“ It takes time to build trust ”: a survey Ontario’s school-based HPV immunization program ten years post-implementation

Abstract

Objectives: Describe Ontario's school-based human papillomavirus (HPV) vaccination program from the perspective of local public health units (PHUs). Methods: In 2018, Vaccine Preventable Diseases (VPD) managers at each of Ontario's 35 PHUs were invited to participate in an online survey regarding the organization and delivery of their HPV vaccination program. Questions were asked on the school-based program, training and support of vaccine providers, communication and promotion, assessing coverage rates and perceptions of the program's strengths and challenges. Descriptive statistics were generated for close-ended items. A thematic content analysis was performed for open-ended items. Results: Eighteen PHUs (54%, n = 19/35) responded. All responding PHUs provided the HPV vaccine in publicly funded schools but only 6 reported being permitted to provide HPV vaccine in private schools. Fact sheets, Q&As or other written information locally developed by the PHUs were the main tools used to communicate with parents (n = 17), students (n = 13), school personnel (n = 13) and school board officials (n = 9). The most frequently reported barriers were: limited program resources, negative perceptions held by parents and/or school staff regarding the HPV vaccine, logistical issues (e.g., getting the consents forms returned, collaboration with schools for vaccine delivery) and the fact that HPV vaccination is not mandatory under Ontario legislation. Conclusion:Local public health units that implement HPV vaccine programs in schools identified logistical barriers, public perceptions about the HPV vaccine and the voluntary nature of the program as the main barriers.

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

“…As already reported in Canada [13], fear of parents' negative reactions was a significant barrier to HPV promotion at school in our study. Parents (especially mothers) play a major role in HPV vaccination decisionmaking [37] and should be involved in interventions promoting HPV vaccination in schools.…”

“…Strengthening the role of school in promoting HPV vaccination require buy-in from all school stakeholders, including teachers, school health staff (generally a parttime nurse in France), administrative and support staff [10]. Together with other barriers (e.g., limited school and vaccination program resources, competing priorities within the school setting, logistical issues), school staff 's poor knowledge about HPV and negative perceptions regarding the HPV vaccine (e.g., concerns about its safety and efficacy) could impair the delivery and effectiveness of school-based HPV vaccination programs [13,14]. Previous studies conducted abroad (e.g., US, New-Zealand, Italy) have reported a lack of knowledge about HPV among school staff [15][16][17], including school nurses [18,19], but French data are lacking to date.…”

Characteristics of immunisation support programmes in Canada: a scoping review and environmental scan

“…This programme used a direct transfer between clinician and pharmacy to reduce the likelihood of vaccine prescriptions becoming lost and promoting programme completion from education to vaccination. 46 Providing convenience in programme participation facilitated the success of some programmes 40 ; for example, through the availability of on-site (ie, drop-in), free vaccine clinics 47 (ES1, personal communication) in convenient locations (eg, workplace, pharmacies schools). 14 40 42 48 Similarly, vaccine support programmes that are provided in a timely manner without requiring effort from the participant may promote participation.…”

Factors influencing human papillomavirus school-based immunization in Alberta: A mixed-methods study protocol

“…Parents/guardians often have insufficient or inadequate information about the HPV vaccine [6,[9][10][11][12][13]; this issue can be exacerbated by language barriers, which may prevent full understanding of immunization program materials [9,20,22]. Some parents/guardians are apprehensive about the safety of the HPV vaccine [6,[10][11][12][13][14][15][16][17]. There is significant concern from parents/guardians regarding HPV's connection to sexual activity.…”

“…Nurses feel as though they have little capacity to dedicate towards school immunizations due to their already high work load [7][8][9]21]. A highly reported barrier is the issue of obtaining completed consent forms from parents/guardians [6,8,9,15,21,22]. Other logistical issues relate to organizing immunization clinics within schools, including obtaining student immunization records, and running catch-up programs for students who miss immunization days [9,21].…”