Table 2.

Descriptive quotes for theme 1- barriers to HPV vaccination and cervical cancer screening. The words in the brackets are the additions by the authors to clarify the context of participants’ quotes.

Sub-theme	Descriptive quotes
1a. Low knowledge of cervical cancer prevention	I think white discharge that comes out too much wears down the uterus and causes cancer. I don’t have any symptoms such as stinky white discharge, so I just clean myself [such as] hand washing. I don’t have any symptoms, so I don’t visit doctors. If I see the color [of the white discharge] turning even slightly bad or [if I see] any symptoms, I will visit doctors. I haven’t been vaccinated [against HPV because] I just heard of them [i.e., HPV and HPV vaccination]. They are new to me.
1b. Structural barriers	I think it [i.e., low HPV vaccination rate] is partly due to financial conditions. One dose cost more than a million [Vietnam Dong] or two million [Vietnam Dong], and we have to get three doses. We want to screen and vaccinate but it is time and money-consuming, while we are busy with working. I don’t feel anything abnormal, so I just stay at home working and taking care of my husband and children, being busy days and nights. If I go [to a hospital] to get screened, I have to spend the whole day and arrange all the house chores [in advance]. If I go to the city [for screening], it will take 2–3 days.
1c. Psychosocial barriers	[I feel] embarrassed [when taking a Pap test] because I have to take off my pants. However, if I am in pain [i.e., having symptoms], I will have to [take a Pap test], I won’t feel embarrassed anymore. If that’s a mild condition, it’s okay [for other women in the examination room to hear]. If that’s a serious condition, people hear it and may spread the news [that I get the disease]. I find this method [i.e., Pap test] has a disadvantage in that if the doctor is not skillful, it will hurt a lot and it may also bleed. Also, if I take this test several times, it can scratch [my vagina], which causes infections. In general, when a person visits a doctor, if they don’t have the disease [i.e., cancer], it’s fine. If they [figure out they] have the disease, they will have a mental breakdown. They will worry if they have enough money to treat [the disease], how they would be, how their children and family would be; that will be a serious mental breakdown! Young people who screened for the first time would think that other women were looking at them [and judging]: “What kind of women have to take this test?” My sister is too young and would feel embarrassed about taking a gynecological exam and an [HPV] test. I don’t know if she has to test [for HPV] before vaccinating. Is it okay to get [HPV] vaccinated? My unmarried daughter asked for my permission to get [HPV] vaccinated but I didn’t allow her. I’m afraid that [HPV] vaccination would make her unable to have children in the future. When I was in high school, I knew about HPV vaccination, but I didn’t vaccinate because my friends said that there were three doses, but we would die after the second dose.
1d. Healthcare workers impact screening attitudes.	Many doctors are irresponsible. For example, when patients take off their pants slowly, they yell at patients. It’s possibly because of their work pressure. Therefore, people are reluctant to visit doctors. If I see a male doctor, I will go home! I visited doctors twice [i.e., for gynecologic examination], but I only met male doctors [so I didn’t get screened]. Women are afraid of male [doctors]. But actually male [doctors] are always more skillful than female [doctors], frankly speaking!