This dissertation aims to examine non-influenza adult vaccination rates in the United States and the barriers to administration across healthcare settings and stakeholders. These settings include the physician office and pharmacy while stakeholders include HCPs in these settings and consumers.

I aimed to understand where adults are getting their information about vaccines. And who and what would influence them to be vaccinated. Due to various challenges, office-based Health Care Providers are resistant to stocking vaccines in their office. Furthermore, these HCPs are focused on disease management rather than prevention.

I hypothesized that the community pharmacist can help improve adult immunization awareness and administration. However, pharmacists in most states are licensed to administer adult vaccines yet the rates are still low indicating barriers to address in this healthcare setting.

This dissertation references the CDC and Advisory Committee on Immunization Practices as the vaccine sources of truth. In order to best understand the current situation for adult immunizations in the Unites States, next to a review of the literature, I engaged in qualitative research and developed a survey shared with practicing bench pharmacists and retail pharmacy decision makers. I asked questions to understand their connectivity to being an immunizer and what the biggest barriers to increasing adult immunizations in the pharmacy are. The responses confirmed my suspicions that through the support of ancillary staff, like the Pharmacy Technician, and via visual culture there is an opportunity to improve the process and experience of receiving an immunization in the pharmacy. With some simple adjustments, pharmacies are well poised to help raise the rates.

¹ CDC, "Vaccine Coverage Among Adults in the United States, National Health Interview Survey, 2016," AdultVaxView, accessed January 20, 2020, https://www.cdc.gov/vaccines/imz- managers/coverage/adultvaxview/pubs-resources/NHIS-2016.html.