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Simonetti V, Tomietto M, Comparcini D, Pastore F, Stefanizzi P, Tafuri S, Cicolini G. The community nurse's role on the promotion of papillomavirus vaccination among young students: A study protocol. Hum Vaccin Immunother 2024; 20:2314383. [PMID: 38356279 PMCID: PMC10877978 DOI: 10.1080/21645515.2024.2314383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024] Open
Abstract
Vaccination is the principal strategy for primary prevention of infection by Human Papilloma Virus (HPV), which causes different pathological conditions, up to cancer, in both males and females. However, to date, knowledge among adolescents and their parents about the HPV vaccine is still low. The aim of this quasi-experimental, multicenter study is to assess the effectiveness of a digital educational intervention, conducted by a multidisciplinary health-care team including a Community Nurse, to increase adolescents' HPV vaccination uptake, their knowledge, self-efficacy, feelings and involvement in HPV vaccine decision-making, and parents' vaccination hesitancy. The study will be carried out among a population of students (and their parents), aged between 11 and 13, at secondary schools in Italy. Validated questionnaires will be administered to both students and parents at baseline (T0) and 3 months after a digital educational intervention (T1). The findings may be useful in evaluating and deepening a methodology for designing and implementing educational interventions, embedded in the school setting, that could promote the achievement of outcomes within the broader process of youth's health promotion.
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Affiliation(s)
- Valentina Simonetti
- Department of Medicine and Surgery, Casamassima, “LUM University” Giuseppe Degennaro, Bari, Italy
| | - Marco Tomietto
- Department of Nursing, Midwifery, and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Dania Comparcini
- Interdisciplinary Department of Medicine, “Aldo Moro” University of Bari, Bari, Italy
| | - Francesco Pastore
- Department of Biomedicine and Prevention, TorVergata University, Rome, Italy
| | - Pasquale Stefanizzi
- Interdisciplinary Department of Medicine, “Aldo Moro” University of Bari, Bari, Italy
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, “Aldo Moro” University of Bari, Bari, Italy
| | - Giancarlo Cicolini
- Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), ”Aldo Moro” University of Bari, Bari, Italy
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Fisher H, Audrey S, Chantler T, Dominey M, Evans K, Henden L, Hickman M, Letley L, Towson A, Thomas C. Towards successful implementation of public health research into practice: Experiences and lessons learned from EDUCATE. PUBLIC HEALTH IN PRACTICE 2023; 6:100447. [PMID: 38028256 PMCID: PMC10643450 DOI: 10.1016/j.puhip.2023.100447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/11/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background The English schools-based human papillomavirus (HPV) vaccination programme is routinely offered to all young people aged 12-13 years. The EDUCATE lesson was developed to overcome barriers to uptake related to unmet information needs by providing young people with information and answering questions they may have about the HPV vaccine. The resource comprises a PowerPoint presentation, interspersed with five short films and a guidance document for professionals delivering the lesson. Adopting public health research into practice is challenging and few papers describe the process. This paper reports the initial use of the EDUCATE resource in schools and the process involved in supporting wider implementation. Study design Implementation and knowledge mobilisation. Methods Five secondary schools supported implementation of the EDUCATE resource. Delivery took place during April and December 2022 and was observed in four schools, with feedback obtained from two school staff members and 15 young people. Alongside this, meetings were held with over 80 stakeholders with the aim of identifying possible policy levers to encourage use of the EDUCATE resource, and to enhance understanding of how wider scale and sustained impact can be achieved. Results Overall, the resource was positively received by school staff and young people engaged well during the lesson. As a result of the stakeholder networking activities, the research team worked with the Personal, Social, Health and Economic (PSHE) Association to adapt the materials to meet their Quality Assessment and incorporate elements, such as more interactive activities, requested during the implementation study. Conclusion The EDUCATE resource has the potential to change practice by enhancing information provision about the HPV vaccine in schools and supporting young people nationally to make informed decisions. Key learnings from the project include the importance of integrating input from target users at all stages of the research process, pragmatism in relation to evaluation research designs, and incentivising researchers to undertake translation activities through further funding and a greater focus on impact. Together, these can help facilitate the availability of public health resources and their adoption into 'real-world' practice.
