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Which changes in adolescents' knowledge, attitudes, and practices following a school-based intervention in France
Amanda Munoz1, Amandine Gagneux-Brunon2, Anne-Sophie Le Duc-Banaszuk3
1Emerging Disease Epidemiology Unit, Institut Pasteur, Université Paris Cité, 25 rue du Dr Roux, 75015 Paris, France.
Background:
In France, human papillomavirus vaccine (HPVV) coverage among adolescents remains below the national objective. The PrevHPV randomised trial assessed three intervention components to improve HPVV coverage among adolescents: educational and motivational activities (EMM); vaccination campaigns (FA) in middle schools; and General Practitioner (GP) training. FA increased vaccine uptake, while EMM improved vaccine uptake or intention, as well as HPVV-related knowledge, attitudes, and practices (KAP). This secondary analysis aimed to assess whether the positive effect of EMM on HPVV uptake or intention was mediated by specific KAP improvements.
Methods:
A total of 2758 adolescents aged 13 to 15 years from 39 schools completed online questionnaires at baseline and 5 months post-intervention. We created binary variables for the outcome "gain in vaccine uptake or intention during follow-up" and for favourable changes in individual KAP items. We used mediation analyses to evaluate indirect effects of individual KAP items on the association between EMM and uptake/intention, adjusting for FA and GP components and accounting for school-level clustering.
Results:
EMM was associated with an increase in HPVV uptake or intention (OR:1.57, 95% CI: 1.02-2.41). The strongest significant mediation effects occurred via improved attitudes toward the vaccine's benefit-risk balance (indirect effect ORIE:1.14), vaccine safety (ORIE:1.12) and accessibility (ORIE:1.11), as well as for having discussed HPV vaccination with friends (ORIE:1.11) and for higher self-rated level of knowledge about the vaccine (ORIE:1.10).
Conclusion:
These results help understanding the specific positive effects of co-constructed in-class educational activities and underpin the importance of improving vaccine-related attitudes - not only knowledge.
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