Barriers and facilitators to HPV vaccination in rural South Carolina pharmacies: a qualitative investigation.

Introduction: As many as 14 million people contract a new case of HPV each year in the United States, with over 37,000 HPV cancers diagnosed each year. However, HPV vaccination coverage varies greatly with disparities by population and region. In rural areas, HPV vaccination rates for adolescents are significantly lower (12%) than for teens living in urban areas while HPV cancer rates are higher comparatively. Pharmacy-based vaccination services reduce accessibility barriers, as approximately 90% of Americans live within five miles of a community pharmacy. Unfortunately, implementation of HPV vaccination in community pharmacy settings remains low. Therefore, the objective of this study was to identify perceived barriers and facilitators to HPV vaccination services among South Carolina pharmacists.

Methods: Qualitative interviews with community-based pharmacists practicing in rural South Carolina were conducted from August-December 2021. Community pharmacists practicing in areas with primary Rural-Urban Commuting Area (RUCA) codes of 4 and above were invited to participate in this study. Recruitment continued until point of saturation. Interviews were approximately 30 min in length and conducted using a semi-structured guide. Interview questions were open-ended and designed to elicit barriers and facilitators to administering the HPV vaccination in a pharmacy setting. All interviews were audio-recorded and transcribed. Transcripts were deductively coded using the Consolidated Framework for Implementation Research (CFIR), using NVivo to manage and analyze data.

Results: Ten pharmacists participated in the qualitative interviews. Fourteen CFIR constructs were identified during qualitative analysis and interpretation. Applying the CFIR rating rules, seven constructs were found to have a strong influence (+ 2 or -2). Constructs with a strong positive influence, and indicated as facilitators, included "patient needs and resources" and "cosmopolitanism", while constructs with a strong negative influence, and indicated as barriers, included "design quality and packaging", "cost", "available resources", "external policy and initiatives", and "innovation participants".

Conclusion: Multiple barriers and facilitators were identified as impacting HPV vaccination in rural South Carolina community pharmacies. Addressing these barriers may improve pharmacy-based HPV vaccination services, thereby improving access in rural communities. Findings from this study will be used to develop implementation strategies to increase administration of the HPV vaccine in pharmacy settings.