Table 4. Health care provider matrix of performance objectives, determinants, and change objectives.

Behavioral outcome: Physicians will vaccinate eligible patients against HPV in accordance with ACIP guidelines

Performance Objectives	Behavioral Determinants*
	Knowledge	Skills and Self-efficacy	Outcome Expectations	Normative Beliefs
PO.1. Collaborate with clinic’s champion on AVP strategies to promote HPV vaccination	K.1a: Identify the designated AVP champions in his/her clinic K.1b: Describe the role of AVP champions as mediators for strategic rollout of 4 strategies* in clinics	SSE.1a: Demonstrate ability to collaborate with clinic champion on strategies* to promote HPV vaccination SSE.1b: Express confidence in ability to collaborate with clinic champion on strategies* to promote HPV vaccination	OE.1: Expect that collaborating with clinic’s champion on HPV vaccine promotion strategies will improve personal and clinic-level HPV vaccination rates	NB.1: Recognize that vaccinating all eligible patients against HPV in accordance with ACIP guidelines is part of the network’s expectation for optimal physician performance
PO.2. Review quarterly assessment and feedback report for HPV vaccination	K.2a: Identify when and how A&F reports will be delivered K.2b: Describe the content of the A&F reports K.2c: Recognize that A&F is one of the most effective strategies to promote vaccination	SSE.2a: Demonstrate ability to state personal and clinic-level vaccine rates from a quarterly A&F report SSE.2b: Demonstrate ability to state personal HPV vaccination goal for the following quarter SSE.2c: Express confidence in ability to interpret A&F reports	OE.2a: Expect that reviewing A&F reports will allow his/her clinic and staff to track progress toward HPV vaccination goals OE.2b: Expect that reviewing A&F reports will improve personal and clinic-level HPV vaccination rates	NB.2: Recognize that vaccinating all eligible patients against HPV in accordance with ACIP guidelines is part of the clinic network’s expectation for optimal physician performance
PO.3. Coordinate with clinical support staff to ensure consistent messaging is delivered to patients regarding HPV vaccination	K.3a: Describe the difference between consistent and inconsistent messaging about HPV vaccination in a clinic setting K.3b: Recognize that inconsistent messaging about HPV vaccination occurs in clinics K.3c: Recognize that inconsistent messaging about HPV vaccination can lead to parental vaccine hesitancy	SSE.3a: Demonstrate ability to communicate with clinical staff about consistent HPV vaccine messaging** SSE.3b: Express confidence in ability to communicate with clinical staff about consistent HPV vaccine messaging**	OE.3a: Expect that delivering consistent messaging from all clinical staff to patients will reduce patient/parent resistance OE.3b: Expect that delivering consistent messaging from all clinical staff to patients will improve personal and clinic-level HPV vaccination rates	NB.3: Recognize that vaccinating all eligible patients against HPV in accordance with ACIP guidelines is part of the clinic network’s expectation for optimal physician performance
PO.4. Check forecaster at every encounter to identify if patient is eligible for vaccination	K.4a: List ACIP eligibility criteria for HPV vaccination in adolescents K.4b. Describe functions of Forecaster K.4c: Recognize that patients are less likely to come back to doctor after age 13	SSE.4a: Demonstrate ability to check forecaster in a timely manner to determine patient vaccinations status SSE.4b: Express confidence in ability to check Forecaster in a timely manner	OE.4a: Expect that identifying eligible patients at every encounter will reduce missed opportunities to vaccinate OE.4b: Expect that identifying eligible patients at every encounter will improve personal and clinic-level HPV vaccination rates	NB.4: Recognize that vaccinating all eligible patients against HPV in accordance with ACIP guidelines is part of the clinic network’s expectation for optimal physician performance