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Affiliation(s)
- Harriet Fisher
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE), Bristol Medical School, University of Bristol, Bristol, UK
| | - Suzanne Audrey
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE), Bristol Medical School, University of Bristol, Bristol, UK
| | - Tracey Chantler
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Vaccinations and Immunisation, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | | | - Karen Evans
- School-aged Immunisation Team, Sirona Care & Health, Bristol, UK
| | - Lizzie Henden
- Communities and Public Health Team, Bristol City Council, Bristol, UK
| | - Matthew Hickman
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE), Bristol Medical School, University of Bristol, Bristol, UK
| | - Louise Letley
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Alix Towson
- School-aged Immunisation Team, Sirona Care & Health, Bristol, UK
| | - Clare Thomas
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE), Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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Fisher H, Chantler T, Mounier-Jack S, Audrey S. Human papillomavirus vaccine communication materials for young people in English-speaking countries: A content analysis. HEALTH EDUCATION JOURNAL 2022; 81:513-528. [PMID: 35910267 PMCID: PMC9326800 DOI: 10.1177/00178969221092135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective To undertake a content analysis of human papillomavirus (HPV) vaccine communication materials available to young people. Design Content analysis. Setting Majority English-speaking countries. Methods Between March and April 2020, a web engine was utilised to search for and retrieve relevant communication materials. Content analysis was used to describe how the following key issues were covered: (1) side effects, (2) safety, (3) practicalities related to receiving the HPV vaccine and (4) gender-specific information. Results A total of 44 separate communication materials were retrieved, predominantly videos, webpages and leaflets. There was a focus on mild side effects of the vaccine (43.2%), with less frequent reference being made to moderate or serious side effects (22.7%). Reassurance concerning the safety profile of vaccine was communicated by referencing the widespread use of the HPV vaccine (31.8%). Information regarding formal criteria for entry into the vaccination programme emphasised country-specific eligibility criteria (59.1%), the setting in which vaccination was offered (38.6%) and the number of doses required (38.6%). Content intended to improve young people's experiences of receiving the HPV vaccine was less often provided (22.7%). Gender-specific content usually related to specific HPV-related diseases (52.3%) and/or the availability of cervical cancer screening programmes (52.3%). Conclusion A variety of different communication tools were retrieved encompassing a wide variety of formats and content, reflective of different vaccination programmes and the varied priorities of organisations producing the materials. Findings will inform the co-production of a tailored educational package to improve access to information by populations of young people identified as having lower HPV vaccine uptake.
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Affiliation(s)
- Harriet Fisher
- National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tracey Chantler
- National Institute for Health Research Health Protection Research Unit in Vaccinations and Immunisation, London School of Hygiene and Tropical Medicine, London, UK
| | - Sandra Mounier-Jack
- National Institute for Health Research Health Protection Research Unit in Vaccinations and Immunisation, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzanne Audrey
- National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Fisher H, Chantler T, Finn A, Kesten J, Hickman M, Letley L, Mounier-Jack S, Thomas C, Worthington K, Yates J, Audrey S. Development of an educational package for the universal human papillomavirus (HPV) vaccination programme: a co-production study with young people and key informants. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:16. [PMID: 35468845 PMCID: PMC9035505 DOI: 10.1186/s40900-022-00349-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The English schools-based human papillomavirus (HPV) vaccination programme is routinely offered to all young people aged 12-13 years, to prevent cancers affecting the cervix, vulva, vagina, penis, anus and mouth. Lower uptake among some population groups has been identified, in part, because of unmet information needs among young people. To address these unmet needs we report intervention planning and development processes to co-produce an educational package about the HPV vaccine. METHODS We used co-production research methodologies and the 'person-based approach' involving the following iterative stages: (i) collating and analysing primary and secondary evidence, including HPV vaccine communication materials, interviews and workshops; (ii) developing guiding principles; (iii) undertaking a behavioural analysis informed by the Behaviour Change Wheel and