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Introduction of School-Based HPV Vaccination in Sweden: Knowledge and Attitudes among Youth, Parents, and Staff
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis is to provide a better understanding of knowledge, attitudes, consent, and decision-making regarding Human papillomavirus (HPV) vaccination, seen from the perspectives of concerned parties – high school students, school nurses, and parents.

Two quantitative studies were performed: one descriptive cross-sectional study and one quasi-experimental intervention study. Qualitative studies using focus group interviews and individual interviews were also performed.

High school students’ knowledge about HPV and HPV prevention was low but their attitudes toward HPV vaccination were positive. An educational intervention significantly increased the students’ knowledge regarding HPV and HPV prevention. Their already positive attitudes toward condom use and HPV vaccination remained unchanged. The students wanted to receive more information about HPV from school nurses. The school nurses were also positive to HPV vaccination but identified many challenges concerning e.g. priorities, obtaining informed consent, culture, and gender. They saw an ethical dilemma in conflicting values such as the child’s right to self-determination, the parents’ right to make autonomous choices on behalf of their children, and the nurse’s obligation to promote health. They were also unsure of how, what, and to whom information about HPV should be given. Parents, who had consented to vaccination of their young daughters, reasoned as follows: A vaccine recommended by the authorities is likely to be safe and effective, and the parents were willing to do what they could to decrease the risk of a serious disease for their daughter. Fear of unknown adverse events was overweighed by the benefits of vaccination. Parents also saw the school nurse as an important source of HPV information.

Conclusions: Positive attitudes toward HPV vaccination despite limited knowledge about HPV, are overarching themes in this thesis. School nurses have a crucial role to inform about HPV prevention. It is important that the concerned parties are adequately informed about HPV and its preventive methods, so that they can make an informed decision about vaccination. A short school-based intervention can increase knowledge about HPV among students. From a public health perspective, high vaccination coverage is important as it can lead to a reduced number of HPV-related disease cases. 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. , 62 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 962
Keyword [en]
Human papillomavirus, HPV, cervical cancer, vaccination, condom use, adolescents, school-nurses, parents, knowledge, attitudes, intervention
National Category
Medical and Health Sciences Medical Ethics Nursing
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-212886ISBN: 978-91-554-8836-9 (print)OAI: oai:DiVA.org:uu-212886DiVA: diva2:683776
Public defence
2014-02-21, Gustavianum, Auditorium Minus, Akademigatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Funder
Swedish Cancer Society
Available from: 2014-01-31 Created: 2013-12-16 Last updated: 2014-02-10
List of papers
1. High HPV vaccine acceptance despite low awareness among Swedish upper secondary school students
Open this publication in new window or tab >>High HPV vaccine acceptance despite low awareness among Swedish upper secondary school students
2009 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 14, no 6, 399-405 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate knowledge of human papillomavirus (HPV) and attitudes to HPV vaccination and condom use among Swedish first year upper secondary school students. METHODS: Classroom questionnaire filled in by 608 students from a strategic sample of seven upper secondary schools in Sweden. RESULTS: Only 13.5% (n = 82) of the students had heard about HPV and 6% (n = 35) were aware of HPV vaccination. As many as 84% (n = 508) would like to be vaccinated against HPV. The high cost of vaccination was the greatest obstacle (total group 37%, n = 227); among girls the second major hindrance was the fear of needles (19%, n = 65). Before considering an HPV vaccination 73% (n = 443) wanted more information and 36% (n = 220) would like to receive such information from the school nurse. The students considered it less likely that they would use a condom when having intercourse with a new partner if they were vaccinated than if they were not (p < 0.001). CONCLUSION: Despite intensive marketing directed at potential vaccine consumers, knowledge of HPV and of HPV vaccines was very low among first year upper secondary school students. Their attitude towards vaccination was positive but most of them wanted more information before considering vaccination.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-111802 (URN)10.3109/13625180903229605 (DOI)000277147900004 ()19929642 (PubMedID)
Available from: 2009-12-22 Created: 2009-12-22 Last updated: 2017-12-12Bibliographically approved
2. Knowledge of human papillomavirus among high school students can be increased by an educational intervention
Open this publication in new window or tab >>Knowledge of human papillomavirus among high school students can be increased by an educational intervention
2010 (English)In: International Journal of STD and AIDS (London), ISSN 0956-4624, E-ISSN 1758-1052, Vol. 21, no 8, 558-562 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to evaluate the effect of an educational intervention concerning human papillomavirus (HPV) directed at Swedish first year high school students. The intervention consisted of a class room lesson, a website and a folder. Outcome variables were knowledge of HPV and attitudes to preventive methods such as HPV vaccination, condom use and Pap smear testing. An intervention group (n = 92) was matched with two comparison groups (n = 184). At baseline, the median score for HPV knowledge was one out of 10 in both groups. At follow-up, the median knowledge score had increased to six in the intervention group, but was still one in the comparison group (P < 0.001). Attitudes to HPV vaccination, condom use and Pap smear testing remained the same (P > 0.05). In conclusion, a short school-based intervention can greatly increase the students' knowledge about HPV, but attitudes and behaviours are less easy to influence.

