ingest cdrApp 2017-08-15T20:57:52.871Z d91e81c8-5a8a-4e8a-976c-cad4e396e5ee modifyDatastreamByValue RELS-EXT fedoraAdmin 2017-08-15T20:58:35.918Z Setting exclusive relation modifyDatastreamByValue RELS-EXT fedoraAdmin 2017-08-15T20:58:45.084Z Setting exclusive relation addDatastream MD_TECHNICAL fedoraAdmin 2017-08-15T20:58:54.031Z Adding technical metadata derived by FITS modifyDatastreamByValue RELS-EXT fedoraAdmin 2017-08-15T20:59:11.792Z Setting exclusive relation addDatastream MD_FULL_TEXT fedoraAdmin 2017-08-15T20:59:21.577Z Adding full text metadata extracted by Apache Tika modifyDatastreamByValue RELS-EXT fedoraAdmin 2017-08-15T20:59:39.691Z Setting exclusive relation modifyDatastreamByValue RELS-EXT cdrApp 2017-08-22T13:59:55.026Z Setting exclusive relation modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-01-25T19:06:42.634Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-01-27T18:41:57.295Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-03-14T16:31:09.629Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-05-18T18:53:57.565Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-07-11T15:15:41.322Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-07-18T10:52:28.943Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-08-21T19:40:34.412Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-09-27T20:37:44.639Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-10-12T10:59:49.625Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-10-17T16:18:21.662Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2019-03-21T21:17:09.861Z Parth Shah Author Department of Health Behavior Gillings School of Global Public Health The role of pharmacy in HPV vaccination of U.S. adolescents Purpose. Pharmacies could play a meaningful role in improving HPV vaccine uptake in US adolescents. This dissertation aimed to evaluate the intrapersonal, provider, and structural factors related to pharmacies as vaccination settings that might motivate parents to obtain pharmacist-provided HPV vaccinations for their children. Methods. Aim One: I conducted structural equation modeling to evaluate how the type of pharmacy parents (n=1,504) use to get medications for their adolescent children was associated with willingness to get these children HPV vaccine from pharmacists. Aim Two: I conducted analysis of variance and multiple regression models to examine how parents (n=1,500) perceived relative advantages of vaccine delivery in pharmacies compared to doctors’ offices. Aim Three: I conducted geospatial analyses to assess whether community pharmacists can improve access to HPV vaccination services in primary health care shortage areas in Texas, which allows pharmacists to immunize adolescents. Results. Aim One: Compared to parents who used chain pharmacies, parents who used independent pharmacies were less willing to get their adolescent children HPV vaccine from pharmacists (β=-.094; p=.001). Service quality and satisfaction suppressed this relationship. Aim Two: Parents were more willing to get their children HPV vaccine from a pharmacist if they indicated more relative advantages in vaccine delivery in pharmacies (β=.29; p<.001), and if they believed vaccine delivery features related to patient accessibility were more important than features related to the health care environment (β=.20; p<.001). Aim Three: When pharmacists were included as adolescent vaccine providers along with primary care physicians, census tracts shifted towards adequate coverage in 35% (1,055/3013) of urban tracts and in 18% (92/521) of rural tracts. Conclusion. Pharmacies could increase HPV vaccine uptake by improving parents’ perception of service quality at pharmacies they use. Pharmacies that provide adolescent vaccinations should capitalize on their relative advantages in patient accessibility over doctors’ offices, while also improving on vaccine delivery features related to the health care environment which parents believed to be superior in doctors’ offices. Pharmacists could potentially increase access to HPV vaccination for parents and adolescents in states that allow pharmacists to immunize adolescents. Spring 2017 2017 Public health alternative vaccination setting, HPV vaccine, human papillomavirus, pharmacists, pharmacy, preventive care delivery eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Noel Brewer Thesis advisor Shelley Golden Thesis advisor Carol Golin Thesis advisor Macary Marciniak Thesis advisor Justin Trogdon Thesis advisor text Parth Shah Creator Department of Health Behavior Gillings School of Global Public Health The role of pharmacy in HPV vaccination of