385 - Implementing School-Associated Vaccination Events in Colorado: A Statewide Survey of Public School Nurses

Publication Number: 2374.385

Laura J. Faherty, MaineHealth, Portland, ME, United States; Ariella Korn, RAND, Boston, MA, United States; Liliane Nienstedt, Vanderbilt University School of Medicine, Nashville, TN, United States; Ashley Gromis, RAND, Santa Monica, CA, United States

Background: Schools are important settings for delivering vaccines. School vaccination programs often involve time-limited events (hereafter "school-associated vaccination events," or SAVEs) coordinated by school nurses. It is unknown how the facilitators of and barriers to holding SAVEs vary by school- and community-level characteristics.

Objective: This study (1) describes school nurses' perceptions of barriers and facilitators to implementing SAVEs (or "implementation determinants") in Colorado public schools between 2018-2024, and (2) examines associations of implementation determinants with characteristics of the school and surrounding community.

Design/Methods: We fielded a web-based survey of school nurses that worked in at least one Colorado public school in Fall 2024. Participants described the "temporary, time-limited vaccination events" offered by their school(s) from July 1, 2018 to June 30, 2024. Survey items to assess perceptions of implementation facilitators and barriers were informed by the Consolidated Framework for Implementation Research (CFIR). We linked survey responses to publicly available school- and community-level data and analyzed these data using descriptive statistics.

Results: A total of 366 nurses responded to the survey, for a 43% response rate, representing 631 unique schools meetingour eligibility criteria. During the study period, 114 schools held one or more SAVEs, totaling 301 events. Of the 474 schools that reported not holding a SAVE during the study period, respondents serving 73.0% of those schools said that SAVEs would have been helpful. The nurses that held SAVEs identified several facilitators of offering these events, such as parental awareness and trust, and external partnerships. (Figure 1). The nurses who did not hold SAVEs noted several barriers, including lack of guidance, staff time, and external partnerships (Figure 2). Table 1 depicts variation in nurse-reported barriers by school and community characteristics. Across school characteristics, lack of access to guidance was a top barrier. Nurses who worked in at least one rural school were more likely to indicate that politicization was a top barrier to implementing SAVEs. Staff time was a key barrier for nurses working at smaller schools, schools serving families with lower incomes, and high schools.

Conclusion(s): School nurses need clear guidance and strong external partnerships with health care systems and public health departments to help coordinate SAVEs in a changing political landscape. Specifically, nurses in rural schools would benefit from additional support to navigate the politicization of vaccines.

Figure 1. Facilitators of nurses' ability to hold SAVEs (n=82)
Respondents rated the extent to which various factors influenced their ability to hold School-Associated Vaccination Events (SAVEs) using a 5-point Likert scale. In this figure, "agree" includes responses of "strongly agree" and "agree," reflecting nurse agreement that these factors were influential and presumably served as potential facilitators to implementing SAVEs. "Disagree" includes "strongly disagree" and "disagree" ratings, signifying that nurses did not feel that these factors were influential, likely reflecting barriers to implementing SAVEs. The exception is politicization, which was framed as a factor that, if present, would hinder SAVE implementation. The figure excludes "not applicable" responses.

Figure 2. Barriers to holding SAVEs (n=182)
Respondents rated the extent that various barriers were important reasons for not holding School-Associated Vaccination Events (SAVEs).

Table 1. Selection of top barriers (percent of respondents ranking barriers as top three) by school and community characteristics
(a) Looking across location and grade spans, we limit each column to those who served at least one rural school, or school of a certain grade span.
(b) Because nurses worked at multiple schools, the responses were grouped to nurses who worked at schools that, on average, had fewer than 200 students or served student populations where over 75% of students were eligible for FRPL.
Abbreviations: ES: elementary school; MS: middle school; HS: high school