title: Social mobilisation, consent and acceptability: a review of human papillomavirus vaccination procedures in low and middle-income countries.
abstract: Social mobilisation during new vaccine introductions encourages acceptance, uptake and adherence to multi-dose schedules. Effective communication is considered especially important for human papillomavirus (HPV) vaccine, which targets girls of an often-novel age group. This study synthesised experiences and lessons learnt around social mobilisation, consent, and acceptability during 55 HPV vaccine demonstration projects and 8 national programmes in 37 low and middle-income countries (LMICs) between January 2007 and January 2015.
  
  
  
  A qualitative study design included: (i) a systematic review, in which 1,301 abstracts from five databases were screened and 41 publications included; (ii) soliciting 124 unpublished documents from governments and partner institutions; and (iii) conducting 27 key informant interviews. Data were extracted and analysed thematically. Additionally, first-dose coverage rates were categorised as above 90 %, 90-70 %, and below 70 %, and cross-tabulated with mobilisation timing, message content, materials and methods of delivery, and consent procedures.
  
  
  
  All but one delivery experience achieved over 70 % first-dose coverage; 60 % achieved over 90 %. Key informants emphasized the benefits of starting social mobilisation early and actively addressing rumours as they emerged. Interactive communication with parents appeared to achieve higher first-dose coverage than non-interactive messaging. Written parental consent (i.e., opt-in), though frequently used, resulted in lower reported coverage than implied consent (i.e., opt-out). Protection against cervical cancer was the primary reason for vaccine acceptability, whereas fear of adverse effects, exposure to rumours, lack of project/programme awareness, and schoolgirl absenteeism were major reasons for non-vaccination.
  
  
  
  Despite some challenges in obtaining parental consent and addressing rumours, experiences indicated effective social mobilisation and high HPV vaccine acceptability in LMICs. Social mobilisation, consent, and acceptability lessons were consistent across world regions and HPV vaccination projects/programmes. These can be used to guide HPV vaccination communication strategies without additional formative research.
authors.affiliation: Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania.
authors.forename: Severin
authors.initials: S
authors.lastname: Kabakama
authors.affiliation: Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania. Katherine.Gallagher@lshtm.ac.uk.|Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK. Katherine.Gallagher@lshtm.ac.uk.
authors.forename: Katherine E
authors.identifier: 0000-0002-5604-7647
authors.initials: KE
authors.lastname: Gallagher
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK.
authors.forename: Natasha
authors.initials: N
authors.lastname: Howard
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK.
authors.forename: Sandra
authors.initials: S
authors.lastname: Mounier-Jack
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK.
authors.forename: Helen E D
authors.initials: HE
authors.lastname: Burchett
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK.
authors.forename: Ulla K
authors.initials: UK
authors.lastname: Griffiths
authors.affiliation: PATH, Vaccine Access and Delivery, PO Box 900922, Seattle, WA, 98109, USA.
authors.forename: Marta
authors.initials: M
authors.lastname: Feletto
authors.affiliation: PATH, Vaccine Access and Delivery, PO Box 900922, Seattle, WA, 98109, USA.
authors.forename: D Scott
authors.initials: DS
authors.lastname: LaMontagne
authors.affiliation: Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania.|Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK.
authors.forename: Deborah
authors.initials: D
authors.lastname: Watson-Jones
mesh_terms: D000293:Adolescent; D001364:Awareness; D002648:Child; D003142:Communication; D003906:Developing Countries; D005260:Female; D006078:Government Programs; D006801:Humans; D008297:Male; D030361:Papillomavirus Infections / Q000517:prevention & control* / Q000821:virology; D053918:Papillomavirus Vaccines; D010290:Parents; D010342:Patient Acceptance of Health Care; D015397:Program Evaluation; D036301:Qualitative Research; D012931:Social Environment; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000821:virology; D014611:Vaccination
chemical_list: D053918:Papillomavirus Vaccines
keywords: Acceptability; Communication; Consent; HPV; LMICs; Mobilisation; Vaccination