TABLE 4

Summary of Successful Techniques

Parents
 Parents want to prevent cancer
  “It’s important for her to get the HPV vaccine cause it can prevent cervical cancer. I just wanted my daughter to have every chance to not get HPV. And also to protect her from cervical cancer. She’s still a virgin thank god! But if she ever did have sex with multiple partners, to be able to protect her from that.”African-American mother of 15-year-old, public clinic
  “Just thinking in the long run, anything that would protect from any cancer down the road just seemed to make sense to me.”White mother of 14-year-old, private practice
 Parents trust provider recommendations
  “Because her doctor knows, just like I know. Because her doctor has been with her since she was born.” African-American mother of 16-year-old, public clinic
  “I trust my doctor’s advice and I also think there has been enough research to prove that the vaccine is effective so I felt that it was important to go ahead.”White mother of 15-year-old, private practice
 Parents think benefits outweigh risks
  “It’s a harmless vaccine and could have life-saving qualities.”White parent of 15-year-old, public clinic
  “Since I can’t control everything I thought I’d rather have her protected”Latino parent of 17-year-old, private practice
 Parents want a strong recommendation
  “I want someone to say to me ‘you need to do this for your daughter, you’re doing the right thing.’ Because people are unsure and they’re afraid and they don’t want to make a decision that’s going to hurt their child.”White mother of 12-year-old, private practice
 Providers emphasize cancer prevention
  “I also point out this is pretty much the only vaccine we have that prevents a kind of cancer. That’s something that is a big deal.”–Pediatrician in private practice
  “My husband knew somebody who had mouth and throat cancer too... maybe if that person had the HPV vaccine it would have protected them.”–Pediatrician in private practice
  “I’ll start a conversation by saying, ‘In your experience with your health right now, you may be screened for cervical cancer by means of a Pap smear… because cervical cancer can obviously be something that can be life-threatening but if caught soon, it can be taken care of, and this is how your health is impacted by this virus right now. Well, children now have the option of getting this vaccine which is actually very effective at reducing the risk for contracting that same virus.’”–Pediatrician at the public clinic
Providers
 Providers normalize the HPV vaccine/coadminister with other vaccines
  “What I’ve been doing is saying to them, “Okay, after the first push in the first two years of life when babies get vaccines at every visit, the next big push is at 4 and the next big push is at 11” and so that they’re, they know this is when I’m going to be doing it. I think that’s helpful… Most of the time I don’t get questions. I give a little, tiny spiel about each of them so that they’re all seen as kind of equal.”–Pediatrician at public clinic
 Providers give a strong recommendation
  “In my experience, it's the confidence with which I make the recommendation that seems to be the most convincing because my patients know me, and so if I say, ‘You need this,’ they say, ‘Okay, if you say I need it, I need it.’”–Pediatrician at public clinic
  “Maybe [age 13–14 is] subconsciously where I flip the switch, and maybe I’m not doing a hard enough sell at 11.”–Pediatrician at private practice