Table 2.

Theme 1-Provider support for postpartum HPV vaccination

Sub-theme	Example Quotes
Pro- vaccine attitudes	“I feel very strongly, positively, for the vaccination. I try to promote it a lot.” (DO, Resident, Pediatrics) “I don’t really see any harm with the vaccine.” (RN, OB/GYN) “Considering it’s the first vaccine against cancer. Very little concerns. I mean, if we could do that for everything, that would be awesome. ” (MD, Resident, OB/GYN) “I think the benefits outweigh the small uncertainty about… how long it is effective for. I don’t have any hesitation offering it… It’s still a new vaccine. But there’s promise in that it’s effective for a long time.” (MD, Resident, OB/GYN)
The impact of vaccinating hard-to- reach women	“In our hospital, our population is incredibly underserved. None of them have insurance. So all the women we are vaccinating are women that otherwise don’t have access to healthcare. And [would] not otherwise get this vaccine. Most of them only see a doctor when they’re pregnant.” (MD, Resident, OB/GYN) “We have a lot of patients that are immigrants, who only get coverage because they are pregnant, but don’t get any other healthcare outside of pregnancy. So usually if there’s anything that’s elective that they want, we usually can’t do it.” (MD, Resident, OB/GYN) “I know that there's been a lack of education to moms that are older than 18, between the ages of 18 to 26. Because at that time you're in your prime, you're probably not going to the doctor as much. You're probably not going yearly. Most people aren't. So, whenever they do have a baby, it's really good for them to get that education” (RN, Pediatrics)
Perceived patient benefits	“They come in the clinic… like “Oh my God! I am HPV positive!”. …So there’s this stigma of that virus is really bad.” (MD, Resident, OB/GYN) “It’s a huge benefit because 1 in 4 women are getting HPV infections. Men are spreading it. Teens are very sexually active and very high risk sexual behaviors… So Just from a transmission standpoint, I think it’s very important.” (DO, Resident, Pediatrics) “Whenever you say, “This vaccine could prevent HPV, which can lead to cervical cancer… They’re like “OH!” I think just saying those words, I think that’s a huge benefit knowing that.” (RN, Pediatrics) “I would probably emphasize that it can prevent some of the warts… Nobody wants to have warts [laughter]… Even if they weren’t worried about cancer, they don’t want warts.” (MD, OB/GYN) I lost a patient to congenital HPV. Vocal cords. So that’s a big one for me.” (MD, Pediatrics)
Perceived patient barriers	“Do they think it’s important to them?… Probably not… because they are so young and I think the misconception is that cancer only happens in older women.” (MD, Resident, OB/GYN) “Thinking they are going to breastfeed that they are going to harm their babies some way. Same kind of resistance I get for influenza…. [and] pertussis vaccination… But they think they’re actually harming their newborn because they feel like it’ll get into the breastmilk.” (MD, OB/GYN) “For the patients that are hard to reach because they can’t complete the vaccine because of transportation or cost issues, then going for routine visits and screening is going to be an issue regardless of if they’ve gotten the vaccine or not.” (MD, Resident, OB/GYN) “I’ve seen some patients who haven’t completed the course. Whether it’s because they didn’t come to any more postpartum visits…. But a lot of times you don’t see them until the next pregnancy.” (MD, Resident, OB/GYN)