U.S. adolescents Purpose. Pharmacies could play a meaningful role in improving HPV vaccine uptake in US adolescents. This dissertation aimed to evaluate the intrapersonal, provider, and structural factors related to pharmacies as vaccination settings that might motivate parents to obtain pharmacist-provided HPV vaccinations for their children. Methods. Aim One: I conducted structural equation modeling to evaluate how the type of pharmacy parents (n=1,504) use to get medications for their adolescent children was associated with willingness to get these children HPV vaccine from pharmacists. Aim Two: I conducted analysis of variance and multiple regression models to examine how parents (n=1,500) perceived relative advantages of vaccine delivery in pharmacies compared to doctors’ offices. Aim Three: I conducted geospatial analyses to assess whether community pharmacists can improve access to HPV vaccination services in primary health care shortage areas in Texas, which allows pharmacists to immunize adolescents. Results. Aim One: Compared to parents who used chain pharmacies, parents who used independent pharmacies were less willing to get their adolescent children HPV vaccine from pharmacists (β=-.094; p=.001). Service quality and satisfaction suppressed this relationship. Aim Two: Parents were more willing to get their children HPV vaccine from a pharmacist if they indicated more relative advantages in vaccine delivery in pharmacies (β=.29; p<.001), and if they believed vaccine delivery features related to patient accessibility were more important than features related to the health care environment (β=.20; p<.001). Aim Three: When pharmacists were included as adolescent vaccine providers along with primary care physicians, census tracts shifted towards adequate coverage in 35% (1,055/3013) of urban tracts and in 18% (92/521) of rural tracts. Conclusion. Pharmacies could increase HPV vaccine uptake by improving parents’ perception of service quality at pharmacies they use. Pharmacies that provide adolescent vaccinations should capitalize on their relative advantages in patient accessibility over doctors’ offices, while also improving on vaccine delivery features related to the health care environment which parents believed to be superior in doctors’ offices. Pharmacists could potentially increase access to HPV vaccination for parents and adolescents in states that allow pharmacists to immunize adolescents. Spring 2017 2017 Public health alternative vaccination setting, HPV vaccine, human papillomavirus, pharmacists, pharmacy, preventive care delivery eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Noel Brewer Thesis advisor Shelley Golden Thesis advisor Carol Golin Thesis advisor Macary Marciniak Thesis advisor Justin Trogdon Thesis advisor text Parth Shah Creator Department of Health Behavior Gillings School of Global Public Health The role of pharmacy in HPV vaccination of U.S. adolescents Purpose. Pharmacies could play a meaningful role in improving HPV vaccine uptake in US adolescents. This dissertation aimed to evaluate the intrapersonal, provider, and structural factors related to pharmacies as vaccination settings that might motivate parents to obtain pharmacist-provided HPV vaccinations for their children. Methods. Aim One: I conducted structural equation modeling to evaluate how the type of pharmacy parents (n=1,504) use to get medications for their adolescent children was associated with willingness to get these children HPV vaccine from pharmacists. Aim Two: I conducted analysis of variance and multiple regression models to examine how parents (n=1,500) perceived relative advantages of vaccine delivery in pharmacies compared to doctors’ offices. Aim Three: I conducted geospatial analyses to assess whether community pharmacists can improve access to HPV vaccination services in primary health care shortage areas in Texas, which allows pharmacists to immunize adolescents. Results. Aim One: Compared to parents who used chain pharmacies, parents who used independent pharmacies were less willing to get their adolescent children HPV vaccine from pharmacists (β=-.094; p=.001). Service quality and satisfaction suppressed this relationship. Aim Two: Parents were more willing to get their children HPV vaccine from a pharmacist if they indicated more relative advantages in vaccine delivery in pharmacies (β=.29; p<.001), and if they believed vaccine delivery features related to patient accessibility were more important than features related to the health care environment (β=.20; p<.001). Aim Three: When pharmacists were included as adolescent vaccine providers along