Engaging Culturally and Linguistically Diverse (CALD) communities in school-based vaccination for human papillomavirus (HPV)

The leading cause of abnormal cervical lesions and invasive cervical cancer is persistent infection with a high-risk type of human papillomavirus (HPV). As prevention tools and treatments for cervical disease and cancer are readily available, but not accessed equally by all populations, this leads to health inequities. Australia has a national strategy to eliminate cervical cancer as a public health problem by 2035. This prevention will occur through increasing access to cervical screening, HPV vaccination and disease treatment, particularly for priority populations.One of five Australian population groups recognised by the national strategy as being a priority population for cervical cancer elimination is those who identify as culturally and linguistically diverse (CALD). We know little though about how CALD communities engage with cervical cancer prevention tools, especially HPV vaccination delivered through school. We also know little about what cervical cancer prevention interventions are wanted or needed for priority CALD communities or how these programs can be delivered in both a participatory and culturally safe way. My thesis presents an in-depth program of research to answer one broad research question: ‘How can academic and health system partnerships implement Community Engaged (CE) practices and research approaches to engage local CALD communities about one cervical cancer prevention tool (HPV vaccination)?’.To address knowledge gaps in how CE practice can impact HPV vaccination interventions I conducted a systematic review of the academic literature using an established CE health framework to synthesise my review findings. I identified links between how CE is practised within HPV vaccination interventions and how CE may improve intervention measures and outcomes.Building on these findings I leveraged a long-standing academic-community health service partnership to implement a small-scale participatory action research (PAR) project with one priority CALD community. Guided by the five phases of PAR, I used a participatory research method (World Cafés) to identify how a community engages with school and HPV vaccination. These discussions initiated the partnership’s ‘preparing for action’ phase and the co-design of a tailored health information website. The project ‘action’ (dissemination of the website), ‘evaluation’ and ‘reflection’ phases followed. Taking the lessons I learned, I then collaborated with key stakeholders to reflect on how the findings of my thesis could support policy recommendations on achieving the broader CE goals and targets of three national strategies, including the national cervical cancer elimination strategy.Overall, my thesis demonstrates how long-standing, local academic and community health service partnerships can implement participatory CE practices and approaches with local priority CALD communities. This thesis also highlights the benefits, practicalities and limitations associated with practising more participatory CE research to support HPV vaccination uptake. Whilst my results are not generalisable to other CALD communities, my processes and methods are transferrable to partnerships wanting to engage CALD communities in cervical cancer prevention and immunisation.