Acceptability, appropriateness, sustainment, and implementation cost of a multicomponent strategy to increase HPV vaccination in pediatric primary care: secondary results of a cluster-randomized trial
4 affiliations
- 1Department of Pediatrics, Washington University School of Medicine in St. Louis, MSC 8505-45-01, 660 S. Euclid Ave, St. Louis, MO 63110 USA
- 2Bursky School of Public Health, Washington University, St. Louis, MO USA
- 3Division of Infectious Disease, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH USA
- 4Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO USA
Abstract
Background: Implementation outcomes and cost are as essential as clinical effectiveness for evidence-based practice adoption, yet few HPV vaccination improvement studies have assessed both using validated tools. Moreover, sustainment remains understudied in randomized controlled trials beyond the active implementation period. This gap limits the ability of health systems to make informed decisions about adoption and scale-up of the implementation strategy.
Objective: To assess implementation outcomes, including acceptability, appropriateness, sustainment, and estimate implementation costs from two stakeholder perspectives for a multicomponent strategy designed to improve HPV vaccination in pediatric primary care practices.
Methods: We conducted a secondary analysis of a 24-month cluster randomized controlled trial involving 20 pediatric practices. Implementation outcomes were assessed among providers using validated tools post-implementation. Because implementation outcomes were assessed following exposure and at different time points across study groups, analyses reflect provider perceptions of the strategy rather than causal comparisons. Implementation costs for the 10 intervention practices were evaluated from two perspectives: practice facilitators and practice personnel. Costs were calculated using personnel time multiplied by national wage rates from the 2023 U.S. Bureau of Labor Statistics. We used a micro-costing approach to estimate implementation resource use. Cost-effectiveness was assessed as cost per percentage-point improvement per practice and cost per additional adolescent vaccinated.
Results: Among 43 post-implementation survey responses (60% response rate), mean scores of acceptability (4.33 of 5) and appropriateness were high (4.37 of 5), with positive sustainment (3.95 of 5). Mean implementation cost was $10,021 per practice, requiring 93 h of facilitator time and 44 h of practice personnel time per practice over 24 months. Cost per additional adolescent completing the HPV vaccination series was $527 (facilitator: $238, practice: $289). These findings suggest favorable implementation outcomes alongside transparent, dual-perspective resource estimates.
Conclusions: The multicomponent strategy demonstrated high acceptability and appropriateness among providers, minimal disruption to clinical operations, and maintained positive sustainment ratings 12 months post-implementation. By reporting provider perceived implementation outcomes with detailed cost data from both implementer and practice perspectives, this study provides actionable evidence to inform feasibility and scalability of HPV vaccination implementation strategies in pediatric primary care.
Trial registration: ClinicalTrials.gov NCT04180462.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s43058-026-01068-w.
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BibTeX
@article{wang2026acceptability,
title = {{Acceptability, appropriateness, sustainment, and implementation cost of a multicomponent strategy to increase HPV vaccination in pediatric primary care: secondary results of a cluster-randomized trial}},
author = {Ruoyun Wang and Sherry Dodd and Shannon Rook and Sharon Graham and Abigail R. Barker and Katie Plax and Michelle I. Silver and Allison A. King},
journal = {Implementation Science Communications},
year = {2026},
month = aug,
doi = {10.1186/s43058-026-01068-w},
url = {https://doi.org/10.1186/s43058-026-01068-w},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Acceptability, appropriateness, sustainment, and implementation cost of a multicomponent strategy to increase HPV vaccination in pediatric primary care: secondary results of a cluster-randomized trial
AU - Ruoyun Wang
AU - Sherry Dodd
AU - Shannon Rook
AU - Sharon Graham
AU - Abigail R. Barker
AU - Katie Plax
AU - Michelle I. Silver
AU - Allison A. King
PY - 2026
DA - 2026/08/06
JO - Implementation Science Communications
DO - 10.1186/s43058-026-01068-w
UR - https://doi.org/10.1186/s43058-026-01068-w
AB - Background: Implementation outcomes and cost are as essential as clinical effectiveness for evidence-based practice adoption, yet few HPV vaccination improvement studies have assessed both using validated tools. Moreover, sustainment remains understudied in randomized controlled trials beyond the active implementation period. This gap limits the ability of health systems to make informed decisions about adoption and scale-up of the implementation strategy. Objective: To assess implementation outcomes, including acceptability, appropriateness, sustainment, and estimate implementation costs from two stakeholder perspectives for a multicomponent strategy designed to improve HPV vaccination in pediatric primary care practices. Methods: We conducted a secondary analysis of a 24-month cluster randomized controlled trial involving 20 pediatric practices. Implementation outcomes were assessed among providers using validated tools post-implementation. Because implementation outcomes were assessed following exposure and at different time points across study groups, analyses reflect provider perceptions of the strategy rather than causal comparisons. Implementation costs for the 10 intervention practices were evaluated from two perspectives: practice facilitators and practice personnel. Costs were calculated using personnel time multiplied by national wage rates from the 2023 U.S. Bureau of Labor Statistics. We used a micro-costing approach to estimate implementation resource use. Cost-effectiveness was assessed as cost per percentage-point improvement per practice and cost per additional adolescent vaccinated. Results: Among 43 post-implementation survey responses (60% response rate), mean scores of acceptability (4.33 of 5) and appropriateness were high (4.37 of 5), with positive sustainment (3.95 of 5). Mean implementation cost was $10,021 per practice, requiring 93 h of facilitator time and 44 h of practice personnel time per practice over 24 months. Cost per additional adolescent completing the HPV vaccination series was $527 (facilitator: $238, practice: $289). These findings suggest favorable implementation outcomes alongside transparent, dual-perspective resource estimates. Conclusions: The multicomponent strategy demonstrated high acceptability and appropriateness among providers, minimal disruption to clinical operations, and maintained positive sustainment ratings 12 months post-implementation. By reporting provider perceived implementation outcomes with detailed cost data from both implementer and practice perspectives, this study provides actionable evidence to inform feasibility and scalability of HPV vaccination implementation strategies in pediatric primary care. Trial registration: ClinicalTrials.gov NCT04180462. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s43058-026-01068-w.
SN - 2662-2211
ER -