the Behaviour Change Technique taxonomy; (iv) development of a preliminary logic model; (v) co-production of resources, and; (vi) refinement of resources informed by feedback from young people and key informants. RESULTS We co-produced EDUCATE, a theory-based educational package, that is designed to be delivered to young people prior to being offered the HPV vaccine to support uptake. Young people and key informants identified the following key issues to include as content: (i) HPV-related information; (ii) how vaccines work; (iii) safety and side-effects of the HPV vaccine; (iii) eligibility for the HPV vaccination programme, and; (iv) preparation of young people to receive the HPV vaccine. A manual for professionals (e.g. immunisation nurses, school staff) delivering the intervention and a PowerPoint presentation, interspersed with five short films, were co-produced with young people and key informants. Following feedback, the content of the EDUCATE package was refined to increase acceptability, engagement, and persuasiveness to the target users. CONCLUSION Engagement with young people and key informants was integral to the development of our rigorously developed, theory-based intervention to address young people's information needs about the HPV vaccination programme. The acceptability and persuasiveness of the package has been maximised by working closely with young people and key informants to develop the content. An implementation study to examine how the EDUCATE package is implemented in practice and the impact on uptake of the HPV vaccination programme is underway.
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Affiliation(s)
- Harriet Fisher
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK.
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, UK.
| | - Tracey Chantler
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Adam Finn
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Joanna Kesten
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Hickman
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Louise Letley
- Immunisation and Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Sandra Mounier-Jack
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Clare Thomas
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Julie Yates
- Screening and Immunisation, NHS England and Improvement South West, Bristol, UK
| | - Suzanne Audrey
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Fisher H, Chantler T, Denford S, Finn A, Hickman M, Mounier-Jack S, Roderick M, Tucker L, Yates J, Audrey S. Development of a multicomponent intervention to increase parental vaccine confidence and young people's access to the universal HPV vaccination programme in England: protocol for a co-design study. BMJ Open 2022; 12:e062050. [PMID: 35387837 PMCID: PMC8987754 DOI: 10.1136/bmjopen-2022-062050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Persistent infection with HPV can result in cancers affecting men and, especially, women. Lower uptake exists by area and different population groups. Increasing parental confidence about, and adolescent access to, the universal HPV vaccination programme may help reduce inequalities in uptake. However, the evidence-base for interventions to address uptake for schools-based HPV vaccination programmes is currently lacking. This study protocol outlines how a multicomponent intervention to address this evidence gap will be codesigned with parents. METHODS AND ANALYSIS The proposed research will be undertaken in localities covered by two immunisation teams in London and the south-west of England. The 'person-based approach' to intervention development will be followed. In the first phase, an exploratory qualitative study will be undertaken with key stakeholders (n=8) and parents (n=40) who did not provide consent for their adolescent child to be vaccinated. During the interviews, parents' views on ways to improve parental confidence about, and adolescents' access to, HPV vaccination will be sought. The findings will be used to inform the co-design of a preliminary plan for a targeted, multicomponent intervention. In the second phase, at least two parent working groups (n=8) will be convened and will work with creative designers to co-design communication materials aimed at increasing parents' confidence in vaccination. At least two workshops with each parent group will be organised to obtain feedback on the intervention plan and communication materials to ensure they are fit for purpose. These findings will inform a protocol for a future study to test the effectiveness of the intervention at increasing HPV vaccination uptake. ETHICS AND DISSEMINATION The National Health Services Research Ethics Service and London School of Hygiene & Tropical Medicine Observational / Interventions Research Ethics Committee provided approvals for the study (reference 22/SW/0003 & 26902, respectively). We will work with parent advisory groups to inform our dissemination strategy and co-present our findings (eg, at community events or through social media). We will disseminate our findings with academics and healthcare professionals through webinars and academic conferences, as well as peer-reviewed publications.
