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

Cam Escoffery, Kara Riehman, Lesley Watson, A Sandy Priess, Marcie Fisher Borne, Sean Nathaniel Halpin, Carlie Rhiness, Emily Wiggins, Michelle C Kegler, Cam Escoffery, Kara Riehman, Lesley Watson, A Sandy Priess, Marcie Fisher Borne, Sean Nathaniel Halpin, Carlie Rhiness, Emily Wiggins, Michelle C Kegler

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.

Figures

Figure
Figure
Major themes of barriers and facilitators to implementing the HPV VACs (Vaccinate Adolescents Against Cancers) Program across domains of the Consolidated Framework for Implementation Research (CFIR), May–August 2016. This figure does not show all possible constructs, because the federally qualified health centers participating in the study did not report barriers or facilitators for every construct.

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