Models of Health Behavior and Systems and Overcoming Barriers to Improved Immunization Rates

  • Jonathan M. Raviotta
  • Richard K. Zimmerman


Despite the availability of effective vaccines, they are often underused. Though many barriers to immunizations exist, primary care providers can overcome these barriers through systematic implementation of immunization quality improvement programs. This chapter prepares primary care clinicians to improve vaccination coverage in their patient panel. The chapter examines the public health dynamics of the US immunization program and common theoretical models of health behavior used in immunization program planning. The Social Determinants of Health framework is presented as an alternative to the more frequently used health behavior models to guide complex multi-system immunization interventions. Current research in the field of implementation science is explained to equip the reader to plan an immunization improvement intervention. The chapter concludes with a review of the most effective evidence-based interventions designed to improve immunization coverage. The 4 Pillars™ Practice Transformation Program for immunization is offered as a taxonomy of critical leverage points that will guide the selection of quality improvement strategies.


Immunization Vaccination Quality improvement Overcoming barriers to immunization Physician behavior Office behavior Clinical practice 


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Family Medicine and Clinical EpidemiologyUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.University of Pittsburgh School of MedicinePittsburghUSA

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