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Table 3 Psychological responses to positive HPV test results (Examples of the steps in the analysis)

From: Iranian women’s psychological responses to positive HPV test result: a qualitative study

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“When I got home after learning of my 1 results, I started browsing the Internet until morning. I kept reading and crying. I was worried, I thought maybe I have Chlamydia or other STDs that I even don't know them, just like this one.” (P.9, 40, hrHPV)

Shock, Unexpected result, Denial, "Why me?" reaction

Phobia, Catastrophizing, Fear of death, Distress, Psychosomatic symptoms

Primary psychological reactions

1. Initial confrontation

Information seeking; stressful and confusing

Search to find the source of infection

Being vigilant about other STIs

Trying to understand the status quo

Concerns over the cervical cancer

Fear of other HPV-associated cancers

Worries about HPV-related cancers

Not covering colposcopy, freezing and other STIs check-ups by insurance

High cost of HPV vaccine

Financial concerns related to HPV management

"Even if the government can cover 100% of HPV costs, many people do not benefit from it for fear of having their names recorded in insurance records. I don't even write my real name on the sample I give to the courier for transfer to the lab. I always ask the doctor's secretary to give me the last appointment so that the office is not crowded and no one sees me." (P.19, 38, hrHPV)

Shame, guilt and self-blame

Negative body image

Fear of social rejection

Receiving health care anonymously

Annoying behavior of health care providers

Stigma and Fear of disclosure

2. STD-related psychological burden

Separation, Blame, Conflict, Rejection, Accusation

Acceptance (past), Trust (non-sexual), Forgiveness (support)

Changing in emotional relationship

Fear of self-transmission to other parts of the body

Self-protection by avoiding sexual contacts

Worries about infecting partner

Concerns over infecting family members non-sexually

Fear of spreading the virus

"God likes me so much that it's been detected. I spent a lot of money on charity. I think I was getting this virus as a warning to be careful. I started reading "the Thanksgiving Miracle" book. I'm talking to my immune system just like a baby in my belly. My immune system will be able to combat the virus. I'll get rid of it soon."(P.3, 27, Mixed)

Remedies from alternative medicine

Healthier food, Vitamins intake

Modifying lifestyle

Following up health status

Improving physical health

3. Rebuilding health

Changing attitude toward the sexual issue

Increasing Condom use

Limiting sexual partners

Practicing safer sex

seeking and providing support

Wishful thinking, Thankfulness, Hope for Heal

Growing spirituality and emotional well-being