title: Missed opportunities for HPV vaccination in adolescent girls: a qualitative study.
abstract: OBJECTIVE
  The goal of this study was to identify the rationale by parents/guardians and providers for delaying or administering human papillomavirus (HPV) vaccination to girls.
  
  
  METHODS
  Qualitative interviews were conducted with parents/guardians accompanying their vaccine-eligible 11- to 17-year-old daughters to medical visits. Interviews were conducted in 1 public clinic and 3 private practice settings to ascertain why girls did or did not receive HPV vaccination. Questions probed vaccine decision-making from the point of view of parents/guardians and providers.
  
  
  RESULTS
  A total of 124 parents/guardians and 37 providers participated. The most common reasons parents reported for not vaccinating their daughters was the lack of a physician recommendation (44%). Both parents and providers believed that HPV vaccination provided important health benefits, but the timing of vaccination with relation to sexual activity was an important theme related to vaccine delay. Providers with lower self-reported vaccination rates delayed vaccine recommendations in girls perceived to be at low risk for sexual activity, and several parents reported that their providers suggested or supported delaying vaccination until their daughters were older. However, parents/guardians and providers agreed that predicting the timing of sexual debut was extremely difficult. In contrast, providers with high vaccination rates presented HPV vaccination as a routine vaccine with proven safety to prevent cancer, and parents responded positively to these messages.
  
  
  CONCLUSIONS
  Although most parents and providers believe that HPV vaccination is important, missed opportunities result from assumptions about the timing of vaccination relative to sexual activity. Routinely recommending HPV vaccination as cancer prevention to be coadministered with other vaccines at age 11 years can improve vaccination rates.
authors.affiliation: Boston University School of Medicine, Boston, Massachusetts; rebecca.perkins@bmc.org.
authors.forename: Rebecca B
authors.initials: RB
authors.lastname: Perkins
authors.affiliation: Edith Nourse Rogers Memorial Veterans Hospital-Bedford, Bedford, Massachusetts; Boston University School of Public Health, Boston, Massachusetts;
authors.forename: Jack A
authors.initials: JA
authors.lastname: Clark
authors.affiliation: Boston University School of Public Health, Boston, Massachusetts;
authors.forename: Gauri
authors.initials: G
authors.lastname: Apte
authors.affiliation: Boston University School of Medicine, Boston, Massachusetts;
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Vercruysse
authors.affiliation: Boston University School of Medicine, Boston, Massachusetts;
authors.forename: Justen J
authors.initials: JJ
authors.lastname: Sumner
authors.affiliation: Harvard Vanguard Medical Associates, Chelsmford, Massachusetts; and.
authors.forename: Constance L
authors.initials: CL
authors.lastname: Wall-Haas
authors.affiliation: Harvard Vanguard Medical Associates, Burlington, Massachusetts.
authors.forename: Anna W
authors.initials: AW
authors.lastname: Rosenquist
authors.affiliation: Boston University School of Medicine, Boston, Massachusetts;
authors.forename: Natalie
authors.initials: N
authors.lastname: Pierre-Joseph
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D010287:Parent-Child Relations; D010342:Patient Acceptance of Health Care / Q000523:psychology; D036301:Qualitative Research; D012725:Sexual Behavior / Q000523:psychology; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control / Q000523:psychology; D014611:Vaccination / Q000523:psychology / Q000706:statistics & numerical data*
chemical_list: D053918:Papillomavirus Vaccines
keywords: HPV vaccination; missed opportunities; parental attitudes; provider attitudes; qualitative methods