Understanding the Feedback Session: a Process Evaluation of AFIX in Oregon

Background: Seven health educators (HEs) at the Oregon Immunization Program (OIP) routinely conduct AFIX visits in Oregon.  Approximately 30% of HE time is spent on AFIX and other provider-related activities, including preparing for visits, traveling to sites, conducting AFIX visits, and documenting feedback from those visits.  In an effort to optimize time spent on AFIX visits OIP initiated a process evaluation of how AFIX feedback sessions are conducted.

Setting: Provider sites that received an AFIX visit between June 2008 and November 2009.

Population: Provider site staff involved with the delivery of immunizations who attended a feedback as part of an AFIX visit.

Project Description: Between 2008 and 2009, HEs systematically documented AFIX feedbacks, including how feedbacks are conducted, who attends feedbacks, and what goals were set by provider staff attending feedbacks. This process evaluation describes characteristics of completed feedbacks.

Results/Lessons Learned:Between June 2008 and November 2009, 63 AFIX visits to 58 unique provider sites were captured in the program database.  An average of 9 staff attended feedback sessions for 40 documented visits, totaling 351 attendees. Attendees most commonly included MAs or LPNs (36%), followed by RNs (14%), MDs and clinical managers (6% each). Most feedbacks (67%, 42/63) were conducted in–person; 13 of which occurred as exchange sessions (multiple clinics attending 1 session). 46% of clinics received feedback by mail. 38% of clinics set goals to improve immunization up-to-date rates. Goals focused on assessing UTD status for children at all visits, utilizing forecasting tools, increasing frequency of reporting to Oregon’s IIS, improving uptake of the 4th DTaP, and better utilization of reminder and recall systems.  Understanding these characteristics of feedbacks will help HEs facilitate future AFIX visits and encourage more clinics to set goals to improve vaccination coverage. Additional consideration should be made concerning the role of feedback participants and their ability to influence decisions at the clinic-level.