How can immunization coverage in urban counties be improved? A pilot study of a Kansas county.

Vaccination coverage is sometimes lower in urban counties compared with their rural counterparts. Increasing private health providers' participation in the Vaccines for Children (VFC) program and in centralized immunization data collections systems or registries are 2 recommended strategies for increasing urban and statewide vaccination coverage. The purpose of this pilot study was to examine perceived barriers to providing immunization services in a group of private health clinics in an urban county and to obtain the clinics' recommendations for improvement. A survey was developed and mailed to a sample of 57 health clinics obtained from a medical roster. The response rate was 65%. Several clinic- and patient-related barriers to immunization were identified. The most prevalent clinic-related barriers that providers reported were patient noncompliance (73%) and clinic scheduling problems (14%). In terms of patient-related barriers, the most frequently cited were patients' work schedules (41%) and unawareness of the importance of immunization (41%). The data also suggested misconceptions and lack of information among providers pertaining to the VFC program and the immunization registry. The information obtained from this pilot study may assist researchers, practitioners, policy makers, and others in their efforts to improve immunization coverage as it pertains to private health providers and their role in these efforts. Implications for further studies and education initiatives are addressed.