BACKGROUND:
Codified among the Standards for adult immunization practices, patient-oriented and community-based approaches should be used by health centers to reach target populations. However, these are not one-way interactions. To date, the interaction between a clinic's operational decisions, the communities served, and the consequence for vaccination programs have not been described.

OBJECTIVE:
To describe the interaction between community values and clinic operational strategies to reach target populations, and the impact these strategies have on coverage rates for the community.

METHOD:
Analysis of the programmatic strategies used by five clinics in San Diego to reach out to their respective communities.

RESULT:
Community values affect a clinic's targeted vaccination strategies. The strategies selected vary in the cost and efficacy impacting coverage rates. Results will be presented on how this interaction influences a clinic's decision to use specific vaccination delivery strategies. When clinics believe vaccinations are not highly valued by the community they serve, there is clear de-emphasis placed on activities such as mass vaccination clinics. When a clinic perceive that its community holds certain members in a higher ranking *(e.g. elders or women of child-bearing age), the clinic's case management is directed towards those community members. When a clinic perceives its community is strongly in favor of vaccination services, it aggressively markets mass vaccination services.

CONCLUSION:
This study suggests that health disparities may be the result of a complex interaction between community values and the vaccination strategies selected by the clinics serving those communities.

LEARNING OBJECTIVES:
To gain understanding of the interaction between community values and clinic operational strategies to reach target populations, and the impact these strategies have on coverage rates for the community.