Evaluation of a Minigrant Program for Multilevel Interventions to Promote Human Papillomavirus Vaccination in Rural...

Rates of human papillomavirus (HPV) vaccine are lower in rural counties than in urban areas. The objective of the minigrants evaluation was to assess HPV vaccination uptake, factors related to implementation success, and barriers to implementation.

We conducted a concurrent, mixed-methods evaluation guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) and CFIR (Consolidated Framework for Implementation Science) frameworks. Four health departments received funding, a toolkit with implementation strategies, and monthly technical assistance calls or a learning collaborative for 1 year. The data sources were program documents, staff interviews and surveys, immunization databases, and caregiver or young adult surveys. Key evaluation metrics were 1) reach of patients and adoption of intervention levels (patient, provider, or practice); 2) HPV vaccination effectiveness; 3) implementation perspectives from staff, caregivers, and young adults; 4) implementation barriers and facilitators; and 5) program sustainability capacity.

Most sites adopted 2 of 3 levels (patient, provider, or practice). Common multilevel strategies for series completion were patient education, incentives, provider training, and patient reminders. The total HPV vaccination rate increased 26.7% from 2023 to first quarter 2024, and initiation rate increase was 51.8% across the county departments. Overall, on a scale from 1 to 5, with 1 being "strongly disagree" to 5 being "strongly agree," sites reported positive experiences with program implementation and perceived the program was feasible (mean, 4.4 points), acceptable (mean, 4.4 points), and appropriate (mean, 4.2 points). Staff members also reported high ease of implementation (mean, 4.0 points) and commitment to program delivery (mean, 4.8 points). The parents or caregivers (n = 20) reported in surveys that they saw educational materials (100%), received educational materials (90%), and received a vaccine reminder (75%). CFIR-related facilitators were priority of the health issues, leadership involvement, technology infrastructure, communications about the vaccine and program, available resources, and staff training at the inner setting and external support at the outer setting. Barriers included limited resources, communication and structural characteristics (eg, technology, issues related to electronic health records), and local attitudes and conditions. The mean program sustainability capacity score was 4.2, with highest scores for evaluation, effectiveness, and workflow integration.

Multilevel intervention strategies can successfully increase HPV vaccination rates in rural settings with implementation supports to address cancer prevalence in rural areas.