PURPOSE: To understand why adolescents who initiate the HPV vaccine series fail to complete all three shots. METHODS: Semi-structured interviews were performed with parents/guardians of 11-17 year old daughters and pediatric primary care providers in one inner-city public clinic and three private practices to determine why girls who received at least one dose of the HPV vaccine did or did not complete the series. The number of shots received was confirmed by electronic medical record review. Content analysis was used to identify themes related to series completion. RESULTS: 65 parents/guardians participated: 37 whose daughters received 1 or 2 doses of HPV vaccine and 28 whose daughters completed 3 doses. Most (n=24, 65%) parents/guardians failed to complete the series because they thought the clinics would remind them of subsequent doses. 9 (24%) cited logistical barriers. 4 (11%) decided to stop the vaccine series. 33 providers participated: 24 physicians, 3 nurse practitioners, and 6 registered nurses. 52% of providers told parents to schedule appointments, 41% scheduled the second dose at the time the first dose was given, and 7% tried to immunize patients when they returned for other appointments; providers confirmed that few parents chose to stop the series. No practice had a system in place to ensure series completion. CONCLUSIONS: Most failure to complete the HPV vaccine series occurred because providers expected parents to make appointments while parents expected to be reminded. Increased use of reminder/recall systems and clear communication of expectations regarding appointment scheduling could improve completion rates.

Evidence-based practice (EBP) in mental health was initiated in the United States due to state legislation. The EBP implementation process is complex due to multiple factors related to organizational culture. Mental health agencies implementing EBP processes can expect significant personnel changes due to higher turnover rates, which may have a negative effect on the quality of services. The purpose of this study was to investigate the relationship between providers' attitudes toward the adoption of EBPs and organizational culture. The theoretical framework for this study was organizational culture theory and the Denison organizational culture model. This correlational and predictive study examined the relationship between the domains behind 112 provider attitudes as measured by the Evidence-Based Practice Attitude Scale and the multiple traits of organizational culture as measured by the Denison Organizational Culture Survey. A Pearson correlation was conducted in order to determine whether there were significant relationships prior to conducing a standard multiple regression and a stepwise multiple regression analysis. This study found a significant relationship between the mission trait and general provider attitudes and between the involvement trait and organizational support. The stepwise regression analysis found the mission trait to be a predictor of general provider attitudes. The standard regression analysis found the involvement trait to be a predictor of organizational support. Having this new insight could help managers make adjustments that may help providers be receptive to EBP adoption and ultimately may help in decreasing an organization's turnover. A more stable work environment may be conducive to the provision of higher quality services, leading to social change.