Guard Your Health

To develop the participatory intervention, Lamoille County community stakeholders were engaged to provide input regarding local barriers to HPV vaccination and opportunities to overcome them. Stakeholder input provided insight regarding Lamoille County identity, including parental concerns, trusted local organisations, and community values. Stakeholders also served as local partners, engendering community support and buy-in to create an intervention centred on potentially sensitive topics including sexually transmitted infections (STIs) and vaccine hesitancy.

Based on stakeholder-identified barriers to HPV vaccination in Lamoille County and a review of the literature, the University of Vermont developed the Guard Your Health intervention, which centred around a fair offered to three schools (a high school, a middle school, and a technical school for 10-12th grade students). Peer educators hosted booths at this fair, which - based on student interests and community concerns identified by stakeholders - included the following 4 categories: HPV and sexual health; disease prevention; healthcare and emergency response; and vaping cessation.

The experience featured a raffle, where, to enter a ticket, students had to correctly answer questions by learning from the Guard Your Health peer educators or posters made by students during the fair campaign. Stakeholders and youth stakeholders helped identify raffle prizes that would be both motivating and health-promoting to the adolescents in Lamoille County. Guard Your Health peer educators helped develop raffle ticket questions and were encouraged to discuss - either with their peers, teachers, or the primary author - information they would be teaching prior to their fair to ensure their comfort and confidence. School-based HPV vaccination was offered to students (whose parents had given consent) during the fair.

The HPV awareness campaign began a month prior to the Guard Your Health fair with advertisement and promotion. Flyers were hung in hallways and in the school nurses' office, and classrooms were visited to discuss HPV and the HPV vaccine. One week before the event, the high school held a remote schoolwide assembly for the students to hear the story of a male teacher at their school who was a survivor of an HPV-associated oropharyngeal cancer.

Also, a sexual health curriculum was delivered to four cohorts of 10th grade students over four 80-minute sessions, with the final day coinciding with the Guard Your Health fair. Based on stakeholders' perceived limitations of the current health curriculum, emphasis was placed on STI prevention and de-stigmatisation of sexual health, particularly in the context of gender stereotypes.

Immunisation and Vaccines, Health, Youth

In Lamoille County, a rural community in northern Vermont, only 48.1% of youth aged 15 have completed their HPV vaccine series, compared with over 60% of 15-year-olds in other Vermont counties. Although rural areas are heterogeneous in many regards, few interventions engage stakeholders to develop community-specific solutions that overcome obstacles such as communication gaps and barriers associated with healthcare equity. For example, lack of consistent and reliable access to broadband internet may prevent adolescents and their caregivers from learning about HPV or the HPV vaccine, since social media can increase HPV vaccine-related knowledge and awareness. Residents of rural areas also share wider challenges to HPV vaccination with their non-rural counterparts, including barriers associated with healthcare equity. Adolescents (and adults) in rural areas have limited access to consistent healthcare appointments, both due to a shortage of providers and to long travel distances to care.

The University of Vermont found that the Guard Your Health intervention was well received by the Lamoille County community. They suggest that such a multicomponent peer-based approach may prove beneficial beyond the scope of HPV vaccination, such as addressing hesitancy associated with other vaccines.