Secondary analyses to test the impact on inequalities and uptake of the schools-based human papillomavirus (HPV) vaccination programme by stage of implementation of a new consent policy in the south-west of England

Harri Fisher*, Marion R Roderick, Matt Hickman, Rosy A Reynolds, John A A Macleod, Julie Yates, Jo Ferrie, Karen Evans

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Objectives To test the impact on inequalities and uptake of the schools-based human papillomavirus (HPV) vaccination programme by stage of implementation of a new policy providing additional opportunities to consent. Setting Two local authorities in the south-west of England. Participants Young women (n=7129) routinely eligible for HPV vaccination aged 12–13 years during the intervention period (2017/2018 to 2018/2019 programme years). Interventions Local policy change that included additional opportunities to provide consent (parental verbal consent and adolescent self-consent). Outcomes Secondary analyses of cross-sectional intervention data were undertaken to examine uptake by: (1) receipt of parental written consent forms and; (2) percentage of unvaccinated young women by stage of implementation. Results During the intervention period, 6341 (89.0%) eligible young women initiated the HPV vaccination series. Parental written consent forms were less likely to be returned where young women attended alternative education provider settings (p<0.001), belonged to non-white British ethnic groups (p<0.01) or more deprived quintiles (p<0.001). Implementation of parental verbal consent and adolescent self-consent reduced the percentage of unvaccinated young women from 21.3% to 16.5% (risk difference: 4.8%). The effect was greater for young women belonging to the most deprived compared with the least deprived quintile (risk difference: 7.4% vs 2.3%, p<0.001), and for young women classified as Unknown ethnic category compared with white British young women (6.7% vs 4.2%, p<0.001). No difference was found for non-white British young women (5.4%, p<0.21). Conclusions Local policy change to consent procedures that allowed parents to consent verbally and adolescents to self-consent overcame some of the barriers to vaccination of young women belonging to families less likely to respond to paper-based methods of gaining consent and at greater risk of developing cervical cancer. Trial registration number 49 086 105.
Original languageEnglish
Article numbere044980
Number of pages10
JournalBMJ Open
Volume11
Issue number7
Early online date7 Jul 2021
DOIs
Publication statusPublished - 7 Jul 2021

Bibliographical note

Funding Information:
The authors express their gratitude to staff at In Health Intelligence for data linkage and extracting the data from the Child Health Information System, and to the immunisation and administrative teams at Sirona Healthcare who facilitated access to the immunisation consent records as part of this study. The study is partly supported by the NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol. This research was supported by the National Institute for Health Research (NIHR) Applied Research Collaboration West (NIHR ARC West). The work was undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UKCRC Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.

Funding Information:
Acknowledgements The authors express their gratitude to staff at In Health Intelligence for data linkage and extracting the data from the Child Health Information System, and to the immunisation and administrative teams at Sirona Healthcare who facilitated access to the immunisation consent records as part of this study. The study is partly supported by the NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol. This research was supported by the National Institute for Health Research (NIHR) Applied Research Collaboration West (NIHR ARC West). The work was undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UKCRC Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.

Funding Information:
Funding This work is funded by the National Institute for Health Research’s Research for Patient Benefit (NIHR RfPB) programme (project number PB-PG-0416–20013).

Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

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