Barriers in the School-Based Pan-Gender HPV Vaccination Program in Sweden: Healthcare Providers' Perspective

How to overcome information and communication barriers in Human Papillomavirus vaccination? A SWOT analysis based on the opinions of European family doctors in contact with young people and their parents

BACKGROUND

Family doctors (FDs)/General practitioners (GPs) are the key contact points for young people and their parents regarding Human Papillomavirus (HPV) vaccination. However, their recommendations are influenced by communication skills.

OBJECTIVES

Under the EU4Health project, PROTECT-EUROPE, WONCA Europe led a task to identify and analyse strategies for clinicians' interpersonal communication skills when discussing HPV and its vaccination with young people and their parents.

METHODS

Strengths, Weaknesses, Opportunities, Threats (SWOT) analysis using qualitative data focused on HPV vaccine acceptance and communication with the target population. FDs/GPs, members of WONCA Europe, were recruited using convenience and snowball sampling through surveys at conferences and emails.

RESULTS

223 FDs/GPs from 36 countries participated. Strengths included face-to-face communication, extensively used to promote the HPV vaccine. Weaknesses involved financial constraints, limited knowledge about gender-neutral vaccination, safety concerns, and time pressure during the consultations. Opportunities included confidentiality, open dialogue, trusting relationship between FDs/GPs and the target population, continuing medical education, school training, and questions & answers sessions to increase vaccine communication. Threats included social norms and cultures, stigmas against HPV, and anti-vaccination movements hindering discussions on HPV vaccination.

CONCLUSION

It is crucial to train FDs/GPs to address knowledge gaps, enhance communication skills, and maintain a trusting relationship with patients when discussing HPV vaccination. Overcoming financial barriers and ensuring gender-neutral vaccination programs are accessible across Europe are also essential. Providing accurate information through the web- and school-based channels and developing community-oriented approaches targeting sociocultural factors and different needs to eliminate HPV vaccine stigmas should be considered when recommending the vaccine.

Stakeholders' perspectives on barriers to and facilitators of school-based HPV vaccination in the context of COVID-19 pandemic-related disruption: a qualitative mixed methods study

Despite successfully implementing the Human Papilloma Virus Vaccine (HPVV) program, Saskatchewan (SK) struggled to improve HPVV uptake rates. This suboptimal uptake of HPVV with a status quo of HPV-linked cervical cancer incidence rate is mainly because HPVV's impact on cancer prevention has not been realized adequately by vaccine providers and receivers. Further exploration of determinants of HPVV uptake is required to uncover high-resolution quality improvement targets for investment and situate contextually appropriate policies to improve its uptake. The study undertook a qualitative inquiry into understanding stakeholders' perspectives on HPVV experience through school-based programmes. It collected data through semi-structured initial interviews (N = 16) and follow-up interviews (N = 10) from across Saskatchewan's four Integrated Service Areas. Document analysis was conducted on all publicly available documents that included information on HPVV from January 2015 to July 2023. Thematic analysis of the data identified that inadequate information, awareness and education about HPV infection and HPVV among several groups, especially, parents, youth and school staff, was the main barrier to optimal HPVV uptake. Vaccine-related logistics, including the technical and text-heavy vaccine information sheet, understaffing, and time constraints, were other important factors that impeded HPVV uptake. A person-centred approach could educate parents in multiple dimensions.

An exploration of teacher and school-based nurse perceptions of current HPV education offered to students 15-16 years old in post-primary schools in Northern Ireland, UK

INTRODUCTION

Human papillomavirus virus (HPV) is highest among young adults 15-24 years old. High-risk strains are responsible for the development of cancers including cervical, vaginal, vulvar, anal, oropharyngeal and penile. Despite HPV school-based vaccination programmes in the UK, HPV vaccination uptake rates continue to fluctuate due to misinformation and vaccine hesitancy post COVID-19. The aim of this study is to explore perceptions of post-primary school teachers and nurses regarding the current HPV education provision and the need to provide HPV education to students 15-17 years old when they are most likely to be becoming sexually active.

METHODS

A qualitative study was conducted using online semi-structured interviews between February-August 2022 with post-primary teachers and nurses in Northern Ireland, UK. Stratified random sampling was used to contact schools to recruit participants. Recruitment continued until data saturation was reached. Braun & Clarke's six-phase framework for reflexive thematic analysis was used to analyse the data.