PO.5. Deliver strong recommendation for HPV vaccination to all eligible patients at time of visit	K.5a: Recognize HPV vaccination is an effective cancer prevention tool K.5b: Recognize HPV vaccination is safe and recommended by medical organizations with the same strength as other adolescent vaccines K.5c: Describe components of a strong HPV vaccine recommendation	SSE.5.1: Demonstrate ability to deliver strong HPV vaccine recommendation SSE.5.2: Express confidence in ability to deliver strong HPV vaccine recommendation	OE.5a: Expect that delivering a strong HPV vaccine recommendation to all eligible patients will reduce patient/parent resistance OE.5b: Expect that delivering a strong HPV vaccine recommendation to all eligible patients will improve the likelihood of patients initiating the HPV vaccine series	NB.5a: Recognize that vaccinating all eligible patients against HPV in accordance with ACIP guidelines is part of the clinic network’s expectation for optimal physician performance NB.5b: Recognize that HPV vaccination is widely endorsed by medical organizations and other physicians as a safe and effective cancer prevention tool NB.5c: Recognize that physicians tend to overestimate the level of hesitancy parents have about the HPV vaccine
PO.5a. Bundle HPV vaccine recommendation with other vaccines when patient is due for other vaccinations at the same visit	K.5a: Describe the difference between a bundled HPV recommendation and one that singles out HPV from other vaccines K.5b: Describe key elements of a bundled HPV vaccine recommendation	SSE.5a.1: Demonstrate ability to deliver bundled HPV vaccine recommendation SSE.5a.2: Express confidence in ability to deliver bundled HPV vaccine recommendation	OE.5a: Expect that bundling HPV vaccine recommendation with other vaccinations will reduce patient/parent resistance OE.5b: Expect that bundling HPV vaccine recommendation with other vaccinations will improve the likelihood of patients initiating the HPV vaccine series	NB.5a: Recognize that vaccinating all eligible patients against HPV in accordance with ACIP guidelines is part of the clinic network’s expectation for optimal physician performance
PO.6. Determine specific patient/parent concern if they express vaccine hesitancy	K.6a: List common parental concerns related to vaccine hesitancy	SSE.6a: Demonstrate ability to identify specific patient/parent concerns related to HPV vaccination SSE.6b: Express confidence in ability to identify specific patient/parent concerns	OE.6a: Expect that identifying specific patient/parent concerns will save time in vaccine discussions OE.6b: Expect that identifying specific patient/parent concerns will improve the likelihood of patients initiating the HPV vaccine series	NB.6: Recognize that vaccinating all eligible patients against HPV in accordance with ACIP guidelines is part of the clinic network’s expectation for optimal physician performance
PO.7. Communicate tailored message to address specific patient/parent concern	K.7: Describe key talking points to address common parental concerns related to vaccine hesitancy	SSE.7a: Demonstrate ability to deliver tailored message to patients/parents about their specific vaccination concerns SSE.7b: Express confidence in ability to deliver tailored message to patients/parents about their specific vaccination concerns	OE.7a: Expect that delivering tailored messages to address patient/parent vaccination concerns will save time in vaccine discussions OE.7b: Expect that delivering tailored messages to address patient/parent vaccination concerns will improve the likelihood of patients initiating the HPV vaccine series	NB.7: Recognize that vaccinating all eligible patients against HPV in accordance with ACIP guidelines is part of the clinic network’s expectation for optimal physician performance
PO.8. Remind patients to schedule 2nd and 3rd HPV vaccine dose before leaving the office	K.8a: Describe CDC’s recommended dosing schedule for the HPV vaccine series K.8b: Recognize the importance of series completion for optimal cancer prevention benefits	SSE.8a: Demonstrate ability to remind patients to schedule 2nd and 3rd vaccine dose before leaving the office SSE.8b: Express confidence in ability to remind patients to schedule 2nd and 3rd HPV vaccine dose before leaving the office	OE.8: Expect that reminding patients to schedule their 2nd and 3rd HPV vaccine dose will improve the likelihood of patients completing the HPV vaccine series	NB.8: Recognize that vaccinating all eligible patients against HPV in accordance with ACIP guidelines is part of the clinic network’s expectation for optimal physician performance

^*Strategies include: Immunization Champions, Assessment and Feedback (A&F), CME, and Provider Cues.

^**Communication with clinical staff should include ensuring they: present HPV vaccination with the same importance as other vaccines, bundle the introduction of HPV vaccine with other vaccines when appropriate, and understand that physicians are looking to increase their vaccination rates and thus expect to vaccinate all eligible patients against HPV when they come in for a visit.