with primary care physicians, census tracts shifted towards adequate coverage in 35% (1,055/3013) of urban tracts and in 18% (92/521) of rural tracts. Conclusion. Pharmacies could increase HPV vaccine uptake by improving parents’ perception of service quality at pharmacies they use. Pharmacies that provide adolescent vaccinations should capitalize on their relative advantages in patient accessibility over doctors’ offices, while also improving on vaccine delivery features related to the health care environment which parents believed to be superior in doctors’ offices. Pharmacists could potentially increase access to HPV vaccination for parents and adolescents in states that allow pharmacists to immunize adolescents. Spring 2017 2017 Public health alternative vaccination setting, HPV vaccine, human papillomavirus, pharmacists, pharmacy, preventive care delivery eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Noel Brewer Thesis advisor Shelley Golden Thesis advisor Carol Golin Thesis advisor Macary Marciniak Thesis advisor Justin Trogdon Thesis advisor text Parth Shah Creator Department of Health Behavior Gillings School of Global Public Health The role of pharmacy in HPV vaccination of U.S. adolescents Purpose. Pharmacies could play a meaningful role in improving HPV vaccine uptake in US adolescents. This dissertation aimed to evaluate the intrapersonal, provider, and structural factors related to pharmacies as vaccination settings that might motivate parents to obtain pharmacist-provided HPV vaccinations for their children. Methods. Aim One: I conducted structural equation modeling to evaluate how the type of pharmacy parents (n=1,504) use to get medications for their adolescent children was associated with willingness to get these children HPV vaccine from pharmacists. Aim Two: I conducted analysis of variance and multiple regression models to examine how parents (n=1,500) perceived relative advantages of vaccine delivery in pharmacies compared to doctors’ offices. Aim Three: I conducted geospatial analyses to assess whether community pharmacists can improve access to HPV vaccination services in primary health care shortage areas in Texas, which allows pharmacists to immunize adolescents. Results. Aim One: Compared to parents who used chain pharmacies, parents who used independent pharmacies were less willing to get their adolescent children HPV vaccine from pharmacists (β=-.094; p=.001). Service quality and satisfaction suppressed this relationship. Aim Two: Parents were more willing to get their children HPV vaccine from a pharmacist if they indicated more relative advantages in vaccine delivery in pharmacies (β=.29; p<.001), and if they believed vaccine delivery features related to patient accessibility were more important than features related to the health care environment (β=.20; p<.001). Aim Three: When pharmacists were included as adolescent vaccine providers along with primary care physicians, census tracts shifted towards adequate coverage in 35% (1,055/3013) of urban tracts and in 18% (92/521) of rural tracts. Conclusion. Pharmacies could increase HPV vaccine uptake by improving parents’ perception of service quality at pharmacies they use. Pharmacies that provide adolescent vaccinations should capitalize on their relative advantages in patient accessibility over doctors’ offices, while also improving on vaccine delivery features related to the health care environment which parents believed to be superior in doctors’ offices. Pharmacists could potentially increase access to HPV vaccination for parents and adolescents in states that allow pharmacists to immunize adolescents. 2017-05 2017 Public health alternative vaccination setting, HPV vaccine, human papillomavirus, pharmacists, pharmacy, preventive care delivery eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Noel Brewer Thesis advisor Shelley Golden Thesis advisor Carol Golin Thesis advisor Macary Marciniak Thesis advisor Justin Trogdon Thesis advisor text Parth Shah Creator Department of Health Behavior Gillings School of Global Public Health The role of pharmacy in HPV vaccination of U.S. adolescents Purpose. Pharmacies could play a meaningful role in improving HPV vaccine uptake in US adolescents. This dissertation aimed to evaluate the intrapersonal, provider, and structural factors related to pharmacies as vaccination settings that might motivate parents to obtain pharmacist-provided HPV vaccinations for their children. Methods. Aim One: I conducted structural equation modeling to evaluate how the type of pharmacy parents (n=1,504) use to get medications for their adolescent