Pediatric Practice Experiences Administering the 2nd Dose of the Influenza Vaccine: An AAP Pediatric Research in Office Settings (PROS) Study

Wynn C, Stockwell M, Nekrasova E, Torres A, Griffith M, Shone L, Localio R, Shults J, Unger R, Ware L, and Fiks A

Presented at the 2021 Pediatric Academic Societies Annual Meeting

Background: Less than half of children needing 2 doses of influenza vaccine in a season receive both, leaving them at increased risk of disease. Little is known about barriers and facilitators to increasing full influenza vaccination coverage.

Objective: To explore experiences of pediatric clinicians and staff in administering the 2^nd influenza vaccine dose.

Design/Methods: We conducted 7 focus groups and 4 individual interviews with PROS practices that participated in the 2^nd season (2018-19) of the NIH-funded Flu2Text RCT of text message reminders for 2^nd influenza vaccine dose. Of 37 participating practices, 10 were selected for focus groups/individual interviews through stratified sampling of practices with the highest (n=5) and lowest (n=5) effect sizes in the RCT. Semi-structured discussion guides with clinicians (16 pediatricians, 9 nurse practitioners), nurses (n=3), medical assistants (n=5), and staff (n=5) included questions that addressed parental, practice and health system barriers/facilitators to 2^nd dose administration. Using the Systems Model of Clinical Preventive Care as a conceptual framework, which focuses on factors involved in the provision and receipt of clinical preventive care, 2 investigators independently coded transcripts (K=.86, high agreement) with NVivo 12 Plus. Coding inconsistencies were resolved by consensus.

Results: We identified themes aligning with the Systems Model of Preventive Care (Table 1). Influenza vaccine administration, especially the 2^nd influenza dose, differed from other childhood vaccines. Perceived barriers included parents’ general vaccine hesitancy, uncertainty about 2^nd dose necessity, and transportation issues. Practice/system level factors such as vaccine availability and difficulty scheduling the 2^nd dose were also identified. Despite barriers, participants reported most parents accepted the 2^nd dose and highlighted a number of factors that enabled vaccination, including influenza vaccine clinics, education on necessity of both doses, local media coverage, and their existing relationships with families. Themes did not differ by practice performance in the RCT or by 2^nd dose completion.

Conclusions: Despite distinct challenges, pediatric practices incorporated strategies to encourage receipt of the 2^nd dose for those who need it. Themes from this study provide a framework for understanding challenges and opportunities to bolster 2^nd dose influenza vaccination uptake.