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Table 2 Selection of behavior change techniques and implementation change strategies to increase HPV vaccine use

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

COM-B factor from the BCW [2] Potentially modifiable determinant of behavior, i.e., barrier or facilitator from CFIR-guided analysis [3] Theoretical domain and techniques for behavior change from TDF-guided analysis [20] Implementation strategy [19]
Capability Unaware of all benefits to the teen and practice of vaccination at 11/12-year check-up vs. deferring vaccine until older
(intervention characteristics, outer setting)
• Provide information about benefits of HPV vaccine at 11/12-check-up for teen and for practice
Develop and distribute educational materials for provider
Conduct educational outreach visits
Capability Lack of ability to effectively recommend HPV vaccine for use at the 11/12-year check-up
(characteristics of individuals, outer setting, and process)
• Model/demonstrate communication strategy
• Rehearse use of communication strategy
• Set goals for use of communication strategy and monitor behavior
• Undertake graded tasks
Develop and distribute educational materials
For providers: 4-part communication strategy
• Make a strong recommendation
• Provide simple responses for common questions
• Provide personal information about vaccine use if appropriate
• Implement a follow-up plan if parent is hesitant
For parents: brochures/posters
Test components of communication strategy in cyclical small tests of change using practice facilitation
Motivation No or limited interest in changing approach to HPV vaccine delivery
(characteristics of individuals, inner setting)
Action planning
• Set goal for change
• Planning the change
Audit and provide feedback of HPV vaccine coverage
Promote adaptability for target age to encourage participation
Practice facilitation
Motivation Low self-confidence to provide strong recommendation, address parental concerns and deal with hesitant parents to allow timely use of vaccine
(characteristics of individuals)
Belief about consequences
• Undertake graded tasks. Use problem-solving, decision-making and goal setting
• Process for encouragement and support
• Provide feedback of improvement
Social influences
• Process for encouragement and support
Test components of communication strategy in cyclical small tests of change using practice facilitation
Tailor implementation strategies
Practice facilitation
Opportunity Lack of vaccine delivery system
(inner setting, process)
Environmental context and resources
• Environmental changes to process of HPV vaccine delivery using all available resources
Conduct educational outreach visits
Practice facilitation
Conduct cyclical small tests of change
  1. BCW Behavior Change Wheel, CFIR Consolidated Framework for Implementation Research, TDF Theoretical Domain Framework