Barriers and facilitators to pneumococcal vaccination in rural community pharmacy: A qualitative study

Background Inadequate pneumococcal vaccine uptake in rural U.S. communities remains a significant barrier to effective pneumococcal disease prevention. Community pharmacists are well-positioned to expand vaccine coverage by offering and administering pneumococcal vaccines, but face unique challenges in rural pharmacy settings. Objective To explore pharmacist-reported barriers and facilitators to pneumococcal vaccination in rural community pharmacies. Methods Qualitative interviews were conducted with twenty rural pharmacists from a practice-based research network (a collaborative group of community pharmacies engaged in applied research to improve pharmacy practice) across seven U.S. states. Pharmacists were purposefully sampled based on their state and the number of pneumococcal vaccines administered at their pharmacy in the previous year. Interviews assessed factors influencing pneumococcal vaccination across levels of the Social Ecological Framework. Interviews continued until thematic saturation was reached, and iterative thematic analysis of de-identified interview transcripts was conducted until no new themes emerged. Results Barriers and facilitators to pneumococcal vaccination were identified across all socioecological levels. At the individual level, themes included pharmacists' attitudes, training, and rapport with patients, as well as patients' attitudes, knowledge, and out-of-pocket costs. At the organizational level, themes were related to the pharmacy workflow, staff, time constraints, immunization area, and vaccine stocking costs. Community-level themes involved local physicians, social influences, and factors specific to rural areas. Policy-level themes encompassed vaccination guidelines, states' immunization registries, reimbursement, and immunization regulations. Conclusion Pneumococcal vaccination in rural community pharmacies is influenced by multilevel factors, including individual, organizational, community, and policy factors. Effective interventions will require training initiatives for pharmacists, resources to improve patients' vaccine knowledge and attitudes, organizational strategies to streamline immunization workflow, and policy changes to advance pharmacy-based immunization services that account for rural community needs.