Evaluating implementation by rural clinics of evidence-based interventions to promote HPV vaccination

Despite the well-established link between vaccination against human papillomavirus (HPV) and a decreased risk of cancer, HPV vaccine uptake in rural communities is low. Evidence-based interventions (EBIs) to promote HPV vaccination exist but are not universally implemented in rural settings due to various challenges. To understand the support needed by rural clinics in implementing EBIs, the University of Iowa partnered with the American Cancer Society (ACS) to evaluate an ACS HPV Vaccinating Adolescents against Cancers Quality Improvement Learning Collaborative that was delivered to six clinics in two rural health systems. The study aimed to assess the effectiveness of the learning collaborative approach for helping rural clinics implement EBIs aimed at increasing HPV vaccine uptake.

Semistructured interviews were conducted with clinic staff at six time points throughout the 2-year intervention. Interviews were conducted over the phone and were recorded and transcribed. Members of the research team coded the interviews using codebooks informed by the interview guides. The analysis compared the health systems and identified the changes they made in response to assistance provided by the collaborative.

Clinic staff implemented the following EBIs: utilizing the immunization registry, strong provider recommendation, and provider education. Implementation of scheduling next dose fluctuated during the intervention. Differences were noted in the two health systems' implementation using electronic health records for patient and provider reminders.

Small, rural clinics can implement effective EBIs, given proper support. This is important as such EBIs can increase HPV vaccination rates and help prevent HPV-associated cancers.