The Impact of a School-Based Multicomponent Intervention for Promoting Vaccine Uptake in Italian Adolescents: A Retrospective Cohort Study

School-based health promotion programmes have been found to be an effective strategy for improving knowledge and attitudes around, as well as access to, adolescent immunisation. In Italy, the Public Health Institute of the Università Cattolica del Sacro Cuore of Rome designed a project called "VacciniAmo le Scuole" ("We vaccinate the schools"), which proposes to evaluate and enhance parents' and students' knowledge and attitudes of prevention regarding vaccine-preventable diseases (VPDs) in collaboration with the Italian Ministry of Education and local health authorities. The present study evaluates the impact of this school-based multicomponent intervention on the adherence of Italian secondary school students to recommended adolescent vaccines.

The VacciniAmo le Scuole project was conducted in 2015 in 4 secondary schools in 3 Italian regions (Lazio, Basilicata, and Sicily). Each class received a 90-minute health promotion intervention, which included a theoretical introduction and a second, more interactive, component featuring role-play techniques, as well as a pre-post questionnaire. Students' parents received at home a similar questionnaire, which includes a section requesting their informed consent and invitation to a meeting with the project team. After the school interventions, each local health authority arranged to receive students and parents at least one day in their surgery to carry out the recommended vaccinations for adolescents.

The impact of VacciniAmo le Scuole was tested using a retrospective cohort design, comparing the aggregated immunisation coverage in one of the schools in which the project was implemented (intervention school) to a matched school from the same geographical area. Seven hundred and fifty-five resident students in the RM Local Health Authority were included: 265 from the intervention school and 490 from the control school. At baseline, the intervention school had significantly higher immunisation rates for Meningococcal B, but lower ones for the 4th dose of dTap.

After 8 months, a higher percentage of students received the human papillomavirus (HPV) (30.5% vs. 13.8% of females; p = 0.003), Meningococcal C (6.0% vs 2.0%; p = 0.005), and Meningococcal B (14.7% vs 0.3%; p <0.001) vaccines in the intervention school compared with control. The pre-post differences were significant for these vaccines.

The researchers explain these results by pointing to several factors. First, the intervention was carried out using an interactive approach, role play, which the schools reportedly appreciated. Second, the intervention was developed in close collaboration with the local health authority. For this reason, it was tailored according to the local needs, and the entire project team was available to address students', parents', and teachers' concerns regarding vaccination along the project period. Finally, while most  school-based programmes have focused on a specific vaccine (usually HPV), this project was developed to increase the awareness and the coverage of all the recommended vaccination for adolescents.

Despite the higher rate of students receiving at least 1 vaccine in the intervention school (41.2% vs 33.9%) that exceeded the control school in the overall coverage for all the investigated vaccines, both the schools remain far below national targets. One possible reason is that the vaccinations were administered in a different location than in the ambulatory of the school. According to the researchers, this reason should be taken into strong consideration when implementing a school-based health promotion programme.

In conclusion: "The Local Health Authorities should implement and evaluate similar school-based interventions to give Italian students trustworthy information regarding vaccination and, consequently, being protected against vaccine preventable diseases. Better results could be reach[ed by] offering the vaccination in school facilities."