Table 3 Factors influencing behaviours related to HPV vaccination
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 now...how 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 |