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Affiliation(s)
- Harriet Fisher
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE), University of Bristol, Bristol, Bristol, UK
| | - Tracey Chantler
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Vaccinations and Immunisation, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Denford
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE), University of Bristol, Bristol, Bristol, UK
| | - Adam Finn
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Matthew Hickman
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE), University of Bristol, Bristol, Bristol, UK
| | - Sandra Mounier-Jack
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Vaccinations and Immunisation, London School of Hygiene and Tropical Medicine, London, UK
| | - Marion Roderick
- Department of Paediatric Immunology and Infectious Diseases, University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Julie Yates
- Screening and Immunisation, South West, NHS England South, Taunton, UK
| | - Suzanne Audrey
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE), University of Bristol, Bristol, Bristol, UK
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Davies C, Marshall HS, Zimet G, McCaffery K, Brotherton JML, Kang M, Garland S, Kaldor J, McGeechan K, Skinner SR. Effect of a School-Based Educational Intervention About the Human Papillomavirus Vaccine on Psychosocial Outcomes Among Adolescents: Analysis of Secondary Outcomes of a Cluster Randomized Trial. JAMA Netw Open 2021; 4:e2129057. [PMID: 34726749 PMCID: PMC8564580 DOI: 10.1001/jamanetworkopen.2021.29057] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Delivery of vaccination to adolescents via a school-based program provides an opportunity to promote their involvement in health decision-making, service provision, and self-efficacy (belief in one's ability to perform a certain behavior). OBJECTIVE To examine the effect of a human papillomavirus (HPV) vaccination education and logistical intervention on adolescent psychosocial outcomes. DESIGN, SETTING, AND PARTICIPANTS In this cluster randomized trial and process and qualitative evaluation, adolescents aged 12 to 13 years (first year of high school) were recruited at high schools in Western Australia (WA) and South Australia (SA) in 2013 and 2014. Statistical analysis was performed from January 2016 to December 2020. INTERVENTIONS The complex intervention consisted of an adolescent intervention to promote knowledge and psychosocial outcomes, shared decisional support tool, and logistical strategies. MAIN OUTCOMES AND MEASURES Prespecified secondary outcomes were assessed. The HPV Adolescent Vaccination Intervention Questionnaire (HAVIQ) was used to measure changes in adolescent knowledge (6-item subscale), fear and anxiety (6-item subscale), self-efficacy (5-item subscale), and decision-making (8-item subscale). The hypothesis was that the intervention would improve adolescent involvement in vaccine decision-making (measured before dose 1 only), improve vaccine-related self-efficacy, and reduce vaccine-related fear and anxiety (measured before doses 1, 2, and 3). Mean (SD) scores for each subscale were compared between intervention and control students. In the process evaluation, focus groups were conducted. Analyses of the HAVIQ data were conducted from 2016 to 2020. Qualitative analyses of the focus groups were undertaken from 2017 to 2020. RESULTS The trial included 40 schools (21 intervention and 19 control) across sectors with 6967 adolescents (mean [SD] age, 13.70 [0.45] years). There were 3805 students (1689 girls and 2116 boys) in the intervention group and 3162 students (1471 girls and 1691 boys) in the control group. The overall response rate for the HAVIQ was 55%. In WA, where parental consent was required, the response rate was 35% (1676 of 4751 students); in SA, where parental consent was not required, it was 97% (2166 of 2216 students). The mean (SD) score for decision-making in the intervention group before dose 1 was 3.50 (0.42) of 5 points and 3.40 (0.40) in the control group, a small but significant difference of 0.11 point (95% CI, 0.06 to 0.16 point; P < .001). There was a small difference in favor of the intervention group in reduced vaccination-related anxiety (pre-dose 1 difference, -0.11 point [95% CI, -0.19 to -0.02 point]; pre-dose 2 difference, -0.18 point [95% CI, -0.26 to -0.10 point]; pre-dose 3 difference, -0.18 [95% CI, -0.24 to -0.11]) and increased vaccination self-efficacy (pre-dose 1 difference, 4.0 points; [95% CI, 1.0 to 7.0 points]; pre-dose 2 difference, 4.0 points [95% CI, 2.0 to 6.0 points]; pre-dose 3 difference, 3.0 points [95% CI, 1.0 to 5.0 points]). Focus group data from 111 adolescents in 6 intervention and 5 control schools revealed more confidence and less anxiety with each vaccine dose. CONCLUSIONS AND RELEVANCE In this cluster randomized trial, there was a small difference in adolescent decisional involvement and vaccine-related confidence and reduced vaccination-related fear and anxiety that was maintained throughout the vaccine course in the intervention vs control groups. Guidelines for vaccination at school should incorporate advice regarding how this outcome can be achieved. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN12614000404628.
