Human Papillomavirus Immunization in Rural Primary Care

Area of Science:

• Public Health
• Vaccinology
• Healthcare Management

Background:

• Human papillomavirus (HPV) and related cancers pose a significant health burden.
• Rural areas exhibit disproportionately low HPV vaccination rates.
• Primary care clinics are crucial for HPV vaccine delivery.

Purpose of the Study:

• To identify effective strategies in rural primary care clinics with high HPV vaccination rates.
• To utilize a positive deviance approach to uncover success factors.
• To inform quality improvement interventions for HPV vaccination in rural settings.

Main Methods:

• Ranked rural clinics by HPV vaccine up-to-date rates using 2018 Oregon Immunization Program data.
• Purposively sampled clinics from top and bottom quartiles.
• Conducted interviews, surveys, and 2-day observational visits with 12 clinics.

Main Results:

• Clinics with higher HPV vaccination rates implemented standardized workflows for vaccine identification and administration.
• Designated and supported vaccine champions were a key factor.
• Clinical staff readiness to administer vaccines irrespective of visit type was observed.
• Effective communication strategies involved clear, persuasive recommendations and education.

Conclusions:

• Positive deviance analysis revealed key characteristics of high-performing rural clinics for HPV vaccination.
• Findings offer actionable guidance for improving HPV vaccination quality in rural primary care.
• Interventions can be tailored based on identified workflows, champion roles, staff adaptability, and communication techniques.