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Table 3 Factors influencing behaviours related to HPV vaccination

From: ‘It’s a can of worms’: understanding primary care practitioners’ behaviours in relation to HPV using the theoretical domains framework

Theme / construct domain Subtheme / specific belief Practitioner * Sample quote
   GPs Practice nurses  
1. Knowledge Not enough information available about it - ‘I suppose the big difficulty with it really is mmm what to do with girls who are mmm maybe that little bit older... You’re not quite sure if they have had sexual encounters or not and whether it’s still worthwhile giving it or not’ - GP 0058
  Rapidly changing area -
  Uncertainty over how long the protection afforded by vaccination will last
  Uncertainty over whether to vaccinate older / sexually active girls or women -  
  Uncertainty over whether to vaccinate boys  
  Most of the information comes from pharmaceutical companies and is viewed as biased  
2. Skill Difficulty of dealing with a consultation where both mother and daughter are present (and/or mother asking about vaccination for daughter) ‘It’s quite a tricky consultation [when mother and daughter are both present] and you’re very aware of everybody’s, the confidentiality issues for the girl, mmm for you know that mum who’s come with her, for all of the type of thing’ - Practice nurse 5001
  Difficulty assessing whether a patient has been sexually active
3. Social / professional role and identity Feel out of touch (because HPV vaccination programme is being delivered through schools) - ‘You see it’s very difficult and I find it’s quite difficult since most of my patients are GMS § and in many of these houses there’ll be a few girls, and I know the people can’t afford the bloomin stuff ..’ - GP 0090
4. Beliefs about capabilities Practitioners are not comfortable discussing HPV vaccination - ‘It’s a bit too new probably compared to some of the other, you know the baby vaccines that are out like they’re going donkeys years now and they seem fairly safe. I’m sure the other two [HPV vaccines] are as well, but I can’t guarantee it’ - Practice nurse 5020
  The vaccine is too new to be considered in primary care -
5. Beliefs about consequences HPV vaccination can cause serious side effects ‘Are you allowing them to be more sexually active by giving them the vaccine. .. I must admit personally speaking initially when I first saw I was oh my goodness you know girls will become more promiscuous’ - Practice nurse 5040
  Vaccination might encourage promiscuity
  Belief that vaccine is effective
  Belief that vaccine is safe
6. Motivation and goals Don't think HPV vaccination is necessary - ‘I don’t know much it’s [HPV vaccination] warranted’ - GP 0086
7. Memory, attention and decision processes - - - -
8. Environmental context and resources The cost is very high ‘I think the price is astronomical. And outrageous…’ - GP 0034
  It would involve a lot of extra work for GPs to provide HPV vaccination -  
  HPV vaccine is not stocked in the surgery -  
9. Social influences If practitioner has a daughter they would vaccinate her ‘If it was daughter I’d do it [vaccinate her]’ - GP 0016
  Patients don't know anything about HPV vaccination  
  Parents don't want to know that their children are sexually active  
  There has been a lot of negative publicity about HPV vaccination  
10. Emotion Nervousness about managing an HPV vaccination consultation when both mother and daughter are present ‘That can be a little bit of a minefield there especially if you’ve got the mother and daughter in front of you’ - GP 0026
11. Behavioural regulation Sourcing vaccine at a cheaper price ‘We got together as a group… and we sourced it as cheaply as we could because we bought it as a group so we got a group discount’ - Practice nurse 5001
  Having written information available to provide to patients
  Having posters advertising that the vaccine is available in the surgery / waiting rooms  
12. Nature of the behaviour Don't see patients in the relevant age group ‘I actually don’t see very many young you know, at the ages where I could see them around 12 or 13… I so rarely see children now’ - GP 0092
  1. * √ = Mentioned by at least one practitioner.
  2. - = Not mentioned by any practitioners.
  3. § Patients who have access to free GP appointments and prescriptions by having a means-tested medical card.