title: "I just signed": Factors influencing decision-making for school-based HPV vaccination of adolescent girls.
abstract: OBJECTIVE
  Australia was one of the first countries to implement a nationwide program providing HPV vaccination to girls at school. To date, there are no published studies describing decision-making processes and behavior postimplementation of HPV vaccination of adolescents participating in a school-based program.
  
  
  METHODS
  A purposive sample of nine schools was selected to reflect a range of vaccination coverage and school types. Semistructured focus groups with girls and interviews with parents, teachers, and immunization nurses (n = 185) were conducted until saturation was reached. Transcripts were analyzed inductively and emergent themes were subject to constant comparison.
  
  
  METHODS
  Explanatory model of decision-making in HPV vaccination.
  
  
  RESULTS
  An explanatory model of decision-making and behavior was constructed from the data. Five decision-making states emerged across a continuum of vaccination behavior: active decision-vaccinated, passive decision- vaccinated, passive decision- not vaccinated, active decision- not vaccinated, and antivaccination. A range of factors influenced participants in each decision-behavior state. Adolescents were often part of the decision-making process. Where adolescents were not involved, nonagreement sometimes occurred.
  
  
  CONCLUSIONS
  We have presented a variety of paths girls and their parents experience regarding decision-making and behavior in HPV vaccination. Attitudes, past experiences, and worldviews contributed to this process.
authors.affiliation: Discipline of Paediatrics and Child Health, University of Sydney, Australia, at The Children's Hospital at Westmead, Sydney, Australia. dr.spring@gmail.com
authors.forename: Spring Chenoa Cooper
authors.initials: SC
authors.lastname: Robbins
authors.forename: Diana
authors.initials: D
authors.lastname: Bernard
authors.forename: Kirsten
authors.initials: K
authors.lastname: McCaffery
authors.forename: Julia M L
authors.initials: JM
authors.lastname: Brotherton
authors.forename: S Rachel
authors.initials: SR
authors.lastname: Skinner
mesh_terms: D000293:Adolescent; D003657:Decision Making; D005178:Faculty; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009035:Mothers; D033262:Narration; D009517:New South Wales; D030361:Papillomavirus Infections / Q000517:prevention & control*; D010342:Patient Acceptance of Health Care; D012572:School Health Services / Q000706:statistics & numerical data*; D012573:School Nursing; D014611:Vaccination / Q000706:statistics & numerical data*