"The only vaccine that we really question is the new vaccine": A qualitative exploration of the social and behavioural drivers of human papillomavirus (HPV) vaccination in Tonga.

Mohamed, Y; Luey, E; Kata, U; Tukia, O; Lotulelei, S; Tei, A; 'Ofanoa, R; Overmars, I; Frawley, J; Vodonaivalu, L; Seale, H; Jenkins, K; Joshi, K; Datt, H; Sagan, S; Dynes, M; Danchin, M; Kaufman, J

"The only vaccine that we really question is the new vaccine": A qualitative exploration of the social and behavioural drivers of human papillomavirus (HPV) vaccination in Tonga.

Mohamed, Y Luey, E Kata, U Tukia, O Lotulelei, S Tei, A 'Ofanoa, R Overmars, I Frawley, J

Vodonaivalu, L Seale, H Jenkins, K Joshi, K Datt, H Sagan, S Dynes, M Danchin, M Kaufman, J

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Publisher:: Elsevier
Publication Type:: Journal Article
Citation:: Vaccine, 2025, 59, pp. 127280
Issue Date:: 2025-05-23

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Field	Value	Language
dc.contributor.author	Mohamed, Y
dc.contributor.author	Luey, E
dc.contributor.author	Kata, U
dc.contributor.author	Tukia, O
dc.contributor.author	Lotulelei, S
dc.contributor.author	Tei, A
dc.contributor.author	'Ofanoa, R
dc.contributor.author	Overmars, I
dc.contributor.author	Frawley, J https://orcid.org/0000-0001-6037-0140
dc.contributor.author	Vodonaivalu, L
dc.contributor.author	Seale, H
dc.contributor.author	Jenkins, K
dc.contributor.author	Joshi, K
dc.contributor.author	Datt, H
dc.contributor.author	Sagan, S
dc.contributor.author	Dynes, M
dc.contributor.author	Danchin, M
dc.contributor.author	Kaufman, J
dc.date.accessioned	2025-06-04T02:55:48Z
dc.date.available	2025-05-15
dc.date.available	2025-06-04T02:55:48Z
dc.date.issued	2025-05-23
dc.identifier.citation	Vaccine, 2025, 59, pp. 127280
dc.identifier.issn	0264-410X
dc.identifier.issn	1873-2518
dc.identifier.uri	http://hdl.handle.net/10453/187611
dc.description.abstract	INTRODUCTION: Human papillomavirus (HPV) vaccination is crucial for cervical cancer elimination, particularly in the Pacific where screening and treatment are limited. The HPV vaccine was introduced through schools in Tonga in November 2022 for adolescent girls. Despite high routine childhood vaccine coverage in Tonga, uptake of the HPV vaccine has been slow. This study explored the social and behavioural drivers of HPV and routine childhood vaccination in Tonga to inform tailored strategies to increase vaccine uptake. METHODS: We conducted qualitative interviews and focus groups in Nuku'alofa between June and October 2023 with parents (n = 32), adolescent girls (n = 24), teachers (n = 15), nurses (n = 7), and immunization staff (n = 5). Data were analysed thematically and mapped to the World Health Organization's Behavioural and Social Drivers of vaccination framework. RESULTS: Parents, teachers, and girls had limited knowledge of the HPV vaccine. Some feared it would encourage promiscuity or impact fertility. While trust in routine childhood vaccines was high, participants felt the COVID-19 pandemic had reduced confidence in new vaccines. Some vaccinated girls felt the HPV vaccine offered protection whereas others were afraid of side effects. Practical barriers included non-standardised consent forms that had to be returned to schools, the vaccine rollout timing, and school participation. CONCLUSION: Providing youth, parents and teachers with accurate, culturally appropriate information and supporting teachers to discuss vaccination and facilitate consent may improve HPV vaccine uptake in Tonga.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier
dc.relation.ispartof	Vaccine
dc.relation.isbasedon	10.1016/j.vaccine.2025.127280
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	06 Biological Sciences, 07 Agricultural and Veterinary Sciences, 11 Medical and Health Sciences
dc.subject.classification	Virology
dc.subject.classification	32 Biomedical and clinical sciences
dc.subject.classification	42 Health sciences
dc.title	"The only vaccine that we really question is the new vaccine": A qualitative exploration of the social and behavioural drivers of human papillomavirus (HPV) vaccination in Tonga.
dc.type	Journal Article
utslib.citation.volume	59
utslib.location.activity	Netherlands
utslib.for	06 Biological Sciences
utslib.for	07 Agricultural and Veterinary Sciences
utslib.for	11 Medical and Health Sciences
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
pubs.organisational-group	University of Technology Sydney/Faculty of Health/School of Public Health
pubs.organisational-group	University of Technology Sydney/UTS Groups
pubs.organisational-group	University of Technology Sydney/UTS Groups/Women & Children’s Health Research Collaborative (WCHC)
pubs.organisational-group	University of Technology Sydney/UTS Groups/INSIGHT: Institute for Innovative Solutions for Wellbeing and Health
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/
dc.date.updated	2025-06-04T02:55:46Z
pubs.publication-status	Published online
pubs.volume	59

Abstract:

INTRODUCTION: Human papillomavirus (HPV) vaccination is crucial for cervical cancer elimination, particularly in the Pacific where screening and treatment are limited. The HPV vaccine was introduced through schools in Tonga in November 2022 for adolescent girls. Despite high routine childhood vaccine coverage in Tonga, uptake of the HPV vaccine has been slow. This study explored the social and behavioural drivers of HPV and routine childhood vaccination in Tonga to inform tailored strategies to increase vaccine uptake. METHODS: We conducted qualitative interviews and focus groups in Nuku'alofa between June and October 2023 with parents (n = 32), adolescent girls (n = 24), teachers (n = 15), nurses (n = 7), and immunization staff (n = 5). Data were analysed thematically and mapped to the World Health Organization's Behavioural and Social Drivers of vaccination framework. RESULTS: Parents, teachers, and girls had limited knowledge of the HPV vaccine. Some feared it would encourage promiscuity or impact fertility. While trust in routine childhood vaccines was high, participants felt the COVID-19 pandemic had reduced confidence in new vaccines. Some vaccinated girls felt the HPV vaccine offered protection whereas others were afraid of side effects. Practical barriers included non-standardised consent forms that had to be returned to schools, the vaccine rollout timing, and school participation. CONCLUSION: Providing youth, parents and teachers with accurate, culturally appropriate information and supporting teachers to discuss vaccination and facilitate consent may improve HPV vaccine uptake in Tonga.

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http://hdl.handle.net/10453/187611