Table 3.

Strategies to improve adolescent vaccination rates including the use of new technologies, as identified through focus group discussions

Theme
Sub-theme	Representative Quote from Provider	Representative Quote from Parent (P) or Adolescent (A)
Educational tools	“So if there was some way that’s in the media to increase the education before [the parents] came in. Because a lot of times they don’t know, and so once they come in, they’ll listen to you tell them about it, but then it’s, ‘Ok, we’ll think about it.’”	P: “… if you had all that information, you know, instead of walking into the office and them saying, ‘this is what’s due.’ You know, if you got that prior, I mean, obviously, that would be helpful.”
		P: “I was thinking, like, a webpage … giving us information about infants, you know, toddlers, young adults, or young adolescents. Giving us a chance to turn on, getting on, OK, well, my son’s 14-years-old. What is new out there for us?”
Reminder-recall notices	“Through the last couple of years, we’ve started printing our list of overdue teens and sending them [a] postcard … I think we’ve gotten a fairly good response from them … I think we started the year at 57% for our teen [immunization] rate, and we’re at like 75% over the course of the year.” “We’re still using a [database system] that … is not as smart as it could be … It could be embedded with more intelligence to pull out, you know, teenagers who are due for a tetanus shot or something, but the technology’s not there yet.”	P: “I get text messages from my kids but I, honestly, … would rather get a postcard.”
		P: “Ask preferences. You know, I prefer a postcard, but somebody … that’s 24 years old that has a new baby is probably gonna prefer a text message … I think you have to kinda look at different age groups and what they prefer.”
Using technology
Varying levels of access to and comfort with using Internet	“We have a mixed population out here. Either there’s money to have [the Internet] or there’s not…”	P: “…it would be nice if there was a site where you can go and have all that information. ‘Cause I’m sure if you don’t have Internet at home, you can go to the library and access it somehow.”
	“Another suggestion for people that didn’t have access to the, to Internet, maybe we could have a computer [in the clinic] with information.”
		P: “The people I talk to … a lot of them use Internet to access stuff regarding personal issues with their children
		and their families, and I think that would be wonderful.”
Using alternative communication modalities	“… I mean, they’re on their smart phones all the time, and Facebook, and texting … I think people would definitely be up for [using technology to communicate with the doctor].”	P: “Yeah, have all the modes of media because, you know, for most of us, this is, the phone is our lifeline.”
		P: “I mean, everybody’s got email now…”