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P23 - Implementation evaluation of school-based interventions to improve HPV vaccine coverage in France: results of a mixed-method study embedded in the PrevHPV randomized controlled trial. Evaluation de l'implémentation d'interventions en milieu scolaire visant à améliorer la couverture vaccinale HPV en France : résultats d'une étude mixte au sein de l'essai contrôlé randomisé PrevHPV
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Edité par CCSD ; Elsevier Masson -
International audience. Background and objective(s)Human papillomavirus (HPV) vaccine coverage (VC) remains lower than expected in many countries, particularly France. In 2018, the French authorities launched the PrevHPV research program to codevelop school- and primary care-based interventions with stakeholders and evaluate their effectiveness and implementation. The school-based interventions were ‘education and motivation’ and ‘at-school vaccination’. Analyses, without considering the dose of intervention received, showed that only the ‘at-school vaccination’ intervention significantly increased VC at two months. Implementation weaknesses may negatively impact effectiveness; therefore, it is worth having an in-depth understanding of the intervention implementation. This investigation aimed to evaluate the implementation of the school-based interventions of the PrevHPV program.Material and MethodsWe carried out a mixed-method study embedded in the national cluster randomized controlled trial PrevHPV (July 2021-June 2022). The cluster was the municipality (n=91). The ‘education and motivation’ intervention consisted (i) for parents, of a web conference on HPV infection and vaccination; and, (ii) for 8th–9th grade pupils, of two educational group sessions on those topics during school hours, using participatory learning and e-health tools. The ‘at-school vaccination’ intervention consisted of offering free vaccination to all pupils whose parents agreed on school premises. Quantitative data were collected through standardized activity reports and self-administered questionnaires; the implementation outcomes were fidelity, dose, reach, acceptability and sustainability. Qualitative data were collected through semi-structured group interviews with school staff and analyzed using the Consolidated Framework for Implementation Research.ResultsWe found high rates for: fidelity (e.g., 69% of the targeted classes had two sessions and 89% of schools invited all pupils for at-school vaccination); acceptability (e.g., pupils’ attentiveness and participation satisfying in 90% of the sessions, 96% of vaccinated pupils and 78% of school staff satisfied with the organization of vaccination days); and sustainability (e.g., 91% and 76% of participating schools considered conducting sessions and vaccination days the following year, respectively). However, the withdrawal of 1/3 of schools before the trial started and difficulties in mobilizing parents (e.g., <1% of invited parents participated in a web conference) negatively impacted dose and reach. Facilitators of and barriers to the implementation related to the intervention content and format, the characteristics of both the external and internal environment of the school, the numerous stakeholders and individuals involved, and the implementation strategies used. Facilitators included well-designed provided tools, supportive regulations, motivated leaders, and the presence of an external facilitator; barriers included staff workload, financial and material resources.ConclusionSchools can play a significant role in HPV vaccine promotion but are challenging settings for implementation. This study highlights challenges for involving stakeholders (parents, school staff) and the organizational changes this implies. This study has practical implications for implementing such interventions in real life, which is more valuable since HPV vaccination has been offered at school to all French 7th-grade pupils since 2023.
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