Facilitators and Barriers to the Implementation of the HPV VACs (Vaccinate Adolescents Against Cancers) Program: A Consolidated Framework for Implementation Research Analysis

Abstract

Purpose and Objectives The human papillomavirus (HPV) vaccine is an effective but underused method for preventing multiple cancers, particularly cervical cancer. Although interventions have successfully targeted barriers to HPV vaccine uptake in various clinical settings, few studies have explored their implementation. Our study examines the delivery of the HPV VACs (Vaccinate Adolescents Against Cancer) Program and elicits information on barriers and facilitators to implementation. Intervention Approach The VACs Program pilot was a multilevel, evidence-based intervention conducted by the American Cancer Society in 30 federally qualified health centers (FQHCs) in the United States. Evaluation Methods We conducted in-depth interviews (N = 32) by telephone with representatives of 9 FQHC partners. We structured the interview guides on Consolidated Framework for Implementation Research (CFIR) domains. We asked about project start-up activities, implementation strategy selection, policy- and practice-level changes, staffing structure, challenges, and key factors leading to project success. At least 2 researchers coded each interview transcript verbatim. Results Participants most frequently identified the electronic health record system, training and education, concrete tools and resources, and provider champions as facilitators to implementing HPV VACs. Limited staff resources, challenges of electronic health records, issues with state immunization registries, patient misinformation about vaccines and vaccine stigma, cultural/language barriers, competing priorities, levels of funding, staff buy-in, training needs, and low health literacy were identified as barriers. Implications for Public Health Providing appropriate training for FQHC staff members and providers along with technical assistance and facilitation tools were critical for increasing provider confidence in recommending HPV vaccine. Addressing capacity-building and implementation barriers in FQHCs can increase effective implementation of evidence-based interventions to increase HPV vaccination uptake and reduce the burden of future cancers.

Understanding the decision to immunize: insights into the information needs and priorities of people who have utilized an online human papillomavirus (HPV) vaccine decision aid tool

“…Nevertheless, HPV vaccine coverage rates in Alberta remain below the 90% target rate. 1 Despite a large body of evidence proving the safety and efficacy of HPV immunization, low immunization rates are often attributed to insufficient information to support decision-making (Chan et al 2012), exposure to misinformation in online spaces that contributes to vaccine hesitancy (Madden et al 2012), or structural barriers that are specific to the local context (Escoffery et al 2019). There is therefore a need to examine factors that may function as barriers to HPV vaccine uptake to improve existing programs and inform new interventions that will support increased HPV immunization rates.…”

Identifying Strategies to Reduce Missed Opportunities for HPV Vaccination in Primary Care: A Qualitative Study of Positive Deviants

“…29 Participants from positive deviant practices had leadership support, multidisciplinary teams, and practice champions that made their efforts successful, as noted by others. 30,31 Having a “whole clinic” approach to improving HPV vaccination enhanced practices’ success. This involved having nurses and other staff receive training on the importance of the HPV vaccine to motivate them to implement prompts or perform previsit planning.…”

“…Other authors have identified that strong provider "buy-in" and having a designated office immunization champion are needed to improve vaccination rates. [31][32][33] As Self-Determination Theory 34 would predict, once practice personnel understood the burden of HPV disease and had strategies to reduce missed opportunities, most were intrinsically motivated by improving the care of patients, rather than extrinsically by receipt of MOC credit or monetary incentives.…”

Perceived Barriers and Facilitators to Using Knowledge Brokers in Canadian Rehabilitation Settings: A Qualitative Study

“…As per CFIR rating rules, the rating process was used to help elucidate the relative importance of each construct across all interviews [70]. The rating was performed for two dimensions: valence and magnitude.…”