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Table 3 The process of thematic content analysis of the interviews and natural group discussions

From: “A Somali girl is Muslim and does not have premarital sex. Is vaccination really necessary?” A qualitative study into the perceptions of Somali women in the Netherlands about the prevention of cervical cancer



Phase 1

Initial themes identified

After six interviews: interview with three mothers and three young women.

- Perceptions of Human Papillomavirus (HPV) vaccination

- HPV vaccination preparedness

- Perceptions of the child vaccines

- Perceptions of Papanicolaou Screening (Pap smears) and preparedness

- Gender and sexuality

- Male circumcision

- Information on HPV vaccination and Pap smears

- Advice for National Immunization Program (NIP) and National Screening Program (NSP)

Phase 2

New themes identified; themes merged and renamed

After 13 interviews: interview with seven young women.

- Perceptions of HPV vaccination and participation decision

- Perception of other vaccination of the NIP

- Perceptions of Pap smears and participation decision

- Male circumcision

- Role as parent or daughter

- Taboo topics: Double sexual standard, Female Genital Mutilation (FGM), Sexual

- Transmitted Infections (STIs), cancer, sex, and homosexuality

- Information: Sharing and obtaining

- Recommendations for NIP and NSP

Phase 3

Intersectionality applied: final themes identified

After 20 interviews and two group discussions:

- Barriers to participation in HPV vaccination and Pap smears: distrust towards side effects and Dutch healthcare system, lack of knowledge, language barriers, and embarrassment due to FGM and having a Dutch, male, non-Muslim practitioner

• Interview with four young women and three mothers.

• Each group discussion with 12 to 14 mothers.

- Information and decision-making: Informal sources of information and collective decision-making

- HPV risk perception: men’s roles in HPV transmission and cultural stigmas on HPV