Riehman K, Watson L, Preiss A, Fisher-Borne M, Halpin S, Rhiness C, Wiggins E, Kegler MC. Facilitators and barriers to the implementation of the HPV VACs (vaccinate adolescents against cancers) program: a consolidated framework for implementation research analysis. Poster presented at the 11th Annual Conference on the Science of Dissemination and Implementation in Health; December 3, 2018. Washington, DC.

BACKGROUND: The human papillomavirus (HPV) vaccine is an effective but underutilized method for preventing multiple cancers, particularly cervical cancer. While interventions have successfully targeted barriers to HPV vaccine uptake in various clinical settings, few studies have explored their implementation. The current study examines the delivery of the HPV VACS (Vaccinate Adolescents against Cancer) Program and assesses barriers and facilitators to implementation related to Consolidated Framework for Implementation Research (CFIR) domains and constructs.

METHODS: The VACS pilot was a multilevel intervention conducted by the American Cancer Society in 30 Federally Qualified Health Centers (FQHCs) around the country. In-depth interviews (n=32) were conducted by phone with representatives from nine FQHC partners. Interview guides were structured around CFIR constructs and inquired about project start-up activities, implementation strategy selection, policy and practice-level changes, staffing structure, challenges, and key factors leading to project success. Verbatim interview transcripts were each coded by at least two researchers.

FINDINGS: The EHR system, training and education, concrete tools and resources, and provider champions were most frequently identified as facilitators to implementing HPV VACS. Alternately, limited staff resources, EHR challenges, issues related to 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. The facilitators to implementation were more concentrated in the inner setting and process domains whereas the barriers were distributed more evenly throughout the range of CFIR domains.

IMPLICATIONS FOR D&I RESEARCH: Providing appropriate training for staff 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 health centers can increase effective implementation of the HPV vaccine EBIs and reduce the burden of future cancers.