Co-production of an educational package for the universal HPV vaccination programme tailored for schools with low uptake: A participatory study

BACKGROUND: Infection with HPV can lead to cancers affecting men and women. From September 2019, the schools-based HPV vaccination programme, already delivered to young women, will include young men aged 12 to 13 years. Our research shows some areas and population groups have lower coverage. Some young women attending schools where vaccination coverage is low had unmet information needs about HPV vaccination which may stop them receiving the vaccine.

AIMS: To develop an educational package with young people, that can be used within the adolescent schools-based vaccination programme, tailored to increase vaccine coverage in areas and populations with lower uptake. We will also find out whether it would be possible to undertake a larger scale study to test whether the education package helps increase young people's understanding about the HPV vaccine, their involvement in the decision-making process, and whether this leads to an increase in how many young people receive the vaccine in schools with lower coverage.

RESEARCH PLAN: Recruitment of participants will take place through healthcare organisations, youth groups and schools in areas where HPV vaccination coverage is low. The research has three stages. In Stage One, we will review existing immunisation materials for young people. We will also talk to young people aged 12 to 15 years and other key stakeholders (NHS commissioners, immunisation nurses, youth workers/practitioners, & school staff) to find out who they think should deliver the educational package and what the content should be.

In Stage Two, creative designers from Eight media agency and young people (n=6) from Creative Youth Network will co-produce the content and materials (e.g. videos, power points) for the educational package. A workshop will be organised in a youth organisation where young people (6-8) are asked to comment on important vaccine messages and the best way to deliver the messages. The co-production team will produce materials using the feedback from participants. Three more workshops in additional youth organisations (18-24) will be organised to obtain further feedback. The co-production team will make changes to the materials according to what the young people say until they are fit for purpose. Using the findings from Stages One and Two, we will develop a theory to explain how we think the educational package is supposed to work.

In Stage Three, we will undertake some preliminary testing of the educational package; focussing on how it can be delivered in schools and whether it is acceptable to young people and key stakeholders. We will invite schools (n=4) with lower coverage of the HPV vaccination programme in the South West of England and South London to take part. At this stage, we think the educational package will last about an hour and will be delivered to Year 8 students about two weeks before the vaccination session. The session will aim to create a safe space for young people to ask questions they have about the HPV vaccine and what to expect during the vaccination process.

We will observe the delivery of the education package and carry out more interviews with young people and key stakeholders. This will help us find out whether the educational session is delivered as intended, which parts work well, and which parts do not work well, and why. We will also test ways of getting feedback from young people and find out whether it is possible to collect information about types of consent obtained from the immunisation team.

STUDY FINDINGS: To share the results of the study we will organise a workshop with young people and key stakeholders (NHS commissioners, immunisation nurses, youth workers/practitioners, & school staff) and a webinar. The findings will be published in academic journals and presented at conferences. We will finalise the theory we developed and make recommendations about whether to carry out a future study with a larger number of schools.

BACKGROUND: Persistent infection with HPV can result in cancers affecting men and women. From September 2019, the English schools-based HPV vaccination programme, already delivered to young women, will be expanded to include young men aged 12 to 13 years. Our research to date has identified lower uptake by geographical area and among different population groups, including minority ethnic groups. Some young women attending schools with lower uptake have unmet information needs. We hypothesise that mechanisms to address information needs and increase young people's autonomy in consent procedures will result in higher uptake.

AIM: To co-produce with young people an educational package about the HPV vaccine tailored at increasing vaccine uptake in schools and populations with lower uptake.

RESEARCH PLAN: The MRC framework for development and evaluation of complex interventions will inform intervention development. Recruitment of young people aged 12 to 15 years and key stakeholders (NHS commissioners, school staff, immunisation nurses, youth workers/practitioners) will be facilitated through existing links with healthcare organisations, and schools and youth community organisations in areas with lower uptake of the HPV vaccination programme. The proposed research will comprise three phases: (i) a rapid review of adolescent immunisation materials and preliminary qualitative interviews with young people and key stakeholders; (ii) theory development and co-production of HPV vaccine communication materials in an iterative process with young people, and; (iii) testing delivery mechanisms and acceptability of the educational package in four schools with lower uptake.

STUDY FINDINGS: A dissemination event for young people and key stakeholders and webinar with the National Immunisation Network will be organised. The study findings will be published in peer-reviewed journals and presented at conferences. Recommendations for a future larger-scale study will be made.

If our longer-term planned programme of research is successful, the educational package could be made available nationally to benefit young people, schools and healthcare organisations. Young people may benefit from being empowered to make positive decisions which can help protect their health. If they are immunised against HPV, they will receive protection against an infectious disease that can lead to the development HPV-related cancers and genital warts. This will help NHS England and Public Health England strengthen their longer-term objective for the HPV vaccination programme to eliminate HPV-related cancers and genital warts. Young people may also be empowered to make other positive health-related decisions in the future, such as for the MenACWY and Tdap routine adolescent vaccination programmes.

Health and school professionals involved in the delivery of the HPV vaccination programme may benefit. Young people may engage more positively with the consent procedures than our previous research has shown. This could reduce the organisational burden to school staff in relation to sending reminders (e.g. phone calls, text messages, face-to-face contact) and students and parents to return consent forms. Impact on the immunisation teams' time obtaining parental verbal consent for students without completed consent forms may be minimised. Immunisation nurses may also feel empowered and more confident to assess young people's Gillick competency in schools where the educational package has been delivered.

Finally, the study could provide a model for research into future educational packages for other adolescent vaccination programmes and other health programmes with a schools-based model of delivery.