Table 2.

Emergent Themes related to Perceptions and Practice.

	Prevailing view – major theme	Contrasting/outlier view – minor theme
Recommendation vs. administration	“I certainly understand the recommendations and support those, but I just don't feel as adamant about it just because of the relative infrequency that we've seen the problem arise”	“I think that with everything else that we have to worry about taking care of these patients and their unborn children…the last thing on my mind is this vaccine. So I really think we're making a huge deal out of something that is not life threatening and earth shattering.”
	“I would start by saying that we do not stock in our office, that doesn't preclude me from prescribing it, where you can go to the pharmacy, get the vaccine as a medical benefit, like a prescription, bring it back here and we can give you the shot.”	“Well, usually, it's, oh we recommend this and we don't have it available in the office, we just want you to understand that you will be getting it in the hospital, and if the patient has concerns, or doesn't want it, I mean, they wouldn't, you know, state that otherwise, it's sort of much, hey, you're getting this, that's it.”
Implementation challenges	Reimbursement Challenge:
	“The reimbursement is another issue. I don't really like to, you know, submit any more claims to the insurance company for them to deny that I already do…”	“I don't want to set a dual standard care where you give or take a public assistance patient and you can't give them a vaccine being reimbursed but then you're giving them to some people that can pay. So, my limitation on that is the inability to get reimbursed for, on a consistent basis. Otherwise, I would probably push it.”
	Logistical Challenge:
	“…Because I'm like not the administrator person in our office, you know, I don't get too involved in, you know, but storage, you know how long, expiration, I mean there's like a lot of stuff that goes on I think that, you know, is complicated.”	N/A
	Transportation Challenge:
	“…We actually sent the patients to the health department to get it, which was a little bit of an issue because most of them, well not most of them, but some of them depend on public transportation and so we actually had to figure out they were going to get there from the building that we were in…”	N/A
	Patient Refusal Challenges:
	“She just didn't like vaccines in general, and she didn't think she needed it, and she just doesn't want to expose her baby to anything, and she didn't feel she needed it.”	N/A
Low clinical priority for ob-gyns	“Well, again, and you know babies, newborns are susceptible to pertussis if it's prevalent in the community. So, I mean, if it was prevalent, I would probably give it a five [on a 1–5 scale], but if it's not prevalent in the community, then the chances of babies getting exposed to it I think are fairly small.”	“Yeah, it's not high. I mean we still have herd immunity, I mean it's, I mean I think they're making a big deal out of it. I'm not, I'm not convinced it's a big of a problem as they're saying it is, but, you know, I don't see it.”
Vaccine benefits recognized	“I think the main importance of the vaccine is to confer immunity, you know, in the newborn, before they can be vaccinated, because, again, newborns are very susceptible to pertussis and it's potentially a lethal disease.”	“If some woman got vaccinated say two to three years ago, she probably has some antibodies to pertussis that are still present and therefore will be transmitted to the baby. Now then, I don't understand them to be as high as if she get revaccinated, but there's probably some protection still remaining.”
	“I think it's effective, and I don't see a lot people with pertussis, so I assume it's working.”	“Well, there's studies actually in the, in the CDC report, there's actually a reference to a study that indicated that the benefit if anything was a very, very negligible or slight benefit for the patient receiving it to protect her baby. It's, you know, when you use this product I would imagine you're using it more with the intention of protecting the mother, not with the intention of, of providing passive immunity to the baby.”