Which changes in adolescents' knowledge, attitudes, and practices following a school-based intervention in France increase HPV vaccination uptake and intentions? A mediation analysis.

Authors

Amanda Munoz, Amandine Gagneux-Brunon, Anne-Sophie Le Duc-Banaszuk, Sébastien Bruel, Morgane Michel, Aurélie Gauchet, Damien Oudin Doglioni, Anne-Sophie Barret, Jocelyn Raude, Nathalie Thilly, Judith E Mueller, PrevHPV Consortium

Published in

Vaccine. Volume 92. Pages 129150. Sep 17, 2026. Epub Sep 17, 2026.

Abstract

In France, human papillomavirus vaccine (HPVV) coverage among adolescents remains below the national objective. The PrevHPV randomised trial assessed three intervention components to improve HPVV coverage among adolescents: educational and motivational activities (EMM); vaccination campaigns (FA) in middle schools; and General Practitioner (GP) training. FA increased vaccine uptake, while EMM improved vaccine uptake or intention, as well as HPVV-related knowledge, attitudes, and practices (KAP). This secondary analysis aimed to assess whether the positive effect of EMM on HPVV uptake or intention was mediated by specific KAP improvements.
A total of 2758 adolescents aged 13 to 15 years from 39 schools completed online questionnaires at baseline and 5 months post-intervention. We created binary variables for the outcome "gain in vaccine uptake or intention during follow-up" and for favourable changes in individual KAP items. We used mediation analyses to evaluate indirect effects of individual KAP items on the association between EMM and uptake/intention, adjusting for FA and GP components and accounting for school-level clustering.
EMM was associated with an increase in HPVV uptake or intention (OR:1.57, 95% CI: 1.02-2.41). The strongest significant mediation effects occurred via improved attitudes toward the vaccine's benefit-risk balance (indirect effect OR_IE:1.14), vaccine safety (OR_IE:1.12) and accessibility (OR_IE:1.11), as well as for having discussed HPV vaccination with friends (OR_IE:1.11) and for higher self-rated level of knowledge about the vaccine (OR_IE:1.10).
These results help understanding the specific positive effects of co-constructed in-class educational activities and underpin the importance of improving vaccine-related attitudes - not only knowledge.

PMID:
42753385
Bibliographic data and abstract were imported from PubMed on 18 Sep 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.