Organizational Variation in Implementation of an Evidence-Based Human Papillomavirus Intervention

Introduction "1-2-3 Pap" is a video-based intervention designed to improve human papillomavirus (HPV) vaccine adherence rates among young women in rural Eastern Kentucky. The efficacy trial for the original intervention linked video exposure with increased likelihood of vaccine series completion among the target audience. Given their historic focus on prevention, local health departments were selected as pilot sites to study implementation of 1-2-3 Pap in a public health setting and identify site-specific variations in its implementation. Methods A mixed-method, pre- and post-comparison pilot study conducted between October 2013 and April 2014 addressed three primary research questions: (1) how specific implementation planning activities using existing organizational resources and processes affect the selection and optimization of dissemination channels for evidence-based public health interventions; (2) what organizational resources, processes, or other attributes facilitate or impede implementation of evidence-based public health interventions; and (3) how variation in dissemination channels corresponds with intervention outcomes. Results Although analysis conducted in October 2014 found that the pilot study did not generate significant changes in HPV vaccine rates, data yielded from the Organizational Readiness to Change Assessment survey instrument and process evaluation interviews revealed variation in pre-study planning and in the use and coordination of staff, the adaptation of materials provided for implementation, and sites' ability to access HPV vaccine rate data throughout the study. Conclusions The mixed-method pilot study advances dissemination and implementation science through identification of variation in planning activities and use of organizational resources and processes for implementation of prevention interventions in public health settings.