Table 2 Selection of behavior change techniques and implementation change strategies to increase HPV vaccine use
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) | Knowledge • 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) | Skills • 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 Reminders Practice facilitation Conduct cyclical small tests of change |