Adoption of a multicomponent intervention to improve HPV vaccination in France: a mixed methods study

BACKGROUND: HPV vaccine coverage (VC) in France has always been lower than in most high-income countries. As part of the PrevHPV project, we developed and evaluated a school-based multicomponent intervention to improve HPV VC among French adolescents. We assessed the adoption of the PrevHPV intervention among secondary schools and its associated factors. METHODS: We carried out a pragmatic cluster randomized controlled trial (April 2021-June 2022) in 14/25 French school districts. The cluster was the municipality. Municipalities were eligible if there was only one secondary school and most inhabitants aged 11-14 years attended this school. We then contacted the head of the school to ask him/her to participate in the study. Based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework, we described municipalities’ exclusions, schools participation and associated factors (Chi(2), t-tests). We also used qualitative data from six focus groups with participating school staff to explore facilitators and barriers to adoption at the school level. RESULTS: Compared to non-eligible municipalities (n = 2658), eligible ones (n = 1205) were smaller, less urban and deprived, with lower accessibility to general practitioners. Out of 346 randomly selected municipalities, 91 (26%) accepted to participate. Participating schools were smaller and located in more deprived municipalities than non-participating ones. During the trial, 31/91 (34%) schools discontinued intervention; we did not identify any characteristic associated with discontinuation. Qualitative data showed that several contextual factors can influence adoption at the school-level: human resources (school staff availability, turnover and attitudes towards vaccination, especially for school nurses); material (e.g. computer equipment) and financial resources; parents’ attitudes towards vaccination. CONCLUSIONS: These results can guide policy making on school-based HPV vaccine promotion in France and Europe. KEY MESSAGES: • The PrevHPV project is supported by the French health authorities and conducted by a multidisciplinary consortium to tackle a long-lasting public health concern in France. • Should the intervention prove effective, these results are expected to help stakeholders scale-up the school-based PrevHPV intervention in France and other European countries.