Article Title

An In-Depth Interview Study of Immunization Providers to Understand Practice Patterns, Barriers and Facilitators for Administering the 3-Dose HPV Vaccine Series

Publication Date



HPV vaccine, adherence


Background/Aims: Vaccination with the quadrivalent human papillomavirus (HPV) vaccine presents an opportunity to reduce the burden of conditions caused by HPV types 6, 11, 16 and 18. Despite increases in HPV vaccine initiation since its introduction in 2006, the 3-dose series completion rate among age-eligible males and females remains low. Provider recommendation has been identified as one of the strongest influences on HPV vaccine initiation. However, limited research has examined the contribution of provider factors to HPV vaccine completion. The purpose of this study was to gain an understanding of barriers and facilitators to HPV vaccine series completion from the perspective of immunization providers.

Methods: Rates of HPV vaccination were examined for 201 pediatrics and family medicine clinics serving adolescent members in Southern California. These clinics were ranked with regard to the proportion of age-eligible males and females who completed the 3-dose HPV vaccine series in order to identify the three highest and three lowest performing clinics. Data were collected through semistructured telephone interviews within three subsets of immunization providers: pediatricians, family practice physicians, and immunization nurses. Our goal was to interview at least 10 providers from each subset within the highest and lowest ranked clinics in order to reach thematic saturation. Providers were recruited through presentations at staff meetings and via email and telephone. The Health Behavior Framework and the Competing Demands Model were used to develop the interview guide.

Results: Sixty-two interviews were conducted from December 2013 to August 2014; 30 providers were recruited from clinics with the lowest completion rates and 32 from the highest-performing clinics. Interviews were recorded and transcribed verbatim. Interviews focused on the following themes: 1) provider knowledge, attitudes and behaviors, 2) perceptions of patient knowledge and attitudes, and 3) system-level influence on vaccination. Data analysis using Nvivo software is ongoing. It is anticipated that final theme generation will be completed by December 2014. Additional results will be discussed.

Discussion: We expect that the results of this study will help guide the design of multilevel interventions targeting the provider and health care system to improve HPV vaccine series completion.




March 30th, 2015


April 28th, 2015