Facilitators and Barriers to the Implementation of the HPV VACs (Vaccinate Adolescents Against Cancers) Program: A Consolidated Framework for Implementation Research Analysis
Facilitators and Barriers to the Implementation of the HPV VACs (Vaccinate Adolescents Against Cancers) Program: A Consolidated Framework for Implementation Research Analysis
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DOI：
10.5888/pcd16.180406
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发表时间：
2019-07-01
影响因子：
5.5
通讯作者：
Kegler, Michelle C.
中科院分区：
文献类型：
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作者：
Escoffery, Cam;Riehman, Kara;Kegler, Michelle C.
目的和目的人乳头瘤病毒（HPV）疫苗是预防多种癌症，特别是宫颈癌的有效但未得到充分利用的方法。虽然干预措施已成功地针对各种临床环境中HPV疫苗摄取的障碍，但很少有研究探讨其实施。我们的研究检查了HPV VACs的交付（为青少年接种癌症疫苗）计划并获取有关实施障碍和促进因素的信息。干预方法VACs计划试点是一个多层次的，由美国癌症协会在美国30个联邦合格的健康中心（CADHCs）进行的循证干预。评价方法我们进行了深入访谈（N = 32）通过电话与9个联合国人权事务高级专员办事处合作伙伴的代表进行了交流。我们构建了关于实施研究综合框架（CFIR）领域的访谈指南，我们询问了项目启动活动，实施战略选择，政策和实践层面的变化，人员配置结构，挑战以及导致项目成功的关键因素。至少有2名研究人员编码每个采访成绩单逐字resultsParticipants最经常确定的电子健康记录系统，培训和教育，具体的工具和资源，和供应商冠军的促进者实施HPV VACs。有限的人力资源、电子健康记录的挑战、州免疫登记处的问题、患者对疫苗的错误信息和疫苗污名、文化/语言障碍、相互竞争的优先事项、资金水平、工作人员的接受、培训需求，对公共卫生的影响为卫生和健康委员会工作人员和提供者提供适当的培训沿着技术援助和促进工具，这对于增加提供者对推荐HPV疫苗的信心至关重要。解决能力建设和实施障碍，可以提高循证干预措施的有效实施，以增加HPV疫苗接种率并减少未来癌症的负担。
Purpose and ObjectivesThe 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 ApproachThe 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 MethodsWe 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.ResultsParticipants 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 HealthProviding 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.