Need: The human papillomavirus (HPV) vaccine can protect against infection with HPV types that cause anogenital and oropharyngeal cancers. Despite the safety and efficacy of the HPV vaccine to protect against these types of cancers, vaccination rates among adolescents are well below the Healthy People 2030 goal of 80% series completion. Availability and implementation of adolescent immunizations in alternative settings, such as schools, can increase vaccination rates, particularly among underserved populations. However, schools often face barriers in implementing immunization programs. All for Them (AFT) is a multilevel multicomponent program that comprises three synergistic evidence-based s...

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Need: The human papillomavirus (HPV) vaccine can protect against infection with HPV types that cause anogenital and oropharyngeal cancers. Despite the safety and efficacy of the HPV vaccine to protect against these types of cancers, vaccination rates among adolescents are well below the Healthy People 2030 goal of 80% series completion. Availability and implementation of adolescent immunizations in alternative settings, such as schools, can increase vaccination rates, particularly among underserved populations. However, schools often face barriers in implementing immunization programs. All for Them (AFT) is a multilevel multicomponent program that comprises three synergistic evidence-based strategies (social marketing campaign, comprehensive school-based vaccination clinics, and school nurse education) and offers an approach that schools and health care provider partners can use to effectively increase HPV vaccine initiation and completion among school-aged adolescents. Overall Project Strategy: Implementing All for Them (IM-AFT) will be a multifaceted implementation strategy designed for use by schools, school districts, and community health centers (CHCs) interested in impacting adolescent vaccination, and HPV vaccination in particular, in their communities. The final content and design of IM-AFT is dependent on guidance and feedback from a stakeholder advisory group, results of our formative work for this project and previous AFT projects, and the implementation intervention development process. We will use Implementation Mapping, a systematic approach to implementation planning that integrates theory, empirical evidence, and stakeholder feedback to develop methods and strategies to enhance AFT adoption, implementation, and maintenance. We will conduct a needs, assets, and readiness assessment to: 1) identify barriers and facilitators of implementation, 2) understand potential implementers' readiness and capacity for implementation of AFT, and 3) inform IM-AFT program development. Based on our current work implementing AFT, we anticipate that the IM-AFT core strategies will comprise a web-based implementation toolkit, training course, and technical assistance program. These active dissemination strategies are among the compilation of implementation strategies produced by the Expert Recommendations for Implementing Change (ERIC) and School Implementation Strategies, Translating ERIC Resources (SISTER) projects. The toolkit will be adaptable for AFT adopters based on site type (e.g., school, CHC), resource availability, and implementer capacity. Training components will include synchronous and asynchronous formats for maximum flexibility in supporting AFT adopters in preparing to effectively implement the toolkit in diverse settings. Technical assistance will be provided via a four-part ECHO series to prepare users for AFT implementation in the field and to build a collaborative learning community among potential implementers for enhanced sustainability. Specific Goals: The first goal of this project is to develop and test a multifaceted implementation approach to disseminating AFT (including development and testing of a dissemination toolkit, training course, and technical assistance program). Following development and alpha/beta testing, we will conduct a pilot study with users from schools, school districts, and CHCs to evaluate feasibility, usability, and acceptability of IM-AFT (Goal 2), and fidelity of implementing AFT (Goal 3). Significance and Impact: This project will assist Texas schools and CHCs in building capacity to implement a multicomponent effective approach to HPV vaccination in school settings. IM-AFT will create a learning community to reduce barriers to implementation of vaccination strategies and can institutionalize AFT as standard practice among potential adopters. This dissemination grant will provide an opportunity to forge new partnerships between schools and CHCs to improve HPV and other adolescent vaccination rates in underserved populations to reduce the prevalence of vaccine-type HPVs in Texas communities.

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