School nurses' attitudes and experiences regarding the human papillomavirus vaccination programme in Sweden: a population-based survey

Maria Grandahl, Tanja Tydén, Andreas Rosenblad, Marie Oscarsson, Tryggve Nevéus, Christina Stenhammar, Maria Grandahl, Tanja Tydén, Andreas Rosenblad, Marie Oscarsson, Tryggve Nevéus, Christina Stenhammar

Abstract

Background: Sweden introduced a school-based human papillomavirus (HPV) vaccination programme in 2012, and school nurses are responsible for managing the vaccinations. The aim of the present study was to investigate the attitudes and experiences of school nurses regarding the school-based HPV vaccination programme 1 year after its implementation.

Methods: Data were collected using a web-based questionnaire in the spring of 2013, and 83.1% (851/1024) of nurses responded.

Results: There were strong associations between the nurses' education about the HPV vaccine and their perceived knowledge about the vaccine and a favourable attitude towards vaccination (both p < 0.001). School nurses who received a high level of education were more likely to have a positive attitude to HPV vaccination compared with nurses with little education about HPV vaccination (adjusted odds ratio [OR] = 9.8; 95% confidence interval [CI]: 3.797-25.132). Nurses with high perceived knowledge were more likely to have a positive attitude compared with those with a low level of perceived knowledge (OR = 2.5; 95% CI: 1.299-4.955). If financial support from the government was used to fund an additional school nurse, nurses were more likely to have a positive attitude than if the financial support was not used to cover the extra expenses incurred by the HPV vaccination (OR = 2.1; 95% CI: 1.051-4.010). The majority, 648 (76.1%), had been contacted by parents with questions about the vaccine, mostly related to adverse effects. In addition, 570 (66.9%) stated that they had experienced difficulties with the vaccinations, and 337 (59.1%) of these considered the task to be time-consuming.

Conclusions: A high level of education and perceived good knowledge about HPV are associated with a positive attitude of school nurses to the HPV vaccination programme. Thus, nurses require adequate knowledge, education, skills and time to address the questions and concerns of parents, as well as providing information about HPV. Strategic financial support is required because HPV vaccination is a complex and time-consuming task.

