{
  "abstract": "Background 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. Methods 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. Results 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 ORIE:1.14), vaccine safety (ORIE:1.12) and accessibility (ORIE:1.11), as well as for having discussed HPV vaccination with friends (ORIE:1.11) and for higher self-rated level of knowledge about the vaccine (ORIE:1.10). Conclusion 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.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "name": "Amanda Munoz"
    },
    {
      "name": "Amandine Gagneux-Brunon"
    },
    {
      "name": "Anne-Sophie Le Duc-Banaszuk"
    },
    {
      "name": "Sébastien Bruel"
    },
    {
      "name": "Morgane Michel"
    },
    {
      "name": "Aurélie Gauchet"
    },
    {
      "name": "Damien Oudin Doglioni"
    },
    {
      "name": "Anne-Sophie Barret"
    },
    {
      "name": "Jocelyn Raude"
    },
    {
      "name": "Nathalie Thilly"
    },
    {
      "name": "Judith Mueller"
    },
    {
      "name": "Prevhpv Consortium"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/be4738pv1nqxq.bib",
  "cited_by": 0,
  "doi": "10.1016/j.vaccine.2026.129150",
  "fulltext_url": null,
  "id": "be4738pv1nqxq",
  "issns": [
    "0264-410X",
    "1873-2518"
  ],
  "landing_url": "https://ehesp.hal.science/hal-05762954v1",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "hal",
      "0.sdv"
    ],
    [
      "hal",
      "1.sdv.spee"
    ],
    [
      "openalex",
      "2713|Cervical Cancer and HPV Research"
    ]
  ],
  "openalex": "W7213462747",
  "pdf_url": "https://ehesp.hal.science/hal-05762954/document",
  "pmcid": null,
  "pmid": "42753385",
  "published": "2026-09-24",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/be4738pv1nqxq.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:40Z",
      "native_id": "hal-05762954",
      "source": "hal",
      "url": "https://ehesp.hal.science/hal-05762954v1"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "hal:0.sdv",
      "subfield": "general"
    },
    {
      "field": "medicine",
      "origin": "hal:1.sdv.spee",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Which changes in adolescents' knowledge, attitudes, and practices following a school-based intervention in France increase HPV vaccination uptake and intentions? A mediation analysis",
  "title_text": "Which changes in adolescents' knowledge, attitudes, and practices following a school-based intervention in France increase HPV vaccination uptake and intentions? A mediation analysis",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:40Z",
  "url": "https://research.draconitic.com/paper/be4738pv1nqxq",
  "venue": "Vaccine",
  "versions": []
}