Current practices, opportunities to improve, and behavioral targets related to HPV vaccination in community pharmacies: A qualitative study of pharmacy staff and parents.

Human papillomavirus (HPV) causes 39,300 cancers annually in the United States, yet adolescent vaccination coverage remains suboptimal. Community pharmacies are highly accessible and authorized to vaccinate adolescents but remain underutilized for HPV vaccination. This study examined how current pharmacy vaccination practices align with parent expectations and identified modifiable behavioral and implementation targets to improve uptake. We conducted a qualitative study using key informant interviews with pharmacy staff (n = 11) and parents of adolescents ages 9-17 (n = 13) between February – March 2021. Interview guides were informed by the 5As Behavioral Counseling Framework and Theoretical Domains Framework (TDF). Data were analyzed using framework-guided rapid content analysis to identify themes related the vaccination workflow stages. Analyses identified 31 current practices and 35 opportunities for improvement across the 5As, as well as 20 behavioral constructs spanning 12 domains. Key gaps identified by pharmacy staff included inconsistent adolescent vaccine assessment, limited proactive recommendations, lack of standardized communication, insufficient documentation and follow-up for hesitancy, and fragmented reminder and scheduling systems. Parents valued convenience and clear, concise recommendations, while staff highlighted workflow and system constraints. Opportunities centered on standardizing assessment and communication, expanding technician roles, implementing proactive prompts and reminders, improving care coordination with primary care providers, and strengthening follow-up processes. Pharmacy-based HPV vaccination can be strengthened through targeted behavioral and workflow changes across the vaccination continuum. These findings provide a theory-informed, practice-ready framework to guide intervention design and evaluation aimed at increasing HPV vaccine uptake and series completion in community pharmacy settings.