Promoting HPV vaccination at school: a mixed methods study exploring knowledge, beliefs and attitudes of French school staff

Abstract

Background HPV vaccine coverage in France remained lower than in most other high-income countries. Within the diagnostic phase of the national PrevHPV program, we carried out a mixed methods study among school staff to assess their knowledge, beliefs and attitudes regarding HPV, HPV vaccine and vaccination in general, and regarding schools’ role in promoting HPV vaccination. Methods Middle school nurses, teachers and support staff from four French regions participated between January 2020 and May 2021. We combined: (i) quantitative data from self-administered online questionnaires (n = 301), analysed using descriptive statistics; and (ii) qualitative data from three focus groups (n = 14), thematically analysed. Results Less than half of respondents knew that HPV can cause genital warts or oral cancers and only 18% that no antiviral treatment exists. Almost 90% of the respondents knew the existence of the HPV vaccine but some misunderstood why it is recommended before the first sexual relationships and for boys; 56% doubted about its safety, especially because they think there is not enough information on this topic. Schools nurses had greater knowledge than other professionals and claimed that educating pupils about HPV was fully part of their job roles; however, they rarely address this topic due to a lack of knowledge/tools. Professionals (school nurses, teachers and support staff) who participated in the focus groups were unfavourable to offering vaccination at school because of parents’ negative reactions, lack of resources, and perceived uselessness. Conclusions These results highlight the need to improve school staff knowledge on HPV. Parents should be involved in intervention promoting HPV vaccination to prevent their potential negative reactions, as feared by school staff. Several barriers should also be addressed before organizing school vaccination programs in France.

An Integrative Review of the Influence on Human Papillomavirus Vaccination Adherence among Adolescents

“…However, a study showed half of the school staff and parent respondents in a study in French doubted the safety of HPV vaccination. Therefore, it is advised to enhance school staff knowledge about the evidence-based practice of HPV before giving information to adolescents in school [ 57 ]. Most of all, it is important to make school staff aware about their potential influence on adolescents’ and parents’ attitudes toward HPV vaccination [ 58 ].…”

School Teachers’ Perceptions of Adolescent Human Papillomavirus (HPV) Vaccination: A Systematic Review

“…Table 1 shows the characteristics of the included studies [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Studies were conducted in various geographic settings: five studies from Asia (Hong Kong, Japan, the Republic of Korea, and Uzbekistan), two studies from North and South America (Canada and Peru), five studies from Africa (Kenya, Nigeria, and Tanzania), and three studies from Europe (France and Scotland).…”

“…Five studies [23,28,29,33,36] had unclear reporting of whether the relationship between the researcher and participants had been adequately considered during the interviews. All three mixed-methods studies [27,32,34] were compliant with the quality criteria except for the item regarding adequate rationale for using a mixed-methods design to address the research question (only one study [27] met this criterion). Overall, the included studies were relevant to the topic, presented their data and research findings coherently, and reflected on their methodological limitations.…”

“…Ten studies [25,[27][28][29][31][32][33][34][35][36] described teachers' overall lack of knowledge regarding the etiology of HPV-associated diseases, the availability of the HPV vaccine and its effectiveness in preventing HPV-associated cancers, and boys' eligibility for HPV vaccination. Less than 50% of primary, middle, and high school teachers in six studies conducted in Nigeria, Kenya, Japan, Tanzania, and France knew that HPV causes genital warts and cancer and had heard of the HPV vaccine and its benefits in preventing cervical cancer [25,27,31,32,34,35]. Less than 5% of teachers in Kenya knew that the vaccine can prevent vulvar and anal cancers in addition to cervical cancer [32], and 23% of teachers in a French study responded correctly that HPV can cause oral cancer [27].…”

Effectiveness of a School- and Primary Care–Based HPV Vaccination Intervention

“…20 First, published evidence on facilitators and barriers to the uptake of HPV vaccination, and on existing interventions to improve vaccination in general and for HPV in particular among adolescents helped identify the framework of a 3-component intervention: (1) educating and motivating adolescents in middle schools; (2) training general practitioners (GPs) on up-to-date HPV information and motivational interviewing techniques; and (3) free HPV vaccination at school. A diagnostic phase was then carried out to identify-among others-knowledge, beliefs, barriers, and preferences around HPV vaccination and the sociodemographic factors associated with each, [21][22][23][24] to define the exact content of each component to appropriately address vaccine hesitancy in our population. The final version of the PrevHPV multicomponent intervention was constructed with the target populations to fit to all French adolescents, regardless of their sociodemographic characteristics.…”