children was associated with willingness to get these children HPV vaccine from pharmacists. Aim Two: I conducted analysis of variance and multiple regression models to examine how parents (n=1,500) perceived relative advantages of vaccine delivery in pharmacies compared to doctors’ offices. Aim Three: I conducted geospatial analyses to assess whether community pharmacists can improve access to HPV vaccination services in primary health care shortage areas in Texas, which allows pharmacists to immunize adolescents. Results. Aim One: Compared to parents who used chain pharmacies, parents who used independent pharmacies were less willing to get their adolescent children HPV vaccine from pharmacists (β=-.094; p=.001). Service quality and satisfaction suppressed this relationship. Aim Two: Parents were more willing to get their children HPV vaccine from a pharmacist if they indicated more relative advantages in vaccine delivery in pharmacies (β=.29; p<.001), and if they believed vaccine delivery features related to patient accessibility were more important than features related to the health care environment (β=.20; p<.001). Aim Three: When pharmacists were included as adolescent vaccine providers along with primary care physicians, census tracts shifted towards adequate coverage in 35% (1,055/3013) of urban tracts and in 18% (92/521) of rural tracts. Conclusion. Pharmacies could increase HPV vaccine uptake by improving parents’ perception of service quality at pharmacies they use. Pharmacies that provide adolescent vaccinations should capitalize on their relative advantages in patient accessibility over doctors’ offices, while also improving on vaccine delivery features related to the health care environment which parents believed to be superior in doctors’ offices. Pharmacists could potentially increase access to HPV vaccination for parents and adolescents in states that allow pharmacists to immunize adolescents. 2017 Public health alternative vaccination setting, HPV vaccine, human papillomavirus, pharmacists, pharmacy, preventive care delivery eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Noel Brewer Thesis advisor Shelley Golden Thesis advisor Carol Golin Thesis advisor Macary Marciniak Thesis advisor Justin Trogdon Thesis advisor text 2017-05 Parth Shah Creator Department of Health Behavior Gillings School of Global Public Health The role of pharmacy in HPV vaccination of U.S. adolescents Purpose. Pharmacies could play a meaningful role in improving HPV vaccine uptake in US adolescents. This dissertation aimed to evaluate the intrapersonal, provider, and structural factors related to pharmacies as vaccination settings that might motivate parents to obtain pharmacist-provided HPV vaccinations for their children. Methods. Aim One: I conducted structural equation modeling to evaluate how the type of pharmacy parents (n=1,504) use to get medications for their adolescent children was associated with willingness to get these children HPV vaccine from pharmacists. Aim Two: I conducted analysis of variance and multiple regression models to examine how parents (n=1,500) perceived relative advantages of vaccine delivery in pharmacies compared to doctors’ offices. Aim Three: I conducted geospatial analyses to assess whether community pharmacists can improve access to HPV vaccination services in primary health care shortage areas in Texas, which allows pharmacists to immunize adolescents. Results. Aim One: Compared to parents who used chain pharmacies, parents who used independent pharmacies were less willing to get their adolescent children HPV vaccine from pharmacists (β=-.094; p=.001). Service quality and satisfaction suppressed this relationship. Aim Two: Parents were more willing to get their children HPV vaccine from a pharmacist if they indicated more relative advantages in vaccine delivery in pharmacies (β=.29; p<.001), and if they believed vaccine delivery features related to patient accessibility were more important than features related to the health care environment (β=.20; p<.001). Aim Three: When pharmacists were included as adolescent vaccine providers along with primary care physicians, census tracts shifted towards adequate coverage in 35% (1,055/3013) of urban tracts and in 18% (92/521) of rural tracts. Conclusion. Pharmacies could increase HPV vaccine uptake by improving parents’ perception of service quality at pharmacies they use. Pharmacies that provide adolescent vaccinations should capitalize on their relative advantages in patient accessibility over doctors’ offices, while also improving on vaccine delivery features related to the health care environment which parents believed to be superior in doctors’ offices. Pharmacists could potentially increase access to HPV vaccination for parents and adolescents in states that allow pharmacists to immunize adolescents. 