Table 1.

Qualitative protocol for understanding attitudes and experiences with the HPV vaccine

Patients and Parents (Semi-Structured Interviews)		Providers (Focus Groups)
Question topic	Question example	Question Example
Patients and Parents General perceptions and attitudes towards vaccines Providers Perceptions of patient/parent perceptions	• How do you feel about vaccines in general? • To what extent do you think that vaccines are helpful (or effective)? Do you think that some vaccines are more helpful or effective than others? If so, which ones? • To what extent do you think that vaccines are harmful (or ineffective)? Do you think that some vaccines are more harmful than others? If so, which ones? • Whom do you trust to give you information about vaccines in general? • Whom do you usually go to first when you have questions about vaccines, and why? (Probe for people you know, from healthcare providers, from others, and from the internet or media)	• How much do you think parents and adolescent patients trust or do not trust the HPV vaccine to protect adolescents’ health? • What types of concerns have parents [adolescents] said to you about the HPV vaccine? What types of positive feedback have you heard?
Patients and Parents Assessment of HPV knowledge Providers Assessment of patients’ and parental knowledge	• Tell me what comes to mind when you hear “HPV?” • How is HPV prevented, if at all? • How did you learn about HPV? • Which sources were most helpful? Least helpful?	• To what extent do you think they think that the HPV vaccine is harmful, or ineffective? To what extent do they think it is safe or effective? • To what extent do you think they think that the HPV vaccine is necessary? • To what extent do you think they think that the HPV vaccine does or does not have side effects? • To what extent do you think they think that the HPV vaccine does or does not cause discomfort when or after it is administered? • To what extent do you think they think that the vaccine does or does not cause teens to have sex? • To what extent do you think they think that the HPV vaccine is helpful (or effective)? • To what extent do you think that they know that the HPV vaccine prevents cancer? Prevents STIs?
Patients and Parents Perceptions of the HPV vaccine Providers Perceptions of how patients and parents view the HPV vaccine	• How much do you trust or not trust the HPV vaccine? Why or why not? • To what extent are you willing or not willing to vaccinate your child(ren) for HPV? • To what extent do you think that the HPV vaccine is necessary or not necessary for boys? For girls? • To what extent do you think that the HPV vaccine is harmful or ineffective? • From whom or where have you heard information about the HPV vaccine? • To what extend do you believe what you have heard about the HPV vaccine? • From whom or where do you think your child gets information about HPV?	• How do patients and parents react to the idea of the HPV vaccine? • What kinds of things do parents typically say when you bring up the vaccine? • What kinds of questions do parents ask? • How are these questions addressed? By whom? • What types of reasons do patients and parents give when declining the vaccine? • How do you respond when parents decline for their adolescent to get the vaccine? • In general, how do you address a situation where a parent declines? What do you say?
Patients and Providers Perceived systems-level factors affecting vaccine uptake and adherence Providers Perceptions of provision of care and systems-level factors influencing vaccine uptake and adherence	• If you have not received the vaccine, what factors played a role? • What factors related to you, your child, or your healthcare provider played a role? • How much do you intend to get the 2nd and 3rd shots for your child? • What kinds of things might be a barrier to your child coming back to get the 2nd and 3rd shots? • What kinds of things might be helpful in getting your child back for the 2nd and 3rd shots?	• What kinds of things do you think that the clinic does particularly well and what kinds of things do you think that the clinic does less well in getting adolescents to take the HPV vaccine? • Why do you think that things work that way in the clinic? • What kinds of things might be a barrier to adolescent patients coming back to get the 2nd and 3rd shot? • What kinds of things might be helpful in getting adolescent patients back for the 2nd and 3rd shots? • What kinds of things can healthcare providers and clinics do to help get more children vaccinated for HPV? • What kinds of information could healthcare providers give to parents about the vaccine? • How should healthcare providers communicate with parents to let them know about the vaccine? • What would help parents and adolescents initiate the vaccine series? • What would help parents and adolescents complete the vaccine series? • What kinds of things can the clinic do to help remind parents about the 2nd and 3rd doses of the vaccine? • What methods of communication reminders would be most helpful (email, texts, phone, etc.)?
Patients and Parents Perceived individual-level factors affecting vaccine uptake and adherence Providers Perceptions offering the HPV vaccine	• What kinds of questions and concerns did you have about the HPV vaccine when it was first introduced to you by the clinic staff? • What kinds of questions and concerns did your child have? • To what extent were your and your child’s concerns addressed or not addressed? If yes, how and by whom, and with what information? If no, why do you feel that your concerns were not addressed? • If you did receive the vaccine, how was it decided that you would get the HPV vaccine?	• How do you discuss HPV with adolescent patients and their parents? • What factors influence your decision to offer the HPV vaccine to an adolescent and parent of an adolescent patient? • How do you present information about the HPV vaccine to patients and parents? • What kind of things do you typically discuss with adolescents about the HPV vaccine? • When offering the vaccine, to what extent do you talk to the adolescent?
Patients and Parents Feedback on proposed intervention Providers Feedback on proposed intervention	• What kinds of things can healthcare providers and clinics do to help get more children vaccinated for HPV? • What do you think about the following intervention components: • Text message reminders for follow-up visits? • Educational materials like pamphlets and videos? • Computer systems to track patients who do and do not initiate and complete the vaccine? • Tracking whether physicians are offering and giving the vaccine, and giving them feedback about how they are doing? • Provider reminders about patients who are due to start the vaccine series or receive another dose? • Teaching healthcare providers how to communicate with patients who refuse the vaccine?	• What kinds of things can healthcare providers and clinics do to help get more children vaccinated for HPV? • What do you think about the following intervention components: • Text message reminders for follow-up visits? • Educational materials for parents and adolescents like pamphlets? • Computer systems to track adolescent patients who do and do not initiate and complete the vaccine? • Tracking whether physicians are offering and giving the vaccine, and giving them feedback about how they are doing? • Implementing and using a quality measure of clinic and physician HPV vaccination rates? • Provider reminders in the electronic health record about adolescent patients who are due to start the vaccine series or receive another dose? • Teaching healthcare providers how to use supportive communication strategies to address vaccine refusal?