Cervical cancer is the fourth most common type of cancer in women and more than 95% of cervical cancer is caused by sexually transmitted Human Papilloma Virus (WHO, 2022).  WHO recommends a vaccination coverage of 90% to eliminate cancers caused by Human Papilloma Virus (HPV). The primary focus is the vaccination of girls aged 9-14 before the start of sexual activity, with secondary targets of boys and older women where feasible and affordable.

The European aim is to achieve 90% HPV vaccine coverage by 2030. However, HPV vaccination programmes, across Europe, were disrupted by the Covid-19 pandemic (Crul et al, 2020). The HPV vaccination rate across many EU countries now well under 50% (European Commission, 2024).

The challenges to achieving vaccine target outcomes vary, with different contexts experiencing different inhibitors cultivating vaccine hesitancy and distrust (ECO, 2022). Amongst high-income countries, low vaccine confidence among parents/carers and young people results from misinformation, a lack of trust in health authorities and vaccine manufacturers, and concerns about vaccine safety (ibid).

Face-to-face educational interventions are recommended as the most effective means of addressing vaccine hesitancy and improving vaccine uptake. (Edwards et al, 2022). In order to maximize effectiveness, these interventions should be tailored to the local context (ECO, 2022)

In Ireland, the HPV vaccine is offered free to all 1st year post-primary students in Ireland as part of a school-based HPV vaccination programme. However, this vaccination programme does not include an accompanying educational intervention to heighten awareness and understanding of the HPV vaccine and vaccination process.

To help address this, this research project aimed to develop awareness and understanding of immunology, vaccines and HPV vaccination among primary and secondary students, through peer-to-peer collaboration.

It sought to empower young people to critically analyse information and perceptions around the HPV vaccine in order to promote informed choices around HPV vaccination, and thus develop confident advocates for HPV immunisation. 

It explored new ways of bringing the arts into health awareness communication, using Science, Technology, Engineering, Art, Maths (STEAM) approaches and to evaluate the effect of a STEAM intervention on Irish teenagers’ knowledge, understandings around HPV vaccination and their confidence to advocate for the HPV vaccine.

The project focused on the following research questions: In what ways can STEAM engage and motivate students to learn about immunology, vaccines, HPV and HPV vaccinations? And in what ways can STEAM help them to develop the competence and confidence to communicate their understandings about immunology, vaccines, HPV and HPV vaccinations? In what ways can peer-to-peer collaboration help to achieve these outcomes?

The participants, incorporating a diversity of socio-economic backgrounds, were 4th yr students (16-17 year olds) and 1^st yr students (12-13 year olds) from 5 post-primary schools and final year students (11-12 year olds) from 2 primary schools.

An interdisciplinary, intersectoral, international team was assembled with expertise in immunology, creative pedagogies, design and behavioural psychology. The 4^th yr students participated in a series of STEAM workshops on immunology, vaccination and HPV, designed and facilitated by the interdisciplinary team. Using the principles of active learning (Bransford et al 1999) the students critically examined and developed their knowledge and understandings of inoculation, vaccination and HPV through drama in education strategies, poster creation, story boarding, storytelling and video creation in a visual thinking methodology (Averinou and Pettersson 2020). Through dialogical peer-to-peer teaching and learning), the students co-created localised, culturally inclusive, and scientifically informed stories around HPV vaccination and immunisation in short videos and roleplays which they shared with 1^st year post-primary and final year primary school students.

This project centred around an interdisciplinary, cross sectoral collaboration. It involved a team of academics from departments of Education, Design, and Applied Sciences, Health and Social Care from two universities in two countries, along with a Cancer NGO, and secondary and primary students. A case study was employed using a qualitative, arts-based methodology. Arts based approaches were used to gather data on the 4th year students’ knowledge and understandings of immunology, vaccines, HPV vaccination prior to and after the STEAM intervention. Instruments used included poster creation, story boarding, journey mapping, role play, improvisation and video creation. Focus groups with the 4th year students were employed for feedback on their experiences of the STEAM workshops and on their own facilitation of workshops for younger peers. Focus groups were further employed with the younger students for feedback on their learnings after participating in the workshops facilitated by their 4th yr peers. Exit slips completed by the 1st yr students after these workshops gave further insights into their key learnings. The project used a staged approach with each stage informing the preparation of the next: • 4th Year post-primary school students (N= 44), from 5 schools, participated in on-campus STEAM Workshops to critically analyse and build upon their current understandings on immunology, vaccines, HPV and HPV vaccinations through active learning approaches leading to their creation of artefacts, posters and videos on suitable for use in workshops they would facilitate for their younger peers. Data on their opinions, learnings and understandings collected through arts-based methodologies. Data on their overall experiences of the STEAM workshops was gathered through 7 focus group interviews (N=32). • Prior to the HPV vaccine roll-out in the schools, 4th yr students co-facilitated short workshops using arts-based approaches, including role-play and the short videos they prepared for younger peers (11-13 years) in primary school and 1st yr post-primary. Data was collected from 4th yr students (N=21) on their experiences, insights and learnings from preparing and delivering the workshops. Data from the primary and 1st year students on their experience of the workshops and what best helped their learning through post-workshop focus groups. Exit slips (n=275) completed by 1st years showed their key learnings through art and words. • Post HPV vaccine roll-out in the schools, 1st years completed an online qualitative questionnaire (n=25) on their experiences of participating in the peer-led workshops. Reflexive thematic analysis used (Braun & Clarke 2022).

Data analysis is ongoing. Preliminary findings indicate that a co-designed STEAM intervention shows promise in supporting teenage peers’ advocacy of the HPV vaccine for younger peers. Students highlighted how they valued the equity of opportunity felt through participation in the STEAM workshops. Having completed the workshops participants felt more confident in communicating their understandings and knowledge about immunology, vaccines and HPV vaccination to peers and others. As students’ understandings and knowledge grew through the STEAM approach their attitudes to the HPV vaccine became more positive. Creative approaches and peer-to-peer learning developed better understandings of inoculation, vaccines and HPV cancers and vaccination.

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