Effectiveness of a school-based multicomponent intervention on parental HPV knowledge, vaccination attitudes, and children's HPV vaccine completion: A mixed-methods cluster randomized controlled trial.

Abstract

To evaluate the effectiveness of a school-based multicomponent intervention on parental HPV knowledge, attitudes, and daughters' vaccine initiation and completion rates. A mixed-methods study was conducted using cluster-randomized controlled trial (cRCT) supplemented by a qualitative descriptive phase. Ten eligible elementary schools in Indonesia were randomized (1:1) to intervention (n = 193 parents) or control (n = 181 parents) groups. The intervention consisted of an 8-minute educational video followed by a 30-minute facilitated discussion, supplemented by text reminders. Quantitative outcomes (knowledge, attitudes, and vaccine uptake) were analyzed using ANCOVA and chi-square tests. Semi-structured interviews (n = 16) explored parental decision-making through content analysis. Refusal and withdrawal rates were 0.52% and 1.31%, respectively. After adjusting for covariates, the intervention group showed significantly higher HPV knowledge [F(1, 362) = 43.51, p < .001, η² = .107] and more positive attitudes [F(1, 362) = 14.38, p < .001, η² = .038] than the control group. Vaccine initiation and completion rates were significantly higher in the intervention group (χ² = 5.40, p = .020). Qualitative findings complemented the quantitative results by demonstrating that the digital intervention corrected HPV misconceptions, reduced vaccine safety concerns, strengthened trust in the school-based vaccination program, and reinforced vaccination decisions through social support and reminder messages. A multicomponent intervention combining a digital educational video, facilitated discussion, and text reminders was associated with improvements in parental HPV knowledge and attitudes and was a modest increase in vaccine uptake in a rural school-based setting. These findings suggest that such interventions may support informed parental decision-making and may contribute to strengthening school-based HPV vaccination programs in similar settings. School-based vaccination programs may benefit from supplementing digital materials with structured discussion sessions to facilitate personalized counseling. This approach may facilitate informed decision-making and help address cultural or social barriers in settings with similar contextual characteristics.