How to overcome information and communication barriers in Human Papillomavirus vaccination? A SWOT analysis based on the opinions of European family doctors in contact with young people and their parents.

European Journal of General Practice 2024, VOL. 30, NO. 1, 2393858 https://doi.org/10.1080/13814788.2024.2393858 Research Article How to overcome information and communication barriers in Human Papillomavirus vaccination? A SWOT analysis based on the opinions of European family doctors in contact with young people and their parents Hüsna Sarıca Çevika# Mehmet Ungana# , A. Gülsen Ceyhun Pekera# , Süleyman Görpelioğlub# , Shlomo Vinkerc# and Department of Family Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey; bTürkiye İş Bankası, Ankara, Turkey; cDepartment of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel a KEY MESSAGES • Face-to-face, trust-based communication is a strength and opportunity for FDs/GPs to promote the HPV vaccine in all countries. • The lack of free-of-charge, nationally implemented gender-neutral vaccination represents a policy weakness needing improvement. • Stigma and vaccine hesitancy pose major threats, which FDs/GPs must proactively address, supported by robust public health policies. ABSTRACT Background: Family doctors (FDs)/General practitioners (GPs) are the key contact points for young people and their parents regarding Human Papillomavirus (HPV) vaccination. However, their recommendations are influenced by communication skills. Objectives: Under the EU4Health project, PROTECT-EUROPE, WONCA Europe led a task to identify and analyse strategies for clinicians’ interpersonal communication skills when discussing HPV and its vaccination with young people and their parents. Methods: Strengths, Weaknesses, Opportunities, Threats (SWOT) analysis using qualitative data focused on HPV vaccine acceptance and communication with the target population. FDs/GPs, members of WONCA Europe, were recruited using convenience and snowball sampling through surveys at conferences and emails. Results: 223 FDs/GPs from 36 countries participated. Strengths included face-to-face communication, extensively used to promote the HPV vaccine. Weaknesses involved financial constraints, limited knowledge about gender-neutral vaccination, safety concerns, and time pressure during the consultations. Opportunities included confidentiality, open dialogue, trusting relationship between FDs/GPs and the target population, continuing medical education, school training, and questions & answers sessions to increase vaccine communication. Threats included social norms and cultures, stigmas against HPV, and anti-vaccination movements hindering discussions on HPV vaccination. Conclusion: It is crucial to train FDs/GPs to address knowledge gaps, enhance communication skills, and maintain a trusting relationship with patients when discussing HPV vaccination. Overcoming financial barriers and ensuring gender-neutral vaccination programs are accessible across Europe are also essential. Providing accurate information through the web- and school-based channels and developing community-oriented approaches targeting sociocultural factors and different needs to eliminate HPV vaccine stigmas should be considered when recommending the vaccine. ARTICLE HISTORY Received 27 April 2024 Revised 1 August 2024 Accepted 13 August 2024 KEYWORDS General practice; health communication; Human papillomavirus; primary prevention; vaccines CONTACT A. Gülsen Ceyhun Peker Department of Family Medicine, Ankara University School of Medicine, Hacettepe, Talatpaşa Blv No:82, 06230 Altındağ/Ankara, Turkey. # Participated in the project on behalf of WONCA Europe. Supplemental data for this article can be accessed online at https://doi.org/10.1080/13814788.2024.2393858. © 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent. 2 H. SARICA ÇEVIK ET AL. Introduction Human Papillomavirus (HPV) is the most frequent sexually transmitted infection (STI) that can lead to cervical, anal, penile, vaginal, vulvar, and oropharyngeal cancers [1]. 31.1% of cancer cases attributed to infections in both sexes worldwide were caused by HPV in 2020 [2]. The Eurobarometer survey on Europeans’ attitudes towards vaccination (2019) concluded that 79% of respondents would consult a physician for information about vaccines. Physicians and other healthcare professionals (HCPs) were considered the most reliable sources of vaccine information. 2/3 of the participants stated they were vaccinated upon physicians’ recommendation. However, 48% of the participants noted that vaccines can cause serious side effects, and 38% stated that the vaccine can cause the disease it should be protected from [3]. HPV vaccination is associated with a reduced risk of HPV-associated cancers [4]. Effective HPV vaccination programs have critical importance in mitigating both the health and economic impacts of HPV-related cancers. In 2017, an estimated 7,085 HPV-attributable cancer deaths occurred in the United States, resulting in 154,954 years of potential life lost and a present value of future lifetime productivity loss of $4.2 billion. 91% of these deaths and economic burdens were attributable to high-risk HPV types targeted by the 9-valent HPV vaccine [5,6]. However, according to the results of the Vaccine Confidence Project, the importance of the HPV vaccine decreased between 2020 and 2022, which shows that society has reduced confidence in HPV vaccines [7]. Conversely, countries such as Ireland have programs aimed at eliminating cervical cancer through vaccination [8]. Family doctors (FDs)/general practitioners (GPs) are the key contact points and trusted sources of information for young people and their parents/caregivers regarding HPV vaccination. However, HCPs’ recommendations vary between settings and are affected by multi-level factors, which also result in a lack of confidence and knowledge to provide recommendations to the target audience [9]. One of the flagship commitments of Europe’s Beating Cancer Plan is to support Member States in extending routine vaccination against viruses that can cause cancers. PROTECT-EUROPE is an EU4Health project with the participation of WONCA Europe and other European organisations. One of the project’s aims is to optimise one-to-one communication to leverage patients’ trust in clinicians to help increase vaccine uptake [10]. WONCA Europe has led a task to identify and analyse strategies for clinicians’ interpersonal communication skills focused on HPV and its vaccination when talking with young people and their parents through a SWOT analysis workout. Methods Participants and sampling In this research, FDs/GPs (...truncated)