Barriers and facilitators to HPV vaccination in primary care practices: a mixed methods study using the Consolidated Framework for Implementation Research

Abstract Background In the United States, the effective, safe huma papilloma virus (HPV) vaccine is underused and opportunities to prevent cancer continue to be missed. National guidelines recommend completing the 2–3 dose HPV vaccine series by age 13, well before exposure to the sexually transmitte...

Full description

Bibliographic Details
Main Authors: Jane M. Garbutt, Sherry Dodd, Emily Walling, Amanda A. Lee, Katharine Kulka, Rebecca Lobb
Format: Article
Language:English
Published: BioMed Central 2018-05-01
Series:BMC Family Practice
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12875-018-0750-5
id doaj-art-9816e72f00b648a0875931cef7e26705
recordtype oai_dc
spelling doaj-art-9816e72f00b648a0875931cef7e267052018-08-16T01:18:31ZengBioMed CentralBMC Family Practice1471-22962018-05-0119111110.1186/s12875-018-0750-5Barriers and facilitators to HPV vaccination in primary care practices: a mixed methods study using the Consolidated Framework for Implementation ResearchJane M. Garbutt0Sherry Dodd1Emily Walling2Amanda A. Lee3Katharine Kulka4Rebecca Lobb5Departments of Medicine and Pediatrics, Washington University School of MedicineDepartment of Pediatrics, Washington University School of MedicineDepartment of Pediatrics, Washington University School of MedicineDepartment of Surgery, Washington University School of MedicineDepartment of Pediatrics, Washington University School of MedicineDepartment of Surgery, Washington University School of MedicineAbstract Background In the United States, the effective, safe huma papilloma virus (HPV) vaccine is underused and opportunities to prevent cancer continue to be missed. National guidelines recommend completing the 2–3 dose HPV vaccine series by age 13, well before exposure to the sexually transmitted virus. Accurate characterization of the facilitators and barriers to full implementation of HPV vaccine recommendations in the primary care setting could inform effective implementation strategies. Methods We used the Consolidated Framework for Implementation Research (CFIR) to systematically investigate and characterize factors that influence HPV vaccine use in 10 primary care practices (16 providers) using a concurrent mixed methods design. The CFIR was used to guide collection and analysis of qualitative data collected through in-person semi-structured interviews with the primary care providers. We analyzed HPV vaccine use with data abstracted from medical charts. Constructs that most strongly influenced vaccine use were identified by integrating the qualitative and quantitative data. Results Of the 72 CFIR constructs assessed, seven strongly distinguished and seven weakly distinguished between providers with higher versus lower HPV vaccine coverage. The majority of strongly distinguishing constructs were facilitators and were related to characteristics of the providers (knowledge and beliefs; self-efficacy; readiness for change), their perception of the intervention (relative advantage of vaccinating younger vs. older adolescents), and their process to deliver the vaccine (executing). Additional weakly distinguishing constructs that were facilitators were from outer setting (peer pressure; financial incentives), inner setting (networks and communications and readiness for implementation) and process (planning; engaging, and reflecting and evaluating). Two strongly distinguishing constructs were barriers to use, one from the intervention (adaptability of the age of initiation) and the other from outer setting (patient needs and resources). Conclusions Using CFIR to systematically examine the use of this vaccine in independent primary care practices enabled us to identify facilitators and barriers at the provider, interpersonal and practice level that need to be addressed in future efforts to increase vaccine use in such settings. Our findings suggest that implementation strategies that target the provider and help them to address multi-level barriers to HPV vaccine use merit further investigation.http://link.springer.com/article/10.1186/s12875-018-0750-5HPV vaccineImplementation strategiesCFIR
institution Open Data Bank
collection Open Access Journals
building Directory of Open Access Journals
language English
format Article
author Jane M. Garbutt
Sherry Dodd
Emily Walling
Amanda A. Lee
Katharine Kulka
Rebecca Lobb
spellingShingle Jane M. Garbutt
Sherry Dodd
Emily Walling
Amanda A. Lee
Katharine Kulka
Rebecca Lobb
Barriers and facilitators to HPV vaccination in primary care practices: a mixed methods study using the Consolidated Framework for Implementation Research
BMC Family Practice
HPV vaccine
Implementation strategies
CFIR
author_facet Jane M. Garbutt
Sherry Dodd
Emily Walling
Amanda A. Lee
Katharine Kulka
Rebecca Lobb
author_sort Jane M. Garbutt
title Barriers and facilitators to HPV vaccination in primary care practices: a mixed methods study using the Consolidated Framework for Implementation Research
title_short Barriers and facilitators to HPV vaccination in primary care practices: a mixed methods study using the Consolidated Framework for Implementation Research
title_full Barriers and facilitators to HPV vaccination in primary care practices: a mixed methods study using the Consolidated Framework for Implementation Research
title_fullStr Barriers and facilitators to HPV vaccination in primary care practices: a mixed methods study using the Consolidated Framework for Implementation Research
title_full_unstemmed Barriers and facilitators to HPV vaccination in primary care practices: a mixed methods study using the Consolidated Framework for Implementation Research
title_sort barriers and facilitators to hpv vaccination in primary care practices: a mixed methods study using the consolidated framework for implementation research
publisher BioMed Central
series BMC Family Practice
issn 1471-2296
publishDate 2018-05-01
description Abstract Background In the United States, the effective, safe huma papilloma virus (HPV) vaccine is underused and opportunities to prevent cancer continue to be missed. National guidelines recommend completing the 2–3 dose HPV vaccine series by age 13, well before exposure to the sexually transmitted virus. Accurate characterization of the facilitators and barriers to full implementation of HPV vaccine recommendations in the primary care setting could inform effective implementation strategies. Methods We used the Consolidated Framework for Implementation Research (CFIR) to systematically investigate and characterize factors that influence HPV vaccine use in 10 primary care practices (16 providers) using a concurrent mixed methods design. The CFIR was used to guide collection and analysis of qualitative data collected through in-person semi-structured interviews with the primary care providers. We analyzed HPV vaccine use with data abstracted from medical charts. Constructs that most strongly influenced vaccine use were identified by integrating the qualitative and quantitative data. Results Of the 72 CFIR constructs assessed, seven strongly distinguished and seven weakly distinguished between providers with higher versus lower HPV vaccine coverage. The majority of strongly distinguishing constructs were facilitators and were related to characteristics of the providers (knowledge and beliefs; self-efficacy; readiness for change), their perception of the intervention (relative advantage of vaccinating younger vs. older adolescents), and their process to deliver the vaccine (executing). Additional weakly distinguishing constructs that were facilitators were from outer setting (peer pressure; financial incentives), inner setting (networks and communications and readiness for implementation) and process (planning; engaging, and reflecting and evaluating). Two strongly distinguishing constructs were barriers to use, one from the intervention (adaptability of the age of initiation) and the other from outer setting (patient needs and resources). Conclusions Using CFIR to systematically examine the use of this vaccine in independent primary care practices enabled us to identify facilitators and barriers at the provider, interpersonal and practice level that need to be addressed in future efforts to increase vaccine use in such settings. Our findings suggest that implementation strategies that target the provider and help them to address multi-level barriers to HPV vaccine use merit further investigation.
topic HPV vaccine
Implementation strategies
CFIR
url http://link.springer.com/article/10.1186/s12875-018-0750-5
_version_ 1612695146663510016