Barriers in the School-Based Pan-Gender HPV Vaccination Program in Sweden: Healthcare Providers’ Perspective
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Setting and Participants
2.3. Data Collection
2.4. Data Analysis
3. Results
- Addressing various reasons for vaccine hesitancy;
- Interpreting professional responsibilities;
- Creating a safe space for the individual child.
3.1. Addressing Various Reasons for Vaccine Hesitancy
3.1.1. Encountering Hesitant Parents
“They [parents] don’t think this is relevant for them, because you only have sex with one and that is who you marry. And that’s hard to get around. I can’t speak against that.” FG2
3.1.2. Communicating with Outspoken Vaccine-Skeptical Parents
“But those who are genuine anti-vaxxers, those who won’t say yes to anything, it’s like… Some families, there’s no use even calling them because they will only get angry at me, that ‘you should stop nagging about that, you know where we stand’.” FG1
3.1.3. Providing Enough Information but Respecting the Parents’ Own Decision
“It is not often that I actually have talked to parents who have said no [referring to vaccine] in fifth grade, to ask. Because I’m scared that they will feel questioned. I’ve experienced that they became a bit upset when I did. So, it is my way of respecting their decision and then I have several years to offer again and discuss.” FG4
3.2. Interpreting Professional Responsibilities
3.2.1. Defining the Extent of Responsibilities
“(…) because vaccinations are really nothing I have to make any assessments about or go in to like, in my profession as much…rather, it’s an offer and I, like, give the pre-written information with a consent form and then you answer questions or refer to the Public Health Agency, full stop.” FG6
“If it’s my responsibility to constantly remind and offer, or if you just leave it to the parents to let us know… well I don’t have many who have said no…but I don’t call them up.” FG6
“Yes, because it feels a little bit like a failure when you don’t get everyone to say yes. Yes, actually because it is within our professional responsibility.” FG1
“I would very much like to have a lecture about it, actually, maybe at work meetings or a good document that can be used.” FG7
3.2.2. Lacking Guidelines
“But for those who decline, then we [state driven schools in the municipality] have just decided that we send out a letter when we go through all vaccinations in eighth grade. Then we send out a new offer to those who declined.” FG4
3.2.3. Supporting the Child to Be Involved in Decision Making
“I thought that in ninth grade she was mature enough to make the decision. I believed that, that when she was in ninth grade, she was fully capable to make that decision, but I was not allowed [according to supervisor] to vaccinate.” FG4
3.3. Creating a Safe Space for the Individual Child
3.3.1. Using Strategies to Overcome Children’s Fear of Needles
“...At the hospital it is not prioritized… So, because of that I have girls who have not taken the second dose HPV, and actually one boy who has not taken dose two I think… doesn’t dare. I think it’s so sad…” FG7
3.3.2. Being Confronted with Gender Inequities of the Pan-Gender Vaccination Program
“I must say that when the boys got it, when it was implemented for them in the childhood vaccination program, I received unbelievably many calls from parents with older children who wished to vaccinate their child, they thought it was very unfair.” FG4
3.3.3. Supporting Unvaccinated Children
“I think it’s difficult when parents have said no but then the children come and ask ‘can’t you vaccinate me anyway? Mom and dad don’t have to know or find out.’... then I handled it by letting the pupils call their parents from my phone and… talk to their parents.” FG7
4. Discussion
4.1. Main Findings
4.2. Strengths and Limitations of the Study
4.3. Findings in Relation to Other Studies
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Interview Transcript | Initial Coding | Sub-Category | Category |
---|---|---|---|
I have offered to actively contact them [parents] again to see how things are going. Because they are busy and then they should remember this also. So, I choose to actively get in touch with them again, with another offer (FG 2) | Choose to offer again actively | Defining extent of responsibilities | Interpreting professional responsibilities |
they are welcome to contact me if they change their mind, it is up to the parents to get in contact (FG 2) | It is up to the parents |
Age (Years) | |
30–49 | 13 |
≥50 | 22 |
Country of Birth | |
Sweden | 33 |
Other | 2 |
Education | |
Registered nurse | 2 |
Specialist degree in Primary health care | 22 |
Specialist degree in Pediatric nursing | 10 |
Other specialist degrees in nursing | 1 |
Experience of HPV Vaccination (Years) | |
≤2 | 10 |
3–9 | 14 |
≥10 | 11 |
Work Experience as School Nurse | |
≤5 | 16 |
≤10 | 10 |
>10 | 9 |
School Management of Represented Schools * | |
Private | 2 |
State | 45 |
Range of Total Number of Students in Represented Schools | 200–708 |
Categories | Addressing Various Reasons for Vaccine Hesitancy | Interpreting Professional Responsibilities | Creating a Safe Space for the Individual Child |
---|---|---|---|
Sub-categories | Encountering hesitant parents | Defining the extent of responsibility | Supporting unvaccinated children |
Communicating with outspoken vaccine-skeptics | Lacking guidelines | Using strategies to overcome fear of needles | |
Providing enough information but respecting parents’ own decision | Supporting the child to be involved in decision making | Being confronted with gender inequities in the pan-gender vaccination program |
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Enskär, I.; Enskär, K.; Nevéus, T.; Hess Engström, A.; Grandahl, M. Barriers in the School-Based Pan-Gender HPV Vaccination Program in Sweden: Healthcare Providers’ Perspective. Vaccines 2023, 11, 310. https://doi.org/10.3390/vaccines11020310
Enskär I, Enskär K, Nevéus T, Hess Engström A, Grandahl M. Barriers in the School-Based Pan-Gender HPV Vaccination Program in Sweden: Healthcare Providers’ Perspective. Vaccines. 2023; 11(2):310. https://doi.org/10.3390/vaccines11020310
Chicago/Turabian StyleEnskär, Ida, Karin Enskär, Tryggve Nevéus, Andrea Hess Engström, and Maria Grandahl. 2023. "Barriers in the School-Based Pan-Gender HPV Vaccination Program in Sweden: Healthcare Providers’ Perspective" Vaccines 11, no. 2: 310. https://doi.org/10.3390/vaccines11020310
APA StyleEnskär, I., Enskär, K., Nevéus, T., Hess Engström, A., & Grandahl, M. (2023). Barriers in the School-Based Pan-Gender HPV Vaccination Program in Sweden: Healthcare Providers’ Perspective. Vaccines, 11(2), 310. https://doi.org/10.3390/vaccines11020310