WHAT'S KNOWN ON THIS SUBJECT: Rates of human papillomavirus (HPV) vaccination lag behind other adolescent vaccines. Research indicates that provider recommendation is the key to improving HPV vaccination rates and that most adolescents who are unvaccinated received other vaccines, indicating missed opportunities for HPV vaccination. WHAT THIS STUDY ADDS:This study explores in-depth the content of provider-patient conversations that either create or prevent opportunities for HPV vaccination. Effective and ineffective conversations are presented with the goal of providing practical tools to improve communication regarding HPV vaccines.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 decisionmaking 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. Pediatrics 2014;134:e666-e674 AUTHORS:

Objective To explore low-income, minority parents’ attitudes, intentions, and actions with regards to human papillomavirus (HPV) vaccination for their daughters. Study design Semi-structured interviews were conducted in English and Spanish with parents of girls aged 11–18 who were attending clinic visits in an urban medical center and a community health center. We assessed intention with formal scales, probed parents’ attitudes regarding vaccination with open-ended questions, and used medical record review to determine vaccination rates. Data were analyzed using descriptive statistics and qualitative methods. Results Seventy-six parents participated: 43% Black, 28% Latino, 26% White. Most were mothers, had completed high school and described themselves as religious; nearly one-half were immigrants. Intention correlated highly with vaccine receipt: 91% of parents intended to vaccinate their daughters against HPV, and 89% of girls received vaccination within 12 months of the interview. Qualitative analysis revealed that most parents focused on the vaccine’s potential to prevent cervical cancer. Some parents expressed concerns about unknown side-effects and promoting unsafe sexual practices, but these concerns did not hinder acceptance in most cases. Conclusions Most low-income, minority parents viewed HPV vaccination as a means of protecting their daughters from cancer, and thus chose to vaccinate their daughters.

Although parents in our study had limited understanding of HPV disease in males, most would vaccinate their sons if recommended by their physicians.