Table 2.

Current knowledge about and challenges to adolescent vaccination, as identified through focus group discussions

Theme
Sub-theme	Representative Quote from Provider	Representative Quote from Parent (P) or Adolescent (A)
Knowledge about adolescent vaccination
Lack of awareness about recommended adolescent vaccines	“I think it takes a lot of time in the office to go over each vaccine and to understand the importance of it, especially [with] new vaccines, you know, like the HPV vaccine … There’s a lack of understanding on their side.”	A: “I don’t know when we [should] get [vaccines] because most of the time my parents don’t either.”
		A: “Yeah, I never know when I have a vaccination coming. Until you get to [the doctor’s office] and they’re like, oh, you’re overdue.”
Impact of changing immunization schedules		P: “See the thing with me is they changed the vaccination rules … so I had to research all of this information in regard to shots. I didn’t know anything.”
		P: “Yeah, I feel like it’s easier to know what my dog needs than what my kids need.”
Lack of routine preventive care	“… a lot of education needs to be done in the community, letting them know that routine health is important … they’re not making it in for that routine visit, because the parents [think] the kid’s fine.”	P: “My daughter, up until this year, has not competed in sports and she’s healthy. So she hasn’t been to see the [doctor]. I called for, I don’t know, for some silly thing and I thought we could just call and get, I think it was a ‘script or something like that. And they said, ‘well, she probably should come in. It’s been ten years since she’s been in the office.’ And so all these, she had to have five shots. And it isn’t like I’m a bad mom…”
Decision process about vaccination
Parents are primary decision makers	“I think a lot of parents let them get away with not wanting [the vaccines] … like the whiney 15-year-old who says she doesn’t want to do it, I think they are more likely to say, ‘ugh, she’s just being a teenager. Fine, we’ll just come back and do it.’ And then you sort of miss that opportunity.”	A: “I guess my parents mostly until, like, lately. They kinda tell me I need to get one and I’m OK with it.”
		P: “I made the decisions until my daughter was 18.”
Increasing role for adolescents in vaccination decisions	“Adolescents are more of a partner in their health decision-making than younger children, and they have the ability to say ‘no’, and parents will often respect that, rather than necessarily what the doctor is advising.	P: “I’ll let my daughter make the decision [to get the HPV vaccine] on her own.”