PATH's Cervical Cancer Prevention Action Planner

Community sensitization and mobilization

Successful community outreach requires consistent messages repeated in a wide variety of materials and reinforced by interpersonal contact as well as via mass and local media channels. Thus, it is crucial that managers carefully plan, implement, and adequately resource community mobilization efforts.

In sensitizing communities, trusted authorities and community members should be engaged to disseminate information and counteract rumors. Among these trusted individuals are teachers, who can play an important role in educating families, especially when HPV vaccinations are given at schools. Endorsement of the vaccination program by the government, indicating that the vaccine is safe and efficacious, is also critical for community acceptance. In some project countries, government officials were involved in formal launch ceremonies for the vaccination programs. This gave credibility to the programs and demonstrated that governments had made a political commitment to protect girls from cervical cancer.

Most families have had positive experiences with immunization programs, and this can be leveraged to build community support for HPV vaccination as well. The PATH projects found that for general audiences, it was important to emphasize that the purpose of HPV vaccination is to prevent cervical cancer, rather than to explain that it prevents infection with HPV, a virus most people have never heard about. While the mode of HPV infection was clearly explained, informational messages did not over-emphasize that the vaccine prevents a sexually transmitted infection; rather, the main message always was cancer prevention. Communities in general were concerned about cancer, and they responded positively to anti-cancer messages.

It is important to tell people that there will not be an immediate impact on reducing cervical cancer rates, but that their daughters will have protection later in life against cancer caused by the HPV types that are in the vaccine. It is also important to emphasize the continuing need for screening and treatment of precancer among adult women, as well as among vaccinated girls when they are older.

Advocacy and communications programs should include plans to address possible reports of AEFIs due to the new vaccine, to deal with community concerns, and to respond promptly to rumors and other negative publicity. Managers may already have in place a crisis communications plan for situations related to other health interventions, but if not, HPV vaccination program planning provides a good opportunity to pull together a team experienced in communicating with stakeholders, the media, and the community.

The WHO manual Immunization in Practice Module 8: Building Community Support for Immunization offers many ideas for raising awareness about immunization issues and includes a chapter on dealing with misinformation and rumors. The publication Cervical Cancer, Human Papillomavirus (HPV) and HPV Vaccines: Key Points for Policy-Makers and Health Professionals discusses the benefits and limitations of the vaccines and ways to address the concerns of different stakeholders.

Audiences, educational materials, and methods

Immunization managers will want to organize IEC activities to reach the target population of young adolescent girls and their families. This will require a different approach from that used for routine childhood vaccinations, and these efforts should include providing information and materials to schools. The broader community also should be engaged; community leaders, village elders, town council members, women’s groups, youth organizations, and religious leaders are some of the groups that can influence people to support HPV vaccination. If vaccinations will be carried out at schools, teachers and administrators must be informed of the benefits of vaccination, committed to the program, and involved in planning the vaccination sessions.

When communicating with families, community members, and community leaders, it is important to identify key messages and to decide on appropriate types of materials for different audiences. For parents, extended families, and the general community, leaflets, posters, radio messages, informational meetings, public announcements, and articles in the local media all work well. Providing some details to parents about the testing of the vaccines in clinical trials and their excellent safety records will encourage them to make sure that their daughters receive the vaccine. For community leaders, fact books about cervical cancer and HPV vaccines are useful in helping them to respond to questions from their constituents.

While mass media and printed materials can be very useful, it is important to remember that interpersonal communication is the most common, and often the most effective, communication channel, particularly in addressing community needs, doubts, and concerns.

Members of medical societies, local health experts, and practicing physicians play an important role in informing families about health matters, so it is also important to engage these audiences. Messages to these groups may be presented in training manuals or meetings, and can consist of detailed information on HPV infection, the epidemiology of cervical cancer, current practice in screening and treatment for cervical cancer, and HPV vaccination.

