Insights about All for Them implementation: A qualitative assessment
Introduction
Despite the availability of prophylactic human papillomavirus (HPV) vaccines to prevent HPV-associated cancers, HPV vaccine series completion rates are low among U.S. adolescents. All for Them (AFT) is a theory- and evidence-based multilevel, multicomponent program designed to effectively increase HPV vaccine uptake among medically underserved youth. AFT comprises 1) a parent-focused social marketing campaign to normalize HPV vaccination, 2) comprehensive school-based vaccination clinics (SBVCs), and 3) continuing school nurse education about HPV vaccination. This study sought to understand AFT implementation from the perspectives and experiences of school and provider partners as part of the needs, assets, and resource assessment to inform the development of a multifaceted dissemination and implementation strategy.
Methods
We conducted semi-structured, in-depth interviews with implementers of AFT. We analyzed the data using Rapid Assessment Procedures, a team-based method of iterative qualitative assessment emphasizing rigor and analytical efficiency. We summarized interviews and transferred the completed summaries into a single matrix with domain names corresponding to the interview questions. We used the matrix to streamline the process of synthesizing content and key constructs, identifying gaps in the data, and noting similarities, differences, and trends across the respondent roles. Finally, we extracted salient quotes to illustrate each emergent theme.
Results
We interviewed five school implementers and five healthcare provider implementers. Qualitative analysis revealed several themes from each respondent role in three domains: 1) Implementation facilitators, 2) Implementation barriers, and 3) Recommendations for potential adopters and implementers of AFT. For schools, advertisement and information provision and school-level organizational support were effective, while providers unanimously perceived the AFT team’s coordination as the primary implementation facilitator. Barriers for schools included nurses’ initial resistance to additional work for SBVCs, scheduling issues, and difficulty reaching parents. Providers expressed clinic staff shortages, consent form review, and minimal school-provider collaboration as challenges of AFT implementation. Schools recommended that potential AFT adopters and implementers: 1) convene informational pre-implementation meetings, 2) incentivize involvement from students, parents, and teachers, and 3) ensure proper clinic preparation. Providers suggested: 1) establishing provider-school relationships, 2) securing a location in schools conducive to running mobile vaccine clinics, and 3) sharing SBVC experiences from other AFT providers to avoid “re-inventing the wheel.” Both implementer types emphasized the importance of support from a dedicated coordinator for efficient school-provider communication to maximize success of program implementation.
Conclusion
All for Them is a synergistic approach that entails considerable coordination and communication across various collaborating parties. Implementers of AFT in their different roles collectively voiced that in addition to the facilitators of AFT implementation, the program needs to consider existing barriers and lessons learned. These key stakeholder insights will contribute to further adaptation of AFT implementation strategies to institutionalize AFT as standard practice and to develop a dissemination and implementation approach that considers the needs and capacities of potential adopters and implementers. With robust coordination and adequately addressed barriers, AFT can facilitate school districts and community healthcare providers to build partnerships to reduce health disparities in medically underserved areas and the prevalence of HPV-associated cancers through improved vaccination rates and fewer missed clinical opportunities among Texas adolescents.