An exploratory study to determine the feasibility and processes needed to implement the Immunization Neighborhood to increase HPV vaccination among African American adolescents and adolescents in the general population: A multi-partner perspective

Limited education and healthcare access are major contributors to Human Papillomavirus (HPV) vaccination disparities among African American adolescents. The Immunization Neighborhood (IN) involves enhanced communication and collaboration among providers to address people's needs by expanding access points and education to increase vaccination. Because needs of immunization providers and parents to effectively collaborate are unknown, this study explored the feasibility of and processes needed for IN utilization across key partners: pediatricians, pharmacists, school nurses, health department staff, and African American parent-child dyads. We conducted a semi-structured interviews in a qualitative, descriptive study with a purposive sample of 30 African American parent-child dyads and 37 immunization providers in Middle Tennessee. The Consolidated Framework for Implementation Research (CFIR) guided inductive-deductive thematic analysis. We identified facilitators and barriers to IN utilization for four CFIR domains: (1) Intervention characteristics; (2) Outer setting; (3) Inner setting; and (4) Individual characteristics. Across CFIR domains and partners, key perceived facilitators include convenience, accessibility, extended hours, partner coordination, and existing subsidized programs. Perceived barriers included fragmented vaccination tracking, limited vaccine registry interoperability, existing policies, and lack of knowledge and trust in immunization providers and settings. Our study highlights the need for multi-component, collaborative, and patient-centered strategies for IN implementation to improve adolescent HPV vaccination rates, especially among African American adolescents. Policy changes to reduce out-of-pocket expenses, increase insurance coverage, require reporting to state immunization registries, encourage collaborative practices, and allow HPV vaccine delivery in schools could potentially enhance IN impact.