Table 3. Thematic presentation of barriers to HPV vaccination in Oyam District.

Major Theme	Sub-theme–barrier
Individual	- Inadequate knowledge about the HPV vaccine - Caregivers’ lack of awareness of vaccine and vaccination activities - Change of residential location or school within or outside the district between doses - Absenteeism or dropout from school - Fear of injection pain - Discouragement from vaccination by caregivers or peers
Health facility	- Limited healthcare workers’, VHTs’ and teachers’ knowledge about HPV vaccine and national HPV vaccination policy - Lack of strategies targeting out-of-school girls - Vaccine supply shortages and inadequacies of cold chain infrastructure - Limited social mobilization and community engagement activities - Unpredictable transportation for staff and vaccine resulting in irregular vaccination outreach events to schools and communities - Unfulfilled healthcare staff expectation to be paid extra allowances and financial incentives for teachers - Few healthcare workers at health facilities to deliver the vaccine to recipients - Un-friendly healthcare workers - Lack of reminder/recall strategies for 2nd vaccine dose
Community	- Rumors and misconceptions about the vaccine and vaccination - Strong traditional and religious beliefs - Mistrust of government intention of introducing new vaccines - Busy schedules and gendered nature of domestic work