title: Managing uncertainty: healthcare professionals' meanings regarding the HPV vaccine.
abstract: BACKGROUND
  New preventive technologies such as vaccines offer insight into psychological, social, and cultural landscapes. Providers have a key role in parents' decisions for vaccinating their children. Yet, perspectives from providers regarding the human papillomavirus (HPV) vaccine, or vaccination in general, are rarely sought
  
  
  OBJECTIVE
  Our objective in this paper is to understand how the HPV vaccine is perceived by health care providers and the multiple contextual meanings it elicits.
  
  
  METHODS
  We conducted interviews with 20 health care professionals in Bulgaria about their attitudes and practices related to HPV vaccination and their recommendations for policies. The verbatim-transcribed interviews were analyzed through narrative analysis, with a special focus on language.
  
  
  RESULTS
  We illustrate providers' contradictory and contextualized constructions of the vaccine and the narrative strategies they use to manage any uncertainty it elicits. These include being advocates and missionaries for preventive health, confirming their trust in the medical profession and professional organizations, challenging patients' concerns with rational explanations, normalizing the risk of medical innovations, and avoiding the sexual nature of HPV transmission.
  
  
  CONCLUSIONS
  The introduction of a vaccine to prevent HPV infection, and by implication, possibly cervical and other cancers, created hope, and at the same time, intensified confusion and uncertainty. Providers have been frustrated for years with the rising mortality from cervical cancer in Bulgaria, and their perceived powerlessness in affecting this. HPV vaccination, on the other hand, seems relatively simple and "taming uncertainty" positions them as instrumental in limiting (or even eliminating) morbidity and mortality in future generations.
authors.affiliation: Department of Health Sciences, Northeastern University, Robinson Hall 209, Boston, MA, 02115, USA, i.todorova@neu.edu.
authors.forename: Irina
authors.initials: I
authors.lastname: Todorova
authors.forename: Anna
authors.initials: A
authors.lastname: Alexandrova-Karamanova
authors.forename: Yulia
authors.initials: Y
authors.lastname: Panayotova
authors.forename: Elitsa
authors.initials: E
authors.lastname: Dimitrova
authors.forename: Tatyana
authors.initials: T
authors.lastname: Kotzeva
mesh_terms: D001291:Attitude of Health Personnel; D002031:Bulgaria; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D007802:Language; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines; D010290:Parents / Q000523:psychology; D010465:Perception; D036301:Qualitative Research; D035501:Uncertainty; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000821:virology; D014611:Vaccination / Q000523:psychology
chemical_list: D053918:Papillomavirus Vaccines