title: The school nurse, the school and HPV vaccination: a qualitative study of factors affecting HPV vaccine uptake.
abstract: School nurses in the United Kingdom are largely responsible for delivering the human papillomavirus (HPV) vaccine to 12-13 year old girls. In order to assess the impact of HPV vaccination on school nurses' roles, we gave a questionnaire to all 33 school nurses who offered Cervarix ™ in two Primary Care Trusts one year ahead of the national vaccine programme. Key organisational issues raised by the school nurses were the size of the team and its skill mix. A few found their schools uncooperative and were dissatisfied with mechanisms for problem resolution. On average, nurses spent an additional 69 h (0.80 h per child) on vaccine-related activities. In semi-qualitative interviews (n=17), school nurses complained of work overload and described the difficulties of establishing good relationships with some of their schools. Nurses expected schools to take some responsibility for ensuring good uptake and were frustrated when help was not forthcoming. We conclude that variation in uptake between schools in part reflects a difficult relationship with the school nurse which may be attributed to characteristics of the school, schools' attitudes towards health interventions, organisational problems, multiple school nurse roles and/or personal ability. Some of these issues will need to be addressed to ensure continued high vaccine coverage as HPV vaccination becomes a less prioritised, routine activity.
authors.affiliation: Academic Unit of Obstetrics and Gynaecology, Manchester Academic Health Science Centre, University of Manchester, School of Cancer and Enabling Sciences, Manchester M13 OJH, UK. loretta.brabin@manchester.ac.uk
authors.forename: Loretta
authors.initials: L
authors.lastname: Brabin
authors.forename: Rebecca
authors.initials: R
authors.lastname: Stretch
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Roberts
authors.forename: Peter
authors.initials: P
authors.lastname: Elton
authors.forename: David
authors.initials: D
authors.lastname: Baxter
authors.forename: Rosemary
authors.initials: R
authors.lastname: McCann
mesh_terms: D000293:Adolescent; D002648:Child; D003695:Delivery of Health Care / Q000458:organization & administration; D005260:Female; D006801:Humans; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D012573:School Nursing; D011795:Surveys and Questionnaires; D006113:United Kingdom; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D053918:Papillomavirus Vaccines