Table 2 Subthemes under CFIR constructs by facilitators and barriers, and implementation strategies matched using CFIR-ERIC tool
CFIR domains and constructs | High-performing school | Low-performing school | Implementation strategiesa | |
|---|---|---|---|---|
Innovation characteristics | Evidence strength and quality | Implementers emphasized solid evidence on the effectiveness of SLIV ( +) | Implementers recognized evidence on the effectiveness of SLIV ( +) | |
Outer setting | Needs and resources of parents | Parents were satisfied with easy access and timely reminders ( +) Generally, parents attached more importance in children’s influenza vaccination during COVID-19 pandemic ( +) Parents perceived susceptibility of influenza (+ *) Parents perceived severity of influenza (+ *) Parents perceived barriers to vaccination, such as misunderstanding about risks of influenza vaccine (− *) Parents perceived benefits of influenza vaccine (+ *) | Parents were satisfied with easy access and timely reminders ( +) Generally, parents attached more importance in children’s influenza vaccination during COVID-19 pandemic ( +) Parents perceived susceptibility of influenza (+ *) Parents perceived severity of influenza (+ *) Parents perceived barriers to vaccination, such as misunderstanding about risks of influenza vaccine (− *) Parents perceived benefits of influenza vaccine (+ *) | Obtain and use parents and family feedback (76%) Involve parents and family members (71%) Conduct local needs assessment (57%) |
Cosmopolitanism | Clear responsibilities and close collaboration among the Department of Health, Department of Education, and schools ( +) Top-down authority ( +) Challenge of arranging time for vaccine administration and influenza vaccine supply ( −) | Clear responsibilities and close collaboration between the Department of Health and Department of Education ( +) Top-down authority ( +) Challenge of arranging time for vaccine administration and influenza vaccine supply ( −) | Build a coalition (62%) Promote network weaving (50%) Develop academic partnerships (50%) | |
External policy and incentives | SLIV policy has been in place for many years and was valued by governments ( +) | SLIV policy has been in place for many years and was valued by governments ( +) | ||
Inner setting | Networks and communications | Efficient communications in school ( +) Parents focused on information related to children, and responded quickly ( +) | Efficient communications in school ( +) Parents focused on information related to children, and responded quickly ( +) | |
Implementation climate | ||||
Compatibility | School implementers deemed SLIV as routine work ( +) | School implementers deemed SLIV as routine work ( +) | ||
Relative priority | School gave priority to SLIV ( +) | School gave priority to SLIV ( +) | ||
Readiness for implementation | ||||
Access to knowledge and information | Training by the Department of Health and Department of Education at the district level to guide school physicians to organize, educate, and mobilize for SLIV was insufficient ( −) School physicians trained teachers, educated students, and provided the class headteachers with targeted materials containing contents and skills to communicate with parents ( +) | Training by the Department of Health and Department of Education at the district level to guide school physicians to organize, educate, and mobilize for SLIV was insufficient ( −) Training and education to teachers and students were undervalued by school physicians ( −) | Conduct educational meetings (79%) Develop educational materials (59%) Distribute educational materials (55%) | |
Individual characteristics | Knowledge and beliefs about the innovation | School physician’s competence and enthusiasm for implementing SLIV ( +) | ||
Individual identification with organization | Parents trusted in the school and government ( +) | Parents trusted in the school and government ( +) | ||
Process | Planning | School physicians and community health center staff routinely implemented annual SLIV according to notification from the Department of Health and the Department of Education (0) SLIV was not affected because it was scheduled early ( +) | School physicians and community health center staff routinely implemented annual SLIV according to notification from the Department of Health and the Department of Education (0) SLIV was severely delayed due to conflicts with COVID-19 vaccination schedule ( −) | Develop an implementation blueprint (73%) Conduct local needs assessment (50%) |