Summary of findings 9. Multi‐component provider intervention compared to usual practice.

Comparison 9: multi‐component provider intervention compared to usual practice
Population: healthcare providers and their adolescent patients (boys and girls aged 11–21 years) Setting: USA Intervention: multi‐component performance improvement continuing medical education interventiona Comparison: usual practice
Outcomes	Impact	№ of participants (studies)	Certainty of the evidence (GRADE)*
HPV vaccine uptakeb	A multi‐component provider intervention (including an education session, repeated contacts, individualised feedback, and incentives) probably improves uptake of HPV vaccine compared to usual practice. Girls in the intervention group are probably more likely to receive their next HPV vaccine dose than those in the comparison group (odds ratio 1.6, 95% CI 1.1 to 2.2). The effects are probably larger for boys (odds ratio 25.00, 95% CI 15.00 to 40.00), and this may be because publicly funded HPV vaccination for boys became available during the study.	15,849 adolescents (1)c	⊕⊕⊕⊝ Moderated
HPV: human papillomavirus. *GRADE Working Group grades of evidence: High certainty: this research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different† is low. Moderate certainty: this research provides a good indication of the likely effect. The likelihood that the effect will be substantially different† is moderate. Low certainty: this research provides some indication of the likely effect. However, the likelihood that it will be substantially different† is high. Very low certainty: this research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different† is very high. †Substantially different = a large enough difference that it might affect a decision.

^aThe intervention involved: (1) 6–8 education visits over 12 months by an HPV physician‐educator; (2) focused education sessions on HPV‐related topics designed to change the way providers viewed the importance of HPV vaccination and responded to parents' hesitation toward HPV vaccines; (3) individualised feedback where providers and practices received individual reports that showed their performance compared to other providers in their practice on HPV vaccination coverage; and (4) quality improvement incentives whereby physicians were eligible to receive maintenance‐of‐registration credits, which fulfilled requirements for maintaining board certification.

^b The lag‐time between delivery of the intervention and assessment of outcomes was six months.

^cPerkins 2015 (cluster‐randomised trial).
 ^d Downgraded one level because of serious indirectness, given that this finding is based on one study from one setting.