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

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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.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-023-15342-2.

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Most cited references 36

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Beyond confidence: Development of a measure assessing the 5C psychological antecedents of vaccination

Cornelia Betsch, Philipp Schmid, Dorothee Heinemeier … (2018)

Background Monitoring the reasons why a considerable number of people do not receive recommended vaccinations allows identification of important trends over time, and designing and evaluating strategies to address vaccine hesitancy and increase vaccine uptake. Existing validated measures assessing vaccine hesitancy focus primarily on confidence in vaccines and the system that delivers them. However, empirical and theoretical work has stated that complacency (not perceiving diseases as high risk), constraints (structural and psychological barriers), calculation (engagement in extensive information searching), and aspects pertaining to collective responsibility (willingness to protect others) also play a role in explaining vaccination behavior. The objective was therefore to develop a validated measure of these 5C psychological antecedents of vaccination. Methods and findings Three cross-sectional studies were conducted. Study 1 uses factor analysis to develop an initial scale and assesses the sub-scales’ convergent, discriminant, and concurrent validity (N = 1,445, two German convenience-samples). In Study 2, a sample representative regarding age and gender for the German population (N = 1,003) completed the measure for vaccination in general and for specific vaccinations to assess the potential need for a vaccine-specific wording of items. Study 3 compared the novel scale’s performance with six existing measures of vaccine hesitancy (N = 350, US convenience-sample). As an outcome, a long (15-item) and short (5-item) 5C scale were developed as reliable and valid indicators of confidence, complacency, constraints, calculation, and collective responsibility. The 5C sub-scales correlated with relevant psychological concepts, such as attitude (confidence), perceived personal health status and invulnerability (complacency), self-control (constraints), preference for deliberation (calculation), and communal orientation (collective responsibility), among others. The new scale provided similar results when formulated in a general vs. vaccine-specific way (Study 2). In a comparison of seven measures the 5C scale was constantly among the scales that explained the highest amounts of variance in analyses predicting single vaccinations (between 20% and 40%; Study 3). The present studies are limited to the concurrent validity of the scales. Conclusions The 5C scale provides a novel tool to monitor psychological antecedents of vaccination and facilitates diagnosis, intervention design and evaluation. Its short version is suitable for field settings and regular global monitoring of relevant antecedents of vaccination.

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The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey

Heidi Larson, Alexandre de Figueiredo, Zhao Xiahong … (2016)

Background Public trust in immunization is an increasingly important global health issue. Losses in confidence in vaccines and immunization programmes can lead to vaccine reluctance and refusal, risking disease outbreaks and challenging immunization goals in high- and low-income settings. National and international immunization stakeholders have called for better monitoring of vaccine confidence to identify emerging concerns before they evolve into vaccine confidence crises. Methods We perform a large-scale, data-driven study on worldwide attitudes to immunizations. This survey – which we believe represents the largest survey on confidence in immunization to date – examines perceptions of vaccine importance, safety, effectiveness, and religious compatibility among 65,819 individuals across 67 countries. Hierarchical models are employed to probe relationships between individual- and country-level socio-economic factors and vaccine attitudes obtained through the four-question, Likert-scale survey. Findings Overall sentiment towards vaccinations is positive across all 67 countries, however there is wide variability between countries and across world regions. Vaccine-safety related sentiment is particularly negative in the European region, which has seven of the ten least confident countries, with 41% of respondents in France and 36% of respondents in Bosnia & Herzegovina reporting that they disagree that vaccines are safe (compared to a global average of 13%). The oldest age group (65+) and Roman Catholics (amongst all faiths surveyed) are associated with positive views on vaccine sentiment, while the Western Pacific region reported the highest level of religious incompatibility with vaccines. Countries with high levels of schooling and good access to health services are associated with lower rates of positive sentiment, pointing to an emerging inverse relationship between vaccine sentiments and socio-economic status. Conclusions Regular monitoring of vaccine attitudes – coupled with monitoring of local immunization rates – at the national and sub-national levels can identify populations with declining confidence and acceptance. These populations should be prioritized to further investigate the drivers of negative sentiment and to inform appropriate interventions to prevent adverse public health outcomes.

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How Many Focus Groups Are Enough? Building an Evidence Base for Nonprobability Sample Sizes

G Guest, Emily E Namey, K McKenna (2016)

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Author and article information

Contributors

Aurélie Bocquier: aurelie.bocquier@univ-lorraine.fr

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 14 March 2023

Publication date PMC-release: 14 March 2023

Publication date Collection: 2023

Volume: 23

Electronic Location Identifier: 486

Affiliations

[1 ]GRID grid.29172.3f, ISNI 0000 0001 2194 6418, Université de Lorraine, APEMAC, ; F-54000 Nancy, France

[2 ]Centre Régional de Coordination Des Dépistages Des Cancers-Pays de La Loire, Angers, France

[3 ]GRID grid.450307.5, ISNI 0000 0001 0944 2786, Université Grenoble Alpes, LIP/PC2S, EA 4145, ; Grenoble, France

[4 ]GRID grid.5388.6, Université Savoie Mont Blanc, LIP/PC2S, ; Chambéry, France

[5 ]Département de Médecine Générale, Université de Paris, Faculté de Santé, UFR de Médecine, F-75014 Paris, France

[6 ]Université de Paris, ECEVE, Paris, France

[7 ]GRID grid.411394.a, ISNI 0000 0001 2191 1995, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, URC Eco Ile-de-France / Hôpital Robert Debré, Unité d’épidémiologie Clinique, ; Paris, France

[8 ]GRID grid.7429.8, ISNI 0000000121866389, INSERM, ECEVE UMR 1123, ; Paris, France

[9 ]Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, F-75015 Paris, France

[10 ]GRID grid.410368.8, ISNI 0000 0001 2191 9284, Université Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche Sur Les Services Et Management en Santé) - U 1309, ; Rennes, F-35000 France

[11 ]Centre International de Recherche en Infectiologie, Team GIMAP, Université Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, CIC INSERM 1408 Vaccinologie, CHU de Saint-Etienne, Saint-Etienne, France

[12 ]GRID grid.410527.5, ISNI 0000 0004 1765 1301, Université de Lorraine, CHRU-Nancy, Département Méthodologie, Promotion, Investigation, ; Nancy, F-54000 France

Article

Publisher ID: 15342

DOI: 10.1186/s12889-023-15342-2

PMC ID: 10011782

PubMed ID: 36918854

SO-VID: c1a02c74-3a89-42b2-9bf7-d0c97532b3e2

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 3 February 2022

Date accepted : 28 February 2023

Funding

Funded by: ITMO Cancer AVIESAN (Alliance Nationale pour les Sciences de la Vie et de la Santé/ National Alliance for Life Sciences & Health)

Custom metadata

ScienceOpen disciplines: Public health

Keywords: human papillomavirus,vaccination,knowledge,attitude,health education,middle school professionals,school-based immunization programs,mixed method study

Data availability:

ScienceOpen disciplines: Public health

Keywords: human papillomavirus, vaccination, knowledge, attitude, health education, middle school professionals, school-based immunization programs, mixed method study

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

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Abstract

Background

Methods

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Conclusions

Supplementary Information

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Global Health Next Generation Network

Most cited references 36

Beyond confidence: Development of a measure assessing the 5C psychological antecedents of vaccination

The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey

How Many Focus Groups Are Enough? Building an Evidence Base for Nonprobability Sample Sizes

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