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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 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  
  1. *Strongly distinguishing factor