Table 3 Facilitators and barriers of Health care workers’ motivation to recommend HPV vaccine using the TDF^a

Social/professional role and identity

Professional responsibility (F)

‘I am a public health nurse, I give health talk to mothers’ Nurse 2, Tertiary HF

6

Impetus for learning (F)

I work in a hospital…I want to learn more…I went through the training’ Social worker, Tertiary HF

2

Beliefs about capabilities

Ability to recommend HPV vaccine and ensure uptake (F)

‘most people I have recommended it to, they have taken it’ Family Physician 1, Tertiary HF

8

Cannot recommend HPV vaccine (B)

‘no, if the knowledge is…adequate, maybe I will recommend it’ Nurse 1, PHC

1

Optimism

Recommendation of HPV vaccine will lead to its uptake (F)

‘and even with our own effort to health educate them, I know they will turn up’ Nurse 4, Secondary HF

2

Beliefs about consequences

Reduce cervical and other HPV associated cancers’ burden (F)

‘…reduce the incidence of cervical cancer…cut down maternal mortality…would increase life expectancy’ Pediatrician 1, Tertiary HF

13

Increased indiscriminate sex (B)

‘they will go on with this false sense of security that they are protected against HPV, they are having indiscriminate sexual exposure’ Family Physician 1, Tertiary HF

2

Adverse reactions (B)

‘…watch that there is no allergy’ Family Physician 2, Tertiary HF

1

Reduced promiscuity (F)

‘It will caution some ladies from being promiscuous’ Nurse 6, Secondary HF

1

Improved community knowledge of HPV vaccine (F)

‘…it will also make the community to be aware of what the vaccine is about’ Nurse 1, PHC

1

Reinforcement

Structured adolescent health program (F)

‘…establish a well-structured adolescent program…how you will reach the people that are the recipients of the vaccine…’ Pediatrician 1, Tertiary HF

1

HPV vaccine funding from health insurance (F)

‘Government can…put it under NHIS…out of pocket payment will not be there’ Family Physician 2, Tertiary HF

1

Inclusion in routine vaccine schedule (F)

‘…including it in the NPI…it gives a mother a sense of obligation that I need to vaccinate my child’ Family Physician 1, Tertiary HF

1

Intention

Intention to recommend HPV vaccine freely (F)

‘I will recommend it gladly’ Medical Social worker, Tertiary HF

13

Intention to recommend when knowledge is adequate (F)

‘if I have the knowledge now, I will know who it is for, the side effects, the mode of action and all those things… will make me to know who to recommend it’ Nurse 3, PHC

1