title: Improving HPV Vaccination Through a Diverse Multi-state Coalition.
abstract: OBJECTIVE
  Rural and highly religious Intermountain West states demonstrate low levels of HPV vaccination uptake. The Intermountain West HPV Vaccination Coalition (IWHVC) was formed to improve HPV vaccination by enhancing collaborations between cancer centers, health departments, health clinics, religious groups, and community organizations. Coalition members' perceptions and experiences are described within.
  
  
  METHODS
  A cross-sectional online survey was distributed to the IWHVC. N = 86 responded to the online survey. Six subsequent focus groups were conducted (N = 36). Participant demographics, barriers, and facilitators of HPV vaccination were summarized. The first three focus groups were coded in an iterative manner based on a coding scheme. The final three focus groups were selectively coded for content related to five themes: barriers and facilitators to HPV vaccination, how the coalition has been useful, future directions of the coalition, and how to engage religious communities.
  
  
  RESULTS
  Participants suggested that HPV vaccination should occur in a doctor's office (70.9%), public health clinic (64.0%), or at a community health fair (58.1%). Perceived barriers included a lack of education/low knowledge about the HPV vaccine (55.8%), concerns about sexuality/promiscuity (44.2%), and not knowing the vaccine is recommended for boys (38.4%). Participants stressed the importance of gaining buy-in from religious leaders, and felt the coalition helped them advocate for HPV vaccination through networking, idea and information sharing, and voicing their community's needs. Future goals emphasized targeted outreach, sustainable funding, expanded environmental scans, gaining religious support, and policy reforms.
  
  
  CONCLUSIONS
  Targeted coalition work builds community capacity and coordinates HPV vaccination efforts. A community driven coalition approach could help improve HPV vaccination in other rural and highly religious regions.
authors.affiliation: University of Utah College of Nursing, Salt Lake City, UT, 84112, USA. echo.warner@hci.utah.edu.|Jonas Center for Nursing and Veterans Healthcare, New York, NY, 10021, USA. echo.warner@hci.utah.edu.|Cancer Control and Population Sciences Department, Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA. echo.warner@hci.utah.edu.
authors.forename: Echo L
authors.initials: EL
authors.lastname: Warner
authors.affiliation: Cancer Control and Population Sciences Department, Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA.
authors.forename: Brynn
authors.initials: B
authors.lastname: Fowler
authors.affiliation: Cancer Control and Population Sciences Department, Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Martel
authors.affiliation: University of Utah College of Nursing, Salt Lake City, UT, 84112, USA.|Cancer Control and Population Sciences Department, Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA.
authors.forename: Deanna
authors.initials: D
authors.lastname: Kepka
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D017144:Focus Groups; D006266:Health Education / Q000379:methods / Q000458:organization & administration; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D015205:Northwestern United States; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines; D012067:Religion; D012424:Rural Population; D015206:Southwestern United States; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D053918:Papillomavirus Vaccines
keywords: Coalition; HPV vaccination; Intermountain West; Religious; Rural