Addressing Health Inequalities in the Delivery of the Human Papillomavirus Vaccination Programme: Examining the Role of the School Nurse

Abstract

BackgroundHPV immunisation of adolescent girls is expected to have a significant impact in the reduction of cervical cancer. UK The HPV immunisation programme is primarily delivered by school nurses. We examine the role of school nurses in delivering the HPV immunisation programme and their impact on minimising health inequalities in vaccine uptake.Methods and FindingsA rapid evidence assessment (REA) and semi-structured interviews with health professionals were conducted and analysed using thematic analysis. 80 health professionals from across the UK are interviewed, primarily school nurses and HPV immunisation programme coordinators. The REA identified 2,795 articles and after analysis and hand searches, 34 relevant articles were identified and analysed. Interviews revealed that health inequalities in HPV vaccination uptake were mainly related to income and other social factors in contrast to published research which emphasises potential inequalities related to ethnicity and/or religion. Most school nurses interviewed understood local health inequalities and made particular efforts to target girls who did not attend or missed doses. Interviews also revealed maintaining accurate and consistent records influenced both school nurses' understanding and efforts to target inequalities in HPV vaccination uptake.ConclusionsDespite high uptake in the UK, some girls remain at risk of not being vaccinated with all three doses. School nurses played a key role in reducing health inequalities in the delivery of the HPV programme. Other studies identified religious beliefs and ethnicity as potentially influencing HPV vaccination uptake but interviews for this research found this appeared not to have occurred. Instead school nurses stated girls who were more likely to be missed were those not in education. Improving understanding of the delivery processes of immunisation programmes and this impact on health inequalities can help to inform solutions to increase uptake and address health inequalities in childhood and adolescent vaccination programmes.

Knowledge, Attitudes, Practices and Barriers Towards HPV Vaccination among Nurses in Turkey: a Longitudinal Study

“…The HPV vaccine was introduced as a primary prevention strategy to reduce the incidence of CC (Boyce and Holmes, 2012;Wamai et al, 2013) and two types of HPV vaccine (bivalent for HPV 16 and 18; quadrivalent for HPV 6,11,16 and 18) were approved for use in CC prevention program for reducing the risk of pre-invasive and invasive neoplasia of the cervix (WHO, 2007;Pinar et al, 2010;Makwe and Anorlu, 2011;Uzunlar et al, 2013). It is estimated that the HPV immunization program will reduce deaths from CC by two-thirds if uptake reaches 80%.…”

“…It is estimated that the HPV immunization program will reduce deaths from CC by two-thirds if uptake reaches 80%. Many countries such as the UK, Australia, Canada, France, Greece, New Zealand, Norway and Sweden offer the HPV vaccine as part of their national immunization program (Boyce and Holmes, 2012). The vaccine seems to be safe, well tolerated and effective if the vaccine has to be delivered before exposure to the virus, and preferably, at the preadolescence stage, as the antibody responses are higher Uzunlar et al, 2013).…”

Vaccination of adolescents with chronic medical conditions: Special considerations and strategies for enhancing uptake

“…116 Roughly one-third of adolescents with CMCs, including a disproportionately high number of racial and ethnic minorities from urban settings, have no medical home or a usual source of primary care. 1 office has been associated with a greater odds of influenza vaccination of patients with CMCs.…”

Immunisation against HPV in girls with intellectual disabilities

“…Research in other disadvantaged groups has shown in some populations that HPV vaccination rates are significantly lower in communities with high social deprivation3 and among ethnic minority girls,2 3 girls of travelling families, ‘Looked after Children’, some religious groups and girls who are not in school 4…”