ASPO Abstracts
SPEED-HPV: School-Based Pediatric clinics to Educate and Enable Delivery of HPV vaccination
Category: Cancer Health Disparities
Conference Year: 2022
Abstract Body:
Purpose. HPV vaccination rates are higher at Family Health Centers of NYU school-based health centers (SBHCs) in Brooklyn (70%) compared to the rest of the Borough (43%) and NYC (59%). This study examines implementation of HPV vaccination in these SBHCs to identify best practices. Methods. We conducted interviews with 12 clinical staff from 5 NYU SBHCs. Guided by the Consolidated Framework for Implementation Research (CFIR), we used a deductive content analysis to identify vaccination drivers in SBHCs.Results. Intervention-level facilitators include having immunization as a core clinical service, which allows for a smooth integration of HPV vaccination processes; incorporating screening and reminder calls in clinic workflow; and sending parental text reminders. The lack of in-language text messages and materials was cited as a challenge for immigrant parents. Inner setting facilitators include leadership buy-in and support; staff meetings to reinforce vaccination goals and discuss progress; and using electronic health records to track vaccination status. Outer setting facilitators include NYC Department of Health and Mental Hygiene resources, including the Citywide Immunization Registry to track vaccination status and educational materials. The lack of school HPV immunization mandates was viewed as a barrier. Facilitators at the individual-level include a staff champion; self-efficacy to tailor counseling to patients' cultural beliefs; and language and racial/ethnic concordance with patients. Barriers include vaccine hesitancy among staff, which was addressed by ad-hoc staff-led education. Relatedly, interviewees described informal clinic champions as facilitating HPV immunization. Conclusion. We identified strategies to boost HPV vaccination in SBHCs: 1) immunization process workflows ranging from screening to outreach and delivery; 2) motivated staff and champions with relevant knowledge and self-efficacy; 3) leadership commitment to HPV vaccination. Opportunities for improvement were: 1) having in-language and culturally tailored educational materials and reminders; 2) systematically addressing vaccine hesitancy in staff; 3) periodic check-ins to review progress and improve workflow.
Keywords: school-based health centers; HPV vaccine; quality improvement