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Table 4 Facilitators and Barriers for completing the HPV vaccine series by 13th birthday

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

CFIR Domain



Characteristics of HPV vaccine recommendations

*Perceived advantage to vaccinate at age 11/12 compared to older:

• Increased immunogenicity

• Efficient; Can bundle

• Complete series before exposure

• Easier patient access

*Adapt recommendation to initiate at older age

External environment and context

Financial incentives for series completion:

• Increased billing

• Meaningful use for Medicaid

*Not mandated by school therefore offer as optional at age 11/12

Internal context of practice

• Communication across staff and providers to coordinate series completion


• Leadership engaged in system level improvements e.g., EMR


• Use of multiple available resources e.g., EMR alert, outreach calls


Characteristics and attitudes of providers

• *Perceive value in completing series by age 13


• Perceive value in bundling 3 adolescent vaccines


• *Confident to strongly recommend HPV vaccine and to convince hesitant parents


• Enthusiastic about HPV vaccine


• *Already made efforts to increase HPV vaccine use


Process for implementation of HPV vaccine recommendations

• *Routinely provide strong recommendation for HPV vaccine at age 11/12 and bundle 3 vaccines


• Involve staff in meaningful problem-solving


• Reflect on HPV vaccine use with a view to making changes

  1. *Strongly distinguishing factor