Development of an intervention for middle adolescents (15–17 years old) using the Behaviour Change Wheel (BCW) to empower adolescent decision-making regarding HPV vaccination uptake

INTRODUCTION: In the United Kingdom, where a school-based human papillomavirus vaccination programme vaccinates 12-13 year old students, parents/guardians have been the primary decision-makers regarding receipt of the vaccination. As the average age of first sexual intercourse is 15-17 years old, education at this time could provide an opportunity for unvaccinated students to self-consent to vaccination. The aim of this study was to develop a HPV intervention, aimed at middle adolescents (15-17 years old), using the 3 stages of the Behaviour Change Wheel. METHODS: A systematic review informed target behaviours and populations. Focus groups and interviews were conducted throughout Northern Ireland with immunisation nurses (n = 26), middle adolescents (n = 34), and post-primary school teachers (n = 12) and nurses (n = 6). Data analysis was guided by the COM-B model to inform a Behavioural Diagnosis. Subsequently, appropriate intervention functions, policy categories and Behaviour Change Techniques were selected with consideration of APEASE criteria. RESULTS: The systematic review highlighted the lack of interventions designed for middle adolescents; existing interventions were sparse, commonly not based on behavioural theory and focused on female cancers. The study identified twelve barriers to three target behaviours which included: empowering students to make decisions about HPV; empowering professionals' to design and deliver the intervention; and increasing positive public attitudes regarding HPV vaccination. A behaviour change HPV intervention was developed which included school-based HPV education aligned with mandated curriculum changes, alongside vaccination opportunity. The study identified content, mode of delivery and desirable qualities/characteristics of a professional who could design/deliver the HPV education. A public media campaign was deemed important in supporting this central education. DISCUSSION AND CONCLUSION: This study highlights political, social and cultural barriers to HPV intervention success and the need for Public Health Authority and Education Authority support. A feasibility pilot study should be undertaken to assess the real-world practicality of this HPV intervention.