TABLE 2.

Qualitative Categories Grouped by Social Marketing Conceptual Framework

Theme/Topic	Mentioned by	Illustrative Quotes
Barriers
Lack of transportation	M, H, TI	“Transportation … I don’t how to get to the clinic … I don’t have a car.”
Immigration status	TI, KI	“Most of the people we work with are undocumented … for programs like the pharmaceutical company program, it has to be documented, social security number, and so forth.”
Lack of health insurance	M, H, TI, KI	“The vaccine is expensive, only those who have health insurance.”
Language/limited English proficiency	TI	“Sometimes the doctors only speak English, and there is no one to translate, other times there are Spanish-speaking doctors who are embarrassed to speak Spanish.”
Religious beliefs	M, H, TI, KI	“Beliefs in God … you only do it when it is necessary to do so.”
Competing priorities (e.g., work demands)	M, H, TI, HW	“Being too busy at work to worry and care for yourself.” “In the hours when the clinics are open, the boss will not give permission to go.”
Lack of information about where to get vaccine	M, H	“Not knowing where to get the vaccine.”
Need more information about HPV vaccine	M, H, TI, HW	“I would like to learn more, I have heard very little about it. It seems there is always something new, we need to know the risks.”
Misperceptions about HPV vaccine (e.g., target age, worries about side effects)	M, H, HW	“Those who are over 25 (years old or older) and are sexuality active.” “Whether the benefits outweigh the side effects, what is grave, what isn’t, the secondary effects.”
Benefits
Vaccines, in general, are viewed positively	TI, KI, HW	“To prevent that illness (HPV) and much more, for health.”
Enhance mother/daughter communication	TI	“It is very important for me in my case to talk about this with my daughters, not just about HPV, its all the things we need to do, to talk, all the problems with sexual transmissions, it’s very important, this is one of the ways to prevent you know.”
Stay healthy for family and children	M, H, TI	“To do it for your children, that they stay healthy.”
Costs
Money	M, H, TI, HW	“Doctors are expensive, one doesn’t have the money to go.”
Increase the risk of premarital sex	M, H, TI, KI, HW	“Some of my friends say it’s not good because it calls attention to sex and could lead to premarital sex.”
Short- and long-term side effects	M, H, TI, KI	“I don’t think it is good to vaccinate them when they are so young, without knowing the side effects the vaccine can have.”
Place
Geographic distance to health care services	M, H, TI	“Only for women who have a car, if they live too far away they will not be able to go. It is only for those that live nearby.”
Fear of health care facilities	M	“I am afraid to go to the hospital.”
Promotion
Doctor’s recommendation	M, H, TI, KI, HW	“Only if a doctor logically recommended it would I give my daughter the vaccine.”
Internet and other media outlets (TV/radio)	M, H, TI, HW	“If I am not sleeping well or I don’t feel well, we go to the Internet, and do what it says.”
Educational materials and brochures	M, H, TI, HW	“When I go to the doctor, I get brochures, I look at them all.”

NOTE: HPV = human papillomavirus; M = Mexican patient survey participants; H = Honduran patient survey participants; TI = triad interview participants; KI = key informant interview participants; HW = health care worker survey participants.