Table 1.

HPV vaccine messengers

Sub-theme	Quotes
Theme: health professionals and organizations
Trusted local providers	• We need to have information come from somebody that they trust like their healthcare providers and school nurses. • For that crowd at the general assembly, they need to hear from 5 of their local doctors. Those are respected professionals who can counter some of that. The medical community will have to take a much stronger stand on this.
Medical organizations	• Support from trusted sources could help to strengthen the HPV vaccine message. We need to look to see what researchers at HCC are saying about the vaccine. We also need to get support for the vaccine message from groups such as pediatric associations and health insurers. • Get a state chapter of family physicians on board to give stamp of approval so it comes from someone a little higher. • Get support from the Medicaid medical directors. We do have a quarterly meeting of the Medicaid County medical directors where you could say what you are doing and ask for support.
Public health entities	• Try to get support from DHEC and all of their branches/offices for a stamp of approval. • Recommendations from the CDC and DHEC are key; but that comes along with education. • We at DHEC give a simple consistent message to everyone. Focus on the vaccines that the adolescents need.
Theme: community leaders and organizations
Community organizations	• So if you can get the leaders of those churches on board and start with them one-on-one then explain it to the congregations or get the parish nurses or laypeople, which is what we use for witness. (...) If that message is coming from someone seen as a physician or an outsider then it is often times not that well received. • Work with PTAs. Engage the faith community. If they approve things...people are more likely to get vaccinated.
Local public figures	• There is a distrust of government and there is this concern over experimenting. There is a lot of misunderstanding associated with a brand-new vaccine and questions about why we are testing it out on children first. Local community folks could give you a lot of help because if you go into certain counties you want that county’s folks endorsing you.
Healthcare students	• That educational component needs to be involved and so do the younger people, maybe even medical students. They came to our hearings for Smoke-free Charleston in their white coats and it was a really great appearance. The HOSA, Health Occupations Students Association at high schools helped us on some physical activity and nutrition stuff.
Theme: peers
Children	• For us it is helpful to use peer-to-peer recommendation; when students tell other students that they got it and why.
Parents	• Parents put some stock in their doctor, but parent-to-parent communication has been critical for us.
Healthcare professionals	• We have had to get very market specific in terms of our presentations. Nurses don’t want to hear from doctors about how to do their job. We have to identify the right messenger.