Coverage of recommended adolescent vaccines in the United States (US) lags notably behind childhood vaccination. We aimed to determine provider-associated factors which hinder adolescent vaccination as well as successful strategies to maximize adolescent vaccine uptake.
A total of 20 vaccine champions were recruited across counties in North Carolina (NC). Adolescent providers were identified with above average vaccine coverage rates for adolescents aged 13 through 17 within NC Vaccine For Children (VFC) clinical practices. Vaccination champions were interviewed using a semi-structured questionnaire to capture lessons learned for reducing missed opportunities for adolescent vaccination.
Facilitators to adolescent vaccine program success included having systems to identify patients eligible for their first dose of HPV vaccine (95%); routinely providing vaccines to adolescents at well-child visits (95%) and acute visits (75%). Additional facilitators included providing training on adolescent immunizations to other clinic staff (85%); reminders for patients’ vaccination due dates (80%); having standing orders for providing adolescent vaccines (75%); and involvement of NC Immunization Branch in vaccine uptake strategies with clinics (60%). Barriers faced in immunizing adolescents included parents’ opposition due to lack of education or negative media (35%); HPV vaccine stock outs (35%); issues related to child’s sexual activity (30%); concerns about pain following vaccination (15%); and dose completion problems (15%). Steps taken if parents refused or wished to delay vaccines included trying again during next visit (45%); providing education materials (40%), discussing vaccine safety (20%); and asking questions to explore parents’ concerns (15%). Treating HPV vaccine the same as required vaccines when recommending to parents and adolescents was cited as an opportunity for increased rate of HPV vaccination (95%).
Adapting these lessons learned to inform state-specific adolescent vaccination action plans could improve national HPV and other adolescent vaccination rates, and may be applicable to other global populations.