Factors influencing human papillomavirus school-based immunization in Alberta: a qualitative inquiry

While human papillomavirus (HPV) infections and associated cancers are preventable through immunization, vaccine coverage for school-aged boys and girls remains suboptimal in Alberta and across Canada. To reconcile this coverage gap and inform Alberta's school-based HPV immunization program, this study looks to understand barriers and enablers of immunization, how they vary across health zones and population groups, and summarize recommendations to overcome these barriers.

Virtual interviews were conducted with members of the Healthier Together Panel of Albertans who were parents/guardians of school-aged children (11-17 years old). Program stakeholders (e.g., leaders, front-line workers) were separately invited to participate in virtual focus groups. Development of study materials and data analysis were guided by the Conceptual Framework of Access to Health Care. Template thematic analysis was used to analyze the interview and focus group data.

Enablers of HPV immunization included convenience of the school-based program, normalization of the vaccine alongside other routine vaccines, relationship building with schools, parents/guardians, and communities, messaging that included personal stories, and youth engagement. Barriers included gaps in HPV knowledge, perceived lack of trust and transparency, links to sexual activity, consent processes, language barriers, and immunization anxiety. Key recommendations included addressing gaps in HPV messaging, changing the method of program material distribution, employing strategies to reduce immunization anxiety, and continuing to build relationships with parents/guardians, schools, and communities.

A need to improve HPV messaging to address knowledge gaps and misconceptions was identified. Future work could consider perspectives from other providers, including family physicians and pharmacists.