2017 Public health alternative vaccination setting, HPV vaccine, human papillomavirus, pharmacists, pharmacy, preventive care delivery eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Noel Brewer Thesis advisor Shelley Golden Thesis advisor Carol Golin Thesis advisor Macary Marciniak Thesis advisor Justin Trogdon Thesis advisor text 2017-05 Parth Shah Creator Department of Health Behavior Gillings School of Global Public Health The role of pharmacy in HPV vaccination of U.S. adolescents Purpose. Pharmacies could play a meaningful role in improving HPV vaccine uptake in US adolescents. This dissertation aimed to evaluate the intrapersonal, provider, and structural factors related to pharmacies as vaccination settings that might motivate parents to obtain pharmacist-provided HPV vaccinations for their children. Methods. Aim One: I conducted structural equation modeling to evaluate how the type of pharmacy parents (n=1,504) use to get medications for their adolescent children was associated with willingness to get these children HPV vaccine from pharmacists. Aim Two: I conducted analysis of variance and multiple regression models to examine how parents (n=1,500) perceived relative advantages of vaccine delivery in pharmacies compared to doctors’ offices. Aim Three: I conducted geospatial analyses to assess whether community pharmacists can improve access to HPV vaccination services in primary health care shortage areas in Texas, which allows pharmacists to immunize adolescents. Results. Aim One: Compared to parents who used chain pharmacies, parents who used independent pharmacies were less willing to get their adolescent children HPV vaccine from pharmacists (β=-.094; p=.001). Service quality and satisfaction suppressed this relationship. Aim Two: Parents were more willing to get their children HPV vaccine from a pharmacist if they indicated more relative advantages in vaccine delivery in pharmacies (β=.29; p<.001), and if they believed vaccine delivery features related to patient accessibility were more important than features related to the health care environment (β=.20; p<.001). Aim Three: When pharmacists were included as adolescent vaccine providers along with primary care physicians, census tracts shifted towards adequate coverage in 35% (1,055/3013) of urban tracts and in 18% (92/521) of rural tracts. Conclusion. Pharmacies could increase HPV vaccine uptake by improving parents’ perception of service quality at pharmacies they use. Pharmacies that provide adolescent vaccinations should capitalize on their relative advantages in patient accessibility over doctors’ offices, while also improving on vaccine delivery features related to the health care environment which parents believed to be superior in doctors’ offices. Pharmacists could potentially increase access to HPV vaccination for parents and adolescents in states that allow pharmacists to immunize adolescents. 2017 Public health alternative vaccination setting, HPV vaccine, human papillomavirus, pharmacists, pharmacy, preventive care delivery eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Noel Brewer Thesis advisor Shelley Golden Thesis advisor Carol Golin Thesis advisor Macary Marciniak Thesis advisor Justin Trogdon Thesis advisor text 2017-05 Parth Shah Creator Department of Health Behavior Gillings School of Global Public Health The role of pharmacy in HPV vaccination of U.S. adolescents Purpose. Pharmacies could play a meaningful role in improving HPV vaccine uptake in US adolescents. This dissertation aimed to evaluate the intrapersonal, provider, and structural factors related to pharmacies as vaccination settings that might motivate parents to obtain pharmacist-provided HPV vaccinations for their children. Methods. Aim One: I conducted structural equation modeling to evaluate how the type of pharmacy parents (n=1,504) use to get medications for their adolescent children was associated with willingness to get these children HPV vaccine from pharmacists. Aim Two: I conducted analysis of variance and multiple regression models to examine how parents (n=1,500) perceived relative advantages of vaccine delivery in pharmacies compared to doctors’ offices. Aim Three: I conducted geospatial analyses to assess whether community pharmacists can improve access to HPV vaccination services in primary health care shortage areas in Texas, which allows pharmacists to immunize