title: Local health department public vaccination clinic success during 2009 pH1N1.
abstract: BACKGROUND
  Local health departments (LHDs) were responsible for administering vaccine to the public during the 2009 H1N1 campaign but had relatively little guidance or experience to inform such a large campaign with limited vaccine supply. They used various processes to deliver vaccines to the public. Learning from the LHDs that were successful in their public vaccination campaigns can help inform future vaccination efforts.
  
  
  OBJECTIVE
  To learn from H1N1 campaign in order to improve responses to similar events in the future. We used a positive deviance approach to identify positive outlier LHDs during the 2009 H1N1 vaccination campaigns. We then used realist evaluation to learn about the combinations of context and mechanisms that led select LHDs to perform well.
  
  
  METHODS
  This project was a retrospective qualitative study. We used process mapping to define the steps involved in implementing public vaccination clinics. We identified positive outliers in H1N1 public vaccination efforts and conducted in-depth interviews with LHD staff to learn about the context and mechanisms that led to successful public vaccination clinics.
  
  
  METHODS
  This study focused on positive outliers in LHD vaccination efforts during the 2009 H1N1 campaign that implemented public vaccination clinics.
  
  
  METHODS
  Study outcomes focused on the combinations of context and mechanisms that led to successful outcomes in high-performing LHDs. Specific context + mechanism = outcomes stories are reported.
  
  
  RESULTS
  We found that successful LHDs defined priority groups, communicated with the public, maintained adequate staffing, established community partnerships, and maintained flexibility. We describe the specific contexts that triggered key mechanisms, which, when combined, led to successful outcomes.
  
  
  CONCLUSIONS
  The positive deviance and realist evaluation approach allowed us to understand how LHD context triggered specific mechanisms, which led to successful public clinics. The experience of successful LHDs can assist similar LHDs in implementing successful public vaccination clinics in the future.
authors.affiliation: Department of Health Policy and Public Health, University of the Sciences in Philadelphia, Philadelphia, PA 19104, USA. t.klaiman@usciences.edu
authors.forename: Tamar
authors.initials: T
authors.lastname: Klaiman
authors.forename: Katherine
authors.initials: K
authors.lastname: Oʼconnell
authors.forename: Michael
authors.initials: M
authors.lastname: Stoto
mesh_terms: D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data; D006293:Health Promotion / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D007407:Interviews as Topic; D009111:Local Government; D032541:Mass Vaccination / Q000458:organization & administration / Q000706:statistics & numerical data*; D015397:Program Evaluation; D014481:United States / Q000453:epidemiology
chemical_list: D007252:Influenza Vaccines