Theory-based development of an implementation intervention to increase HPV vaccination in pediatric primary care practices

Table 1 Summary of distinguishing factors for completion of HPV vaccine series by 13th birthday characterized using the CFIR(1)

CFIR domain	Construct	Effect
Intervention characteristics	Relative advantage—at age 11–12 (increased immunogenicity, completion of series before risk, access to at-risk population)	Facilitator
Intervention characteristics	Adaptability—use older age of initiation	Barrier
Outer setting	Patient needs and resources—optional as not mandated by school	Barrier
	Peer pressure	Barrier
	External policy and incentives—financial incentives for series completion, e.g., meaningful use	Facilitator
Inner setting	Networks and communication—communication to coordinate implementation of 3 doses across staff and providers	Facilitator
Inner setting	Readiness for implementation—leadership engagement in system level improvements and use of available resources, e.g., EMR alerts, outreach calls	Facilitator
Characteristics of individuals	Knowledge and beliefs—perceive value to completing by age 13	Facilitator
	Knowledge and beliefs—perceive value to bundling	Facilitator
	Self-efficacy—confident to strongly recommend vaccine and to convince hesitant parents	Facilitator
	Self-efficacy—enthusiastic about HPV vaccine	Facilitator
	Readiness to change—has made personal efforts for improvement	Facilitator
Process	Planning—discuss/implement changes for increased vaccine use	Facilitator
	Engaging—involve staff in meaningful problem-solving	Facilitator
	Executing—strong recommendation, routinely provide at age 11/12, bundle 3 vaccines	Facilitator
	Reflecting and evaluating—with a view to making changes	Facilitator