Josephine van Dongen

7 Evaluation of implementing a targeted rotavirus vaccine program 177 Statement Medical doctors (N=51) Other HCP (N=84) p-value I know how to prescribe rotavirus vaccination for my patient within the RIVAR project (n agree with statement, %) 33/46 (71.7) 31/73 (42.5) 0.002 I know which agreements apply in my hospital about administration of rotavirus vaccination and how to arrange this (n agree with statement, %) 32/47 (68.1) 61/77 (79.2) 0.17 Percentages are derived excluding respondents with missing information. Statistical significance (p-value <0.05) is highlighted in bold. The instructions for at home administration of the second dose were clear for 130 parents (74.7%) of vaccinated infants. Among the remaining 43 parents, 35 (81.4%) experienced some level of difficulty in administration of the second dose. In-depth interviews: A study-specific infant related barrier is the eligibility criteria of care between six and 14 weeks of age in a par ticipating facility. A pediatric nurse raised this during the interview: “ Half of this population is already at home before six weeks of age. Well baby clinics include follow-up for these children .”. A study specific healthcare related issue was the sole responsibility of pediatricians for implementation, two interviewees addressed this: “ Is it wise or useful to lay responsibility with the pediatrician? Shouldn’t the well-baby clinic physicians function as a safety net? What is the benefit of making the pediatrician solely accountable? The only group that is missed by well-baby clinic physician are the infants with congenital disorders.” and “The pediatrician is responsible for indication setting. But all practical aspects, administration and logistics of vaccination are not handled by them .”. Another study-specific healthcare related barrier was confusion about RIVAR cohor t-study and RIVAR project. A research nurse highlighted this during the interview: “ From the start of the project confusion existed with regards to cohort-study versus project. Most health care professionals in both hospitals initially perceived the rotavirus vaccine to be a study vaccine and as such only available to cohort-study participants. Since most eligible infants did not participate in the cohort- study it was thought that there was no need for involvement of the treating pediatrician. “. A study specific issue that functioned both as barrier and facilitator was the use of a research nurse/employee to facilitate implementation: “… Throughout the study period the research nurse was responsible, but therefore it was no standard care.“ and “The initial set-up was supported by sufficient time and money within the study budget.Then I found three medium care nurses who now administer the vaccination. “.