School teachers’ perspectives on adolescent human papillomavirus (HPV) vaccination and willingness to recommend the HPV vaccine: A systematic review
Introduction
School nurses are uniquely positioned to educate students about the prevention of sexually transmitted infections such as human papillomavirus (HPV) vaccination, but schools often experience absence of nurses for different reasons. In lieu of school nurses, teachers who closely interact with students and are traditionally well trusted figures by parents may be able to communicate HPV vaccination to students and alleviate parental vaccine hesitancy to increase adolescent uptake of the HPV vaccine. In this systematic review, we explored school teachers’ perspectives on adolescent HPV vaccination and factors associated with their willingness to recommend the HPV vaccine to students.
Methods
We systematically searched three databases (PubMed, Embase, Medline Ovid) with appropriate medical subject headings and keywords to identify relevant peer-reviewed studies published between January 1, 2012 and June 30, 2023. Identified studies were screened and selected according to the predetermined eligibility criteria. The final analysis entailed an extensive summary of the eligible studies and a risk of bias assessment of their methodological quality, followed by a comparison of the results across the studies. This review was registered with PROSPERO (CRD42023429812) and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Results
We reviewed a total of 24 studies comprising 14 quantitative studies, 8 qualitative studies, and 2 mixed-methods studies conducted in various geographical settings. Across the studies, common factors associated with teachers’ willingness to recommend the HPV vaccine to students were HPV-related knowledge, perceived benefits of and barriers to the vaccine, perceived threat of HPV-related illness, and HPV vaccination status of their own children. Teachers generally had low to moderate levels of HPV-related knowledge with low self-efficacy to counsel parents about the vaccine. The information teachers most wanted to obtain was the role of the vaccine in preventing HPV-associated cancers and guidance on effective communication with parents regarding HPV vaccination; provision of educational material subsequently increased their willingness to recommend the vaccine. Some studies noted teachers’ view of schools as adequate venues for HPV education and vaccine delivery. However, frequently mentioned barriers were concerns that the HPV vaccine may condone adolescent sexual promiscuity, fear of side effects, anticipated negative reactions from parents, and opposition from schools that prioritize other health topics over HPV vaccination.
Conclusion
This systematic review highlights school teachers’ perspectives on adolescent HPV vaccination and factors associated with their willingness to recommend the vaccine to students and parents. While teachers reported challenges with recommending the HPV vaccine, they recognized its importance in preventing HPV-associated cancers in adolescence and held positive attitudes toward promoting the vaccine in the school setting. These findings suggest that schools, especially those without nurses, should seek opportunities to offer teachers education on HPV and HPV vaccination as well as sufficient training on HPV vaccine communication practices on the road to effective cancer prevention in adolescence.