Strategies to Enhance Hepatitis B Vaccination Uptake in Federally Qualified Health Centers and Rural Community Pharmacies: A Study Protocol

Background: Hepatitis B vaccination rates in the United States (US) remain suboptimal, with only 34.2% of adults aged 19 years or older having received at least one dose. Pharmacists are accessible, with 96.5% of the population living within 10 miles of a pharmacy, positioning them to improve uptake. Community pharmacies provide broad access to preventive services, while Federally Qualified Health Centers (FQHCs) serve medically underserved and high-risk populations, including individuals at increased risk for hepatitis B infection. Despite their potential reach, hepatitis B vaccination services are inconsistently implemented in rural community pharmacies and FQHCs, with fewer than half of pharmacies offering the vaccine. Limited research has examined implementation strategies to support hepatitis B vaccination delivery across these pharmacy environments. Objectives: To 1) evaluate current hepatitis B vaccination practices and implementation determinants among pharmacists in FQHCs and rural community pharmacies and 2) develop, implement, and evaluate implementation strategies to improve vaccination uptake. Methods: A cross-sectional survey will be administered to pharmacists in FQHC-based and rural community pharmacies across the Southeastern U.S. The Health Resources and Services Administration Data Warehouse and the Haye’s Directory will be used, with one pharmacist recruited per site. The survey will assess Consolidated Framework for Implementation Research domains, knowledge, acceptability, feasibility, appropriateness, and Organizational Readiness for Implementing Change. Descriptive statistics will be calculated, and differences by practice setting will be examined using the Mann-Whitney U test. The survey will be pre-tested by pharmacy students. A one-group pre-post quasi-experimental study will be conducted in South Carolina. Approximately 24 pharmacists practicing in FQHCs and rural community pharmacies will complete a continuing education program and receive a quick reference guide designed to address identified barriers. Data will be collected at baseline and three months post-intervention. Outcomes will include feasibility, acceptability, appropriateness, and the number of hepatitis B vaccinations administered. Intervention engagement will also be examined. The Wilcoxon signed-rank test will evaluate changes over time. Results: Study protocol; data collection has not yet begun. Implications: This study will generate evidence on implementation strategies to improve hepatitis B vaccination in pharmacy settings. Findings may inform scalable, pharmacist-led interventions to enhance vaccination uptake.