• Irina Todorova, Anna Alexandrova-Karamanova, Yulia Panayotova, Elitsa Dimitrova, and Tatyana Kotzeva.
• Department of Health Sciences, Northeastern University, Robinson Hall 209, Boston, MA, 02115, USA, i.todorova@neu.edu.
• Int J Behav Med. 2014 Feb 1; 21 (1): 29-36.

BackgroundNew preventive technologies such as vaccines offer insight into psychological, social, and cultural landscapes. Providers have a key role in parents' decisions for vaccinating their children. Yet, perspectives from providers regarding the human papillomavirus (HPV) vaccine, or vaccination in general, are rarely soughtPurposeOur objective in this paper is to understand how the HPV vaccine is perceived by health care providers and the multiple contextual meanings it elicits.MethodsWe conducted interviews with 20 health care professionals in Bulgaria about their attitudes and practices related to HPV vaccination and their recommendations for policies. The verbatim-transcribed interviews were analyzed through narrative analysis, with a special focus on language.ResultsWe illustrate providers' contradictory and contextualized constructions of the vaccine and the narrative strategies they use to manage any uncertainty it elicits. These include being advocates and missionaries for preventive health, confirming their trust in the medical profession and professional organizations, challenging patients' concerns with rational explanations, normalizing the risk of medical innovations, and avoiding the sexual nature of HPV transmission.ConclusionsThe introduction of a vaccine to prevent HPV infection, and by implication, possibly cervical and other cancers, created hope, and at the same time, intensified confusion and uncertainty. Providers have been frustrated for years with the rising mortality from cervical cancer in Bulgaria, and their perceived powerlessness in affecting this. HPV vaccination, on the other hand, seems relatively simple and "taming uncertainty" positions them as instrumental in limiting (or even eliminating) morbidity and mortality in future generations.

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