title: A home-school-doctor model to break the barriers for uptake of human papillomavirus vaccine.
abstract: BACKGROUND
  A high coverage of human papillomavirus (HPV) vaccination is required to achieve a clinically significant reduction in disease burden. Countries implementing free-of-charge national vaccination program for adolescent girls are still challenged by the sub-optimal uptake rate. Voluntary on-site school-based mass vaccination programs have demonstrated high coverage. Here, we tested whether this could be an option for countries without a government-supported vaccination program as in Hong Kong.
  
  
  METHODS
  A Home-School-Doctor model was evolved based on extensive literature review of various health promotion models together with studies on HPV vaccination among adolescent girls. The outcome measure was uptake of vaccination. Factors associated with the outcome were measured by validated surveys in which 4,631 students from 24 school territory wide participated. Chi-square test was used to analyze association between the categorical variables and the outcome. Multivariate analysis was performed to identify independent variables associated with the outcome with vaccine group as case and non-vaccine group as control.
  
  
  RESULTS
  In multivariate analysis, parental perception of usefulness of the Home-School-Doctor model had a very high odds ratio for uptake of HPV vaccination (OR 26.6, 95% CI 16.4, 41.9). Paying a reasonable price was another independent factor associated with increased uptake (OR 1.71, 95% CI 1.39, 2.1 for those with parents willing to pay US$125-250 for vaccination). For parents and adolescents who were not sure where to get vaccination, this model was significantly associated with improved uptake rate (OR 1.66, 95% CI 1.23, 2.23). Concerns with side effects of vaccine (OR 0.70, 95% CI 0.55, 0.88), allowing daughters to make their own decisions (OR 0.49, 95% CI 0.38, 0.64) and not caring much about daughters' social life (95% CI 0.45, 0.92) were factors associated with a lower uptake.
  
  
  CONCLUSIONS
  The findings of this study have added knowledge on how a school-based vaccination program would improve vaccine uptake rate even when the users need to pay. Our findings are consistent with other study that the most acceptable way to achieve high uptake of HPV vaccine is to offer voluntary school-based vaccination.
  
  
  CONCLUSIONS
  A model of care incorporating the efforts and expertise of academics and health professionals working closely with school can be applied to improve the uptake of vaccine among adolescent girls. Subsidized voluntary school-based vaccination scheme can be an option.
authors.affiliation: JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4th Floor, School of Public Heath, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. alee@cuhk.edu.hk.|Centre for Health Education and Health Promotion, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4th Floor, Lek Yuen Health Centre, Shatin, New Territories, Hong Kong. alee@cuhk.edu.hk.
authors.forename: Albert
authors.initials: A
authors.lastname: Lee
authors.affiliation: JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4th Floor, School of Public Heath, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. wong_martin@cuhk.edu.hk.
authors.forename: Martin C S
authors.initials: MC
authors.lastname: Wong
authors.affiliation: Centre for Health Education and Health Promotion, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4th Floor, Lek Yuen Health Centre, Shatin, New Territories, Hong Kong. ctntracy@gmail.com.
authors.forename: Tracy T
authors.initials: TT
authors.lastname: Chan
authors.affiliation: Department of Microbiology, The Chinese University of Hong Kong, 1st Floor, Clinical Sciences Building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. paulkschan@cuhk.edu.hk.
authors.forename: Paul K S
authors.initials: PK
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D044466:Asian People / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D003657:Decision Making; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D032541:Mass Vaccination / Q000706:statistics & numerical data; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D013334:Students / Q000706:statistics & numerical data; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D053918:Papillomavirus Vaccines