title: Girls' explanations for being unvaccinated or under vaccinated against human papillomavirus: a content analysis of survey responses.
abstract: BACKGROUND
  In England HPV vaccination is offered to all girls age 12-13 years, free-at-the-point-of-receipt, mostly in schools. Coverage is good, but around 20% of girls remain unvaccinated. This research sought to explore reasons for being un-/under vaccinated.
  
  
  METHODS
  An ethnically diverse sample of girls aged 15-16 years attending one of twelve London schools completed a survey three years after being offered HPV vaccination. Girls reported their HPV vaccine status and those who were unvaccinated (had not received any doses of the vaccine) or under vaccinated (had not completed the recommended 3-dose course) recorded reasons for their un-/under vaccinated status. Reasons were reported using free-text and content analysis was used to analyse responses.
  
  
  RESULTS
  Around 74% of un-/under vaccinated girls provided a reason for their vaccination status (n = 259). Among unvaccinated girls, the most common reasons related to lack of perceived need for vaccination, concerns about safety and lack of parental consent. Girls who were under vaccinated gave practical reasons, including the need for more information (e.g. not knowing that multiple doses were needed), administrative issues (e.g. school absence), health and procedural concerns (e.g. fear of needles). Descriptively, there were few differences in the reasons given between girls from different ethnic backgrounds. Girls from Black and Asian backgrounds more commonly thought that the vaccine was not needed. Lack of parental consent without providing further explanation was most often cited by girls from Black backgrounds.
  
  
  CONCLUSIONS
  Safety concerns and lack of perceived need should be addressed to encourage informed uptake of HPV vaccination. Immunisation programme coordinators may be able to increase series completion by tackling practical problems facing under vaccinated girls.
authors.affiliation: Health Behaviour Research Centre, Department of Epidemiology & Public Health, UCL, Gower Street, WC1E 6BT, London, UK. alice.forster@ucl.ac.uk.
authors.forename: Alice S
authors.initials: AS
authors.lastname: Forster
authors.affiliation: Health Behaviour Research Centre, Department of Epidemiology & Public Health, UCL, Gower Street, WC1E 6BT, London, UK. j.waller@ucl.ac.uk.
authors.forename: Jo
authors.initials: J
authors.lastname: Waller
authors.affiliation: Health Behaviour Research Centre, Department of Epidemiology & Public Health, UCL, Gower Street, WC1E 6BT, London, UK. harriet.bowyer@ggc.scot.nhs.uk.
authors.forename: Harriet L
authors.initials: HL
authors.lastname: Bowyer
authors.affiliation: Health Behaviour Research Centre, Department of Epidemiology & Public Health, UCL, Gower Street, WC1E 6BT, London, UK. l.marlow@ucl.ac.uk.
authors.forename: Laura A V
authors.initials: LA
authors.lastname: Marlow
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D004739:England / Q000453:epidemiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008131:London / Q000453:epidemiology; D030361:Papillomavirus Infections / Q000517:prevention & control* / Q000523:psychology; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010290:Parents / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D014611:Vaccination / Q000523:psychology* / Q000706:statistics & numerical data
chemical_list: D053918:Papillomavirus Vaccines