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|a Background: The UK human papillomavirus (HPV) vaccination programme aims to provide girls aged 12-13 with protection against two of the most carcinogenic strains (types 16 and 18) of this sexually transmitted virus which together account for 70% of cases of cervical cancer. Despite evidence suggesting a general lack of knowledge about HPV and its link with cervical cancer, vaccine uptake rates were generally high in the UK for the first year of the HPV vaccination programme. In countries that implemented the HPV programme ahead of the UK, studies have found that girls' and parents' levels of awareness about HPV have increased since implementation of the programme but that knowledge continues to be limited. This study offers some of the first insights from the UK into adolescent girls' understandings of HPV, its link with cervical cancer, and experiences of vaccination, since the programme was introduced in September 2008. Method: Eighteen focus groups were conducted between December 2009 and May 2010 with schoolgirls aged between 12 and 18 living in various parts of the UK. Results: Eighty seven girls participated in these discussions. Typically, girls knew very little about HPV or how they could best protect themselves from HPV infection. Although many of the girls linked HPV to cancer, only half specifically associated it with cervical cancer. Most girls had no idea how long the vaccine would offer them protection. They assumed that HPV vaccination must be important for their health because it was recommended by people they trusted, namely parents and immunisation experts. Just over half of the girls were aware that in the future they would need to attend for cervical screening. Key concerns which girls expressed about HPV vaccination reflected their anxieties about needles, anticipated pain on injection, privacy during vaccination and fears about needle cleanliness. Conclusion: Our data point to a need to continue to address gaps in knowledge about HPV and to provide information to address girls' concerns about vaccination. This could be achieved through targeted campaign materials and by ensuring those involved in delivering the programme are aware of girls' anxieties to prevent limited knowledge and fears about vaccination becoming barriers either to HPV vaccination.
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