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

Abstract

Background: Human papillomavirus (HPV) vaccines effectively prevent, and can even eliminate, HPV-related cancers. Currently, vaccination rates are suboptimal in the national Swedish school-based vaccination program. School nurses play a key role in all aspects of the vaccination process. Therefore, this study aims to explore school nurses’ perceived HPV vaccination challenges. Methods: Seven focus group interviews were conducted with school nurses (n = 35) working in nine socio-demographically diverse municipalities in mid-Sweden. Data were analyzed using qualitative content analysis. Results: Participants described difficulties in encountering and handling the diversity of reasons for vaccine hesitancy. Parents known to be skeptical of vaccines in general were seen as most difficult to reach. Uncertainty was expressed concerning the extent of professional responsibility for vaccine promotion. The informants expressed a lack of guidelines for vaccine promotion and described challenges in supporting the child’s own wishes. Creating a safe space for the individual child was seen as crucial. Other problems described were the challenges of overcoming children’s fear of needles, supporting unvaccinated children, and being confronted with the remaining gender inequities of the pan-gender vaccination program. Conclusions: Our results suggest that school nurses, especially those new to their profession, may benefit from training and guidance22 material on how to address vaccine hesitancy.

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

“…22 The importance of children's participation is reflected in legis- communication and evaluate if the child is capable of making a decision on their own. [23][24][25] School nurses have, however, expressed uncertainty about how to go about with such an evaluation, lacking guidelines or support to make sure the child's wish is final. [24][25][26][27] Fear of pain during injection was a main barrier against being vaccinated.…”

“…[23][24][25] School nurses have, however, expressed uncertainty about how to go about with such an evaluation, lacking guidelines or support to make sure the child's wish is final. [24][25][26][27] Fear of pain during injection was a main barrier against being vaccinated. 17,24,26 To overcome fear, individual support to get through the vaccination was expressed as important, but not always fulfilled.…”

“…[24][25][26][27] Fear of pain during injection was a main barrier against being vaccinated. 17,24,26 To overcome fear, individual support to get through the vaccination was expressed as important, but not always fulfilled. Children had been paired with classmates during vaccination, sometimes against their own preference.…”

“…The Convention on the Rights of the Child has been elevated to Swedish law [2018, 1197] and does not define any specific age when sufficient maturity to participate in healthcare decisions is achieved. In cases of conflicting views in the family, it is up to the healthcare provider to facilitate intra‐family communication and evaluate if the child is capable of making a decision on their own 23–25 . School nurses have, however, expressed uncertainty about how to go about with such an evaluation, lacking guidelines or support to make sure the child's wish is final 24–27 …”

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

“…Some points of disagreement were found among stakeholders when school spacing for vaccine clinic setup (Enskär et al, 2023 ) was discussed, as this factor varied based on the area the participant represented. Nuances were also observed in the follow-up interviews as stakeholders highlighted the importance of school vaccine education in the context of the health promotion model (García-Toledano et al, 2022 ).…”