title: The domino effect: adolescent girls' response to human papillomavirus vaccination.
abstract: OBJECTIVE
  To examine the experience of fear, the fear response, and factors affecting fear in adolescents undergoing school-based human papillomavirus (HPV) vaccination.
  
  
  METHODS
  A purposive sampling strategy and qualitative methods, including observation and face-to-face interviews. Focus groups comprised adolescent girls who were involved in HPV vaccination in 2007 at schools in Sydney, New South Wales. Individual interviews were conducted with parents, teachers and vaccination nurses.
  
  
  RESULTS
  Data from observing vaccination days at three schools and from interviewing 130 adolescents in 20 focus groups, 38 parents, 10 teachers and seven nurses were included in the analysis. All participants discussed the issue of fear and distress experienced by adolescent girls in relation to HPV vaccination. Observations corroborated the focus group and interview data. Our results indicated that fear was promoted by witnessing the fear reactions of peers; perceived judgement by peers; lack of information or misinformation; and being vaccinated later in the day. Fear was moderated by procedural factors, the support of peers, appropriate knowledge, and nurses' distraction techniques or approach. Fear also affected acceptance of HPV vaccination.
  
  
  CONCLUSIONS
  Fear of HPV vaccination was a near universal experience among adolescents in the school setting and was often associated with significant distress that had an adverse impact on the vaccination process. School vaccination could be improved by proactively managing fear and distress.
authors.affiliation: Discipline of Paediatrics and Child Health, University of Sydney at the Children's Hospital Westmead, Sydney, NSW, Australia. dbernard@fpq.com.au
authors.forename: Diana M
authors.initials: DM
authors.lastname: Bernard
authors.forename: Spring C
authors.initials: SC
authors.lastname: Cooper Robbins
authors.forename: Kirsten J
authors.initials: KJ
authors.lastname: McCaffery
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Scott
authors.forename: S Rachel
authors.initials: SR
authors.lastname: Skinner
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D001294:Attitude to Health; D003466:Cultural Characteristics; D005239:Fear / Q000523:psychology; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D009517:New South Wales; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D036301:Qualitative Research; D018570:Risk Assessment; D057545:Social Stigma; D012959:Socioeconomic Factors; D014611:Vaccination / Q000523:psychology* / Q000639:trends
chemical_list: D053918:Papillomavirus Vaccines