Florida physicians’ reported use of AFIX-based strategies for human papillomavirus vaccination

Monica L. Kasting, Shannon M. Christy, Steven K. Sutton, Paige Lake, Teri L. Malo, Richard G. Roetzheim, Tommy Schechtman, Gregory D. Zimet, Barbara J. Walkosz, Daniel Salmon, Jessica A. Kahn, Anna R. Giuliano, Susan T. Vadaparampil

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


HPV vaccination rates in Florida are low. To increase rates, the CDC recommends clinics adhere to components of their evidence-based quality improvement program, AFIX (Assessment, Feedback, Incentives, and eXchange of information). We explored factors associated with engaging in HPV-specific AFIX-related activities. In 2016, we conducted a cross-sectional survey of a representative sample of 770 pediatric and family medicine physicians in Florida and assessed vaccination practices, clinic characteristics, and HPV-related knowledge. Data were analyzed in 2017. The primary outcome was whether physicians’ clinics engaged in ≥1 AFIX activity. We stratified by physician specialty and developed multivariable models using a backward selection approach. Of the participants in the analytic sample (n = 340), 52% were male, 60% were White of any ethnicity, and 55% were non-Hispanic. Pediatricians and family medicine physicians differed on: years practicing medicine (p < 0.001), HPV-related knowledge (p < 0.001), and VFC provider status (p < 0.001), among others. Only 39% of physicians reported engaging in ≥1 AFIX activity. In the stratified multivariable model for pediatricians, AFIX activity was significantly associated with HPV-related knowledge (aOR = 1.33;95%CI = 1.08–1.63) and provider use of vaccine reminder prompts (aOR = 3.61;95%CI = 1.02–12.77). For family medicine physicians, HPV-related knowledge was significant (aOR = 1.57;95%CI = 1.20–2.05) as was majority race of patient population (non-Hispanic White vs. Other: aOR = 3.02;95%CI = 1.08–8.43), daily patient load (<20 vs. 20–24: aOR = 9.05;95%CI = 2.72–30.10), and vaccine administration to male patients (aOR = 2.98;95%CI = 1.11–8.02). Fewer than half of Florida pediatric and family medicine physicians engaged in any AFIX activities. Future interventions to increase AFIX engagement should focus on implementing and evaluating AFIX activities in groups identified as having low engagement in AFIX activities.

Original languageEnglish (US)
Pages (from-to)143-149
Number of pages7
JournalPreventive Medicine
StatePublished - Nov 2018


  • Adolescent health services
  • Cancer vaccines
  • Human papillomavirus
  • Immunization programs
  • Quality improvement programs
  • Vaccination
  • Vaccination promotion

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health


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