title: Health care provider attitudes and practices regarding adolescent immunizations: a qualitative study.
abstract: OBJECTIVE
  Assess health care providers' attitudes and practices regarding adolescent immunizations, including factors that either impede or facilitate vaccination.
  
  
  METHODS
  Focus groups-In 2005, 3 focus groups were conducted in Monroe County, NY for (1) urban primary care physicians (PCPs); (2) suburban PCPs; and (3) nurses from practices represented in PCP groups. Audiotaped discussions were transcribed and analyzed using Atlas.ti. Key informant interviews-We recruited knowledgeable informants (18 physicians, 6 nurses) from across the US. The authors conducted in-depth telephone interviews with the participants, typed their interview notes, and sent them to the participant for verification. Separately for nurses, urban physicians, and suburban physicians results for each question were listed and reviewed by the authors. Themes were added to those from the focus groups.
  
  
  RESULTS
  Three overarching themes were identified: professional buy-in (e.g., reimbursement, professional organization recommendations, disease and vaccine characteristics, office consensus); parent/adolescent buy-in (e.g., school requirements, perception of MD recommendations, cost and insurance coverage, media reports, disease and vaccine characteristics, "vaccine fatigue"), and delivery factors (e.g., vaccine supply, ordering, timing and scheduling, consent).
  
  
  CONCLUSIONS
  Providers identified intertwined system issues that color their attitudes about adolescent immunization.
  
  
  CONCLUSIONS
  Buy-in and delivery factors must be addressed before high immunization rates will be achieved.
authors.affiliation: Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. sharon_humiston@urmc.rochester.edu
authors.forename: Sharon G
authors.initials: SG
authors.lastname: Humiston
authors.forename: Christina
authors.initials: C
authors.lastname: Albertin
authors.forename: Stanley
authors.initials: S
authors.lastname: Schaffer
authors.forename: Cynthia
authors.initials: C
authors.lastname: Rand
authors.forename: Laura P
authors.initials: LP
authors.lastname: Shone
authors.forename: Shannon
authors.initials: S
authors.lastname: Stokley
authors.forename: Peter G
authors.initials: PG
authors.lastname: Szilagyi
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D001291:Attitude of Health Personnel; D006801:Humans; D007114:Immunization; D032541:Mass Vaccination / Q000458:organization & administration; D009518:New York; D030361:Papillomavirus Infections / Q000517:prevention & control; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care