adolescents. Results. Aim One: Compared to parents who used chain pharmacies, parents who used independent pharmacies were less willing to get their adolescent children HPV vaccine from pharmacists (β=-.094; p=.001). Service quality and satisfaction suppressed this relationship. Aim Two: Parents were more willing to get their children HPV vaccine from a pharmacist if they indicated more relative advantages in vaccine delivery in pharmacies (β=.29; p<.001), and if they believed vaccine delivery features related to patient accessibility were more important than features related to the health care environment (β=.20; p<.001). Aim Three: When pharmacists were included as adolescent vaccine providers along with primary care physicians, census tracts shifted towards adequate coverage in 35% (1,055/3013) of urban tracts and in 18% (92/521) of rural tracts. Conclusion. Pharmacies could increase HPV vaccine uptake by improving parents’ perception of service quality at pharmacies they use. Pharmacies that provide adolescent vaccinations should capitalize on their relative advantages in patient accessibility over doctors’ offices, while also improving on vaccine delivery features related to the health care environment which parents believed to be superior in doctors’ offices. Pharmacists could potentially increase access to HPV vaccination for parents and adolescents in states that allow pharmacists to immunize adolescents. 2017 Public health alternative vaccination setting, HPV vaccine, human papillomavirus, pharmacists, pharmacy, preventive care delivery eng Doctor of Philosophy Dissertation Health Behavior Noel T. Brewer Thesis advisor Shelley Golden Thesis advisor Carol E. Golin Thesis advisor Macary Marciniak Thesis advisor Justin Trogdon Thesis advisor text 2017-05 University of North Carolina at Chapel Hill Degree granting institution Parth Shah Creator Department of Health Behavior Gillings School of Global Public Health The role of pharmacy in HPV vaccination of U.S. adolescents Purpose. Pharmacies could play a meaningful role in improving HPV vaccine uptake in US adolescents. This dissertation aimed to evaluate the intrapersonal, provider, and structural factors related to pharmacies as vaccination settings that might motivate parents to obtain pharmacist-provided HPV vaccinations for their children. Methods. Aim One: I conducted structural equation modeling to evaluate how the type of pharmacy parents (n=1,504) use to get medications for their adolescent children was associated with willingness to get these children HPV vaccine from pharmacists. Aim Two: I conducted analysis of variance and multiple regression models to examine how parents (n=1,500) perceived relative advantages of vaccine delivery in pharmacies compared to doctors’ offices. Aim Three: I conducted geospatial analyses to assess whether community pharmacists can improve access to HPV vaccination services in primary health care shortage areas in Texas, which allows pharmacists to immunize adolescents. Results. Aim One: Compared to parents who used chain pharmacies, parents who used independent pharmacies were less willing to get their adolescent children HPV vaccine from pharmacists (β=-.094; p=.001). Service quality and satisfaction suppressed this relationship. Aim Two: Parents were more willing to get their children HPV vaccine from a pharmacist if they indicated more relative advantages in vaccine delivery in pharmacies (β=.29; p<.001), and if they believed vaccine delivery features related to patient accessibility were more important than features related to the health care environment (β=.20; p<.001). Aim Three: When pharmacists were included as adolescent vaccine providers along with primary care physicians, census tracts shifted towards adequate coverage in 35% (1,055/3013) of urban tracts and in 18% (92/521) of rural tracts. Conclusion. Pharmacies could increase HPV vaccine uptake by improving parents’ perception of service quality at pharmacies they use. Pharmacies that provide adolescent vaccinations should capitalize on their relative advantages in patient accessibility over doctors’ offices, while also improving on vaccine delivery features related to the health care environment which parents believed to be superior in doctors’ offices. Pharmacists could potentially increase access to HPV vaccination for parents and adolescents in states that allow pharmacists to immunize adolescents. 