School administrators will need facts about vaccination logistics—for example, about the three-dose schedule, which they will need to add to the school calendar. When they understand and accept basic messages about cervical cancer and its prevention, they often become advocates for the vaccinations at their schools. Teachers will need to learn age-appropriate approaches for discussing cervical cancer with young adolescents, so they should receive leaflets or brochures for this purpose.

Because the mass media can have a major role in promoting either a positive or negative view of the vaccine, getting accurate, easy-to-understand messages to journalists is a good idea before beginning a program. One-to-one outreach to journalists or group discussions with media personnel may be helpful. Cervical cancer “press kits” can be distributed at these sessions.

For examples of key messages and types of materials for specific audiences from some of the PATH project countries, see examples of key messages. Sample community education materials are also available, such as leaflets, posters, and fact sheets. Materials should be ready for dissemination in the community at least one month before vaccination sessions, and should be in the local language.

PATH has produced two other resources on creating communications materials and strategies that can be adapted for HPV vaccination programs: the Immunization and Child Health Materials Development Guide and A Guide to Developing Materials on HIV/AIDS and STIs.

Frequency and intensity of communication

Some types of communication will be carried out only once, such as giving leaflets to girls on their first vaccination day, while others will be repeated a number of times, such as airing radio spots that promote cervical cancer awareness, or announcing HPV vaccination sessions prior to each dose. After the first year of vaccinations, when the vaccine is better known, the intensity of education efforts can decline. However, each new location added in a scaling-up process will need intensive community education at least for the first year.

Table 2 gives suggestions for the timing of messages about vaccination sessions from the HPV vaccination project in Vietnam.

Table 2. Scheduling HPV vaccination messages in Vietnam.

Timing
Activity
Frequency
At least two weeks prior to vaccinations
Billboards/posters placed at the district center and in each community
Posters can be put up when HPV vaccinations are starting, and should remain until the third dose is complete
Messages broadcast on the district radio station
Messages should be broadcast on the district radio station for two to three weeks prior to each dose
Messages broadcast on the community radio station
Messages should be broadcast on the local radio station at least two weeks before vaccination, and two or three times per week for two weeks in each community prior to each dose
At least one week prior to vaccinations
Parent meetings held at the school or in the community
One parent meeting should be held in each community at least one week before first dose
Girls’ meetings or information sessions held at the school or in the community
One group discussion or meeting can be held in each school or health facility at least one week before first dose
Messages broadcast on the radio
Messages should be broadcast on the radio twice a day during the week before each dose (local, district, and national radio stations can be utilized)
Banners and posters placed at the school and the health facility
Banners and posters should be put up at identified places in each school or health facility at least one week before each dose
Day of vaccinations
Provincial or regional meeting held to launch vaccination
A provincial or regional launch meeting can be held on the day of vaccination, attended by provincial/regional and district staff
District meeting held to launch vaccination
A district launch meeting can be held at the district health center, district education department, district authority, or district IEC center, attended by heads of community health centers
Leaflets and counseling provided at vaccination sites on vaccination and active follow-up days (finishing missed doses)
Girls and parents should be counseled on vaccination and active follow-up days (for each dose)
Current information on vaccination progress broadcast on the community loudspeaker
Updated information should be broadcast twice in each community (on and after vaccination day) at the start of a new HPV vaccination program

 

High-level stakeholders and other partners

A stakeholder for an HPV vaccination program is anyone who has an interest in the program, from international organizations to district health departments to local civil society groups. All key stakeholders need to be informed and educated about the HPV vaccination program so they will become engaged and ensure the success of the program.

