The school nurse, the school and HPV vaccination: a qualitative study of factors affecting HPV vaccine uptake

School nurses in the United Kingdom are largely responsible for delivering the human papillomavirus (HPV) vaccine to 12-13 year old girls. In order to assess the impact of HPV vaccination on school nurses’ roles, we gave a questionnaire to all 33 school nurses who offered Cervarix ™ in two Primary Care Trusts one year ahead of the national vaccine programme. Key organisational issues raised by the school nurses were the size of the team and its skill mix. A few found their schools uncooperative and were dissatisfied with mechanisms for problem resolution. On average, nurses spent an additional 69 h (0.80 h per child) on vaccine-related activities. In semi-qualitative interviews (n = 17), school nurses complained of work overload and described the difficulties of establishing good relationships with some of their schools. Nurses expected schools to take some responsibility for ensuring good uptake and were frustrated when help was not forthcoming. We conclude that variation in uptake between schools in part reflects a difficult relationship with the school nurse which may be attributed to characteristics of the school, schools’ attitudes towards health interventions, organisational problems, multiple school nurse roles and/or personal ability. Some of these issues will need to be addressed to ensure continued high vaccine coverage as HPV vaccination becomes a less prioritised, routine activity.     

HPV vaccination among a community sample of young adult women

Objectives

Despite the high efficacy of the human papillomavirus (HPV) vaccine, uptake has been slow and little data on psychosocial barriers to vaccination exist.

Methods

A community sample of 428 women enrolled in a longitudinal study of social development in the Seattle WA metropolitan area were interviewed about HPV vaccine status, attitudes, and barriers to HPV vaccination in spring 2008 or 2009 at ∼age 22.

Results

Nineteen percent of women had initiated vaccination, 10% had completed the series, and ∼40% of unvaccinated women intended to get vaccinated. Peer approval was associated with vaccine initiation (adjusted prevalence ratio (APR) 2.1; 95% confidence interval 1.4-3.2) and intention to vaccinate (APR 1.4; 1.1-1.9). Belief the vaccine is <75% effective was associated with less initiation (APR 0.6; 0.4-0.9) or intention to vaccinate (APR 0.5; 0.4-0.7). Vaccine initiation was also less likely among cigarette smokers and illegal drug users, whereas intention to vaccinate was more common among women currently attending school or with >5 lifetime sex partners, but less common among women perceiving low susceptibility to HPV (APR 0.6; 0.5-0.9).

Conclusions

HPV vaccination uptake was low in this community sample of young adult women. Increasing awareness of susceptibility to HPV and the high efficacy of the vaccine, along with peer interventions to increase acceptability, may be most effective.     

Uptake of HPV Vaccine among young adults with disabilities, 2011 to 2018

IntroductionLittle is known about human papillomavirus (HPV) vaccine uptake among young adults with disabilities (YAWD), despite this population having a higher risk of HPV infection and related cancers compared to the general population.ObjectiveTo compare the prevalence of HPV vaccination among young adults with disabilities to young adults without disabilities. We hypothesized that YAWD would have a lower prevalence of HPV vaccination than the general population.MethodsThis cross-sectional study used data for the years 2011 to 2018 of the National Health Interview Survey. Our analysis included 14,577 people (weighted n = 34,420,024) aged 18 to 26 years. Univariate and multivariable logistic models were used to estimate the role of disability on HPV vaccination uptake among young adults and to identify potential factors associated with HPV vaccination among YAWD.ResultsThe proportion of female and male YAWD with HPV vaccination was similar to those without disabilities, regardless of sex (Female Adjusted Odds Ratio (OR): 1.16; 95% Confidence Interval (CI): 0.91 to 1.48; Male Adjusted OR: 1.05; 95% CI: 0.69 to 1.60). Among female and male YAWD, the proportion with HPV vaccination was 56.1% and 28.5%, respectively. Other factors significantly associated with HPV vaccination among YAWD included age, country of birth, healthcare utilization, and insurance status.ConclusionsHPV vaccination among YAWD did not differ significantly from those without disabilities; however, the prevalence of HPV vaccination among young adult males and females remains significantly below national goals. Connecting young adults, specifically male YAWD, to the healthcare system is of utmost importance to improve HPV vaccination uptake.     

