Our research team found several facilitators while adapting the “1-2-3 Pap” intervention from a rural, Appalachian audience to statewide audiences of young women. Many LHD staff indicated in a recent study (Carmen et al.; publication forthcoming) that the intervention met their organizational priorities and goals; they also perceived the “1-2-3 Pap” intervention to be straightforward and easy to implement. The researchers also discovered that the most coordinated LHDs held staff meetings prior to implementation, which allowed for staff feedback and the opportunity to gain buy-in. Broad inclusion of staff members can help facilitate implementation; they can help determine the best channels and methods for distribution based on their experience with the target population.
It is also imperative to identify local stakeholders, including “vaccination champions” and opinion leaders within potential partnering organizations, early in the program D&I process. Local stakeholders can help facilitate D&I by identifying appropriate messaging for the target audience, getting the word out to the community about the program, and providing additional program resources. For instance, a group of public health practitioners in North Carolina were instrumental in adapting the original “1-2-3 Pap” program for their state by developing culturally-relevant messages and delivery channels. The success of such programs can be substantially enhanced by partnering with stakeholders and involving them throughout the D&I process. Additionally, it would be helpful to pilot test the “1-2-3 Pap” intervention with your target audience prior to launch; this ensures that your audience understands the intervention materials.
Practitioners may also face challenges when implementing the “1-2-3 Pap” intervention. Due to the current climate regarding vaccination, there may be community norms, specifically negative attitudes or beliefs regarding vaccination, which may need to be addressed. Challenges in developing effective partnerships with stakeholders may also occur due to differing attitudes about program effectiveness, limited workforce capacity, or funding. Similarly, successful program implementation within a given organization may be hindered by lack of resources (i.e., staff and funding), competing demands, and state/local mandates. Barriers can be minimized by doing background work; specifically, assessing program needs, such as staff time and training, and determining how your organization can meet these needs in the most relevant yet least burdensome manner (McGladrey; publication forthcoming).
Program implementation may also be difficult if the vaccination infrastructure for a given area is inadequate. For example, some LHDs have expressed difficulty in keeping the HPV vaccine in-stock because of storage requirements (i.e., temperature). Issues surrounding insufficient vaccination data collection systems also surfaced during these studies.
LHDs included in the previously mentioned study noted difficulties in obtaining baseline HPV vaccination rates as well as tracking 3- and 6-month follow-up vaccination rates. All programs experience challenges so we encourage practitioners to proactively work with the staff in their respective organization as well as their stakeholders to overcome them.