Table 3.

Focus group key findings

#	Category	Findings
1	Introducing the HPV vaccine	Providers tended to differentiate HPV vaccine from other vaccines recommended at the 11- to 12-year-old visit, presenting tetanus and diphtheria (Tdap) and meningococcal vaccine (MCV) as required for school but framing HPV as optional, either consciously or subconsciously. Most providers appeared reluctant to pursue the topic of HPV vaccination if the parent was hesitant or resistant, especially for younger children. Practices varied on whether the physician or clinical support staff first introduced the HPV vaccine and whether the parent received the Vaccine Information Statement (VIS) at the beginning or the end of the visit.
2	Provider barriers	Providers, particularly MAs, stated their own concerns as insufficient knowledge about HPV and HPV-related diseases, the perception that there was no immediate need to vaccinate younger adolescents, and not understanding the rationale for HPV vaccination starting at age 11.
3	Parental barriers	Providers stated that the most frequent concerns expressed by parents were not knowing or understanding the diseases the HPV vaccine prevents, wanting to wait until the child was older (child not having sex), wanting to wait until more was known about the long-term effects (vaccine was too new), and wanting to think about it or discuss it with their spouse.