Table 2 Major themes and illustrative quotations identified from in-depth interviews (n = 10)

Current clinical approaches to adolescent HPV vaccination

Existing opportunities to recommend HPV vaccination

“Usually, we go by whatever NCIR is recommending, like the state of North Carolina registrations recommendation. And every time I pull a record for one of our patients, I just look and see if they have already gotten [vaccinations] or are due soon.” (Primary clinic A)

“At any pediatric visit, we’ll print NCIRs, and so we try to pay attention at any visit to be able to offer [the HPV vaccination].” (Primary clinic B)

Addressing caregiver concerns and continuing education

“And even if they still have questions, we get the provider… even if they’re with another patient, they go back into answer the parent’s questions.” (Primary clinic B)

“I feel like some parents, they feel like we're administering the disease into their child.” (Primary clinic B)

Receptiveness to promoting HPV vaccination among 9- and 10-year-olds

Considering HPV vaccination and child social and physical development

“I just think the parents aren't ready to think that their kids are growing up.” (Primary clinic B)

“Looking at my grandchildren, after five, they’re not really getting any shots. So, if they're still coming for the well-child check, go ahead and plant that seed [regarding HPV vaccination].” (Primary clinic A)

Assessing provider feelings of early vaccination

“The vaccine works better the younger we give it.” (Primary clinic B)

“I think age-9 is better… you just can't predict when like kid will have that first experience with someone. Some 12-year-olds are really far away from that, and other 12-year-olds are not, and so I think that if you wait, it's just risky.” (Key informant B)

“I think if you have a year of hesitancy, having that year age-9 is going to make it more likely to stay on time.” (Key informant A)

Willingness and ability to promote age-9 HPV vaccination in the clinic

“… It sort of fit neatly into a new schedule to do the Tdap and the HPV at 10, and then the HPV and the [MenACWY] at 11.” (Key informant A)

“I can see where that would be really exciting to be part of [an age-9 vaccination pilot trial]…then we'd have those results, and we can say this is better.” (Primary clinic B)