NHS Barnsley - HPV vaccine

The Government announced a national immunisation programme to protect against cervical cancer. The initial aim was for it to be offered to all 12-13 year old girls in year 8 at secondary schools from the 2008/9 school year. The vaccination would protect young women from the  human papilloma virus (HPV) virus which is the most common cause of cervical cancer.

NHS Barnsley was seeking to achieve a 90% uptake of the vaccine among year 8 girls across the borough. To this end, it sought to use social marketing approaches to conduct a communications campaign that would achieve this.

TCC Methodology

NHS Barnsley commissioned The Campaign Company to undertake insight work to:

  • Understand levels of awareness of HPV among parents and adolescent girls
  • Gain insight into the attitudes of parents and adolescents towards this – how they feel, concerns, information needs
  • Identify the key influencers and message carriers to use in an oncoming communications campaign

Our initial scoping and secondary research of national and local context led us to recommend that we should target the following groups as part of our insight:

  • Parents of Key stage 3 pupils (years 7-9) – since the key to successful uptake of the vaccine  would be to gain parental consent not the young woman's consent (contrary to the perceived national wisdom at the time)
  • Segment parents along the following behaviour / attitudes towards official advice “trusting parents”, “compliant parents” and “resistant parents”
  • Test differences in awareness and attitudes according to socio-economic grouping and faith

We subsequently conducted insight focus groups and paired interviews with parents from suburban and urban areas in Barnsley, with parents who were actively involved in faith activities and we conducted 'emotichat' discussion groups (ie using emoticons to express individual views and attitudes thereby minimising undue influence from peers) with adolescents from the target group across the borough .

Findings

Key conclusions and insights from our work included the following:

a) The Parents' perspective

  • Parents recognise that vaccination is an important parental responsibility but it is still mothers are the key decision-maker in matters of health relating to children. There is little involvement of the child at that age in those discussions. MMR has increased the awareness or risk of vaccines.
  • High level of awareness of cervical cancer – especially among women but only in context of themselves not their daughter. There is very low awareness of HPV
  • Initial reactions were shock, denial, “not something that’s likely to happen to her at the moment”. After discussion though, the views were more considered and accepting, although there were still some slight reservations due to the “unknown factor”, some anxieties about promiscuity (mostly from parents with older sexually active children as well as a 12-14 year old daughter )
  • Only circumstances the vaccine would be refused would be if there were known adverse or secondary effects
  • Biggest influencers in health decisions were “authority” figures (eg Gps, teachers, nurses, etc) rather than peers.
  • We also found that there were no significant differences in attitude to the vaccine among socio-economic groups or faith groups.

b)  The Adolescents' perspective

  • Key influencers in terms of lifestyle and leisure are peers, siblings and role models and for education they are family, teachers. For a serious problem though: “I know my Mum will sort me out but it’s my Dad that I’m worried about”
  • In terms of attitudes to health, breaking a leg or becoming pregnant is the worst thing that could happen to them at that age. Cancer is an “old person’s” disease. Not comfortable about talking about sexual health with parents – although other family members especially siblings are OK. There were mixed reactions to injections
  • There was no awareness of HPV and little awareness of cervical cancer. Initial reactions included: shock, fear, want vaccine now. After discussion they had moved to: parents will be supportive if they know what’s going on “they won’t believe me though – someone else will have to tell them”
  • Potential barriers to getting vaccine: parents won’t understand, parents aren’t primary decision-maker (“chaotic families” only)

Outcomes

As a consequence of our insight, we recommended that a communications campaign was developed that would be aimed at  parents and have the over-riding message: “This vaccine helps prevent cervical cancer. Sign this form and save your daughter’s life.”

We also recommended that:

  • the communications should provide “education” not just “information”
  • trusted authority figures (eg teachers and health practitioners) be the key message carriers
  • a range of communication channels should be used but face-to-face was key to effecting behaviour change

We recommended that the target parent audience be segmented as:

  • trusting: faith in NHS ability to offer safe vaccines
  • compliant: concerned about risks but will do what’s best
  • resistant: most concerned about side-effects (believe the MMR hype)

and that the message should be segmented accordingly to each group as:

  • HPVV prevents cervical cancer
  • HPVV prevents cervical cancer AND vaccine is safe
  • HPVV prevents cervical cancer AND vaccine is safe AND no indications of long-term effects

As a consequence of our research, NHS Barnsley implemented all of our recommendations in full and advocated to the other South Yorkshire PCTs that they should do so too.

The research not only achieved its primary purpose of obtaining valuable qualitative feedback to inform the HPV vaccine communications campaign. Another benefit was that the process itself raised awareness of vaccine itself and the services of the local NHS. The parents and young women themselves became word of mouth agents who were able to positively encourage others to have the vaccine. Barnsley have succeeded in achieving their target of 90% uptake of the HPV vaccine.
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