RESULTS

Twelve teachers and six nurses participated in the study. Four themes arose based on the analysis including 1) the importance of HPV education 2) self-consent to the HPV vaccine 3) design of the HPV education and 4) delivery of the HPV education. Identified barriers to implementation of HPV education included lack of parental education, religion and the conservative culture of Northern Ireland.

DISCUSSION

Participants perceived HPV education to be poor or non-existent in their schools but placed high importance on this education. They indicated that a non-judgemental health professional would be the ideal person to deliver interactive HPV education as part of a mandated spiral curriculum.

CONCLUSION

HPV education at 15-17 years old provides students with an opportunity to learn about their HPV risk, their HPV vaccination status and an opportunity to self-consent to the HPV vaccine. The Education Authority and Department of Health should support health professionals to deliver consistent robust HPV health information to students of this age.

The role of mental illness and neurodevelopmental conditions in human papillomavirus vaccination uptake within the Swedish school-based vaccination programme: a population-based cohort study

BACKGROUND

Despite documented mental illness-related disparities in cervical cancer screening and incidence, insufficient data exist on differences in cervical cancer prevention strategies, such as human papillomavirus (HPV) vaccination. We aimed to investigate the association of mental illness and neurodevelopmental conditions among girls and their parents with uptake of HPV vaccination in Sweden.

METHODS

This population-based cohort study was based on the Swedish school-based HPV vaccination programme, which offers the first vaccine dose to girls aged 10-13 years, with a second dose offered within 12 months. We identified all girls born between Jan 1, 2002, and March 1, 2004, using the Swedish Total Population Register-ie, those eligible for two vaccine doses in the vaccination programme from its initiation in autumn 2012, to March, 2019. Nationwide Swedish register data (National Patient Register, Prescribed Drug Register, HPV Vaccination Register, National Vaccination Register, Total Population Register, Multi-Generation Register, Longitudinal Integrated Database for Health Insurance and Labour Market Studies, Education Register, National Cervical Screening Registry, and Cancer Register) were used to define individual and parental mental health conditions, including mental illness and neurodevelopmental conditions (defined by a clinical diagnosis and prescribed psychotropic medication use), HPV vaccine uptake (first and second dose), and sociodemographic and clinical characteristics. The two outcomes were uptake of the first HPV vaccine dose by the girl's 14th birthday and uptake of the second dose by the 15th birthday in relation to individual and parental mental health conditions, calculated using multivariable Poisson regression models.

FINDINGS

115 104 girls were included in the study population. 2211 girls (1·9%) had a specialist diagnosis of any mental health condition. Uptake of the first HPV vaccine dose was 80·7% (92 912 of 115 104) and was lower among girls with versus without any mental health condition (adjusted relative risk 0·89 [95% CI 0·87-0·91]). The diagnosis of autism (0·79 [0·75-0·85]) or intellectual disability (0·78 [0·73-0·83]) were most strongly associated with lower HPV vaccine uptake. Vaccine uptake was also lower among girls with versus those without prescribed use of psychotropic medication (0·93 [0·92-0·95]), with the strongest association observed for antipsychotics (0·68 [0·56-0·82]). Uptake of the second dose was 95·0% (88 308 of 92 912), with no strong associations between uptake and mental health conditions in girls or their parents.

INTERPRETATION

Our findings suggest disparities in cervical cancer prevention among girls with mental health conditions, and call for further research to ensure equitable protection.

FUNDING

Swedish Cancer Society.

School children's perceptions about being offered the HPV vaccination - A focus group study

AIM

There is limited knowledge about the perceptions of HPV vaccination in middle-school children. This qualitative study aimed to explore their views.

METHODS

We conducted focus group interviews with children, 10-11 years of age, who had been offered HPV vaccination through the school health services in mid-north Sweden in spring of 2023. Data were analysed with qualitative content analysis.

RESULTS

This study included six focus group interviews with 49 children (boys n = 29; girls n = 20), mean of 11 years of age. Participating children expressed the need to feel safe to be of utmost importance and the means to do so was to be prepared and informed by someone the child trusted. The school nurse was perceived as the expert, best suited to provide factual information, support and motivation, both to children and their parents.

CONCLUSION

We confirm that healthcare providers' recommendations are crucial for HPV vaccine acceptance also from the child's perspective. Improved information about HPV vaccination to children is necessary. Children's right to participate on their own terms is not fulfilled today. Vaccine promotion, both to children and parents, should be actively managed by the school nurse.