Strengthening HPV vaccine confidence and uptake among underserved groups in Sweden

Abstract Background In Sweden, HPV vaccination is freely available to all children aged 10-12 through a national, school-based program. However, HPV vaccine confidence and uptake are lower than those of other childhood vaccines, with notable disparities between groups. School nurses are essential for HPV vaccination, and in a unique position to influence uptake. Aim To increase understanding of school nurses’ perceptions about the challenges associated with providing the HPV vaccine to adolescents in underserved communities in Stockholm, Sweden and inform co-design intervention strategies. Methods This is a qualitative study based on data from 21 in-depth interviews with school nurses working with underserved communities in Stockholm. The data was analysed using inductive reflexive thematic analysis. Results The analysis generated four themes: (1) School nurses are left to manage HPV vaccination by themselves; (2) Individual care and public health - the dual responsibilities of school nurses; (3) The ‘right thing’ - conflicting perceptions of HPV vaccination; and (4) navigating sensitivity around HPV and sex. Together, the themes describe how school nurses are not sufficiently equipped and lack adequate support and resources. They balance promoting HPV vaccine uptake with efforts to make vaccination an empowering experience for each child. Vaccine hesitancy was often seen as the result of limited knowledge, and school nurses generally spoke about decline as something that could be prevented or corrected into the ‘right’ decision by providing proper information. While participants believed they could influence uptake, various challenges, from high workload to heteronormative ideas about sex, often hindered their ability to do so. Conclusions Achieving high HPV vaccine uptake largely relies on the individual school nurses’ interest, knowledge, and efforts rather than established structures and guidelines. This challenges the sustainability of the HPV vaccination programme.