Schoolteachers' Experiences of Implementing School-based Vaccination Programs against Human Papillomavirus in a Chinese Community: A Qualitative Study

"As significant influencers of adolescent students, schoolteachers and schools should receive more support and information on organizing school-based HPV vaccination programs in the future."

In Hong Kong, at the time of writing, the human papillomavirus (HPV) vaccine is optional, and uptake is low. Schools are popular venues for implementing health education and vaccination programmes, yet many adolescents in this country are not adequately informed about the importance of receiving HPV vaccination as a preventive health measure. In this context, and in light of the fact that the health perceptions and behaviour of children and teenagers are influenced by significant others, this study analysed the perceptions of schoolteachers toward HPV vaccination and explored how these perceptions influence schools' motivation in implementing school-based HPV vaccination programmes.

With a Chinese community as the field site of this study, 5 focus group interviews were conducted with 3 male and 32 female schoolteachers from 5 primary and 8 secondary schools in Hong Kong between July 2014 and January 2015. Only 5 participants had received the HPV vaccination, and only one had had her daughter vaccinated.

Barriers to implementing HPV vaccination programmes in schools were:

• Perceptual barriers, including: lack of knowledge regarding HPV vaccination, perception of their students as too young to receive the HPV vaccine, and lack of perceived needs and perceived risk.
• Cultural barriers, including: violation of traditional cultural values (e.g., chastity) and violation of schools' religious beliefs (e.g., Catholicism).
• Institutional barriers, including: opposition from schools (due, for instance, to worries of being blamed by parents for postvaccination adverse events), low priority of HPV vaccination compared with other health education topics, and lack of government support. (Health authorities did not openly promote the importance of HPV vaccination to the public before the government's Policy Address of 2018. However, the government planned to introduce free HPV vaccination to school girls of particular age-groups starting from the 2019/2020 school year.)
• Parental barriers, such as lack of interest.
• Collaborator barriers, such as suspicion of commercial medical companies.

The researchers note that the 5 participants who had received the HPV vaccine had organised HPV vaccination programmes in their schools, which indicates that providing more public health education regarding HPV and HPV vaccination to schoolteachers may empower them to implement school-based vaccination programmes and related health education for students. As compared to the schoolteachers who used the term "cervical cancer vaccine" (to prevent a disease they perceived as irrelevant to their students), these 5 participants had a more positive view, regarding the HPV vaccination programme as a form of health education and brought to their students the message of disease prevention.

The researchers found that the participants deemed non-governmental health organisations and universities to be the most trustworthy and credible institutions. Moreover, the involvement of non-governmental organisations (NGOs) in school-based vaccination programmes achieved an 80% acceptance rate among students and parents. These findings support the adoption of the home-school-doctor model as a meaningful approach to school-based HPV vaccination programmes.

In conclusion: "As students only have limited autonomy in making vaccination decisions and are still undergoing socialization from their significant others, such as schoolteachers, providing public health education regarding HPV and the HPV vaccine to schoolteachers is crucial to enhancing their awareness on the importance of receiving vaccination, which can in turn encourage students to adopt this preventive health behavior."