Table 2 Factors influencing behaviours related to HPV infection

1. Knowledge

Don't know enough about it

‘Probably well the HPV now I have to say I’m not au fait as I say…’ - Practice nurse 5003

It’s an evolving area so it’s hard to keep up to speed

Not enough information available on it

Credibility of information sources

2. Skill

Difficulty initiating a discussion on HPV infection with a patient

‘We try and normalise the whole thing by saying, you know, if we took blood tests off everybody in the clinic you’d find something like 80% of us had evidence of HPV infection at some point in the past’ - GP 0140

Ability to ‘normalise’ HPV infection when talking to patients

Difficulty explaining HPV infection in a way that patients can understand

3. Social / professional role and identity

Don’t want to pass judgement on patients’ sexual behaviours

‘It’s a very mmm difficult situation and you don’t want to lay any blame - Practice nurse 5023

4. Beliefs about capabilities

Difficulty dealing with awkward or sensitive situations

‘There is difficulty because it’s often mmm it very much depends on the context. You know, if mmm if the relationship has broken down or if they have suspicions, they can be a very distressing for women to mmm ask those questions’ - GP 0058

Easier to discuss with patients who are open or interested

More likely to discuss HPV infection with patients if:

Already doing a smear

Patient asks for a prescription for ‘the pill’

Patient presents with genital warts

5. Beliefs about consequences

When discussing HPV infection, patients might:

‘You don’t know whether by highlighting it [HPV infection] that people might stop coming for smears in case it’s positive’ -Practice nurse 5002

Get embarrassed

Be put off having smears

Think they have a sexually transmitted disease

Think their partner is being unfaithful

6. Motivation and goals

Don’t think it’s necessary to discuss HPV infection with patients

‘I wouldn’t see any reason to [talk about HPV infection]’ -GP 0072

Discussing HPV infection with patients is important

7. Memory, attention and decision processes

Topic is not at the forefront of the practitioner’s mind

‘It’s not sort of, of hopping on to the top of my mind..’ -GP 0090

8. Environmental context and resources

Don't have enough time for discussion

‘I suppose maybe to have more aids in very simple descriptions in different languages…it’s simple things that I draw out and explain to people. I don’t have that. I suppose it’s something we need to get together maybe and work on’ - Practice nurse 5001

Need aids for discussion

Need leaflets about HPV to give to patients

9. Social influences

Patients don't know anything about it

‘I would say that most people coming in for cervical screening do not understand or even know the association of HPV to it… They do not associate HPV and cervical cancer in any way whatsoever’ - Practice nurse 5043

Patients don't want to know about it

Need for more publicity

10. Emotion

Sensitive topic because it's about patients' sexual behaviour

‘Well I mean the bottom line is that I think I’m em, along with most of my colleagues, are avoiding the subject. Because we know damn well that it’s about you know hhh you know behaviour you know sexual behaviour. And I mean it’s associated with sleeping with the wrong guy... I think we’re avoiding. I think you’re right, we’re avoiding the topic cos we don’t want to go near it because it’s a can of worms’ - GP 0034

The practitioner might get embarrassed

11. Behavioural regulation

Recognising opportunities to raise topic with patients

‘I try to work it [HPV infection] in sometimes when I’m talking to them initially about contraception and if they’re using the pill and stuff like that.’ - GP 0026

Having aids for the discussion available

Having leaflets available to give to patients

Having a clear plan of what to say

12. Nature of the behaviour

Don't routinely bring HPV infection up with patients

‘It’s not something that I on a regular basis discuss with people…’ - Practice nurse 5043