title: "You're never really off time": Healthcare providers' interpretations of optimal timing for HPV vaccination.
abstract: Healthcare providers have a strong influence on human papillomavirus (HPV) vaccination decisions, yet they often fail to recommend the vaccine to the 11- and 12-year-olds who are targeted by practice guidelines. We sought to understand how providers interpret and value age-based guidelines. We conducted a secondary analysis of data from two qualitative studies of healthcare providers' HPV vaccination attitudes and practices. Participants were physicians, nurse practitioners, and physician assistants in Minnesota (n = 27) and in Washington (n = 17) interviewed in 2012 and 2014 respectively. Verbatim transcripts from each study were analyzed independently using content analysis, and collective findings were then jointly analyzed. The research team worked via consensus to derive codes and describe representative themes. A high proportion of providers reported either a lack of concern about HPV vaccine completion, or concern beginning several years past the recommended target age. Many providers perceived a gradient of HPV vaccination timeliness ranging from age 12 to 26. Instead of age-based recommendations, providers timed recommendations based on perceptions of access to care and patient risk. They often offered "gentle" recommendations and deferred vaccination discussions as a tool to building trust with families. Interventions aimed at helping providers deliver effective recommendations for timely HPV vaccination are needed. Our findings suggest that changing the norm of provider culture to one in which "catch-up" schedules are seen as a suboptimal way to achieve vaccine uptake may be an important goal.
authors.affiliation: Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA; School of Public Health, University of Washington, Seattle, WA, USA.
authors.forename: Nora B
authors.initials: NB
authors.lastname: Henrikson
authors.affiliation: Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
authors.forename: Leah
authors.initials: L
authors.lastname: Tuzzio
authors.affiliation: Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, 133 Brookline Ave, Boston, MA 02215, USA.
authors.forename: Melissa B
authors.initials: MB
authors.lastname: Gilkey
authors.affiliation: Division of General Pediatrics and Adolescent Health, University of Minnesota, 717 Delaware St SE, Minneapolis, MN 55414, USA.
authors.forename: Annie-Laurie
authors.initials: AL
authors.lastname: McRee
keywords: HPV, human papillomavirus; Human papillomavirus (HPV) vaccination; Patient-provider communication