Development and Validation of an Implementation Penetration Assessment Criteria Tool (ImPACT-HPV) for HPV Vaccination in Nigeria

There exists a research-to-practice gap that hinders the penetration of human papillomavirus (HPV) vaccination among adolescent girls and young women in Nigeria. To close this gap requires reliable, validated, easy-to-use tools to identify and measure elements of penetration that drive high performance of HPV vaccination uptake in resource limited settings. Penetration, defined here as the integration of evidence (i.e. HPV vaccines) within the culture of recipient setting or community through policies and practices remains incompletely understood in low resource settings.

Currently, existing measures for penetration suggest that there are three stages that determine the extent of integration within service settings: 1) passages (i.e. single event); 2) routines (repetitive reinforcement of interventions) and 3) niche saturation (or extent in which intervention is integrated). However, these measures often confound several dynamic processes inherent with integrating evidence-based interventions within resource limited settings. They also provide no insight on the multidimensional nature of penetration or whether it may be influenced by important determinants such as: 1) perceptions of passages; 2) enablers or resources for routines; and 3) nurturers or assets for niche saturation. In response to NCI’s Strategic Plan to advance cancer prevention research and increase HPV vaccination coverage.

The overall goal of this F31 is to develop a reliable, valid, and pragmatic assessment tool to identify core features of penetration related to high uptake of HPV vaccines. We proposed to develop the Implementation Penetration Assessment Criteria Tool (ImPACT) with the guidance of the perceptions, enablers, and nurturers domain of the PEN-3 cultural model developed by Airhihenbuwa to address the determinants highlighted above. This study, which builds on the recently funded ACCESS study (R01 CA271033: PI: Iwelunmor: Actions for Collaborative Community Engages Strategies for HPV), will develop the ImPACT Tool through the projects three specific aims: to (1) identify core domains and items that will comprise an Implementation Penetration Assessment Criteria Tool (ImPACT) via in-depth interviews with 20 young women and group concept mapping with 20 key stakeholders; (2) evaluate face validity of the ImPACT tool via cognitive interviewing and pilot test the drafted tool; and (3) evaluate the psychometric properties of the ImPACT tool across 18 sites of the ACCESS study using the Psychometric Evidence Scale criteria as a guide. The project is significant because, if successful, it would be the first reliable, valid, and pragmatic instrument for assessing the penetration of evidence-based HPV vaccination in low resource settings and will also provide a roadmap for building capacity and infrastructure for advancing the reach, adoption, and sustainability of HPV vaccination programs.

This project will also prepare the applicant to become a leading independent researcher in the field of implementation science and support training in rigorous, solution oriented implementation research focused on improving population health outcomes.

Grant Number: 5F31CA294971-02
NIH Institute/Center: NIH
Principal Investigator: Onyekachukwu Anikamadu