Table 2 Key themes from preliminary interviews and workshops

(i) Delivery of educational package

Support for development

Key informants and young people were supportive of the proposed format of the educational package

‘If it was something that was rolled out and the video gets made and there’s a resource pack, I would 99% be sure that we would use it in our session and target those the right age group… we 100% would put it on the curriculum and use it in our youth clubs.’ [Key informant 4, male, youth worker]

Potential to be incorporated as part of the Relationships and Sex Education (RSE) curriculum at schools or as part of the youth organisations own curriculum or programme

‘I mean I think everybody is looking at infection and vaccines at the moment. I think everybody should be including that in their PSHE work from a science perspective, from a PSHE perspective. So, it’s a good time to produce this because vaccines are on everybody’s mind and we can kind of use it as a comparison, you know.’ [Key informant 6, female, Sex and Relationships educator]

Gender

Perceptions of different levels of maturity by gender and the likely impact on their behaviour during the session

‘It’s that thing that involves sex isn’t it and especially with that age group because its Year 8, so some of them know quite a lot, some of them know next to nothing and I think sometimes having the boys and girls together it turns it into that giggly messing about.’ [Key informant 2, school medical officer]

Most frequently young people were of the opinion that delivery should not be differentiated by gender

‘I know probably in Year 8 I would have been fine to sit down with boys and girls but there would have been some people that wouldn’t, so it depends on the year.’ [Young person 1, male, 15 years, workshop 1a]

Recognition that other young people may not be comfortable asking questions in front of the opposite sex

Addressing training needs

Immunisation nurses perceived that different levels of knowledge could hinder delivery of the educational package to young people

‘I think a video and then maybe a one-sided A4, not teaching plan but just some points and aims that you’re trying to get out of different parts, and then maybe some questions that you can ask the young people just to get things flowing.’ [Key informant 4, male, youth worker]

Information provision about the HPV vaccine through a face-to-face session, or online training manual or resource pack was felt sufficient to equip professionals without specific knowledge about the HPV vaccination programme to deliver the educational package

‘Maybe half-day training just to create awareness, give them information, more information about HPV, give them time to actually read it, have understanding about what they are passing out.’ [Key informant 3, female, immunisation nurse]

‘As long as I have the information then I would be reasonably confident to go with it.’ [Key informant 2, school medical officer]

Professional delivery of the educational package

Young people valued professionals with a medical background, who were trusted and felt to have the sufficient expertise to provide the relevant information

‘If I was getting it [the HPV vaccine] done now and I want to speak to someone, I feel like I’d actually want to speak to people who have done it [delivered the vaccination programme] and know what it’s about.’ [Young person 8, female, 15 years]

Skill sets of other professionals were also recognised and felt to benefit delivery of the educational package by being able to creating a safe space to deliver the educational package in which young people felt comfortable to ask personal questions

‘Nine times out of 10 there’s a teacher or that one person [in the school setting] that everyone’s comfortable talking about stuff with and they’re the sort of person then that will be able to shut it down and be more like come on guys we’re having a laugh now … but not shut them down and say we’re not going to talk about it.’ [Key informant 4, youth worker, male]

Some young people recognised the relationships they had with particular professionals would help facilitate more open discussions

‘If they [immunisation nurse] were linked up with a youth worker and they worked well together and could present parts of it each then they might be more… they might be quite willing to ask questions to youth workers then.’ [Key informant 1, immunisation nurse, female]

‘If [Sex and Relationships Educator] came into school and delivered a session about it I would feel really comfortable with her.’ [Young person 1, female, interview]

(ii) Communication of content within the educational package

Risk of developing cancer

Personal experiences of HPV-related cancer could provide a powerful message to be vaccinated

‘If you said 8,000 people in the UK I’d think that still makes that young person go ‘well that’s not going to be me’ you know what I mean like there are 66 million people in this country you know what I mean if they’re good with numbers they’ll know that and they’ll be like that’s not going to be me.’ [Key informant 4, youth worker, male]

Presentation of information related to the annual incidence of cervical cancer was not felt to be an effective way to communicate risk with young people

‘I think just seeing seven out of 10 people [acquire HPV over their life-time], that means like, three people won’t get it and that’s quite—that’s a very small number not being affected by this and it would make me think I may as well go for it.’ [Young person 1, male, workshop 1a]

Information related to the prevalence of HPV was felt to be a more effective message than providing data related to incidence of cancer

‘Personally I would expect people who have actually gone through the cancer that the boys or girls could get… so I think that would be quite good because you could see what they’ve been through… then you can see… oh I should get it because I don’t want that happening to me.’ [Young person 8, female, 15 years old]

‘I think if I’ve got someone in my family or I myself had the cancer and someone stood up and said, ‘let's hear this person talk about their story,’ sitting there watching someone else talk about their story, although it might make me very sad it might also make me very hopeful.’ [Young person 1, male, workshop 1a]

Safety and side-effects

Presenting information on rare but serious side-effects could adversely affect young people’s decision-making about having the HPV vaccine

‘I think it’s [information about serious side-effects] more of something that you’d have to say to their parents because I feel like, if you’d said that to me when I was 12 or 13 I’d probably stay very clear away from it.’ [Young person 1, male, workshop 1a]

‘That might be one thing that would scare somebody and put them off more than it would want to have it done actually, oh my god I’m going to have a shock and it’s going to stop my heart.’ [Key informant 4, youth worker, male]

Sexuality and behaviours

Young people and key informants supported that young people should be told how HPV is transmitted and who is a greater risk

‘I work with someone at the minute who’s 13 and has come out as gay already so it’s good information for them to know that they’re at risk as well.’ [Key informant 5, male, youth worker]

Mixed levels of understanding and embarrassment among vaccine eligible young people and the school environment does not facilitate in-depth conversations or open discussions

‘I think it would have to be very basically written because I think some of the Year 8 boys that I’ve come across have no idea that that is even a possibility and whether parents would take offence at us being the person to broach that with them that this is a possibility. But then there are boys on their, you know, in Year 8, you know, especially if they’re considering that they may be gay that this is something that they are well aware of and it is something they have thought about.’ [Key informant 1, female, immunisation nurse]