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首页> 外文期刊>BMC Family Practice >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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Barriers and facilitators to HPV vaccination in primary care practices: a mixed methods study using the Consolidated Framework for Implementation Research

机译：初级保健实践中HPV疫苗接种的障碍和促进者：使用合并实施研究框架的混合方法研究

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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.
机译：在美国，有效，安全的呼玛乳头状瘤病毒（HPV）疫苗并未得到充分利用，预防癌症的机会仍被错过。国家指南建议，在接触性传播病毒之前，应在13岁之前完成2至3剂HPV疫苗系列。准确描述促进者的特征以及在基层医疗机构中全面实施HPV疫苗建议的障碍可以为有效的实施策略提供依据。我们使用合并实施研究框架（CFIR），使用并行混合方法设计，系统地调查和表征了影响HPV疫苗在10种初级保健实践（16家提供者）中使用的因素。 CFIR被用来指导收集和分析通过与初级保健提供者进行面对面的半结构式访谈而收集的定性数据。我们使用从医学图表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，鉴定出对疫苗使用影响最大的构建体。在评估的72种CFIR构建体中，HPV疫苗覆盖率较高与较低的提供者之间有7个强弱区分。大多数具有显着区别的结构是促进者，并且与提供者的特征（知识和信念;自我效能;改变的准备程度），他们对干预措施的看法（为年轻人和年龄较大的青少年接种疫苗的相对优势）及其过程有关。运送疫苗（执行）。促进者的其他较弱的区分结构是外部环境（同伴压力;财务激励措施），内部环境（网络和沟通以及实施准备情况）和过程（计划;参与，反思和评估）。两种截然不同的结构是使用障碍，一种是干预（适应年龄的适应性），另一种是外部环境（患者的需求和资源）。使用CFIR系统地检查这种疫苗在独立的初级护理实践中的使用情况，使我们能够确定提供者，人际关系和实践水平上的促进因素和障碍，这是今后在此类场所增加疫苗使用量时需要解决的问题。我们的发现表明，针对提供者并帮助他们应对HPV疫苗使用的多层次障碍的实施策略值得进一步研究。

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