Development and effectiveness of educational intervention and comic book to improve HPV vaccination coverage among adolescents from rural areas : Protocol for a Mixed Methods Study (Preprint)

BACKGROUND Human papillomavirus (HPV) is the main cause of sexually transmitted infections, especially cervical cancer. Several of HPV-induced cancers also affect boys (25% of cases). In France, HPV vaccination is recommended for boys and girls aged 11 to 14, with possible catch-up vaccination up to age 19. However, vaccination rates remain low, particularly among boys, prompting the development of new strategies to promote vaccination. Greater knowledge of both potential HPV-induced risks and vaccination benefits in population will help increase vaccination coverage. OBJECTIVE This protocol described the design and methods of a study which aimed at improving HPV vaccination coverage among adolescents aged 15 to 19 attending Rural Family Homes in three French departments, through an educational intervention combined with the distribution of comic book. METHODS Two media were created for this study, an intervention program and a comic book. Intervention program was proposed by multidisciplinary researchers and field workers, and was carry out by health professionals. Comic book was designed on collaboration with adolescents. Comparative analysis of three intervention groups, followed for 6 to 8 months, one of which included the distribution of a comic book, will be carried out using a mixed approach combining quantitative and qualitative methods. RESULTS Funding for the study was obtained in October 2021. Ethical approval was granted in June 2023. Data collection and interviews transcriptions were completed between September 2023 and April 2025. Data analysis is ongoing. The findings of the study will provide essential evidence-based information on obstacles and levers related to non-vaccination against HPV. CONCLUSIONS School interventions and educational media such as comic book help to raise knowledge of the importance of vaccination among adolescents and their parents, and should be more widely used. CLINICALTRIAL This research program was received an ethical approval from the French regulatory authorities, the Comité de Protection des Personnes Ouest VI on 13 June 2023 (national number 2023-A00696-39) and was in accordance with the Declaration of Helsinki guidelines. Clinical trial number is not applicable.