References

    1. World Health Organization. Department of Immunization VaB. Report of the HPV Vaccine Delivery Meeting Identifying Needs for Implementation & Research Geneva, 17-19 April 2012. Geneva, Switzerland: World Health Organization; 2012. [ ]
    1. LaMontagne DS, Barge S, Le NT, Mugisha E, Penny ME, Gandhi S, Janmohamed A, Kumakech E, Mosqueira NR, Nguyen NQ, Paul P, Tang Y, Minh TH, Uttekar BP, Jumaan AO. Human papillomavirus vaccine delivery strategies that achieved high coverage in low- and middle-income countries. Bull World Health Organ. 2011;89:821–30B. doi: 10.2471/BLT.11.08986.
    1. Markowitz LE, Tsu V, Deeks SL, Cubie H, Wang SA, Vicari AS, Brotherton JM. Human papillomavirus vaccine introduction – the first five years. Vaccine. 2012;30(Suppl 5):F139–F148.
    1. Paul P, Fabio A. Literature review of HPV vaccine delivery strategies: Considerations for school- and non-school based immunization program. Vaccine. 2014;9(3):320–326.
    1. Australian Government Department of Health. Immunise Australia Program. Human Papillomavirus (HPV) [ ]
    1. Human Papillomavirus (HPV) Vaccine Uptake Annual Survey 2010/2011. Department of Health. [ ]
    1. Public Health Agency of Sweden. Statistics for HPV vaccinations. [ ]
    1. Swedish Association of Local Authorities and Regions. Consent form HPV vaccination. Stockholm, Sweden: Swedish Association of Local Authorities and Regions [Sveriges Kommuner och Landsting, SKL] 2013. [ ]
    1. Gottvall M, Tyden T, Larsson M, Stenhammar C, Hoglund AT. Challenges and opportunities of a new HPV immunization program perceptions among Swedish school nurses. Vaccine. 2011;29:4576–4583. doi: 10.1016/j.vaccine.2011.04.054.
    1. Hilton S, Hunt K, Bedford H, Petticrew M. School nurses’ experiences of delivering the UK HPV vaccination programme in its first year. BMC Infect Dis. 2011;11:226. doi: 10.1186/1471-2334-11-226.
    1. Boyce T, Holmes A. Addressing health inequalities in the delivery of the human papillomavirus vaccination programme: examining the role of the school nurse. PLoS One. 2012;7(9):e43416. doi: 10.1371/journal.pone.0043416.
    1. Ogilvie G, Anderson M, Marra F, McNeil S, Pielak K, Dawar M, McIvor M, Ehlen T, Dobson S, Money D, Patrick DM, Naus M. A population-based evaluation of a publicly funded, school-based HPV vaccine program in British Columbia, Canada: parental factors associated with HPV vaccine receipt. PLoS Med. 2010;7(5):e1000270. doi: 10.1371/journal.pmed.1000270.
    1. Streiner DL, Norman GR. Health measurement scales: a practical guide to their development and use. 4. New York: Oxford University Press; 2008.
    1. Zimet GD, Rosberger Z, Fisher WA, Perez S, Stupiansky NW. Beliefs, behaviors and HPV vaccine: correcting the myths and the misinformation. Prev Med. 2013;57(5):414–418. doi: 10.1016/j.ypmed.2013.05.013.
    1. Tafuri S, Martinelli D, Vece MM, Quarto M, Germinario C, Prato R. Communication skills in HPV prevention: an audit among Italian healthcare workers. Vaccine. 2010;28(34):5609–5613. doi: 10.1016/j.vaccine.2010.06.028.
    1. Gottvall M, Grandahl M, Höglund AT, Larsson M, Stenhammar C, Andrae B, Tydén T. Trust versus concerns – how parents reason when they accept HPV vaccination for their young daughter. Ups J Med Sci. 2013;118:263–270. doi: 10.3109/03009734.2013.809039.
    1. Grandahl M, Oscarsson M, Stenhammar C, Nevéus T, Westerling R, Tydén T. Not the right time: why parents refuse to let their daughters have the human papillomavirus vaccination. Acta Paediatr. 2014;103(4):436–441. doi: 10.1111/apa.12545.
    1. Brewer NT, Gottlieb SL, Reiter PL, Liddon N, Markowitz L, Smith JS. Longitudinal predictors of human papillomavirus vaccine initiation among adolescent girls in a high-risk geographic. Sex Transm Dis. 2011;38(3):197–204. doi: 10.1097/OLQ.0b013e3181f12dbf.
    1. Mullins TL, Griffioen AM, Glynn S, Zimet GD, Rosenthal SL, Fortenberry JD, Kahn JA. Human papillomavirus vaccine communication: perspectives of 11–12 year-old girls, mothers, and clinicians. Vaccine. 2013;31(42):4894–4901. doi: 10.1016/j.vaccine.2013.07.033.
    1. Arnheim-Dahlstrom L, Pasternak B, Svanstrom H, Sparen P, Hviid A. Autoimmune, neurological, and venous thromboembolic adverse events after immunisation of adolescent girls with quadrivalent human papillomavirus vaccine in Denmark and Sweden: cohort study. BMJ. 2013;347:f5906. doi: 10.1136/bmj.f5906.
    1. Brabin L, Stretch R, Roberts SA, Elton P, Baxter D, McCann R. The school nurse, the school and HPV vaccination: a qualitative study of factors affecting HPV vaccine uptake. Vaccine. 2011;29:3192–3196. doi: 10.1016/j.vaccine.2011.02.038.
    1. Malmqvist E, Helgesson G, Lehtinen J, Natunen K, Lehtinen M. The ethics of implementing human papillomavirus vaccination in developed countries. Med Health Care Philos. 2011;14:19–27. doi: 10.1007/s11019-010-9285-9.
    1. Malmqvist E, Natunen K, Lehtinen M, Helgesson G. Just implementation of human papillomavirus vaccination. J Med Ethics. 2012;38:247–249. doi: 10.1136/medethics-2011-100090.
    1. Dawson A. The moral case for the routine vaccination of children in developed and Developing countries. Health Aff. 2011;30(6):1029–1033. doi: 10.1377/hlthaff.2011.0301.

Source: PubMed

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