title: Provider perceptions of barriers and facilitators of HPV vaccination in a high-risk community.
abstract: BACKGROUND
  Maximizing HPV vaccine uptake among those at highest risk for cervical cancer is critical. We explored healthcare provider perspectives on factors influencing HPV vaccination among adolescent girls in a community with high cervical cancer rates.
  
  
  METHODS
  From March to May 2009, we conducted in-depth interviews with 21 medical staff providing care to adolescent girls at two clinics in Los Angeles, CA, serving a predominantly Hispanic population with high cervical cancer rates. Interviews were recorded and transcribed data were reviewed for coding and thematic content related to potential barriers and facilitators of HPV vaccination.
  
  
  RESULTS
  Providers and medical staff overwhelmingly focused on parental beliefs as barriers to HPV vaccination. Perceived parental misconceptions acting as barriers included the belief that adolescents do not need vaccinations and that no-cost vaccine programs like Vaccines for Children are only available for younger children. Perceived parental concerns that the vaccine will promote sexual activity were prevalent, which prompted providers to frame HPV vaccine as a "routine" vaccine. However, the medical staff felt mothers with a friend or relative supportive of HPV vaccination were more likely to request the vaccine. The staff also noted that for Hispanic parents the "preferred" source of information is peers; if the "right people" in the community were supportive of HPV vaccine, parents were more willing to vaccinate. Other barriers included lack of immunization records among immigrant parents and a difficult-to-reach, mobile clientele.
  
  
  CONCLUSIONS
  Providers noted a number of barriers to HPV vaccination, including some perceived parental misconceptions that could be addressed with education about the need for adolescent vaccines and available free vaccine programs. Because community support appears particularly important to Hispanic parents, the use of promotoras - peer liaisons between health organizations and the community - may increase HPV vaccine uptake in this population.
authors.affiliation: Department of Epidemiology, University of California, Los Angeles, Box 951772, Los Angeles, CA 90095-1772, USA. javan@ucla.edu
authors.forename: Marjan
authors.initials: M
authors.lastname: Javanbakht
authors.forename: Shauna
authors.initials: S
authors.lastname: Stahlman
authors.forename: Susan
authors.initials: S
authors.lastname: Walker
authors.forename: Sami
authors.initials: S
authors.lastname: Gottlieb
authors.forename: Lauri
authors.initials: L
authors.lastname: Markowitz
authors.forename: Nicole
authors.initials: N
authors.lastname: Liddon
authors.forename: Aaron
authors.initials: A
authors.lastname: Plant
authors.forename: Sarah
authors.initials: S
authors.lastname: Guerry
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D002648:Child; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006297:Health Services Accessibility; D006630:Hispanic or Latino; D006801:Humans; D015141:Los Angeles; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010290:Parents / Q000523:psychology; D010342:Patient Acceptance of Health Care; D010465:Perception; D010818:Practice Patterns, Physicians'; D014611:Vaccination / Q000523:psychology*
chemical_list: D053918:Papillomavirus Vaccines