Health care provider attitudes and practices regarding adolescent immunizations: A qualitative study

Objective: Assess health care providers' attitudes and practices regarding adolescent immunizations, including factors that either impede or facilitate vaccination. Methods: Focus groups-In 2005, 3 focus groups were conducted in Monroe County, NY for (1) urban primary care physicians (PCPs); (2) suburban PCPs; and (3) nurses from practices represented in PCP groups. Audiotaped discussions were transcribed and analyzed using Atlas.ti. Key informant interviews-We recruited knowledgeable informants (18 physicians, 6 nurses) from across the US. The authors conducted in-depth telephone interviews with the participants, typed their interview notes, and sent them to the participant for verification. Separately for nurses, urban physicians, and suburban physicians results for each question were listed and reviewed by the authors. Themes were added to those from the focus groups. Results: Three overarching themes were identified: professional buy-in (e.g., reimbursement, professional organization recommendations, disease-and vaccine characteristics, office consensus): parent/adolescent buy-in (e.g., school requirements, perception of MID recommendations, cost and insurance coverage, media reports, disease and vaccine characteristics, "vaccine fatigue"), and delivery factors (e.g., vaccine Supply, ordering, timing and scheduling, consent). Conclusions: Providers identified intertwined system issues that color their attitudes about adolescent immunization. Practice implications: Buy-in and delivery factors must be addressed before high immunization rates will be achieved. (C) 2008 Elsevier Ireland Ltd. All rights reserved.