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Affiliation(s)
- Cristyn Davies
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Helen S. Marshall
- Women’s and Children’s Hospital and School of Medicine and Robinson Research Institute, The University of Adelaide, South Australia, Australia
| | - Gregory Zimet
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Julia M. L. Brotherton
- VCS Population Health, VCS Foundation, Victoria, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa Kang
- Specialty of General Practice, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Health, School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Suzanne Garland
- Centre for Women’s Infectious Diseases Research, The Royal Women’s Hospital, Melbourne, Victoria, Australia
- Reproductive and Neonatal Infectious Diseases, Department of Obstetrics and Gynaecology, University of Melbourne, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - John Kaldor
- The Kirby Institute for Infection and Immunity in Society, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Kevin McGeechan
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - S. Rachel Skinner
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Fisher H, Evans K, Ferrie J, Yates J, Roderick M, Audrey S. Young women's autonomy and information needs in the schools-based HPV vaccination programme: a qualitative study. BMC Public Health 2020; 20:1680. [PMID: 33172415 PMCID: PMC7654043 DOI: 10.1186/s12889-020-09815-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 11/02/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Until 2019, the English schools-based human papillomavirus (HPV) vaccination programme was offered to young women (but not young men) aged 12 to 13 years to reduce HPV-related morbidity and mortality. The aim of this study is to explore the extent to which young women were able to exercise autonomy within the HPV vaccination programme. We consider the perspectives of young women, parents and professionals and how this was influenced by the content and form of information provided. METHODS Recruitment was facilitated through a healthcare organisation, schools and community organisations in a local authority in the south-west of England. Researcher observations of HPV vaccination sessions were carried out in three schools. Semi-structured interviews took place with 53 participants (young women, parents of adolescent children, school staff and immunisation nurses) during the 2017/18 and 2018/19 programme years. Interviews were recorded digitally and transcribed verbatim. Thematic analysis was undertaken, assisted by NVivo software. RESULTS Young women's active participation and independence within the HPV vaccination programme was constrained by the setting of vaccination and the primacy of parental consent procedures. The authoritarian school structure influenced the degree to which young women were able to actively participate in decisions about the HPV vaccination programme. Young women exercised some power, either to avoid or receive the vaccine, by intercepting parental consent forms and procedures. Reliance on leaflets to communicate information led to unmet information needs for young women and their families. Communication may be improved by healthcare professional advocacy, accessible formats of information, and delivery of educational sessions. CONCLUSIONS Strategies to improve communication about the HPV vaccine may increase young people's autonomy in consent procedures, clarify young people's rights and responsibilities in relation to their health care services, and result in higher uptake of the HPV vaccination programme. TRIAL REGISTRATION ISRCTN 49086105 ; Date of registration: 12 January 2018; Prospectively registered.
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Affiliation(s)
- Harriet Fisher
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Karen Evans
- Head of School Nursing and Specialist Nursing Services, Sirona Health & Care, Bristol, South Gloucestershire, UK
| | - Jo Ferrie
- Screening and Immunisations South West, Public Health England, Bristol, UK
| | - Julie Yates
- Screening and Immunisations South West, Public Health England, Bristol, UK
| | - Marion Roderick
- Department of Paediatric Immunology & Infectious Diseases, University Hospitals Bristol and Weston NHS Trust, Bristol, UK
| | - Suzanne Audrey
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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