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