Attitudes toward HPV vaccination among parents of adolescent girls in Mysore,India

This study investigates attitudes toward human papillomavirus (HPV) vaccination among parents of adolescent girls in Mysore, India. Seven focus group discussions were held among parents of adolescent girls stratified by sex, religion and region to explore attitudes about cervical cancer and HPV vaccination. The study found that while parents have limited knowledge about HPV or cervical cancer, most are still highly accepting an HPV vaccine. In addition, high acceptability levels appear to reflect positive attitudes toward the government universal immunization program in general, rather than to the HPV vaccine in particular. The results highlight the need for additional education and health promotion regarding HPV and cervical cancer prevention in India.     

东北师大附小5000名学生免疫接种证查验结果分析

目的了解儿童免疫规划实施情况的现状、儿童入学预防接种证查验工作的流程并提出完善此项工作的合理化建议。方法以我校连续4年对9个年龄段学生预防接种证的查验记录、工作流程为原始资料,进行统计分析。结果通过统计分析儿童免疫规划过程中的持证率、接种率、漏种补种率,提出更加完善的查验证工作流程,使每一名儿童的国家免疫规划全部完成。结论儿童预防接种证查验工作及漏种、补种工作有待进一步改善。     

Applying the COM-B behaviour model to understand factors which impact school immunisation nurses’ attitudes towards designing and delivering a HPV educational intervention in post-primary schools for 15–17 year old students in Northern Ireland,UK

IntroductionHuman Papilloma Virus (HPV) is responsible for the development of cervical, vaginal, vulvar, penile, oropharyngeal and anal cancers. Throughout the UK, Immunisation nurses (IMNs) deliver school-based HPV vaccinations to students 12–13 years old. Providing HPV education to 15–17 year old students may promote decision-making regarding their sexual health and award opportunity for unvaccinated students to self-consent to the vaccination. This study aims to explore the perceptions of IMNs regarding the value of providing HPV education to 15–17 year old students and to explore whether IMNs feel that the design/delivery of this education should form part of their professional role.MethodsSix focus groups were conducted online with IMNs from all five Health and Social Care Trusts in Northern Ireland, UK, between January-June 2021. Data were analysed using the COM-B model to identify factors that might influence IMNs’ behaviour towards designing/delivering this education for 15–17 year old students.ResultsIMNs were highly motivated to design and deliver this HPV education. Facilitators promoting this behaviour included their specialist training, their previous sexual health teaching experience and their desire to educate young people. Barriers negatively influencing this behaviour included lack of time/resources, parental influences, lack of school support and lack of teaching/presentation skills training.ConclusionIMNs feel that they are the most appropriate professionals to design/deliver HPV education for 15–17 year old students. National policy change, based on collaboration between the Public Health Agency and Education Authority, is a key factor in facilitating IMNs to implement this school-based HPV education intervention.     

Obesity prevention in schools: current role and future practice of school nurses

OBJECTIVE: To determine responsibilities of school nurses in delivering obesity prevention services, assess opinions and beliefs about school-based obesity prevention and determine factors associated with school nurses supporting and providing obesity prevention services. METHOD: In fall 2005, a self-administered survey was mailed to 275 school nurses in Minnesota; 221 were returned (response rate=80%). RESULTS: Most (76%) school nurses supported the use of school health services (SHS) for obesity prevention. The likelihood of nurses supporting SHS for obesity prevention (p=0.009), as well as performing more child- (p=0.016) and school-level (p = < 0.001) obesity prevention tasks increased as perceived support for school-based obesity prevention from health care providers and school administrators, teachers and foodservice staff increased. Nurses supportive of school-based height, weight and BMI screening and parent notification were twice as likely to perform child-level obesity prevention tasks (p=0.021) and more than three times as likely to support using SHS for obesity prevention (p=0.005). CONCLUSION: Our study suggests considerable support among school nurses for school-based obesity prevention efforts and a growing interest in providing primary and secondary preventive care services in the school setting. Study findings also speak to the need for preparation, time and support from the school and health provider community.     

