Abstract B64: Using the Consolidated Framework for Implementation Research (CFIR) to identify potential facilitators and barriers of an intervention to increase HPV vaccine uptake
Authors: Selove Rebecca , Foster Maya , Sanderson Maureen , Hull Pamela 
Published: May 2015

Background: African American and Hispanic women have substantially higher rates of cervical cancer incidence and mortality than White women.

Methods: A community-based participatory research (CBPR) project was undertaken to develop, implement and evaluate a culturally-tailored provider intervention to increase uptake of the Human Papilloma Virus (HPV) vaccine among African American and Hispanic adolescents aged 9-18 years and appropriate cervical cancer screening in their mothers. This CBPR is a collaboration between Meharry Medical College, Tennessee State University (TSU), three community health centers in Nashville, Memphis and Chattanooga, and a Community Advisory Board. The current project re-examined provider interview data obtained for developing the intervention to seek information about potential facilitators and barriers to implementation. The study was also undertaken to inform development of follow-up provider interview questions to assess organizational, provider, and intervention characteristics that might enhance or impede implementation with the aim of improving implementation outcomes.

Investigators conducted 20-30 minute interviews in-person or via telephone with 38 providers from four project sites. Three were community health centers located in Memphis, Chattanooga, and Nashville TN, and one was at a historically Black medical school in Nashville. Individuals in the convenience sample were interviewed between August 2009 and July 2001.

Narrative analysis of transcribed interviews was used to identify (a) provider attitudes, beliefs, and practices related to HPV vaccine, and (b) provider perceptions of organizational or cultural factors that might affect implementation outcomes of acceptability, adoption, and sustainability of the intervention. The approach was primarily holistic (as contrasted with a categorical) approach in that provider remarks were interpreted in the overall context of the project. A coding framework based on the Consolidated Framework for Implementation Research (CFIR) was developed in Excel. Two investigators completed the coding of all interviews and generated composite analyses of each interview and of each coding category. The results of all 38 interviews were summarized as responses to the research objectives.

Results: While initial interview questions were developed to inform design of the intervention, this study determined that narrative analysis of interview transcriptions yielded information about all five CFIR domains that may be related to facilitators and barriers of implementation: (1) Intervention: Provider support for HPV vaccine and engaging educational material was strong. (2) Outer setting: Providers described a variety of their patient population's needs, preferences, and cultural/social contexts that may impact implementation. (3) Inner setting: The intervention takes into account provider workflow needs. However, there are likely to be implementation challenges associated with clinic structures and procedures. (4) Provider characteristics: Some provider beliefs and provider-patient communication strategies may facilitate implementation more than others. (5) Process: The CBPR approach may enhance the adoption of the intervention.

Conclusion: Narrative analysis of provider interviews yields rich information regarding facilitators and barriers to implementing a comprehensive provider intervention to facilitate receipt of the HPV vaccine in project sites. Additional provider training in strategic listening and motivational interviewing may improve individual and organizational capacity to increase HPV vaccine uptake in African American and Hispanic adolescents in settings in which the intervention is offered.

Citation Format: Rebecca Selove, Maya Foster, Maureen Sanderson, Pamela Hull. Using the Consolidated Framework for Implementation Research (CFIR) to identify potential facilitators and barriers of an intervention to increase HPV vaccine uptake. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B64. doi:10.1158/1538-7755.DISP13-B64