Health care providers' perspectives on county-level barriers and facilitators to HPV vaccination: A socio-ecological approach (2022-2023).

In Indiana, HPV vaccine series completion is 59.6%. Using a socio-ecological model (SEM) approach, this study investigates county health department providers' perspectives on improving vaccine initiation and completion among adolescents in Indiana. We conducted semi-structured interviews to explore health department providers' opinions on barriers and facilitators of HPV vaccine series initiation and completion amongst parents of adolescents. Thematic analysis was then conducted on the transcribed interviews. Interviews were conducted with 24 county health department providers across Indiana with 54.2% (n = 13) holding a Vaccine Coordinator position. Perceived barriers to initiation at the individual level included the parents' lack of education regarding the HPV vaccine and the importance of prevention. Interpersonally, misinformation and busy schedules for both the parents and adolescents hindered initiation and completion. Further, the presentation of the vaccine by the clinic could affect initiation and completion rates (both positively and negatively). Organizationally, having reminder systems regarding follow-up appointments was a facilitator to completion. Community-level barriers included a lack of providers, transportation, and language issues, but flexible scheduling options were a facilitator. Policy barriers included HPV not being a school-required vaccine. Participants provided valuable insight into perceptions of the HPV vaccine and the barriers and facilitators to HPV vaccine series initiation and completion in Indiana. Barriers to series completion included lack of information and conflicting schedules. Facilitators of series completion included reminder systems and flexible vaccination scheduling options. Interventions that include these facilitators can be developed to improve completion.