2017 Public health alternative vaccination setting; HPV vaccine; human papillomavirus; pharmacists; pharmacy; preventive care delivery eng Doctor of Philosophy Dissertation Health Behavior Noel T. Brewer Thesis advisor Shelley Golden Thesis advisor Carol E. Golin Thesis advisor Macary Marciniak Thesis advisor Justin Trogdon Thesis advisor text 2017-05 University of North Carolina at Chapel Hill Degree granting institution Parth Shah Creator Department of Health Behavior Gillings School of Global Public Health The role of pharmacy in HPV vaccination of U.S. adolescents Purpose. Pharmacies could play a meaningful role in improving HPV vaccine uptake in US adolescents. This dissertation aimed to evaluate the intrapersonal, provider, and structural factors related to pharmacies as vaccination settings that might motivate parents to obtain pharmacist-provided HPV vaccinations for their children. Methods. Aim One: I conducted structural equation modeling to evaluate how the type of pharmacy parents (n=1,504) use to get medications for their adolescent children was associated with willingness to get these children HPV vaccine from pharmacists. Aim Two: I conducted analysis of variance and multiple regression models to examine how parents (n=1,500) perceived relative advantages of vaccine delivery in pharmacies compared to doctors’ offices. Aim Three: I conducted geospatial analyses to assess whether community pharmacists can improve access to HPV vaccination services in primary health care shortage areas in Texas, which allows pharmacists to immunize adolescents. Results. Aim One: Compared to parents who used chain pharmacies, parents who used independent pharmacies were less willing to get their adolescent children HPV vaccine from pharmacists (β=-.094; p=.001). Service quality and satisfaction suppressed this relationship. Aim Two: Parents were more willing to get their children HPV vaccine from a pharmacist if they indicated more relative advantages in vaccine delivery in pharmacies (β=.29; p<.001), and if they believed vaccine delivery features related to patient accessibility were more important than features related to the health care environment (β=.20; p<.001). Aim Three: When pharmacists were included as adolescent vaccine providers along with primary care physicians, census tracts shifted towards adequate coverage in 35% (1,055/3013) of urban tracts and in 18% (92/521) of rural tracts. Conclusion. Pharmacies could increase HPV vaccine uptake by improving parents’ perception of service quality at pharmacies they use. Pharmacies that provide adolescent vaccinations should capitalize on their relative advantages in patient accessibility over doctors’ offices, while also improving on vaccine delivery features related to the health care environment which parents believed to be superior in doctors’ offices. Pharmacists could potentially increase access to HPV vaccination for parents and adolescents in states that allow pharmacists to immunize adolescents. 2017 Public health alternative vaccination setting, HPV vaccine, human papillomavirus, pharmacists, pharmacy, preventive care delivery eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Noel T. Brewer Thesis advisor Shelley Golden Thesis advisor Carol E. Golin Thesis advisor Macary Marciniak Thesis advisor Justin Trogdon Thesis advisor text 2017-05 Parth Shah Creator Department of Health Behavior Gillings School of Global Public Health The role of pharmacy in HPV vaccination of U.S. adolescents Purpose. Pharmacies could play a meaningful role in improving HPV vaccine uptake in US adolescents. This dissertation aimed to evaluate the intrapersonal, provider, and structural factors related to pharmacies as vaccination settings that might motivate parents to obtain pharmacist-provided HPV vaccinations for their children. Methods. Aim One: I conducted structural equation modeling to evaluate how the type of pharmacy parents (n=1,504) use to get medications for their adolescent children was associated with willingness to get these children HPV vaccine from pharmacists. Aim Two: I conducted analysis of variance and multiple regression models to examine how parents (n=1,500) perceived relative advantages of vaccine delivery in pharmacies compared to doctors’ offices. Aim Three: I conducted geospatial analyses to assess whether community pharmacists can improve access to HPV vaccination services in primary health care shortage areas in Texas, which allows pharmacists to immunize adolescents. Results. Aim One: Compared to parents who used chain pharmacies, parents who used independent pharmacies were less willing to get their adolescent children HPV vaccine from pharmacists (β=-.094; p=.001). Service quality and satisfaction suppressed this relationship. Aim Two: Parents were more willing to get their children HPV vaccine