = Somewhat disagree 3 = Neither disagree or agree 4 = Somewhat agree
5 = Strongly agree 27 Having to talk about a sexually
transmitted infection makes conversations about the HPV vaccine uncomfortable.
1 = Strongly disagree 2 = Somewhat disagree 3 = Neither disagree or agree 4 = Somewhat agree
5 = Strongly agree 28 I recommend the HPV vaccine
more often for adolescents at higher risk for getting HPV.
1 = Strongly disagree 2 = Somewhat disagree 3 = Neither disagree or agree 4 = Somewhat agree
5 = Strongly agree 29 Which adolescents do you think
are at higher risk for getting HPV. (Check all that apply)
1 = Older adolescents
2 = Adolescents who are sexually active 3 = Adolescents who have had a sexually transmitted infection
4 = Gay or bisexual male adolescents 5 = Black or Latino adolescents
6 = Adolescents with limited access to health care
7 = All adolescents are at equal risk for getting HPV
30 For 11-12 year olds, you usually... 1 = Recommend they get HPV vaccine at the current visit
2 = Recommend they get HPV vaccine at a later visit
3 = Give a choice about when to get HPV vaccine
4 = Don’t discuss when to get HPV vaccine 5 = Recommend not getting HPV vaccine 31 What is the most effective thing to
say to parents to persuade them to get the HPV vaccine for their 11- 12 year old?
Free text
32 Which of these statements would you use to persuade parents to get the HPV vaccine for their 11-12 year olds? (Check all that apply.)
1 = Would you wait until your child is in a car accident before you tell him or her to wear a seatbelt?
2 = I see you got hepatitis B vaccine for your child. That’s also a cancer vaccine for an infectious disease.
3 = Your daughter can get cervical cancer as an adult, but you can stop that right now. HPV vaccine prevents most cervical cancers.
4 = There will be many things in your son’s life that you can’t control. But you can control whether he gets some dangerous kinds of HPV.
5 = My
son/daughter/grandchild/niece/nephew/friend’s children have gotten HPV vaccine. Your child should, too.
6 = I strongly believe in the importance of this cancer- preventing vaccine.
7 = None of these 33 Some healthcare providers
introduce the HPV vaccine by using a direct statement that assumes parents want to
vaccinate. They might say: "It's time for your child to get the HPV
1 = Instill confidence 2 = Cause mistrust
your visit."
Based on your experience, taking this approach would usually... (Check all that apply)
34 Some healthcare providers introduce the HPV vaccine by trying to engage parents in a conversation about the
vaccine. They might give the information about the HPV vaccine, recommend it and then ask: "Do you have any questions?" Based on your experience, taking this approach would
usually...(Check all that apply)
1 = Instill confidence 2 = Cause mistrust
3 = Lead to same day vaccination
Note. Adapted from “Quality of physician communication about Human Papillomavirus vaccine: Findings from a national survey” by M. Gilkey, T. Malo, P. Shah, M. Hall, & N. Brewer, 2015,
Cancer Epidemiology, Biomarkers, and Prevention, 24(11), p. 1673-1679. Table retrieved from www.unc.edu/∼ntbrewer/hpv.htm