Feasibility of Adolescent Vaccination in Non-Traditional Settings: A Qualitative Study in Denver, Colorado, 2007

Learning Objectives for this Presentation:
By the end of the presentation participants will understand the perceived feasibility of adolescent vaccination in non-traditional settings.

Background:
Vaccinating adolescents in diverse clinical settings may be necessary to maximize vaccination coverage.

Objectives:
To explore the feasibility of adolescent vaccination, in general and against human papillomavirus (HPV), in 4 different clinical settings: school-based health centers, family planning clinics, public health clinics (including those with sexually transmitted infection clinics), and emergency/urgent care clinics.

Methods:
Using a structured interview guide, in-depth interviews were conducted with 30 clinicians and administrators from 11 different urban sites in and around Denver, Colorado in May-November 2007.

Results:
The majority of sites provided one or more different vaccines to adolescents. Some sites, particularly school-based health centers, offered all recommended vaccines to adolescents, including HPV vaccine. Factors present in facilities offering HPV vaccine included a good “fit” with the mission of the organization as well as existing mechanisms (such as the Vaccines for Children program) to cover vaccine costs. Sites that provided some vaccines but not HPV cited funding and consent issues as barriers to HPV provision. For example, HPV vaccine was not offered to adolescents in some family planning clinics, because these sites required parental consent for vaccination and adolescent patients were typically seen for confidential visits without parental involvement. A few sites (such as emergency/urgent care) generally provided only tetanus-containing vaccines to adolescents. Reasons for not providing other vaccines included the lack of “fit” with the setting's clinical mission as well as concern that primary care providers would be unaware that vaccines had been given.

Conclusions:
In a qualitative study of urban non-traditional settings, many facilities provided vaccines, including HPV, to adolescents. Issues of parental consent, vaccine financing, and concordance with the organization's mission may limit HPV provision in some settings.