title: Factors influencing pediatricians' intention to recommend human papillomavirus vaccines.
abstract: OBJECTIVE
  The objectives of this qualitative study were to describe the range of pediatricians' attitudes about human papillomavirus (HPV) vaccines and to explore factors influencing their intention to recommend HPV vaccines, extending the findings of previous quantitative studies.
  
  
  METHODS
  A diverse sample of pediatricians participated in semistructured individual interviews to assess attitudes and intentions regarding HPV immunization. Framework analysis was used for qualitative analysis.
  
  
  RESULTS
  The mean age of the 31 participants was 47 years, 17 (55%) were female, 9 (29%) were black, and 4 (13%) were Latino. The efficacy, safety, and potential health impact of vaccination were the primary factors driving participants' decisions about recommending HPV vaccines. Perceived benefits of HPV vaccination included prevention of HPV-related disease and the opportunity to educate adolescents. Perceived barriers included anticipated parental beliefs (eg, parental denial that their child would be at risk) and provider beliefs (eg, reluctance to discuss sexuality with preadolescents). Participants reported high intention to recommend HPV vaccines overall, but intention varied according to patient age, patient gender, and HPV vaccine type. The primary reasons underlying this variation included perceptions about the health impact of vaccination and relevance of HPV vaccines to the provider's patients. The main factors driving intention to recommend HPV vaccines included knowledge, personal and professional characteristics, office procedures, vaccine cost and reimbursement, parental factors, and specific attitudes about HPV vaccination.
  
  
  CONCLUSIONS
  These findings provide a framework for understanding pediatricians' decisions to recommend HPV vaccines and may be used to guide the design of interventions to maximize vaccine recommendations.
authors.affiliation: Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA. jessica.kahn@cchmc.org
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Kahn
authors.forename: Susan L
authors.initials: SL
authors.lastname: Rosenthal
authors.forename: Abbigail M
authors.initials: AM
authors.lastname: Tissot
authors.forename: David I
authors.initials: DI
authors.lastname: Bernstein
authors.forename: Caitlin
authors.initials: C
authors.lastname: Wetzel
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Zimet
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053918:Papillomavirus Vaccines; D010372:Pediatrics
chemical_list: D053918:Papillomavirus Vaccines