Barriers and facilitators to HPV vaccination in primary care practices: a mixed methods study using the Consolidated Framework for Implementation Research.
Barriers and facilitators to HPV vaccination in primary care practices: a mixed methods study using the Consolidated Framework for Implementation Research.
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DOI：
10.1186/s12875-018-0750-5
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发表时间：
2018-05-07
影响因子：
2.9
通讯作者：
Lobb R
中科院分区：
文献类型：
--
作者：
Garbutt JM;Dodd S;Walling E;Lee AA;Kulka K;Lobb R
在美国，有效、安全的人乳头瘤病毒(HPV)疫苗未得到充分利用，预防癌症的机会继续错失。国家指南建议在13岁之前完成2-3剂HPV疫苗系列接种，远在暴露于性传播病毒之前。准确描述在初级保健环境中全面实施HPV疫苗建议的促进者和障碍可以为有效的实施战略提供信息。我们使用实施研究综合框架(CFIR)，采用并行混合方法设计，在10个初级保健实践(16个提供者)中系统地调查和表征了影响HPV疫苗使用的因素。CFIR被用来指导收集和分析通过与初级保健提供者面对面的半结构化访谈收集的定性数据。我们用从病历中提取的数据分析了HPV疫苗的使用情况。通过整合定性和定量数据，确定了对疫苗使用影响最大的结构。在评估的72个CFIR结构中，7个强区分和7个弱区分在HPV疫苗覆盖率较高和较低的提供者之间。大多数有强烈区别的概念是促进者，与提供者的特征(知识和信念；自我效能；对变化的准备)、他们对干预的看法(接种较年轻青少年的相对优势)以及他们提供疫苗的过程(执行)有关。作为促进者的其他区别较弱的概念来自外部环境(同行压力；财政激励)、内部环境(网络和通信以及实施准备情况)和过程(规划、参与、反思和评估)。两个截然不同的概念是使用障碍，一个来自干预(开始年龄的适应性)，另一个来自外部环境(患者需求和资源)。使用CFIR系统地检查这种疫苗在独立初级保健实践中的使用情况，使我们能够确定提供者、人际关系和实践层面的促进者和障碍，这些因素和障碍需要在未来努力增加此类环境中的疫苗使用量时加以解决。我们的发现表明，针对提供者并帮助他们解决HPV疫苗使用的多层次障碍的实施战略值得进一步研究。
In the United States, the effective, safe huma papilloma virus (HPV) vaccine is underused and opportunities to prevent cancer continue to be missed. National guidelines recommend completing the 2–3 dose HPV vaccine series by age 13, well before exposure to the sexually transmitted virus. Accurate characterization of the facilitators and barriers to full implementation of HPV vaccine recommendations in the primary care setting could inform effective implementation strategies. We used the Consolidated Framework for Implementation Research (CFIR) to systematically investigate and characterize factors that influence HPV vaccine use in 10 primary care practices (16 providers) using a concurrent mixed methods design. The CFIR was used to guide collection and analysis of qualitative data collected through in-person semi-structured interviews with the primary care providers. We analyzed HPV vaccine use with data abstracted from medical charts. Constructs that most strongly influenced vaccine use were identified by integrating the qualitative and quantitative data. Of the 72 CFIR constructs assessed, seven strongly distinguished and seven weakly distinguished between providers with higher versus lower HPV vaccine coverage. The majority of strongly distinguishing constructs were facilitators and were related to characteristics of the providers (knowledge and beliefs; self-efficacy; readiness for change), their perception of the intervention (relative advantage of vaccinating younger vs. older adolescents), and their process to deliver the vaccine (executing). Additional weakly distinguishing constructs that were facilitators were from outer setting (peer pressure; financial incentives), inner setting (networks and communications and readiness for implementation) and process (planning; engaging, and reflecting and evaluating). Two strongly distinguishing constructs were barriers to use, one from the intervention (adaptability of the age of initiation) and the other from outer setting (patient needs and resources). Using CFIR to systematically examine the use of this vaccine in independent primary care practices enabled us to identify facilitators and barriers at the provider, interpersonal and practice level that need to be addressed in future efforts to increase vaccine use in such settings. Our findings suggest that implementation strategies that target the provider and help them to address multi-level barriers to HPV vaccine use merit further investigation.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
8
作者：
Kempe A;O'Leary ST;Kennedy A;Crane LA;Allison MA;Beaty BL;Hurley LP;Brtnikova M;Jimenez-Zambrano A;Stokley S
通讯作者：
Stokley S
影响因子：
12.7
作者：
Opel, Douglas J.;Mangione-Smith, Rita;Taylor, James A.
通讯作者：
Taylor, James A.
影响因子：
33.9
作者：
Reagan-Steiner, Sarah;Yankey, David;Singleton, James A.
通讯作者：
Singleton, James A.
影响因子：
8
作者：
Perkins, Rebecca B.;Clark, Jack A.;Pierre-Joseph, Natalie
通讯作者：
Pierre-Joseph, Natalie