Which changes in adolescents' knowledge, attitudes, and practices following a school-based intervention in France increase HPV vaccination uptake and intentions? A mediation analysis
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.
Related
- Rural iowa adolescents' use, knowledge and attitudes regarding UTVs on public roads.
- Chatbot Intervention and Cancer Risk Knowledge in Adolescents and Young Adults With Cancer Predisposition
- Feasibility and immediate effects of a multimodal, dance-integrated educational video package on eye health knowledge and intentions in Nigeria: A pre-post pilot study
- Knowledge and attitudes toward antimicrobial stewardship and the WHO AWaRe antibiotic classification among healthcare professionals at a tertiary hospital in Ethiopia
- Undergraduate nursing students’ knowledge and attitudes towards Primary Health Care
BibTeX
@article{munoz2026which,
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}},
author = {Amanda Munoz and Amandine Gagneux-Brunon and Anne-Sophie Le Duc-Banaszuk and Sébastien Bruel and Morgane Michel and Aurélie Gauchet and Damien Oudin Doglioni and Anne-Sophie Barret and Jocelyn Raude and Nathalie Thilly and Judith Mueller and Prevhpv Consortium},
journal = {Vaccine},
year = {2026},
month = sep,
doi = {10.1016/j.vaccine.2026.129150},
url = {https://ehesp.hal.science/hal-05762954v1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Which changes in adolescents' knowledge, attitudes, and practices following a school-based intervention in France increase HPV vaccination uptake and intentions? A mediation analysis
AU - Amanda Munoz
AU - Amandine Gagneux-Brunon
AU - Anne-Sophie Le Duc-Banaszuk
AU - Sébastien Bruel
AU - Morgane Michel
AU - Aurélie Gauchet
AU - Damien Oudin Doglioni
AU - Anne-Sophie Barret
AU - Jocelyn Raude
AU - Nathalie Thilly
AU - Judith Mueller
AU - Prevhpv Consortium
PY - 2026
DA - 2026/09/24
JO - Vaccine
DO - 10.1016/j.vaccine.2026.129150
UR - https://ehesp.hal.science/hal-05762954v1
AB - 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.
SN - 0264-410X
SN - 1873-2518
ER -