Table 5.

Human papillovirus (HPV) vaccine attitudes and beliefs by focus group type

Attitudes and Beliefs	Healthcare Providers*	Community Leaders*	Parents	Women
Attitudes
Appalachians are proud, patriotic, religious, conservative, and have close knit family and communities	+	+	+	+
Do not value prevention, ignorant about health, encourage abstinence, HPV is a female stigma	+	+	+	+
Trust of medical community and “outsiders”	+	+/−	+	+
Many foreign-born doctors do not recommend/offer vaccines	+	+
Healthcare providers are disrespectful	+/−		+	+
Suspicion of pharmaceutical companies		+	+
Government intrusion (vaccine mandate)	+	+	+/−	+
Embarrassment associated with having cervical cancer, privacy is important, do not trust “outsiders”	+	+	+
HPV Vaccine promotes promiscuity	+	+	+	−
Women put themselves last on the list, use home remedies	+	+
Stress	+			+
Beliefs
Cervical cancer is hereditary, Vaccines in general are accepted, HPV vaccine implies being sexually active, sex should be associated with marriage, do not like being told what to do	+	+	+	+
Not going to happen to my daughters/myself, medical problems linked to vaccines (autism), abstinent women do not benefit from vaccine	+	+	+
Fear of cancer/fatalism	+	+		+
Sexually active women should not get the vaccine	+	+		+/−
Cervical cancer is caused by an environmental issue (water, air)	+		+	+
Cervical cancer is a “dirty” disease		+
Vaccine if previous STI (HPV or other), abnormal Pap test			+	+

^*Healthcare providers gave answers regarding their patients’ attitudes and beliefs and community leaders’ gave answers about community members’ attitudes and beliefs

Pap:Papanicolaou

(+):mentioned as an attitude or belief; (−):mentioned as not having an attitude or belief; (+/−):mixed messages about attitudes or beliefs; blank:not mentioned