Title: Increasing parental vaccine confidence and young people’s access to the universal human papillomavirus (HPV) vaccination programme: a co-design study
Funder: Department of Health and Social Care

Abstract: AIM: To co-design with parents who did not provide consent for their adolescent children a multi-component intervention to increase confidence about, and access to, the universal human papillomavirus (HPV) vaccination programme. BACKGROUND: Persistent infection with HPV can result in cancers affecting men and, especially, women. In September 2019, the English schools-based HPV vaccination programme, already delivered to young women, was expanded to include young men aged 12 to 13 years. Seeking verbal telephone consent from parents where consent forms are unreturned overcomes some of the barriers to uptake. However, not all parents respond to phone calls. Parents may also provide written refusal due to negative perceptions of need for, safety and effectiveness of vaccination. Increasing parental confidence about, and access to, the universal HPV vaccination programme may help improve uptake. However, the evidence-base for interventions relevant to schools-based programmes is currently lacking. DESIGN AND METHODS: The first study is an exploratory qualitative study to find ways to improve parental confidence about, and adolescents access to, HPV vaccination from the perspectives of key stakeholders and a purposive sample of parents according to their gender, ethnicity, and whether they actively or passively refused vaccination. The findings will be used to inform the co-design of a preliminary plan for a targeted, multicomponent intervention. In the second study, parent working groups will be convened and will work with creative designers to co-design communication materials in multiple languages (as appropriate) aimed at increasing parents confidence in vaccination. A series of workshops will be organised to obtain feedback on the intervention plan and communication materials to ensure they are fit for purpose. These findings will inform a protocol for a future study to test effectiveness of the multi-component intervention at increasing parental vaccine confidence and uptake of the HPV vaccine. PATIENT AND PUBLIC INVOLVEMENT: The proposal was informed by our earlier qualitative research and also discussed with vaccine-eligible young people and groups of parents in Bristol and London. All PPI groups thought better information for parents is needed. PPI groups suggested that a future intervention could include improving access to evidence-based vaccine information through social media outlets or community advocates, and communication training for healthcare professionals. Ongoing PPI with young people and the parent groups will be incorporated at all stages of the study. This will include providing feedback on: (i) strategies to improve recruitment (e.g. accessing hard to reach parents, use of incentives); (ii) the paperwork we use with people who take part (e.g. invitation letters, topic guides); (iii) developing and improving the communication materials, and; (iv) sharing the study findings. DISSEMINATION: We will work with PPI groups to inform our dissemination strategy and co-present our findings with PPI members (e.g. at a community event or through social media). We will summarise the results in multiple languages (as appropriate) to share with parents who took part in the study. We will also share our findings with academics and healthcare professionals through webinars/academic conferences and peer reviewed publications.

Lay abstract: AIM: To design with parents an intervention that increases parents confidence in vaccination and helps young people receive the human papillomavirus (HPV) vaccine more easily. BACKGROUND: Infection with HPV can lead to cancers affecting both men and women. The HPV vaccination programme is offered to young people when they are in Year 8 at school. Some young people may not receive the vaccine because their consent form was not returned. Other parents may refuse the HPV vaccine for their adolescent child because they think the vaccine is unsafe or unnecessary. Improving the way parents find out about the HPV vaccine and places to get the vaccine may help more young people receive immunisation. However, there is currently little evidence to tell us the best way to do this. DESIGN AND METHODS: There are two parts to the proposed research. In the first part, we will interview parents who did not provide consent for their adolescent child to have the HPV vaccine and key healthcare professionals. During the interview, we will ask parents why their adolescent child was not vaccinated, how we can improve the way parents find out about the HPV vaccine, and ways to make it easier for their adolescent children to have the HPV vaccine. Then, we will design a plan for an intervention according to what they say. In the second part of the study, new communication materials in different languages will be co-designed jointly with a creative designer and parents who did not provide consent for their adolescent children. A series of workshops will be organised to ask for feedback and make changes to the intervention plan and communication materials according to what they say. These can be tested in a future study to see if it increases parents vaccine confidence and helps more young people receive the HPV vaccine. PATIENT AND PUBLIC INVOLVEMENT: We developed this proposal from our findings of previous studies carried out with families and healthcare professionals. We have also consulted with vaccine-eligible young people and groups of parents in Bristol and London about this proposal. All PPI groups agreed better information for parents is needed. Suggestions for future interventions included promoting evidence-based information about the HPV vaccine through social media or with community advocates. We will obtain more feedback about our planned research from parent and young people groups throughout the study. DISSEMINATION: We will work with groups of parents and young people to decide the best way to share our study findings. We will summarise the results in different languages to share with parents who took part in the study. We will also share our findings with other researchers and healthcare professionals through conferences and publications in scientific journals.

Research activity codes: 3.4 VACCINES
Health categories: INFECTION