Examples of stakeholders in HPV vaccination programs are the following:

Global level
  • WHO and regional divisions (e.g., Pan American Health Organization)
  • GAVI Alliance
  • Industry (vaccine manufacturers)
  • International nongovernmental organizations (NGOs)
National level
  • Ministry of Health
  • National EPI coordinator
  • National Cancer Institute director
  • Department of Reproductive Health
  • Ministry of Education
  • National medical and nursing associations
  • National NGOs
  • Scientific experts and university researchers
Regional/local levels
  • Cancer treatment center personnel
  • State or district health departments
  • Civil society organizations
  • Women’s/mothers’ groups
  • Youth groups
  • Child health organizations

In some settings, delivery of HPV vaccines may provide opportunities for new partnerships and innovative programming, such as “bundling” adolescent health education and services with an HPV vaccination program. According to the publication Cervical Cancer, Human Papillomavirus (HPV) and HPV Vaccines: Key Points for Policy-Makers and Health Professionals, national immunization programs may wish to consider coordinating or partnering with sexual and reproductive health services, as well as adolescent health, cancer control, and HIV/AIDS programs.

Close working links might also be developed with education services, family support groups, and women’s groups; these include civil society organizations, community-based health and welfare initiatives, and the private sector.

While it is essential for HPV immunization managers to consult and work with individual stakeholders for the success of a vaccination program, it is also important for the stakeholders to collaborate with each other. In Vietnam, for example, program administrators encouraged discussion among community-based groups such as the Women’s Union, Youth Union, teachers, and People’s Health Care Committees.

Table 3 presents an analysis of stakeholder roles and responsibilities from the HPV vaccination program in Uganda, as an example of how to engage people at all levels.

Table 3. Roles and responsibilities of HPV vaccination program stakeholders, Uganda experience.

Stakeholders
Roles and responsibilities
District and municipality/town council leaders
• Advocate for and promote HPV vaccination in the district.
• Mobilize and allocate resources for cervical cancer prevention and HPV vaccination.
• Provide information about cervical cancer screening options.
• Emphasize the importance of completing all three doses.
• Mobilize all eligible girls in the target population for HPV vaccination.
District health management teams
• Plan, budget, and implement the HPV vaccination demonstration project.
• Implement the HPV vaccination communications strategy (including adaptation of communications materials).
• Disseminate messages and materials on cervical cancer prevention.
• Monitor and supervise the vaccination program.
• Emphasize the importance of completing all three doses.
• Mobilize all eligible girls in the target population for HPV vaccination.
• Provide information about cervical cancer screening options.
Health workers in health facilities
• Provide information and distribute materials about the HPV vaccine and about cervical cancer prevention programs.
• Vaccinate all eligible girls and provide counseling support.
• Collaborate with schools in their catchment areas in order to mobilize eligible girls for vaccination.
• Emphasize the importance of completing all three doses.
• Mobilize all eligible girls in the target population for HPV vaccination.
• Provide information about cervical cancer screening options.
Religious/cultural/civic/ village/parish leaders
• Advocate for and promote HPV vaccination in the community.
• Educate communities about the importance of preventing cervical cancer using
HPV vaccine.
• Mobilize parents/guardians to take their eligible daughters to receive HPV vaccination and complete the three doses.
• Emphasize the importance of completing all three doses.
• Mobilize all eligible girls in the target population for HPV vaccination.
• Provide information about cervical cancer screening options.
Photo: PATH/Julie Jacobson

Woman and girls


Additional resources

Print version: Implementing HPV Vaccination Programs (RHO Cervical Cancer website)

Watch videoHPV vaccination video and transcript

Case study: HPV vaccination in Africa

Case study: HPV vaccination in Latin America

Shaping Strategies to Introduce HPV Vaccines: Formative Research Results from India, Peru, Uganda, and Vietnam (RHO Cervical Cancer website)

Conducting Formative Research for HPV Vaccination Program Planning (RHO Cervical Cancer website)

Evaluating HPV Vaccination Pilots (RHO Cervical Cancer website)

HPV delivery strategies that achieved high coverage in low- and middle-income countries (PDF)

Vaccination (RHO Cervical Cancer website)

World Health Organization position paper on human papillomavirus vaccines (PDF)

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