County-level correlates of missed opportunities for HPV vaccination in Indiana: An environmental scan

BackgroundThe goal of this study was to examine variability across the 92 Indiana counties in missed opportunities for HPV vaccination and to assess county-level correlates of missed opportunities.MethodsThe Indiana immunization registry provided county level data on 2017 missed opportunity rates for adolescents ages 11–18. A missed opportunity was an encounter when a patient eligible for HPV vaccination received one or more other recommended vaccines, but not HPV. Potential county-level correlates of missed opportunities included race, income, population density, education, primary care providers per capita, smoking rates, mammography screening, diabetes monitoring, and Pap testing.ResultsThe missed opportunity rate ranged from 31% to 85% across Indiana counties. Higher population density, mammography screening, income inequality, and diabetes monitoring were associated with fewer missed opportunities.ConclusionsWe found wide variability in missed opportunities across counties, which were associated with population density and county-level participation in other health-related behaviors.Sources of supportThis study was supported by the National Cancer Institute under Award Number P30 CA082709-18S4.     

Knowledge and awareness of HPV and the HPV vaccine among young women in the first routinely vaccinated cohort in England

A national school-based human papillomavirus (HPV) vaccination programme has been available for 12–13 year old females in the UK since 2008, offering protection against HPV types 16 and 18, which are responsible for the majority of cervical cancer. Little is known about HPV knowledge in girls who have been offered the vaccine. Girls offered the school-based vaccine in the first routine cohort (n = 1033) were recruited from 13 schools in London three years post-vaccination. Participants completed a questionnaire about HPV awareness, knowledge about HPV and the vaccine, and demographic characteristics including vaccine status. About a fifth of the girls reported they were unaware of the HPV infection. Among those who reported being aware of HPV (n = 759) knowledge was relatively low. Approximately half of the participants knew that HPV infection causes cervical cancer, condoms can reduce the risk of transmission and that cervical screening is needed regardless of vaccination status. These results are helpful in benchmarking HPV-related knowledge in vaccinated girls and could be used in the development of appropriate educational messages to accompany the first cervical screening invitation in this cohort in the future.     

Mothers' support for voluntary provision of HPV vaccine in schools

HPV vaccination rates among adolescents in the United States lag behind some other developed countries, many of which routinely offer the vaccine in schools. We sought to assess mothers’ willingness to have their adolescent daughters receive HPV vaccine at school. A national sample of mothers of adolescent females ages 11-14 completed our internet survey (response rate = 66%). The final sample (n = 496) excluded mothers who did not intend to have their daughters receive HPV vaccine in the next year. Overall, 67% of mothers who intended to vaccinate their daughters or had vaccinated their daughters reported being willing to have their daughters receive HPV vaccine at school. Mothers were more willing to allow their daughters to receive HPV vaccine in schools if they had not yet initiated the vaccine series for their daughters or resided in the Midwest or West (all p < .05). The two concerns about voluntary school-based provision of HPV vaccine that mothers most frequently cited were that their daughters’ doctors should keep track of her shots (64%) and that they wished to be present when their daughters were vaccinated (40%). Our study suggests that most mothers who support adolescent vaccination for HPV find school-based HPV vaccination an acceptable option. Ensuring communication of immunization records with doctors and allowing parents to be present during immunization may increase parental support.     

Attitudes towards HPV immunization of Italian mothers of adolescent girls and potential role of health professionals in the immunization program

We assessed the knowledge of Italian mothers of adolescent girls about HPV and HPV vaccination, their willingness to immunize their daughters, and their perception of the role of different medical specialists in the HPV immunization strategy by a telephone interview. Fifty-four percent of the 807 interviewed mothers reported to have ever heard about HPV, and 84% of them were willing to immunize their daughters. Pediatricians most frequently provided information on HPV vaccine (31%), and were perceived as the preferred immunization providers (77%). Acceptance of HPV immunization was high and was not associated with knowledge of HPV.     

Acceptability and uptake of HPV vaccine in Argentina before its inclusion in the immunization program: a population-based survey

