title: Catching Up With the HPV Vaccine: Challenges and Opportunities in Primary Care.
abstract: OBJECTIVE
  Data confirm that high rates of human papillomavirus (HPV) vaccination have not been achieved despite strong clinician endorsement of the vaccine. We conducted a study of primary care clinicians to assess the broad range of health care delivery, health policy, and attitudinal factors influencing vaccination uptake and opportunities for informed decision making.
  
  
  METHODS
  We implemented a mixed methods study in RIOS Net, a primary care practice-based research network in New Mexico. We first conducted qualitative, in-depth interviews with primary care clinicians, health policy makers, and immunization experts, and followed up with a confirmatory survey distributed to RIOS Net clinician members.
  
  
  RESULTS
  Health service delivery challenges emerged as the greatest barrier to HPV vaccination, specifically the lack of capacity to track and distribute reminders to eligible patients. Clinicians also reported variations in counseling approaches attributable to both age and emphasis on the cancer prevention benefits of the vaccine. There was no evidence of sociocultural influences on vaccine decision making, nor did concerns about perceived overprotection emerge.
  
  
  CONCLUSIONS
  Our findings, based on a long-term program of research, suggest that both patients' attributes and health system delivery are most influential in HPV vaccination coverage challenges. Interventions targeting innovative communication techniques, as well as health system changes that build on efforts toward coordinated care and utilization of other venues to promote vaccination, will be necessary to address these challenges.
authors.affiliation: Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico asussman@salud.unm.edu.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Sussman
authors.affiliation: Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico.
authors.forename: Deborah
authors.initials: D
authors.lastname: Helitzer
authors.affiliation: Agri-Cultura Network, Albuquerque, New Mexico.
authors.forename: Anzia
authors.initials: A
authors.lastname: Bennett
authors.affiliation: Barelas Community Coalition, Albuquerque, New Mexico.
authors.forename: Angélica
authors.initials: A
authors.lastname: Solares
authors.affiliation: Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Marianna
authors.initials: M
authors.lastname: Lanoue
authors.affiliation: Department of Anthropology, University of Maryland, College Park, Maryland.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Getrich
mesh_terms: D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006801:Humans; D008297:Male; D009516:New Mexico; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010342:Patient Acceptance of Health Care; D058007:Physicians, Primary Care; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000523:psychology / Q000706:statistics & numerical data*
chemical_list: D053918:Papillomavirus Vaccines
keywords: adolescent health services; cervical cancer; health care delivery; health services research; mixed methods research; vaccination