| Background. Health experts encourage vaccination within a child's "medical home", typically a healthcare provider's office. In 2008, Advisory Committee on Immunization Practices (ACIP) expanded its influenza vaccination recommendations to include 6-18 year olds, essentially recommending vaccination of every child in the U.S. every year. Objectives: (1) To understand the current practice environment for influenza vaccination of children; (2) To assess the readiness of Pennsylvania Vaccines for Children (VFC) providers to implement the 2009-2010 influenza vaccine recommendation.;Methods. A cross-sectional, mixed methods survey was administered to a sample of 505 Pennsylvania VFC practices. Quantitative data were analyzed using descriptive, bivariate, and logistic regression analyses. Qualitative data were analyzed using the "cutting and sorting" method.;Results. Response rate was 60%. Most practices strongly (60.4%) or somewhat agreed (30.3%) to readiness to implement influenza recommendations, few disagreed (5.7%). Bivariate analysis identified organizational characteristics (practice size, absorptive capacity for change elements, percent of children < 2 years old and function differentiation) and theoretical components of readiness (importance of vaccination as a service, estimated vaccination coverage of 6-18 year olds, staff support of recommendation, and plan to evaluate) as significantly associated with readiness. Logistic regression models found strong predictors for readiness in organizational characteristics (practice size, two absorptive capacity for change elements, and functional differentiation) and theoretical components (agreement with recommendation, estimated vaccination rate of 6-8 year olds, and evaluation plans). Respondents planned an average of 4.96 (SD-2.3) influenza vaccination interventions and number of interventions was associated with readiness. Readiness was described in terms of vaccine supply, parental awareness and education, and origination.;Conclusions. Most providers were at least somewhat ready to implement the expanded influenza vaccination recommendations and planned multiple interventions. Organizational and theoretical factors predictive of readiness level could be considered when developing clinical practice guidelines (CPGs) and exploited to target public and private health outreach and interventions to practices of low readiness. Examination of practice readiness could be enhanced by valid scales or indices to measure readiness. Policy-makers and public health agencies can support VFC providers' effort to implement influenza vaccination by addressing supply, parent awareness and education, and origination issues. |