In Argentina, human papillomavirus (HPV) vaccination was approved in 2006, but not included in the National Immunization Program. In 2008 a mass media campaign was carried out by a cancer Non-Governmental Organization (NGO), but it was stopped due to criticisms about the publicity. In October 2011 the Ministry of Health (MoH) has introduced HPV vaccination in the National Immunization Program. In this context, to assure high HPV vaccine coverage, evidence is needed on factors both associated to vaccine acceptability and uptake. In 2009-2010 we carried out a population-based survey among a representative sample of 1200 women aged 18-49 years from the Metropolitan Area of Buenos Aires. The objective was twofold: first to analyze socio-demographic determinants of women's knowledge on HPV vaccine and secondly, determinants of actual HPV vaccine uptake and acceptability in Argentina after the above-mentioned vaccine advertising shown in mass media in the year 2008. We analyzed vaccine uptake/acceptability separately for women and for their daughters aged 9-15, and willingness to vaccinate one's daughter younger than 9 to receive future HPV vaccination. Results of the 1200 women interviewed, 438 women (36.5%) knew the HPV vaccine and 303 (25%) remembered the mass media advertisement about HPV vaccination. When asked whether she would get vaccinated after having seen/heard the advertisement, around 75% (n=226) of women answered surely/probably yes. No significant differences in socio-demographic characteristics were found among women who would or not get vaccinated. When surveyed, 6 women had been vaccinated. Main reasons for non-vaccination were: "Doctor did not mention/recommend it" (34.1%) and "Vaccine is too expensive" (15.7%). No woman had had their 9-15 year-old daughter vaccinated. Among women who only had at least one daughter under 9 (n=278), 74% answered that they would get their daughter vaccinated if they were pre-adolescents. The conclusion is that, in Argentina, the potential acceptability of the vaccine is high, given that there is acceptance among the professional community, physicians recommend it, and vaccine is affordable.     

Literature review of HPV vaccine delivery strategies: Considerations for school- and non-school based immunization program

School-based vaccination is becoming a more widely considered method of delivering HPV immunizations to an adolescent population; however, many countries do not have experience with delivering adolescent vaccines or school-based programs. This literature review will summarize the experiences from countries implementing non-health facility-based and health facility-based vaccination programs and assess HPV vaccine coverage. In October 2012, a systematic search in PubMed for studies related to the evaluation of national/regional, pilot, or demonstration HPV immunization programs that worked within existing health system yielded nine articles, representing seventeen countries. School-based programs achieved high HPV vaccination coverage rates in 9 to 13-year-old girls across the different studies and geographic locations, suggesting non-health facility-based programs are possible for HPV vaccine introduction. Grade-based, compared to age-based, eligibility criteria may be easier to implement in school settings. More studies are needed to explore the methods to standardize estimates for HPV vaccine coverage so that programs can be appropriately evaluated.     

Evaluation of a school entry immunization record check strategy in 4 counties of Ningxia and Hubei provinces,China

China has a national requirement that children's vaccination status is to be checked upon entry to kindergarten and school; children who have missed vaccine doses are to be referred to vaccination clinics to receive the necessary vaccinations. Most provinces have Immunization Information Systems (IIS) that contain and manage vaccination records of children served by immunization clinics. We conducted an evaluation in Hubei and Ningxia provinces using IIS data to determine the effect of their school entry immunization record checking strategy (SECS) on vaccination coverage and rate of catch-up for selected vaccines.We selected two counties with well-functioning IISs from each province. Names and demographic information of children enrolled in 185 kindergartens and 125 primary school in 2016 were used to identify children in the IIS and obtain their vaccination records. We calculated vaccination coverage before and after implementation of the SECS and determined catch-up rates for 5 vaccines, of which 3 are given before 2 years of age and 2 are given after 2 years of age.Among the 20,215 newly-enrolled children, 75% were able to be matched with IIS records. Few children who had missed one or more doses of the 3 vaccines recommended in the first two years of life received catch-up doses after SECS. For vaccines scheduled after 2 years of age, there was a statistically significant (p < 0.05) coverage increase in both provinces following the school-entry record check. Among children who were age-eligible for the selected vaccines before SCES, the catch-up rate was <50%.SECS provides opportunities to identify incompletely vaccinated children, improve coverage, and remind families of school-age children about up-coming vaccinations; SECS has potential to improve completeness of IIS data and enrollment of children in immunization clinics. Evidence-based policy with implementation guidance and routine monitoring are necessary to improve China’s school entry checking strategy.     

Knowledge and acceptability of the HPV vaccine by school children and their parents in Birmingham

Previous research indicates that knowledge about the HPV vaccine amongst the general public is inadequate 1, 2 and 3. However, since the introduction of the NHS vaccination programme for girls aged 12–13 from autumn 2008 awareness may have increased. We aimed to assess their knowledge about the vaccine, their likelihood of vaccine uptake and whether these were affected by demographic variables such as gender and ethnicity. Questionnaires which were designed to test levels of knowledge about the vaccination programme were distributed to a sample of 12–13 year-old boys and girls and their parents from three schools in Birmingham. In total, 568 questionnaires were distributed, with 434 responses (76.4%).     

