Background:
The relationship between infection with high-risk human papillomavirus (HPV) and cervicalcancer is transforming cervical cancer prevention. HPV tests and vaccinations have recentlybecome available. In Ireland, as elsewhere, primary care practitioners play a key role inprevention. ATHENS (A Trial of HPV Education and Support) aims to develop a theorybasedintervention to support primary care practitioners in their HPV-related practice. Thisstudy, the first step in the intervention development process, aimed to: identify HPV-relatedclinical behaviours that the intervention will target; clarify general practitioners’ (GPs’) andpractice nurses’ roles and responsibilities; and determine factors that potentially influenceclinical behaviour. A secondary objective was to informally assess the utility of theTheoretical Domains Framework (TDF) in understanding clinical behaviours in an area withan evolving evidence-base.
Methods:
In-depth semi-structured telephone interviews were conducted with GPs and practice nurses.The topic guide, which contained open questions and HPV-related clinical scenarios, wasdeveloped through literature review and clinical experience. Interview transcripts werecontent-analysed using the TDF as the coding framework.
Results:
19 GPs and 14 practice nurses were interviewed. The major HPV-related clinical behaviourswere: initiating a discussion about HPV infection with female patients;offering/recommending HPV vaccination to appropriate patients; and answering patients’questions about HPV testing. While the responsibility for taking smears was considered afemale role, both male and female practitioners dealt with HPV-related issues. All 12theoretical domains arose in relation to HPV infection; the domains judged to be mostimportant were: knowledge, emotion, social influences, beliefs about capabilities and beliefsabout consequences. Eleven domains emerged in relation to HPV vaccination, with beliefsabout consequences, social influences, knowledge and environmental context and resourcesjudged to be the most important. Nine domains were relevant to HPV testing, with knowledgeand beliefs about capabilities judged to be the most important.
Conclusions:
The findings confirm the need for an intervention to support primary care practitionersaround HPV and suggest it should target a range of theoretical domains. The TDF provedvaluable in analysing qualitative data collected using a topic guide not specifically designedto capture TDF domains and understanding clinical behaviours in an area with an evolvingevidence-base.