Acceptability of School‐Based Health Centers for Human Papillomavirus Vaccination Visits: A Mixed‐Methods Study

Abstract

BACKGROUND Countries with high human papillomavirus (HPV) vaccination rates have achieved this success largely through school-based vaccination. Using school-based health centers (SBHCs) in the US, where HPV vaccine remains underutilized, could improve uptake. In this mixed-methods study, we examined acceptability, facilitators, and barriers of HPV vaccination visits at SBHCs from the perspectives of adolescents and parents. METHODS We conducted qualitative interviews and structured surveys with adolescents and parents recruited from an urban, hospital-based clinic. Interviews with parents (N = 20) and adolescents (N = 20) were audio-recorded and transcribed for analysis using an iterative thematic approach. Quantitative measures for a survey administered to parents (N = 131) were derived from the qualitative findings. Survey results were analyzed by chi-square tests. RESULTS Many participants expressed favorable opinions of HPV vaccination at SBHCs in qualitative interviews. Facilitators included convenience, ease of scheduling, and not missing work or school. However, barriers were noted including concerns about obtaining care outside the medical home, fragmentation of medical records, and negative perceptions about SBHCs. Quantitative findings revealed that a higher proportion of parents with experience using SBHCs were willing to use a middle school (59.5%) or high school (80.5%) SBHC for HPV vaccinations compared to those who had not used SBHCs (p < .05 for both comparisons). CONCLUSIONS HPV vaccination visits at SBHCs were acceptable, and SBHC users expressed more favorable attitudes. Barriers to HPV vaccination at SBHCs can be addressed through more education about SBHCs’ role, and improvement of systems to coordinate care.

Schoolteachers’ experiences of implementing school-based vaccination programs against human papillomavirus in a Chinese community: a qualitative study

“…Therefore, collaborating with nongovernmental health organizations and universities could be a feasible direction for school-based HPV vaccination programs in the future. Furthermore, school-based health centers in the United States were reported to improve HPV vaccine uptake among adolescents because they offer convenience and do not affect school or work [40]. Despite the lack of school-based health centers in primary and secondary schools in Hong Kong, with the support of the literature indicating school-based format can enhance vaccination motivation [37, 40–43] and offer trust to parents [44], the home-school-doctor model could be considered an alternative in the implementation of school-based HPV vaccination programs [16] in the future to improve vaccine uptake.…”

Examining multilevel influences on parental HPV vaccine hesitancy among multiethnic communities in Los Angeles: a qualitative analysis

“…Pandemic-related challenges such as limited catch-up appointments in the clinics were also noted. School-based interventions may address the logistical barriers in communities where the social needs are greater [ 60 ]. For example, others have found that parents who struggle to take off work and uninsured parents are more willing to partake in school-based vaccination programs [ 61 , 62 ].…”

Exploring Knowledge and Attitudes About Human Papillomavirus Vaccination Among School Nurses in an Urban School District

“…38,39 Countries that have achieved high rates (>70%) of HPV vaccine series completion, such as England and Australia, have largely accomplished this through school-based vaccination programs. [40][41][42][43] In the United States, parents generally have favorable opinions of offering the HPV vaccine at SBHCs 44 although with only 2000 SBHCs in the country 39 most children do not have access to a SBHC. Findings from our study support this claim-with only 12% of our school nurses reporting that they are based in a SBHC.…”