title: Human papillomavirus vaccine series completion: Qualitative information from providers within an integrated healthcare organization.
abstract: This qualitative study aimed to identify doctors' and nurses' perceptions of patient-, provider-, and system-level factors associated with human papillomavirus (HPV) vaccine completion that may be targets for intervention.
  
  
  
  We analyzed data from 61 qualitative interviews with pediatricians, family medicine physicians, and immunization nurses at medical centers that had the highest and lowest HPV vaccine completion rates within the same health care system.
  
  
  
  In both groups, almost all providers reported strong support for the HPV vaccine. In detailing how they talk to parents and patients about the vaccine, more of the providers working at higher completion centers described using effective communication techniques, including engaging parents and patients in two-way conversation and demonstrating awareness of cultural and practical barriers to completion that families may face. Providers at higher completion centers were also more likely to depict a local medical culture supportive of and committed to HPV vaccine completion, with greater levels of proactivity and teamwork. In contrast, providers working at lower completion medical centers described a lack of proactivity, and the strategies they suggested to improve HPV vaccine completion tended to be approaches that someone other than medical providers would implement. The comments made by these providers sometimes reflected a level of negativity and judgment absent from the comments of providers at higher completion centers.
  
  
  
  Interventions to improve HPV vaccination completion rates should address both individual- and system-level factors. Improving communication skills, encouraging a supportive medical culture, and addressing resource issues is likely to improve vaccine adherence.
authors.affiliation: Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA 91101, USA. Electronic address: Sharon.M.Hudson@kp.org.
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Hudson
authors.affiliation: Regional Nursing Research Program, Kaiser Permanente, Southern California, 393 E. Walnut St., Pasadena, CA 91188, USA. Electronic address: June.L.Rondinelli@kp.org.
authors.forename: June
authors.initials: J
authors.lastname: Rondinelli
authors.affiliation: UCLA Center for Cancer Prevention & Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, 650 Charles Young Drive South, A2-125 CHS, Box 956900, Los Angeles, CA 90095-6900, USA. Electronic address: bglenn@ucla.edu.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Glenn
authors.affiliation: Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA 91101, USA. Electronic address: Melissa.X.Preciado@kp.org.
authors.forename: Melissa
authors.initials: M
authors.lastname: Preciado
authors.affiliation: Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA 91101, USA. Electronic address: Chun.R.Chao@kp.org.
authors.forename: Chun
authors.initials: C
authors.lastname: Chao
mesh_terms: D000328:Adult; D003142:Communication; D019033:Delivery of Health Care, Integrated; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009726:Nurses; D015279:Organizational Culture; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000008:administration & dosage / Q000627:therapeutic use*; D010290:Parents; D010342:Patient Acceptance of Health Care; D010817:Physician-Patient Relations; D010820:Physicians; D036301:Qualitative Research; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D053918:Papillomavirus Vaccines
keywords: Adherence; Human papillomavirus; Patient-provider communication; Vaccine