Keyword
hpv, knowledge, adolescent, intervention, HPV vaccine, prevention, condom
National Category
Dermatology and Venereal Diseases
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-132897 (URN)10.1258/ijsa.2010.010063 (DOI)000284445200006 ()20975088 (PubMedID)
Projects
HPV projekt
Available from: 2010-10-28 Created: 2010-10-28 Last updated: 2017-12-12Bibliographically approved
3. Challenges and opportunities of a new HPV immunization program: Perceptions among swedish school nurses
Open this publication in new window or tab >>Challenges and opportunities of a new HPV immunization program: Perceptions among swedish school nurses
Show others...
2011 (English)In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 29, 4576-4583 p.Article in journal (Refereed) Published
Abstract [en]

Aim To investigate school nurses’ perceptions of HPV immunization, and their task of administering the vaccine in a planned school-based program in Sweden. Method: Data were collected through five focus group interviews with school nurses (n = 30). The interviews were recorded, transcribed verbatim and analyzed using content analysis.

Findings The theme Positive attitude to HPV immunization despite many identified problems and challenges summarizes the results. The school nurses saw the program as a benefit in that the free school-based HPV immunization program could balance out social inequalities. However, they questioned whether this new immunization program should be given priority given their already tight schedule. Some also expressed doubts regarding the effect of the vaccine. It was seen as challenging to obtain informed consent as well as to provide information regarding the vaccine. The nurses were unsure of whether boys and their parents should also be informed about the immunization.

Conclusion Although some positive aspects of the new HPV immunization program were mentioned, the school nurses primarily identified problems and challenges; e.g. regarding priority setting, informed consent, culture and gender. In order to achieve a good work environment for the school nurses, and obtain a high coverage rate for the HPV immunization, these issues need to be taken seriously, be discussed and acted upon.

Keyword
HPV, Vaccination, School nurses, Focus groups, Dilemmas, Gender
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-153525 (URN)10.1016/j.vaccine.2011.04.054 (DOI)000292471700006 ()
Available from: 2011-05-14 Created: 2011-05-14 Last updated: 2017-12-11Bibliographically approved
4. Informed Consent for HPV Vaccination: A Relational Approach
Open this publication in new window or tab >>Informed Consent for HPV Vaccination: A Relational Approach
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2015 (English)In: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 23, no 1, 50-62 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to explore the relational aspects of the consent process for HPV vaccination as experienced by school nurses, based on the assumption that individuals have interests related to persons close to them, which is not necessarily to be apprehended as a restriction of autonomy; rather as a voluntary and emotionally preferred involvement of their close ones. Thirty Swedish school nurses were interviewed in five focus groups, before the school based vaccination program had started in Sweden. The empirical results were discussed in light of theories on relational autonomy. The school nurses were convinced that parental consent was needed for HPV vaccination of 11-year-old girls, but problems identified were the difficulty to judge when a young person is to be regarded as autonomous and what to do when children and parents do not agree on the decision. A solution suggested was that obtaining informed consent in school nursing is to be seen as a deliberative process, including the child, the parents and the nurse. The nurses described how they were willing strive for a dialogue with the parents and negotiate with them in the consent process. Seeing autonomy as relational might allow for a more dialogical approach towards how consent is obtained in school based vaccination programs. Through such an approach, conflicts of interests can be made visible and become possible to deal with in a negotiating dialogue. If the school nurses do not focus exclusively on accepting the individual parent's choice, but strive to engage in a process of communication and deliberation, the autonomy of the child might increase and power inequalities might be reduced.

National Category
Medical Ethics
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-212366 (URN)10.1007/s10728-012-0237-9 (DOI)000348414900004 ()23275146 (PubMedID)
Available from: 2013-12-16 Created: 2013-12-09 Last updated: 2017-12-06Bibliographically approved
5. Trust versus concerns: how parents reason when they accept HPV vaccination for their young daughter
Open this publication in new window or tab >>Trust versus concerns: how parents reason when they accept HPV vaccination for their young daughter
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2013 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 118, no 4, 263-270 p.Article in journal (Refereed) Published
Abstract [en]

Background. From spring of 2012, human papillomavirus (HPV) vaccine against cervical cancer is offered free of charge to all girls aged 10-12 years through a school-based vaccination programme in Sweden. The aim of this study was to explore how parents reason when they accept HPV vaccination for their young daughter and also their views on HPV-related information. Methods. Individual interviews with parents (n = 27) of 11-12-year-old girls. The interviews were recorded, transcribed verbatim, and analysed using thematic content analysis. Results. Three themes emerged through the analysis: Trust versus concern, Responsibility to protect against severe disease, and Information about HPV and HPV vaccination is important. The parents expressed trust in recommendations from authorities and thought it was convenient with school-based vaccination. They believed that cervical cancer was a severe disease and felt a responsibility to protect their daughter from it. Some had certain concerns regarding side effects and vaccine safety, and wished for a dialogue with the school nurse to bridge the information gaps. Conclusions. Trust in the recommendations from authorities and a wish to protect their daughter from a severe disease outweighed concerns about side effects. A school-based vaccination programme is convenient for parents, and the school nurse has an important role in bridging information gaps. The findings from this qualitative study cannot be generalized; however, it can provide a better understanding of how parents might reason when they accept the HPV vaccination for their daughter.

Keyword
Decision-making, HPV vaccination, parents, school-based vaccination, school nurses
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-210566 (URN)10.3109/03009734.2013.809039 (DOI)000325527300009 ()23777602 (PubMedID)
Note

De två första författarna delar förstaförfattarskapet.

Available from: 2013-11-13 Created: 2013-11-11 Last updated: 2017-12-06Bibliographically approved

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