Friday, January 27, 2023
| Characteristic | Number |
|---|---|
| Age, ya | |
| 18–26 | 1 |
| 27–39 | 8 |
| 40–59 | 7 |
| ≥60 | 1 |
| Time employed at current clinic, y | |
| 1–3 | 6 |
| 4–6 | 4 |
| ≥6 | 8 |
| Sex | |
| Male | 0 |
| Female | 18 |
| Rurality of clinic | |
| Rural | 14 |
| Urban | 4 |
| Clinic specialtyb | |
| Pediatrics | 6 |
| General practice or family medicine | 12 |
| Gynecology | 1 |
Table 1. Characteristics of Clinic Managers and Administrators (N = 18) and Clinics Participating in Semistructured Interviews on Adolescent HPV Vaccination During the COVID-19 Pandemic, Iowa, August–November 2020
a One participant did not report age.
b Participants could select ≥1 clinic specialty.
| Theme/subtheme | Representative quotes |
|---|---|
| Theme: Decreased opportunities for HPV vaccination and routine care | |
| Structural barriers | [Interviewer: Are there any complications with any of this work that have come up during COVID that’s affected your ability to do any of it?] Participant: Probably the only thing would be that back a few months ago, we all had to cut hours because of location status. But now we’re all back pretty much up to our full-time status. Just got behind during the months of pretty much April, May, and June. (I-8) |
| I mean, there’s a lot of infection control, a lot more infection control focus with our masking mandate and [having patients who are virtual]. Virtual visits are available now. The virtual waiting room to have patients, you know, waiting in their car and communicating via secure text. So, a lot of technological advances were made and pushed through because of this. So, a lot of workflow got changed. (I-9) | |
| So, we have talked as a whole if all of that needs to be looked at just because we had for the safety of patients pushed out appointments if necessary, or we try to do them virtually if possible, region-wide for everybody, not just pediatrics. And I think what came back for most of us as administration is, yeah, we recognize that yes some of our metrics could have been missed due to those time periods. (I-1) | |
| Patient/parental fear of coming into clinic | But like I said, the numbers are down. Parents are just very leery of bringing them in to the doctor’s office. They’ve increased a little bit, the last month or so. (I-4) |
| I mean, our patients were less likely to come in, we had a lot of very fearful families. And even still, they still don’t want to bring their children into an area where they’re going to encounter other people. (I-3) | |
| So just parents that are more worried about coming into the office, just trying to reassure them that we’re keeping kids away from them. (I-18) | |
| Theme: Disruption to ongoing EBI implementation work | |
| Logistical challenges | [Interviewer: And are you still seeing that QI person even over the last six months with COVID?] Participant: No, they were furloughed, but they are back for the last two months I think, and back with a vengeance. They’re working hard to get us back where we need to be. (I-6) |
| [Interviewer: And in terms of your HPV vaccination work, have any new complications arisen during COVID-19? Were you able
to go out to the schools to do a similar sports physical push this year, things like that?] We were not because schools suspended in March and the orientation usually occurred end of March, early part of April . . . so school wasn’t in session at that time. So we missed that opportunity. (I-6) |
|
| Shift in priorities | I think prior to COVID happening, we were putting plans in place on how to increase immunizations, whether that’s signage in the rooms and just communicating with patients and parents about why this is beneficial for your child or for yourself. And then obviously COVID, and that kind of just threw everything quality improvement out the window, while you’re trying to focus on, how the heck are we going to do this? (I-2) |
| A lot has changed prior to COVID and now just trying to ensure that we adhere to all the new guidelines and make sure that we have staff, that we protect our staff as well with PPE and all of those things that are constantly changing, as we’re entering into the search plan. I would say that’s probably [leadership’s] main focus right now. (I-15) | |
Table 2. Themes, Subthemes, and Representative Quotes Resulting From Semistructured Interviews on Adolescent HPV Vaccination During the COVID-19 Pandemic, Iowa, August–November 2020
Abbreviations: EBI, evidence-based intervention; HPV, human papillomavirus; I, interview; PPE, personal protective equipment; QI, quality improvement.
Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™
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This activity is intended for primary care physicians, pediatricians, and other physicians who treat and manage children and adolescents who need vaccinations.
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The COVID-19 pandemic has prevented many adolescents from receiving their vaccines, including the human papillomavirus (HPV) vaccine, on time. However, little is known about the impact of the pandemic on implementation of clinic-level evidence-based interventions (EBIs) that help to improve HPV vaccine uptake. In this qualitative study, we explored the pandemic’s impact on EBI implementation and HPV vaccine delivery.
During August–November 2020, we interviewed clinic managers in a rural, midwestern state about their experiences implementing EBIs for HPV vaccination during the COVID-19 pandemic. We used a multipronged sampling approach with both stratified and purposive sampling to recruit participants from Vaccines for Children clinics. We then conducted a thematic analysis of transcripts.
In interviews (N = 18), 2 primary themes emerged: decreased opportunities for HPV vaccination and disruption to HPV-related implementation work. Most participants reported decreases in opportunities to vaccinate caused by structural changes in how they delivered care (eg, switched to telehealth visits) and patient fear of exposure to COVID-19. Disruptions to EBI implementation were primarily due to logistical challenges (eg, decreases in staffing) and shifting priorities.
During the pandemic, clinics struggled to provide routine care, and as a result, many adolescents missed HPV vaccinations. To ensure these adolescents do not fall behind on this vaccine series, providers and researchers will need to recommit to EBI implementation and use existing strategies to promote vaccination. In the long term, improvements are needed to make EBI implementation more resilient to ensure that progress does not come to a halt in future pandemic events.
