PROJECT SUMMARY Strong health care provider recommendations are the single most influential factor in patient acceptance of vaccination. However, as the number of providers administering vaccines increases, there is a concern of fragmented immunization records in state Immunization Information Systems (IISs), a serious issue at both the provider and state levels. Complete immunization records provided through IISs are necessary at both the point of clinical care, to determine appropriate vaccinations the patient may need and ensure that individuals are not over or under-vaccinated, as well as the population level, to monitor vaccination rates and facilitate outbreak response efforts and recalls. To effectively use IISs, it is critical that each immunization provider administering vaccines 1) assesses immunization status using the IIS and 2) reports each time a vaccine is administered to a patient in the IIS. Previous research has shown significant increases in vaccination rates when IIS is used by immunization providers. Lack of pharmacy participation in IISs has been identified as a serious concern, with only 35% of pharmacists nationwide entering administered vaccination information into an IIS, and even fewer checking the IIS before administering a vaccine. This is important for routine vaccinations and becomes critical in pandemic response efforts, including distribution of COVID-19 vaccines as well as catch up vaccinations that were unable to be administered during the pandemic. Multi-faceted strategies mapped to identified determinants are needed to incorporate IIS into pharmacy workflow including assessing immunization status, recommending needed vaccines, and documenting administered vaccines. The objective of this study is to use an Implementation Mapping framework to identify determinants of and refine strategies to improve IIS implementation in the community pharmacy setting, which will then be evaluated using the Taxonomy of Implementation Outcomes. This will help to achieve the long-term goal, to improve the use of IISs to assess immunization status and recommend vaccines in the rural community pharmacy setting, thereby improving vaccination coverage, response efforts, and making the provision of immunizations safe and efficient. The specific aims are to 1) identify community pharmacy specific determinants to integration of IIS reporting and assessment into pharmacy workflow, 2) tailor IIS Informed Pharmacy Immunization Process implementation strategies using a human-centered design approach, and 3) evaluate selected implementation strategies in a community pharmacy setting. The proposed study will use an explanatory sequential mixed-methods research design to identify and refine pharmacy-specific implementation strategies to improve integration of IISs. Results from this study will serve as the foundation for a large stepped wedge cluster randomized trial among pharmacies in rural South Carolina and other southeastern states, assess...