from a pharmacist if they indicated more relative advantages in vaccine delivery in pharmacies (β=.29; p<.001), and if they believed vaccine delivery features related to patient accessibility were more important than features related to the health care environment (β=.20; p<.001). Aim Three: When pharmacists were included as adolescent vaccine providers along with primary care physicians, census tracts shifted towards adequate coverage in 35% (1,055/3013) of urban tracts and in 18% (92/521) of rural tracts. Conclusion. Pharmacies could increase HPV vaccine uptake by improving parents’ perception of service quality at pharmacies they use. Pharmacies that provide adolescent vaccinations should capitalize on their relative advantages in patient accessibility over doctors’ offices, while also improving on vaccine delivery features related to the health care environment which parents believed to be superior in doctors’ offices. Pharmacists could potentially increase access to HPV vaccination for parents and adolescents in states that allow pharmacists to immunize adolescents. 2017 Public health alternative vaccination setting, HPV vaccine, human papillomavirus, pharmacists, pharmacy, preventive care delivery eng Doctor of Philosophy Dissertation Health Behavior Noel T. Brewer Thesis advisor Shelley Golden Thesis advisor Carol E. Golin Thesis advisor Macary Marciniak Thesis advisor Justin Trogdon Thesis advisor text 2017-05 University of North Carolina at Chapel Hill Degree granting institution Parth Shah Creator Department of Health Behavior Gillings School of Global Public Health The role of pharmacy in HPV vaccination of U.S. adolescents Purpose. Pharmacies could play a meaningful role in improving HPV vaccine uptake in US adolescents. This dissertation aimed to evaluate the intrapersonal, provider, and structural factors related to pharmacies as vaccination settings that might motivate parents to obtain pharmacist-provided HPV vaccinations for their children. Methods. Aim One: I conducted structural equation modeling to evaluate how the type of pharmacy parents (n=1,504) use to get medications for their adolescent children was associated with willingness to get these children HPV vaccine from pharmacists. Aim Two: I conducted analysis of variance and multiple regression models to examine how parents (n=1,500) perceived relative advantages of vaccine delivery in pharmacies compared to doctors’ offices. Aim Three: I conducted geospatial analyses to assess whether community pharmacists can improve access to HPV vaccination services in primary health care shortage areas in Texas, which allows pharmacists to immunize adolescents. Results. Aim One: Compared to parents who used chain pharmacies, parents who used independent pharmacies were less willing to get their adolescent children HPV vaccine from pharmacists (β=-.094; p=.001). Service quality and satisfaction suppressed this relationship. Aim Two: Parents were more willing to get their children HPV vaccine from a pharmacist if they indicated more relative advantages in vaccine delivery in pharmacies (β=.29; p<.001), and if they believed vaccine delivery features related to patient accessibility were more important than features related to the health care environment (β=.20; p<.001). Aim Three: When pharmacists were included as adolescent vaccine providers along with primary care physicians, census tracts shifted towards adequate coverage in 35% (1,055/3013) of urban tracts and in 18% (92/521) of rural tracts. Conclusion. Pharmacies could increase HPV vaccine uptake by improving parents’ perception of service quality at pharmacies they use. Pharmacies that provide adolescent vaccinations should capitalize on their relative advantages in patient accessibility over doctors’ offices, while also improving on vaccine delivery features related to the health care environment which parents believed to be superior in doctors’ offices. Pharmacists could potentially increase access to HPV vaccination for parents and adolescents in states that allow pharmacists to immunize adolescents. 2017 Public health alternative vaccination setting; HPV vaccine; human papillomavirus; pharmacists; pharmacy; preventive care delivery eng Doctor of Philosophy Dissertation Noel T. Brewer Thesis advisor Shelley Golden Thesis advisor Carol E. Golin Thesis advisor Macary Marciniak Thesis advisor Justin Trogdon Thesis advisor text 2017-05 University of North Carolina at Chapel Hill Degree granting institution Shah_unc_0153D_17153.pdf uuid:4c24e3ea-5487-4da5-abde-3a5e147067bf 2017-06-19T15:13:34Z 2019-08-15T00:00:00 proquest application/pdf 3060156 yes