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      School nurses' experiences of delivering the UK HPV vaccination programme in its first year

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          Abstract

          Background

          In the United Kingdom (UK) in September 2008, school nurses began delivering the HPV immunisation programme for girls aged 12 and 13 years old. This study offers insights from school nurses' perspectives and experiences of delivering this new vaccination programme.

          Methods

          Thirty in-depth telephone interviews were conducted with school nurses working across the UK between September 2008 and May 2009. This time period covers the first year of the HPV vaccination programme in schools. School nurses were recruited via GP practices, the internet and posters targeted at school nurse practitioners.

          Results

          All the school nurses spoke of readying themselves for a deluge of phone calls from concerned parents, but found that in fact few parents telephoned to ask for more information or express their concerns about the HPV vaccine. Several school nurses mentioned a lack of planning by policy makers and stated that at its introduction they felt ill prepared. The impact on school nurses' workload was spoken about at length by all the school nurses. They believed that the programme had vastly increased their workload leading them to cut back on their core activities and the time they could dedicate to offering support to vulnerable pupils.

          Conclusion

          Overall the first year of the implementation of the HPV vaccination programme in the UK has exceeded school nurses' expectations and some of its success may be attributed to the school nurses' commitment to the programme. It is also the case that other factors, including positive newsprint media reporting that accompanied the introduction of the HPV vaccination programme may have played a role. Nevertheless, school nurses also believed that the programme had vastly increased their workload leading them to cut back on their core activities and as such they could no longer dedicate time to offer support to vulnerable pupils. This unintentional aspect of the programme may be worthy of further exploration.

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          Most cited references14

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          Future acceptance of adolescent human papillomavirus vaccination: a survey of parental attitudes.

          Loretta Brabin, Farah Farzaneh, Craig S. Roberts … (2006)
          The main target group for vaccination against human papillomavirus (HPV), the sexually transmitted virus that causes cervical cancer, will be young adolescents. We undertook a population-based survey to assess parental consent and potential HPV vaccine uptake in eight secondary schools using stratified randomisation according to school type and ethnicity. Our results suggest that in socially and ethnically mixed populations such as Manchester, an HPV vaccine uptake rate of 80% may be achievable if the vaccine is perceived to be safe and effective. However, most parents lack knowledge about HPV and some are concerned about sexual health issues that would arise as part of a HPV vaccine programme. It will be important to raise general awareness of the role of HPV in cervical cancer without stigmatizing the vaccine.
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            Why do parents decide against immunization? The effect of health beliefs and health professionals.

            M Smailbegovic, Nigel G. Laing, H Bedford (2003)
            To explore the knowledge, attitudes and concerns with respect to immunization and vaccine-preventable infections in parents whose children have not completed the recommended course of immunization. Parents of children resident in the London Borough of Hackney. Children born between 1 January 1999 and 15 February 1999 were identified from the child health database, and cases were defined as those who had defaulted for one or more primary immunization by 18 months of age. After validation of immunization status from health records, questionnaires were sent to parents. Ten respondents from this sample were interviewed. Questionnaires were sent to 129 parents of children identified as not completing the recommended immunization course. Nine questionnaires were returned 'address unknown', and 76 parents returned the completed questionnaire. The response rate from known residents was 76/110 (69%). Eight parents stated that their child had been immunized, leaving 68 questionnaires available for further analysis. Measles, mumps, rubella (MMR) and meningococcal C were most frequently omitted, usually because of concerns about vaccine safety. Twenty-three out of 68 respondents perceived that having their child immunized with a particular vaccine was more risky than non-immunization, particularly for MMR and meningococcal C vaccines. Those who agreed to be interviewed were notably concerned about the MMR vaccine, but not immunization in general. They perceived the information provided by health professionals to be poor. The decision-making process around childhood immunization is complex. Parents require information that is up to date, tailored to their individual needs and provided by health professionals who are well informed.
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              A qualitative study to assess school nurses' views on vaccinating 12–13 year old school girls against human papillomavirus without parental consent

              Rebecca Stretch, Rosemary McCann, Stephen Roberts … (2009)
              Background In the UK, parental consent for the routine vaccination of 12–13 year olds schoolgirls against human papillomavirus (HPV) is recommended, although legally girls may be able to consent themselves. As part of a vaccine study conducted ahead of the National HPV Vaccine Programme we sought the views of school nurses on vaccinating girls who did not have parental consent. Methods HPV vaccination was offered to all 12 year old girls attending schools in two Primary Care Trusts in Greater Manchester. At the end of the study semi-structured, tape-recorded interviews were conducted with school nurses who had delivered the vaccine (Cervarix™). The interview template was based on concepts derived from the Theory of Planned Behaviour. Transcripts were analysed thematically in order to understand school nurses' intentions to implement vaccination based on an assessment of Gillick competency. Results School nurses knew how to assess the competency of under-16s but were still unwilling to vaccinate if parents had refused permission. If parents had not returned the consent form, school nurses were willing to contact parents, and also to negotiate with parents who had refused consent. They seemed unaware that parental involvement required the child's consent to avoid breaking confidentiality. Nurses' attitudes were influenced by the young appearance and age of the school year group rather than an individual's level of maturity. They were also confused about the legal guidelines governing consent. School nurses acknowledged the child's right to vaccination and strongly supported prevention of HPV infection but ultimately believed that it was the parents' right to give consent. Most were themselves parents and shared other parents' concerns about the vaccine's novelty and unknown long-term side effects. Rather than vaccinate without parental consent, school nurses would defer vaccination. Conclusion Health providers have a duty of care to girls for whom no parental consent for HPV vaccination has been given, and in the UK, this includes conducting, and acting upon, an assessment of the maturity and competence of an adolescent minor. To facilitate this, policies, training and support structures for health providers should be implemented.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMC Infect Dis
                Title: BMC Infectious Diseases
                Publisher: BioMed Central
                ISSN (Electronic): 1471-2334
                Publication date Collection: 2011
                Publication date (Electronic): 24 August 2011
                Volume: 11
                Page: 226
                Affiliations
                [1 ]MRC CSO Social and Public Health Sciences Unit, Glasgow, UK
                [2 ]Centre for Epidemiology and Biostatistics, Institute of Child Health, London, UK
                [3 ]London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
                Article
                Publisher ID: 1471-2334-11-226
                DOI: 10.1186/1471-2334-11-226
                PMC ID: 3176210
                PubMed ID: 21864404
                SO-VID: eb2414e3-0472-48df-a98f-07396f5216a8
                Copyright © Copyright ©2011 Hilton et al; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 30 September 2010
                Date accepted : 24 August 2011
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: hpv vaccination,cervical,cancer,school nurses
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: hpv vaccination, cervical, cancer, school nurses

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