齐齐哈尔市312名女医学生HPV疫苗接种意愿及影响因素

目的 调查齐齐哈尔市女医学生HPV疫苗接种意愿及其影响因素,为HPV疫苗推广提供参考依据。方法 于2020年12月—2021年1月,采取方便抽样的方法,在齐齐哈尔市某医学院校抽取312名在校女大学生进行电子问卷调查。结果 312名女医学生宫颈癌、HPV及HPV疫苗相关知识平均得分（6.0±1.4）分。17.9%的学生已经注射了HPV疫苗,在尚未注射HPV疫苗的学生中,75.0%有接种HPV疫苗的意愿。宫颈癌、HPV及HPV疫苗相关知识得分[OR=1.85(1.40～2.43)]和家庭月收入[OR=0.48(0.26～0.91)]是女医学生疫苗接种意愿的独立影响因素（P<0.05）。结论 齐齐哈尔市312名女医学生对宫颈癌、HPV及HPV疫苗的认知不够全面,高校应加强对相关知识的宣传教育,相关部门应调整疫苗价格,促进HPV疫苗的推广。     

Introduction of a National HPV vaccination program into Bhutan

BackgroundCervical cancer is the most common cancer in Bhutanese women. To help prevent the disease, the Ministry of Health (MoH) developed a national human papillomavirus (HPV) vaccine program.MethodsMoH considerations included disease incidence, the limited reach of cervical screening, poor outcomes associated with late diagnosis of the disease, and Bhutan's ability to conduct the program. For national introduction, it was decided to implement routine immunization for 12 year-old girls with the quadrivalent HPV6/11/16/18 (QHPV) vaccine and a one-time catch-up campaign for 13–18 year-old girls in the first year of the program (2010). Health workers would administer the vaccine in schools, with out-of-school girls to receive the vaccine at health facilities. From 2011, HPV vaccination would enter into the routine immunization schedule using health-center delivery.ResultsDuring the initial campaign in 2010, over 130,000 doses of QHPV were administered and QHPV 3-dose vaccination coverage was estimated to be around 99% among 12 year-olds and 89% among 13–18 year-olds. QHPV vaccine was well tolerated and no severe adverse events were reported. In the three following years, QHPV vaccine was administered routinely to 12 year-olds primarily through health centers instead of schools, during which time the population-level 3-dose coverage decreased to 67–69%, an estimate which was confirmed by individual-level survey data in 2012 (73%). In 2014, when HPV delivery was switched back to schools, 3-dose coverage rose again above 90%.DiscussionThe rapid implementation and high coverage of the national HPV vaccine program in Bhutan were largely attributable to the strength of political commitment, primary healthcare and support from the education system. School-based delivery appeared clearly superior to health centers in achieving high-coverage among 12 year-olds.ConclusionsBhutan's lessons for other low/middle-income countries include the superiority of school-based vaccination and the feasibility of a broad catch-up campaign in the first year.     

Knowledge of human papillomavirus (HPV) and HPV vaccination: An international comparison

Since vaccination against human papillomavirus (HPV) became available, awareness of HPV has dramatically increased. Implementation of a vaccine program varies internationally yet no studies have explored the influence this has on the public's knowledge of HPV. The present study aimed to explore differences in awareness of HPV and HPV knowledge across three countries: The US, UK and Australia.     

溧水区成年男性HPV疫苗的认知和接种意愿影响因素研究

目的：了解南京市溧水区成年男性对HPV疫苗的认知情况及接种意愿影响因素,为HPV疫苗在男性人群中推广提供参考建议。方法：采用简单随机抽样对溧水区成年男性进行问卷调查。结果：65.7%的人听过HPV疫苗,48.61%(140/288)有接种意愿,感知障碍性、感知疾病严重性、认知得分对HPV疫苗接种意愿的差异有统计学意义。多因素回归分析显示感知障碍性、感知疾病严重性、学历、婚姻状态、是否有过生殖系统疾病、是否听说过HPV疫苗对接种影响非常显著。结论：溧水区成年男性对HPV疫苗的认知匮乏,接种意愿不高。建议将低文化水平、低家庭收入人群作为健康教育的重点人群,通过医院、社区、网络等多途径、多形式的宣传方式,提高认知水平,并且政府对疫苗价格进行调控或者纳入医保,减轻接种人群的负担,提高人群的接种率。