Table 4 Facilitators and Barriers for completing the HPV vaccine series by 13th birthday
CFIR Domain | Facilitators | Barriers |
|---|---|---|
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 |